Jill Rutter writes about the need to save the NHS Cancer Networks, arguing NHS strategy is not bureaucracy.
In December 2008 I was diagnosed with colorectal cancer. My own delays in going to the doctor, coupled with some GP delays in commissioning tests, meant by the time of my diagnosis the cancer had spread into two of my lymph nodes.
Over the next 15 months I had two lots of surgery, radiotherapy and two courses of chemotherapy. My treatment took me to three different London hospitals: Lewisham, King’s and St Thomas’s.
Nearly four years later I am in good health and can barely see any of my scars.
The fact I have survived is a consequence of the excellent and well-coordinated treatment I received in the three hospitals I attended.
That health professionals from three hospitals worked together in an integrated team to treat me is partly as a consequence of the work of NHS Cancer Networks. The work of these essential parts of NHS strategy is again under threat and like many people who have had cancer I am dismayed.
Cancer survival rates across the UK are lower than compared with other developed. For the type of cancer I had, survival rates in the UK were 12 per cent lower than the OECD average in the period 2004-2009 (Link 3).
In the same period, five-year survival rates for colorectal cancer were 64.7 per cent in Belgium – one of the better performing countries along with the USA, Canada, Australia, Iceland, Japan and Korea. In the UK they were 53.3 per cent.
Partly as a consequence of lower cancer survival rates, the Department of Health appointed Professor Sir Mike Richards as its cancer ‘tsar’ in 1999. In 2000, as the first national clinical director for cancer, his team published the UK’s first National Strategy for Cancer (pdf). Although some cancer networks already existed – they were recommended in the 1995 Calman-Hine report into commissioning cancer services – the 2000 NHS Cancer Plan extended their role.
Today, there are 28 cancer networks across England, typically serving populations of between one and two million people. Alongside heart and stroke networks they employ about 700 people across England. They bring together commissioners of health services, the medical expertise of providers, GPs, local authorities and the voluntary sector. Broadly, they aim to promote the early detection of cancers, drive up standards of treatment across all hospitals, improve GP knowledge and ensure services are less fragmented.
The work that they do is hugely varied. For example, in the last two years the South East London Cancer Network has carried out coordinated public awareness-raising on colorectal cancer, improved the laboratory turnaround times for cervical cancer slides, worked to ensure more patients can receive chemotherapy in hospitals near their homes and helped more patients benefit from enhanced recovery after surgery programmes.
Cancer networks have also ensured radiotherapy equipment is used most effectively. Overall, these low profile organisations have ensured a more strategic approach to preventing and treating cancer.
But the future of the cancer networks is under threat. Previously, Andrew Lansley, the then health secretary, refused to guarantee their future under the coalition government’s health reforms. However, he was forced into a u-turn in 2011 when he gave them a reprieve.
But from April 2013 the NHS Commissioning Board, the body which will take over the running the NHS, has decided to replace the 28 cancer networks in England with just 12. (Heart and stroke networks are being similarly reduced). Moreover, the two groups of networks will have their budgets and staff very significantly reduced, with 700 staff being cut to 100.
These cuts take place at the same time as very major NHS reform in England, with the abolishment of strategic health authorities and primary care trusts and their replacement with local authority-led health and wellbeing boards and 300 or so GP-led clinical commissioning groups in April 2013. These huge changes have been sold as a way of cutting bureaucracy and decentralising healthcare commissioning, the latter being part of the localism agenda.
Yet commissioning cancer services is notoriously complex, as there are many different cancers that progress in many different ways in the individual patient. Cancer networks have rationalised and improved the commissioning of cancer care.
At a time when their work is needed the most, and when the new GP commissioners say they need their expertise (see Ensuring effective commissioning of cancer services: A survey of GPs; pdf), the coalition government is proposing cutting them. The consequence can only be more fragmented services, postcode lotteries and poorer patient care.
We need to retain the cancer networks, and above all we need to argue that NHS strategy saves money and is not bureaucracy.
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