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Each year in England, around 255,000 people are diagnosed with cancer and around 130,000 die from the disease. The NHS spent £6.3 billion on cancer services in 2008-09. Tackling Cancer has been a priority for the Department of Health (the Department) since its ten year NHS Cancer Plan was published in 2000. In 2007 the Department published its five year Cancer Reform Strategy (the Strategy) to deliver improved patient outcomes.
Over the last ten years, the NHS has made significant progress in delivering important aspects of cancer services, with falling mortality rates and consistent achievement of the cancer waiting times targets. Since publication of the Strategy in 2007, improvements have also been made in reducing the average length of stay and numbers of patients treated as day cases. A significant increase in resources has contributed to these improvements, but the progress has also been achieved through clear direction and high profile leadership underpinned by strong performance management linked to waiting times and mortality targets.
We welcome the Department's and NHS's commitment to improving the outcomes for cancer patients. We are concerned, however, that early diagnosis does not happen often enough; whilst cancer survival rates have improved and mortality rates have fallen, the gap in survival rates between England and the best European countries has not been closed. There remain wide, unexplained variations in the performance of cancer services and in the types of treatment available across the country.
It is disappointing that ten years after the publication of the NHS Cancer Plan 2000 there remain significant gaps in information about important aspects of cancer services, in particular information on chemotherapy, on follow-up treatment, and on the stage that a patient's cancer has reached at the time of diagnosis. The Department can not yet measure the impact of the Strategy on key outcomes, such as survival rates, and does not know if it is commissioning cancer services cost-effectively, due to poor data on costs and because outcomes data are not sufficiently timely.
We were surprised that value for money has not been a stronger focus for commissioners, both in securing services to meet the health needs of their local population or in assessing the performance of its suppliers. Few commissioners make best use of the information available and most do not know whether their commissioning is cost-effective.
The Department has recently refreshed its approach to delivering improvements in Cancer Services, with the publication in January 2011 of Improving Outcomes: A Strategy for Cancer. We consider it a priority that the Department should continue to improve information on cancer-related activities. We look to the Department to develop robust mechanisms to ensure the collection of high quality, comprehensive and timely data to raise awareness of cancer, provide transparency in the performance of commissioning consortia, and ultimately drive improved outcomes for cancer patients.
On the basis of a Report by the Comptroller and Auditor General,[1] we took evidence from the Department on its and the NHS's performance in delivering cancer services; on improving information on activity, cost and outcomes of cancer services; and how the Department intends to deliver cost-effective cancer services in the new NHS.
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