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Cancer services are a major priority for the NHS. Although death rates from the disease have been falling, more than one in three people develop cancer at some point in their life. The 10 year NHS Cancer Plan published in 2000 built on existing cancer initiatives, to provide a comprehensive strategy to tackle cancer across the whole patient pathway. It established 34 cancer networks in England, to lead the improvement of cancer services in each locality.
Progress against the targets and commitments in the Plan has been encouraging, though with slippage in meeting some target dates, such as for raising public awareness of the signs and symptoms of cancer. Targets relating to waiting times, to be met by the end of 2005 will prove challenging, as will the target for 800,000 smokers to quit for at least 4 weeks between 2003-04 and 2005-06. Increased funding for cancer services is getting through to the front line and being spent directly to fund new drugs, staffing and new services, though some key staff positions remain vacant.
Cancer networks have introduced a new way of approaching the delivery of cancer services, involving several organisations, including the Strategic Health Authorities, acute and primary care trusts, the voluntary sector and local authorities, with significant successes in terms of better local cancer services, use of new drugs and funding for palliative care. But in some network localities, commissioning of cancer services is not sufficiently joined-up, and relationships between constituent organisations can be difficult. Some lack comprehensive plans to implement the Cancer Plan and monitoring of progress is inconsistent.
There are clear disparities between the affluent and poorer members of society in terms of cancer outcomes, with higher mortality rates in deprived areas and survival rates which consistently favour London and the south. There is also wide geographical variation in the use of NICE approved cancer drugs across the country, including those for breast cancer. With some networks being less effective than others there is a risk that less affluent parts of the country may lose out.
On the basis of a Report from the Comptroller and Auditor General[1] the Committee took evidence from the Department of Health (the Department) on three main issues: improving the provision of cancer services in England; making cancer networks work; and addressing inequalities.
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