1 Improving the provision of cancer
services in England
1. Despite a rise in cancer incidence of 31% between
1971 and 2000 in terms of new cases per 100,000 of the population,
by 2002 the cancer mortality rate had fallen by 12% (18% for men
and 7% for women). Death rates have fallen with the introduction
of national screening programmes and new and better treatments.
2. But better prevention, detection, diagnosis, treatment
and care for cancer remain important goals. More than one in three
people in England will develop cancer at some point in their life;
one in four will die from it; and there are over 220,000 new cases
a year and 128,000 deaths. There are considerable variations in
incidence and mortality between strategic health authorities,
associated with differences in affluence[2].
3. The NHS Cancer Plan, published in September 2000,
is a ten-year programme of fundamental reform of cancer services
in England, with stated aims to:
- save more lives;
- ensure people with cancer get the right professional
support and care as well as the best treatment;
- tackle the inequalities in health that mean unskilled
workers are twice as likely to die from cancer as professionals;
and
- build for the future through investment in the
cancer workforce, through strong research and through preparation
for the genetics revolution, so that the NHS never falls behind
in cancer again.[3]
4. The Cancer Plan is a comprehensive strategy to
tackle cancer, covering the whole patient pathway from prevention
(including lifestyle issues such as smoking and diet) and screening
through to diagnosis, treatment and care; and the investment needed
to deliver these services in terms of improved staffing, equipment,
drugs, treatments and information systems. It formally established
cancer networks across the country, responsible for implementing
the Cancer Plan, and bringing together all the organisations and
health professionals which plan and deliver treatment and care
for cancer patients.[4]
5. The NHS Cancer Plan covers the main elements of
World Health Organisation guidelines for cancer strategies, but
there are ways in which the cancer strategy for England could
be further improved. Individual components of the Cancer Plan
are not explicitly costed, nor does the Plan itself provide a
financial envelope within which strategic decisions can be made.
There is no estimate of the future cancer burden, which makes
it difficult to see how capacity to diagnose and treat patients
can be estimated; and there is no consideration of efficiency
issues through the identification of alternative spending plans.
The Department does now have plans to look at the future estimate
of the cancer burden in England in more detail to inform the cancer
strategy for the next five years.[5]
6. The NHS has undergone major structural and other
changes since the publication of the Cancer Plan, including the
creation of primary care trusts in 2001, the establishment of
Strategic Health Authorities in 2002, and the creation of NHS
Foundation Trusts in 2004. The Cancer Plan is in this respect
starting to look somewhat dated. The Department has not yet taken
a decision on whether to update parts of the cancer Plan or revise
the whole Plan.[6]
7. The Cancer Plan contains many targets and commitments
to be achieved between 2000 and 2010, covering better prevention,
screening, treatment and care, cutting waiting times, and additional
staff and facilities, Figure 1. At this halfway point in
the Plan the NHS has met a number of important targets with, for
example, 975 extra cancer consultants in post by June 2004, a
36% increase in cancer specialist training places by 2003 and
over £400 million of new equipment such as scanners delivered.[7]
8. The C&AG's Report details progress to date.[8]
Progress has been encouraging, though some targets for 2001 to
2004 were not fully met or will be met later than planned. For
example, the target to develop a programme to promote public awareness
of the symptoms of cancer, due by 2001, has not yet been fully
met. Targets for improving routine screening for breast cancer
by 2003 and age coverage by 2004 are expected to be met in 2005.[9]
9. Across the country significant progress has been
made in improving cancer services and managing them more effectively,
in particular, speeding access to cancer diagnosis and treatment.
Over 99% of those referred urgently by a GP to see a cancer specialist
are seen within the 2 week target. While unacceptable variation
remains, there has been an increase in access to NICE approved
cancer drugs across England, and this should in due course contribute
to further cuts in mortality rates from cancer. The Cancer Plan
has five more years to run, and the Department expects that all
targets in the Plan will be met by 2010.[10]
10. For the public in general and above all, those
who have or may have cancer, waiting times for diagnosis and treatment
remain key issues. The Cancer Plan contains targets aimed at cutting
waiting times including targets of one month maximum wait from
diagnosis to treatment and two months maximum wait from urgent
GP referral to treatment that are to be achieved by the end of
2005. These targets, and others such as those for the number of
smokers quitting, pose significant challenges to the cancer networks
and the NHS, and will require considerable effort if they are
to be fully met.[11]
11. In terms of patients choosing where to be assessed
or treated, the Department made it clear that they wanted patients
with cancer to benefit from being able to make such decisions
as much as other patients. The concept of choice may be meaningless,
however, if meeting the two week referral target to see a cancer
specialist is possible only at a limited number of hospitals.
The Department has had extensive discussions with the NHS, and
it had recognised that choice of hospital would not be appropriate
for all services, and it included cancer services in this category.
The Department considered rapid access to services as more important,
though choice is important in cancer services and patients should
be offered more choice about the treatment they receive, including
choice of provider wherever possible.[12]
12. The NHS Cancer Plan announced increased funding
for cancer, with an extra £280 million in 2001-02 rising
to £570 million by 2003-04. Whilst funding for cancer is
not ring-fenced, the results of a tracking exercise by the Department
suggest that all of this extra money has been spent directly on
cancer, including on new drugs, staffing and new services. All
cancer networks have increased their expenditure on cancer quite
considerably over the last three years, with the money allocated
according to a revised formula to better distribute money to geographical
areas according to need. The Cancer Plan also provided £50
million extra funding for specialist palliative care services,
including hospices, provided through a central budget but with
the local cancer network determining where the need is greatest
at the local level.[13]
Figure 1: NHS Cancer Plan contents and key elements[14]
| NHS Cancer Plan contents and key elements
|
| Chapter 1: The challenge of cancer
Good progress in recent years
Relatively poor survival rates
Inequalities in cancer
A postcode lottery of care
Poor patient experience
Meeting the challenge of cancer
Chapter 2: Improving prevention
New national and local targets to reduce smoking in disadvantaged groups
New local alliances for action on smoking
Support in primary care to help people quit smoking
£2.5 million for research into smoking cessation
National five-a-day programme to increase fruit and vegetable consumption
National School Fruit Scheme
Raising public awareness
Chapter 3: Improving screening
Routine breast screening to be extended up to age of 70 and available on request to women over 70
Improved breast screening techniques to increase detection rates
New ways of working
Improved cervical screening techniques
Colorectal screening pilots
The NHS Prostate Cancer Programme
Better understanding of screening
Chapter 4: Improving cancer services in the community
A central role for primary care in new cancer networks
£3 million in partnership with Macmillan Cancer Relief for a lead cancer clinician in each PCT
£2 million for palliative care training for district nurses
New primary care clinical dataset for cancer patients
Chapter 5: Cutting waiting for diagnosis and treatment
Range of waiting time targets, including: maximum two months wait from urgent GP referral to treatment for all cancers by 2005
Roll out of Cancer Services Collaborative to streamline services in all networks
Cancer the first priority for roll out of booked appointments
By 2004 every patient diagnosed with cancer will benefit from pre-planned and pre-booked care
Chapter 6: Improving treatment
Extension of guidance programme to all cancers
NICE appraisal of cancer to end postcode lottery of care
Establishment of specialist teams
| Care of all cancer patients to be reviewed by specialist teams
Monitoring progress to achieve standards
National cancer datasets
Strengthening cancer registries
Chapter 7: Improving care
New supportive care strategy
NICE to develop guidance for supportive care
New training in communication skills
Improved information for patients
New Cancer Information Advisory Group
New internet resources for patients
£50 million extra for hospices and specialist palliative care services
New Opportunities Fund money for palliative care in deprived communities
Chapter 8: Investing in staff
Nearly 1000 extra cancer consultants
Increase in the number of specialist trainees
More cancer nurses, radiographers and other health professionals
More skills and new roles for cancer staff
Targeted training initiatives
Better planning for the future
Chapter 9: Investing in facilities
Substantial investment from New Opportunities Fund
Additional funding in NHS Plan for 50 MRI scanners, 200 CT Scanners and 45 linear accelerators
Modernisation of pathology services
First ever cancer facilities strategy
National audit of major cancer diagnostic facilities
New partnerships with the private sector
Chapter 10: Investing in the future: research and genetics
New National Cancer Research Institute
Additional investment in research infrastructure
Additional investment in prostate cancer research
Partnership with Macmillan Cancer Relief on genetic
counselling
Chapter 11: Implementing the NHS Cancer Plan
Additional £570 million by 2003-04 for cancer services
Implementation of cancer service improvements by cancer networks
Cancer networks develop strategic service delivery plans
Network workforce, education and training and facilities strategies to underpin service delivery plans
Cancer networks commissioning pilots to be established
|
Source: The NHS Cancer Plan
2 C&AG's Report, Tackling cancer in England:
saving more lives (HC 364, Session 2003-04) paras 1-2, 13 Back
3
The NHS Cancer Plan, September 2000 Back
4
C&AG's Report, paras 2, 8, 14 Back
5
C&AG's Report, paras 6-7; Q7 Back
6
C&AG's Report, paras 2.14, 2.43; Qq 12, 72-74 Back
7
C&AG's Report, para 1.13 and Figure 8 Back
8
ibid, Figure 8 Back
9
ibid, para 1.17 and Figure 8 Back
10
ibid, para 1.13, Qq 103-104 Back
11
C&AG's Report, paras 10, 1.18; Qq 8-11 Back
12
Qq 94-95; Ev 16 Back
13
C&AG's Report, para 1.10; Qq 1, 3-4, 40-42, 96-97 Back
14
C&AG's Report, Figure 4 Back
|
