The NHS Cancer Plan, published in September 2000, set out the first comprehensive national strategy to prevent, diagnose and treat the disease, and to reform the way in which cancer services are delivered in the NHS.
The plan not only sought to tackle national variations in care standards and years of underinvestment, but also aimed to raise the level of our cancer services to rival those of the best in Europe. Now three years, an extra £687 million and one health secretary later, what progress has been made towards its goals?
With some targets due to be met by 2005, the three-year progress report, Maintaining the Momentum, published by Health Secretary John Reid in October provides the half-time analysis. While clear improvement in some areas means that there is much for the Government to be pleased about, the report is a useful reminder of the work that remains to be done.
Restructuring of cancer services, with the formation of specialist multi disciplinary cancer teams, has led to a much-needed emphasis on patient focused treatment paths. There are 940 more cancer consultants than in 1997 ? a 30 per cent rise ? but the chronic shortage of radiographers is still resulting in long waiting times for some patients. A shift towards local decision making, with cancer networks linking primary, secondary and tertiary level services across institutional barriers, has also helped to put the patient at the centre of cancer care.
Although cancer mortality rates appear to be on target, inequalities are still apparent. Worryingly, unskilled workers remain twice as likely to die of cancer as professionals, a disparity mainly attributed to differences in diet and smoking rates.
There continues to be concern about whether all the money allocated to cancer services is reaching the frontline. A tracking exercise carried out by the Department of Health earlier this year found that, in some areas, less than 60 per cent of centrally-allocated money reached its destination in the first year of the plan. With recent research by the charity CancerBACUP showing regional differences in the prescribing of the new breast cancer drug Herceptin, despite its recommendation by the National Institute for Clinical Excellence, a second tracking exercise has now been announced.
Maintaining the Momentum provides a motivational half-time analysis ? although the infrastructure has improved, there still needs to be a concerted effort to get the investment to where it is needed and to tackle the social inequalities that remain. Welcoming the publication of the report, Peter Cardy, Chief Executive of Macmillan Cancer Relief, said: "Three years in to the Cancer Plan, the challenge is still to meet the expectations of patients and the public. There is still much to be done in the remainder of this Parliament."
The four aims
? To save more lives, with a commitment to reducing the mortality rate from cancer by at least 20 per cent in people under 75 by 2010 against a 1995 ? 1997 baseline.
? To improve patients' experience of care by ensuring that they get the right professional support and treatment.
? To tackle the inequalities that mean unskilled workers are twice as likely to die of cancer as professionals.
? To build for the future through research and investment in the cancer workforce.
The three core commitments
? National and local targets to address the gap between socio-economic groups in smoking rates and the resulting risks of cancer and heart disease ? smoking rates among manual groups will be reduced from 32 per cent in 1998 to 26 per cent in 2010.
? Goals and targets to reduce waiting times for diagnosis and treatment ? by 2005 there will be a maximum one month wait from diagnosis to treatment for all cancers, and a maximum two month wait from urgent GP referral to treatment for all cancers.
? An extra £50 million NHS investment a year by 2004 in hospices and specialist palliative care, to improve access to these services across the country.
The half-time report
? The death rate from cancer among people under 75 has fallen by 10.3 per cent ? on track to achieving the commitment of a 20 per cent reduction by 2010.
? More than 300,000 people have quit smoking for at least four weeks with NHS help since 2000, and it's hoped that many of these will have given up for good. Pilot projects aimed at reducing smoking rates in deprived communities have also been completed.
? 98 per cent of patients with suspected cancer are now being seen by a specialist within two weeks of being referred urgently by their GP, compared to 63 per cent in 1997, and nearly 97 per cent of women with breast cancer are now receiving their first treatment within one month of diagnosis.
? A national partnership group, made up of voluntary sector organisations and representatives of the NHS, has allocated the distribution of £50 million across the country for improved care for people with terminal cancer. This central budget for specialist palliative care will be available for the three years from 2003-04 to meet the Cancer Plan pledge.
