1 Access to specialist care and diagnosis
1. Whilst the speed with which patients were seen
by a specialist following referral had improved since 2000, too
many patients still experienced delay between referral and consultation
in 2004. Overall, whilst 99% of patients referred urgently by
their GP saw a specialist within two weeks, approximately 40%
of people ultimately diagnosed with cancer were not referred urgently
and were not seen by a specialist within two weeks of referral,
and one fifth waited for one month or more (Figure 2).
70% of patients with breast cancer were seen within two weeks,
but only 32% of prostate cancer patients.[3]
The Department saw the target for all patients to be seen by a
specialist within a maximum 18 weeks from referral as a key driver
for service improvement.[4]
Figure 2:
Waiting times between referral by GP and being seen by a specialist
had improved since 2000 but some patients still waited more than
two weeks
 Source:
National Audit Office
2. Around a third of cancer patients did not find
doctors' explanations of their condition, treatment or tests very
easy to understand. Given the complexities of most types of cancer,
and the range of tests and treatments available, clinicians needed
good communication skills to break bad news with appropriate sensitivity
and care. New guidance published by the National Institute for
Clinical Excellence in March 2004[5]
recommended that patients should be offered a record of significant
matters discussed with consultants and clinicians. At the time
of the NAO survey of cancer patients, just 10% of patients received
a written or audio record of their diagnosis,[6]
though a randomised control trial in Australia had shown that
writing to the patient was beneficial. Whilst a tangible record
in the form of a letter may be appropriate for some patients,
other types of record, such as a recording of the interview, should
be considered for those with poor literacy and language skills.[7]
3. Patients with bowel cancer, although generally
satisfied with the care that they received, frequently expressed
dissatisfaction with the delay between being referred by their
GP and seeing a specialist. Difficulties in correctly identifying
the symptoms of bowel cancer delay prompt access to specialist
care for patients with the disease, undermining patient confidence
and causing anxiety. More than a quarter of patients diagnosed
by their GP as possibly suffering from bowel cancer waited more
than one month to be seen by a specialist and in 2004 30% of bowel
cancer patients reported a deterioration in their condition while
waiting, compared to 16% for other cancers.[8]
Research commissioned by the Department should assist GPs to correctly
identify symptoms suggestive of bowel cancer.[9]
4. With the phased roll-out of bowel cancer screening
from April 2006, the Department is seeking to raise awareness
through working with cancer charities and individual Primary Care
Trusts. The Department also plans to roll out pilots with the
Healthy Communities Collaborative, designed to raise the profile
of cancer and banish any stigma associated with bowel cancer through
community-led initiatives.[10]
3 C&AG's Report, Figure 5 Back
4
Qq 1-2 Back
5
Improving supportive and palliative care for adults, National
Institute for Clinical Excellence (2004) Back
6
C&AG's Report, para 1.13 Back
7
Q 28 Back
8
C&AG's Report, para 1.7, Figure 6 Back
9
C&AG's Report, para 1.2 Back
10
Q 58 Back
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