Conclusions and Recommendations
1. We fully support the work that the Department
has done over the last 10 years to make tackling cancer a priority.
We welcome the progress made by the Department and NHS in reducing
mortality rates and consistently achieving the waiting times targets.
We also note the National Audit Office's value for money conclusion
that further improvements can be achieved by tackling variations
in service delivery and raising performance to the standard of
the best. The key driver of further improvements is the need for
high quality, comprehensive and timely data that is understood
and used to make decisions about how services should be configured.
In the transition to a new NHS structure, the Department must
maintain the momentum it has recently established in improving
information on cancer-related activities. The recommendations
that follow are intended to help the Department further improve
delivery of cancer services and improve outcomes for cancer patients.
2. Early diagnosis is still not happening
often enough and this is reflected in poor one year survival rates
for most cancers compared to other countries.
Whilst cancer survival rates have improved and mortality rates
have fallen, the gap compared to the best performing countries
in Europe has not been closed. The Department estimated that around
10,000 deaths from cancer could be avoided each year if the one
year survival rates in England were the same as the best performing
countries. Key to improving survival is improved awareness and
early diagnosis.
- We welcome the Department's
plans to pilot and evaluate public awareness campaigns about the
symptoms of cancer at a local and regional level. The Department
should report back to us by the end of 2011 on the outcome of
the pilots and the impact that raising public awareness of the
symptoms of cancer has on achieving earlier diagnosis.
- We are concerned that there is an eight-fold
variation between GP practices urgently referring patients with
suspected symptoms of cancer to specialists. We accept that there
will be variation between GPs as some will choose to refer patients
to specialists whilst other GPs will carry out their own diagnostic
tests. However, the Department should ensure that commissioners
investigate as a matter of urgency those GP practices that have
both high and low referral rates and compare their referrals with
their use of diagnostic tests.
3. There remain wide, unexplained variations
in the performance of cancer services and the delivery of treatment
across the country.
There are wide variations in, and poor understanding of: the extent
of emergency admissions; the use of urgent referrals; cancer screening
coverage; the use of radiotherapy machines; and chemotherapy treatment.
The Department should work with commissioners to get a firmer
grip on the reasons for variations and what impact this has on
patient outcomes. In order to reduce the risks of a postcode lottery
in access to treatment and services, the Department should identify
and implement clear and practical actions that can be taken to
spread good practice quickly so that the worst performing Primary
Care Trusts (PCS)s can be brought up to the standards of the best.
4. It is very disappointing that ten years
after the publication of the NHS Cancer Plan 2000, there are significant
gaps in information about important aspects of cancer services.
The lack of information inhibits effective decision making and
limits patient choice. There are shortcomings
in the availability, consistency, timeliness and quality of key
data such as on chemotherapy which accounts for a fifth of the
overall cancer budget. The Department lacks a coherent strategy
to address these gaps and limitations. The Department should develop
a cancer information strategy which includes common standards
for the quality and timeliness of data on cost, activity and outcomes.
It should clarify how it intends this information to be used to
improve patient outcomes and to inform patient choice.
5. A particular problem is the paucity of
data in most regions about the stage that a patient's cancer has
reached at the time of diagnosis. This
information, known as 'staging data', is key to making better
use of resources and improving outcomes, yet only the Eastern
region has anything like acceptable coverage. The Department needs
to convey to cancer registries and, in turn, to clinical teams
the value and importance of recording accurate staging data at
the point of patient diagnosis. The Department should ensure that
staging data is complete and timely in at least 70% of cases in
each region by the end of 2012.
6. The Department cannot measure the impact
of the Strategy on key outcomes, such as survival rates, and does
not know if it is commissioning cancer services effectively, because
cost and outcomes data are not sufficiently timely.
Cancer registries should be required to provide data to the Office
for National Statistics within six months of the end of the relevant
calendar year to enable the Department to speed up the provision
of comprehensive national and regional outcomes data to commissioners.
7. Many commissioners do not do enough to
understand costs and value for money in their delivery of cancer
services. We are concerned that only a
fifth of PCTs had assessed the value for money delivered by their
providers and that 12% had no plans to carry out such an assessment.
In moving towards commissioning by GPs, the Department should
work with the NHS Commissioning Board to set out clear standards
requiring commissioners to demonstrate how they are obtaining
value for money. The Department should say how it will measure
improvements and what incentives and penalties will be used to
ensure that value for money is at the heart of commissioning decisions.
8. The numbers of cancer survivors is expected
to increase from 1.7 million in 2010 to 2 million by 2020, yet
the Department is unable to measure whether it is delivering on
its commitment of more cost-effective provision of follow-up and
care outside hospital. The Department
expects commissioners to identify more cost-effective ways of
providing follow-up services to increasing numbers of cancer survivors
and intends that meeting the increased demand for such services
should be cost neutral. The Department should improve its information
on outpatients and other forms of follow-up care by requiring
such activity to be properly coded. The Department should also
identify and disseminate examples of good practice where savings
and benefits to patients are identified and evaluate what impact
alternative approaches to follow-up care have on hospital activity.
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