Conclusions and recommendations
1. 30% of networks visited by the National
Audit Office did not have comprehensive plans for providing cancer
services in their locality,
though cancer networks have been in place for over three years.
Under new performance management arrangements, Strategic Health
Authorities (SHAs) will be responsible for ensuring networks operate
effectively. SHAs should review the effectiveness of cancer networks
in their locality and where necessary put cancer service plans
in place without delay.
2. Monitoring of performance against Plan
targets by cancer networks is inconsistent and, in five cases,
does not take place. All cancer networks
should establish comprehensive arrangements to monitor progress
against those targets for which they are responsible. For consistency
and appropriate coverage of targets, including the challenging
waiting time targets to be met by the end of 2005, the National
Cancer Director should identify and establish the most suitable
monitoring framework. Network boards should provide annual information
on progress to key stakeholders, including the National Cancer
Director. The networks should then conduct benchmarking to learn
from each other's successes and challenges.
3. A third of cancer networks have at best
an adequate relationship with the primary care trusts that provide
their funding. The creation of NHS foundation
trusts adds a new factor, as their core freedoms bring new opportunities
but also the risk of more limited partnership working and collective
efficiency. Planning, financing and implementing cancer services
need to be done collectively by cancer network organisations rather
than in isolation. Where necessary they should adopt existing
good practice in this respect, which the Department should identify
and disseminate as a basis for joint working towards a shared
goal of better cancer services for patients.
4. Cancer mortality rates tend to be highest
in areas of greatest deprivation, particularly for lung cancer,
with the highest mortality rates twice the lowest across Strategic
Health Authorities. These differences
in part reflect lifestyles, notably the prevalence of smoking
and the extent to which patients with symptoms get them addressed
quickly, as well as the effectiveness of NHS cancer services.
The Cancer Plan contains a number of targets aimed at reducing
inequalities but meeting or exceeding them depends on cancer networks
being fully effective, including having a greater focus on prevention.
All networks should make clear in their delivery plans how cancer
inequalities are to be addressed. The Department should bring
the results of actions to address cancer inequalities together
in a published progress report on this specific issue.
5. The Cancer Plan needs updating to take
account of major NHS structural changes since it was published
five years ago. The current Plan should
be reviewed and a revised version covering the period to 2010
should be published. It should include a more comprehensive set
of targets for the second half of the planning period, and reflect
the estimate of the future burden of cancer currently being developed
by the Department.
6. There is no straightforward but comprehensive
account of progress being made against the Plan targets and commitments.
The Department should publish progress against key cancer outcomes
annually, along the lines of Figure 8 of the Comptroller and Auditor
General's report, to provide a clear and consistent basis for
the public to see how much progress is being made over time.
7. Patients are diagnosed with cancer at a
later stage in the UK than in other European countries and this
particularly affects people from deprived areas in England.
New guidance from NICE sets out best practice for referring patients
with suspected cancer to specialist services on the basis of their
symptoms. Supporting information to help the public understand
the referral guidance should be adapted to provide easily understood
key warning signs and symptoms of cancer. These key indicators
could then be widely publicised, for example through readily available
cards or leaflets, targeting those groups that tend to delay going
to the doctor with symptoms of possible cancer.
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