Cancer Care in the NHSFebruary 2005
Over the last five years the NHS has invested nearly £2.0 billion in improving cancer services using a traditional public sector model. The National Cancer Plan published in 2000 led to a massive injection of funding. We do not believe cancer patients have obtained the best value possible from this remarkable investment.
Changes in the control of funding flow in the NHS have led several NHS agencies – Primary Care Trusts, Strategic Health Authorities, provider trusts, Cancer Networks and the Department of Health – getting involved in decisions on cancer. Some have little relevant expertise and many are overwhelmed. Cancer patients often live in poor health unnecessarily for long periods of time due to a lack of co-ordination of their care by overstretched treatment services.
Several hundred new, highly paid administrative staff have been appointed to re-engineer the journey of patients but this has not resulted in an increase in clinical capacity because of predictable professional staffing shortages on the front line.
The patient voice in determining the future of cancer services has so far been a whisper emanating from a few, well meaning but unrepresentative, professional patients who do not rock the boat. There is no effective choice available for cancer patients.
Delays in first referral have been reduced for those with possible cancer symptoms but the queue for access to diagnostic services for those whose symptoms do not follow a clear pattern and yet still are found to have cancer has lengthened. A Royal College of Radiologists report demonstrated appalling delays in access to curative radiotherapy with 72 per cent of patients in 2003 being treated outside the maximum acceptable delay period compared with 32 per cent in 1998. Many new machines are lying in boxes because of staff shortages.
The Department of Health’s target for 2005 – a wait of one month from diagnosis to first treatment – is in our view impossible to achieve. Such a wait would be unacceptably long in most European countries and certainly in North America.
Despite the use of lottery money to improve diagnostic services, there are still huge delays in obtaining scans and pathology before a decision can be made on the best treatment to offer an individual. There is no coordinated national IT system in place to maximise the use of facilities across artificial administrative boundaries.
Although £124 million in extra funding has been allocated each year for cancer drugs, there is still strong evidence of postcode prescribing with less than 5 per cent of women with breast cancer receiving Herceptin in Derbyshire compared with 90 per cent in Dorset. The drug budget is set to soar with the European registration of several new high cost, targeted molecular therapies now available in the USA. The cancer postcode lottery is set to continue unabated.
In terms of Britain’s social and economic challenges we believe the Cancer Plan is delivering poor value for money. It is operating in a top down, confused bureaucracy. Although outsourcing diagnostic services to the private sector is beginning to increase both capacity and efficiency, there are few innovative partnerships in the delivery of cancer care. True reform is now essential.
We are writing this with a great sense of urgency. The Cancer Plan is simply not delivering as hoped and there are no reasons for expecting any dramatic improvements in the future. In the interests of patients we must look at ways of bringing about a rapid improvement in the situation.
There are feasible, fundable ways forward available. Essentially cancer services should benefit from the economic incentives that have improved the situation in other areas of care including elective surgery and cardiac surgery. While other areas of care are benefiting from greater pluralism, cancer services are still in the era of a complete NHS monopoly within which cancer networks are promoting cartels to block out competition.
In particular, within two years, 30 per cent of diagnostics, radiotherapy and chemotherapy should be outsourced to the independent sector. This would drive innovation, investment and increase the quality of services provided. Such pluralism of provision would be the basis of real patient choice.
In the future the prevalence of cancer will rise trebling the number of people living with cancer in Britain to three million at any one time. This will put further pressure on process and outcomes. Real improvement will not be achieved by simply giving more money to a burgeoning bureaucracy. It requires a serious commitment to reform.