A report produced by the Committee of Public Accounts has said that the push to improve cancer services in England has “lost momentum” in the past two years and that the NHS must adapt to cope with demand.
The Committee of Public Accounts is appointed by the House of Commons to examine the accounts showing the appropriation of the sums granted by Parliament to meet the public expenditure. The report looked at the progress that had been made in improving cancer services and outcomes in England and was published following evidence from a number of cancer charities and experts.
This report has found that the incidence of cancer has grown whilst the resources available to support improvement have reduced. It stated that whilst survival rates continue to improve, nearly a third of people still die within a year of being diagnosed and around half do not survive for five years.
These statistics put the UK in a poor position when compared with the rest of Europe.
The main conclusions of the Committee’s report were:
- The Department of Health and NHS England have allowed a loss of momentum in the drive to improve cancer services
The Committee last reported on cancer services in 2011 and noted at that time that the Department of Health had made significant progress in improving services since the year 2000. However, the most recent report found that, since 2013, the resources dedicated to leading the cancer services had been reduced.
- It is unacceptable that NHS England does not understand the reasons why access to treatment and survival rates are considerably poorer for older people
Cancer patients aged 75-99 years old are 20% less likely to survive for at least one year after diagnosis than those aged 55-64. Older patients are also much less likely to receive treatment such as chemotherapy or surgery.The Committee found that NHS England does not know the extent to which the variations can be explained by factors such as, for example, patient choice or whether older people are being discriminated against in accessing treatment.
- There is unacceptable and unexplained variation in the performance of cancer services across the country
The Committee has noted that there are examples of neighbouring clinical commissioning groups with very different performance. This was a point that the Committee also found in their report of 2011 and reported that the continued variation is unacceptable.
- The NHS is failing to meet national cancer waiting time standards for patients
The target set by the government is for 85% of cancer patients to start treatment within 62 days of being urgently referred by a GP. The Committee reports that meeting the standard has proved difficult because the number of urgent GP referrals increased by 51% between 2009-10 and 2013-14.In fact, the NHS failed to meet the target for the first part of 2014. It also failed to meet the standard for 93% of patients to be seen by a specialist within 2 weeks of being urgently referred with breast symptoms and the expectation that less than 1% of patients should wait for 6 weeks or longer for a diagnostic test.
- Progress in improving patients’ access to radiotherapy treatment has been slow and the current stock of radiotherapy machines now needs replacing
Access to intensity modulated radiotherapy, which is an advanced form of radiotherapy, has improved. However, the overall proportion of patients receiving radiotherapy has stayed at around 35% since 2009-10. The Committee found that England has five radiotherapy machines for every one million people which is actually fewer than most other high-income countries.
Chair of the Committee, Margaret Hodge, was reported as saying:
“With more than one in three people developing cancer in their lifetime, cancer touches the lives of us all at some point, and the Department of Health spends over £6.7bn on cancer services a year. That is why it is so concerning that the Department of Health and NHS England have lost momentum in the drive to improve cancer services in the last two years.”
In response to the Committee’s report, the National Clinical Director for Cancer at NHS England, Sean Duffy, said that the NHS was helping more people survive cancer than ever. However, he acknowledged that it was time to take “a fresh look at how we can do even better across the whole patient journey.”
He explained that the NHS has already established an independent taskforce to develop a new cancer strategy for the next five years. The taskforce will focus on improved prevention, faster diagnosis and better treatment, care and aftercare.
Executive Director of Policy at Cancer Research UK, Sarah Woolnough, was reported as saying:
“It is depressing that too many patients are waiting longer than they should for their diagnosis and effective treatment. We hope the report will urgently catalyse NHS England, the Department of Health and others charged with providing cancer care to deliver the best for all patients, no matter their age, the cancer they suffer from or where they live.
“All patients deserve the best treatment and care and many are not currently receiving it.”
Comment
This report is concerning to read. It is clearly unacceptable that some patients are not receiving the very best possible care and treatment following a diagnosis of cancer. Delays in treatment could have very serious consequences for patients.
It is encouraging that survival rates have improved but it is vitally important that the momentum in the improvement of cancer services continues. This report shows that there is work to be done to get the improvements to cancer services back on track and ensure that patients are provided with the care and treatment that they need and deserve.
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