Select Committee on Public Accounts Second Report


2 Saving more lives through improved treatment

5. During his evidence, the National Cancer Director expressed confidence that cancer mortality rates would fall by 20% for people under the age of 75 by 2010 and that over time our survival rates will reach the level of the rest of Europe.[14] Although survival rates for men and women are improving they still lag behind countries in continental Western Europe with broadly similar population structures, health care systems and per capita wealth (Figure 2).[15] If England's survival rates were comparable with the best in Europe, thousands more people across society, particularly those from deprived backgrounds, would survive for appreciable amounts of time after diagnosis.[16] Figure 2: Five-year relative survival rates for men and women diagnosed between 1990 and 1994


Note: Data for France and Germany are based on outcomes in only a small proportion of those diagnosed with cancer

Source: EUROCARE 3

6. Achieving improvements requires a need for NHS diagnostic and treatment services to ensure that patients are treated more promptly and appropriately, besides enhanced detection of cancer and an improvement in low levels of awareness among sections of the public to facilitate earlier diagnosis, as discussed in part 1.[17]

7. To contribute to earlier detection of cancer, the bowel screening programme is likely to be introduced in 2006,[18] while the breast screening programme is being extended to cover older women at risk and is being carried out using improved screening techniques. If these improvements are to be introduced successfully, more skilled staff need to be recruited to relieve increased pressures on other parts of the system and improve patient outcomes.[19]

8. Surgery remains the main curative treatment for a large majority of cancer patients. Research shows that the best results come when surgery is carried out by specialist surgeons. For the most prevalent cancers, such as breast cancer, specialisation in surgery is becoming the norm. However, the situation is not so satisfactory for prostate cancer. Although most prostatectomy operations are now carried out by surgeons who do at least 5 such operations per year, this a long way off the NICE guidance target that all operations be carried out by teams who do 50 or more prostate operations a year.[20] Out of 133 Trusts where prostatectomies were carried out in 2002-03, only 12 Trusts carried out more than 50 operations.[21] There are also insufficient specialist surgical resources to increase surgery for lung cancer to desirable levels.[22]

9. Survey results from the Royal College of Radiologists show that radiotherapy waiting times in many parts of the country are too long to conform with clinical guidelines on the maximum acceptable delay before the start of treatment. This is putting the lives of many people at risk. The National Cancer Director is now carrying out a "stocktake" of the system and acknowledges the need to improve recruitment and retention of staff, but cannot provide a timetable for improvements in waiting times.[23]

10. As long ago as 1996, we recommended that the NHS should direct clinical audit activity towards those areas of national importance where there was evidence of people receiving sub-optimal treatment.[24] Only now is the Department, in co-operation with clinician groups, developing a national clinical audit database for major cancers to determine why certain groups within the population, such as the elderly and the deprived, receive less radical treatment purely because of their poor physical condition or for other reasons.[25]


14   Qq 158-159, 163 Back

15   Securing our future health: taking a long-term view, Derek Wanless (HM Treasury, 2002) Back

16   Q 43 Back

17   C&AG's Report, paras 17-18, 21-24, 26 Back

18   Q 90 Back

19   Q 91; C&AG's Report, para 2.22 Back

20   Qq 16-24 Back

21   Ev 19-20, 24 (Annex A (i)) Back

22   Q 88 Back

23   Qq 10, 84-87 Back

24   31st Report from the Committee of Public Accounts, National Health Service Executive Clinical Audit in England (HC 304, Session 1995-96). Back

25   Q 14 Back


 
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