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Further reform for cancer services

16th May 2007

Estimates predict a 16% rise in cancer cases over the next ten years. How can the NHS deliver better treatment for people with cancer across the UK? Professor Mike Richards says cancer care services should be further reformed so the NHS can deliver more effective patient care.

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Although the National Cancer Director's report "Getting it right for people with cancer" acknowledges that treatment and organisation of cancer care within the health service has vastly improved over the past three decades, it also stresses the need to develop services in order to meet future challenges.

He writes: “There is still much more that can and must be done to improve services…the challenge gets bigger each year as the number of new cancer cases continues to rise.?

Cancer facts
  • In 2004, there were over 233,600 new cases of cancer in England.
  • One in three people will get cancer during their lifetime and one in four will die from it.
  • The four most common cancers - breast, lung, bowel and prostate - accounted for just over half of the new cases of cancer (excluding non-melanoma skin cancer).
  • Breast cancer accounted for 32% of cancer cases among women.
  • Prostate cancer accounted for 25% of cancer cases among men.
  • Cancer is more common in older people.
  • It is estimated that there will be a 16% increase in new cancer cases over the next 10 years - resulting in over 283,000 new cases of cancer per annum in England by 2016.
Success

The report describes the success of improvements in care for patients with cancer, particularly those implemented recently.

Professor Richards writes: "Cancer care has improved greatly since I first qualified in the 1970s. Re-organisation of services over recent years has played a key part in this and will continue to do so as the changes we are making are completed.?

He describes how doctors in the 1970s faced limitations in their ability to diagnose, screen for and treat cancer. As a consequence, he says: “outcomes for patients were a lot worse than they are now.?

He mentions the Calman-Hine Report in 1995 as acting as the “wake-up call" to ensure cancer patients received good standards of care throughout the country. This was followed by the NHS Cancer Plan in 2000, which issued a “comprehensive plan to tackle cancer.?

Key facts

Professor Richards includes key facts in his report in order to illustrate this progress, including:

  • Death rates from cancer for patients under 75 have fallen by almost 16% in the last seven years.
  • In most cancers, including breast and colon cancer, survival rates have been steadily improving over the past 30 years.
  • Improved waiting times, with 99% of patients with cancer receiving their first treatment within one month of diagnosis.
  • A 49% increase in the number of cancer specialists since 1997.
  • £520m investment in new NHS equipment.
  • A rate of participation in clinical trials that has more than tripled over the past five years.

He highlights five key areas which have played an important role in improving services:

  • Better co-ordination of care
  • Centralisation of complex treatments
  • More convenient services
  • More flexibility
  • Better use of hospital beds
  • He also lists crucial developments in cancer treatment, such as improved screening for breast, cervical and bowel cancer, and rapid access services for people with possible cancer.

    Cancer networks

    Professor Richards describes how a cancer patient may receive treatment from a large number of professionals, teams and organisations within the health service. He underlines the importance of cancer networks in ensuring co-ordination across organisations.

    He says: “The introduction of cancer networks has led to major improvements in communication between organisations...[and] ensured that cancer services are planned properly for each patient, so important when a cancer patient will have tests and treatments over a period of weeks, months, even years in different hospitals and clinics.?

    Centralisation of services

    Professor Richards calls for cancer care to be provided by specialists who can best understand and treat in their area of expertise. He says: “it is important to understand that some cancer services need to be reorganised to make sure they are only provided by experts.?

    In addition, he asks for the public to understand that in some situations they may have to travel further afield to receive specialist treatment. He recognises that access to cancer services which do not involve specialist treatment should be made available on a local basis.

    Convenience is emphasised as a key issue for patients undergoing treatments such as chemotherapy and radiotherapy. Professor Richards uses the fact that nearly 90% of the population live within a 45-minute drive of a radiotherapy centre to illustrate that this may be “a long and tiring journey for someone with cancer especially…[if] the journey has to be made maybe 5 days a week for 5 or 6 weeks.?

    He calls for additional diagnostic and radiotherapy facilities, stating: “we need to think about what more can be done.?

    Skills and community care

    Professor Richards uses the stories of NHS staff to demonstrate how skill-sets can be best employed in the care and treatment of people with cancer. The stories used in the report show how flexible job roles and skills can benefit the patient in terms of speed of treatment. He says: “We need to focus on the skills required to carry out different tasks rather than job titles.?

    Professor Richards also points to community support and surgical developments to speed recovery time as effective ways of ensuring that beds are used efficiently.

    The way forward

    The report concludes by recognising the importance of finishing the health service’s “reorganisation of services.? It calls for additional improvements, including:

    • heightening public awareness of cancer symptoms;
    • increasing NHS capacity in key areas;
    • offering greater patient choice;
    • providing more community based care for terminal patients.
    Cancer Reform Strategy

    The report makes the assertion that “standing still is not an option? and mentions the government has given its consent to the development of a new Cancer Reform Strategy to build on the 2000 Cancer Plan.

    Professor Richards concludes: “This signals that cancer will remain a priority for the government and the NHS for years to come.?

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