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Government launches Cancer Reform Strategy

21st December 2007
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Seven years after the initial launch of the NHS Cancer Plan, in December 2007 the government launched a new five-year plan to improve NHS cancer services. From the cradle to the grave of genetic mutation and carcinogenic inhalation or ingestion, the new strategy aims to work across the disease pathway, encompassing prevention and transforming all areas of care.

The evolution of the original Cancer Plan meant that there were few surprises under the tree or indeed in the hat. Cries of “It’s behind you!? in reality chorused, “It’s right here in front of you, me and us.?

The launch document did not start with the well known phrase “T’was the night before Christmas? but there was a predictability in its content and the delivery. The main aim: to build a world class cancer service in England; the goal: to do this by 2010.

The current figures on cancer care demonstrate improvement, notably around access, diagnosis and treatment. Yet outcomes are another matter:  England still lags behind parts of Europe and other developed world countries.  Put simply, despite all the front end delivery of quicker access and clinically audited and approved care, people can still present late, and cancer – in spite of its reclassification as a long term condition – can still kill.  Metastatic re-presentation, for example, provides roughly a 2 year median survival curtain call.

The headlines in the Cancer Reform Strategy included:

  • Smoking cessation focus
  • Cervical cancer immunisation provision
  • Sun and sun bed awareness
  • Extension of the Breast Cancer Screening Programme to all women between the ages of 47 and 73 by 2012
  • Extension of the NHS Bowel Cancer Screening Programme to all men and women between the ages of 70 and 75 from 2010
  • Equity and access to drug treatments
  • Increased funding for radiotherapy to provide capacity and waiting time standards will also be extended, with the 31-day wait from decision to treat to the start of treatment to cover all cancer treatments, including radiotherapy, by 2010

The tale of Charles Dickens’ Christmas Carol relays the story of the miser Scrooge and provides some uncanny parallels to the timing of this release. The first spectre - that of Jacob Marley - springs to mind: Marley appears to Scrooge exactly 7 years after his death and this reform strategy appears 7 years after the initial Cancer Plan launch.

The spectres and parallels of ghosts past, present and future provide useful mirrors to examine the original Cancer Plan in terms of what it did and did not deliver. The ghost of Christmas future reminds us and our elected government of what we and others expect from a world class service in terms of outcomes.  The ghost of Christmas present reminds us of the reality of a cancer diagnosis and its potential to spoil the part in the panto where Cinders gets her man, the dame gets a laugh and the principal boy slaps his thigh. 

Each day 800 people are diagnosed with cancer and one in three people will receive a cancer diagnosis during the course of their lives.  “It’s behind you!? needs to move from the unseen but known farcical spectre of cancer into a reality where cancer diagnosis and “cure? can be celebrated and where “It’s behind you!? means just that. If prevention strategies win in the end, we can create a future in the present just as Scrooge did. 

The idea of reform suggests a need for change and realignment; in the Cancer Reform Strategy launch, social inequality and poverty featured high on the list and just as vignettes set in Dickens’ time are almost unbelievable when set against today’s standards, let’s ensure that the 2010 NHS Cancer Reform Strategy delivers the outcomes we desire so we can keep pace with some of our European neighbours’ outcomes and aspire to further improvements against others.

In the words of Alan Johnson, Health Secretary:

"Today I have pledged that NHS cancer services will do even more for patients. More to help reduce the risk of developing cancer, more to ensure access to high quality treatment and more to deliver care in the most clinically appropriate and convenient setting for patients.?

We can only hope that the impact of the gift pledged by the government to enable front line service staff and users to improve prevention and outcome rates for cancer by 2010, has as big an impact as the turkey sent by Scrooge to make amends.

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