CHI/Audit Commission report on cancer care
CHI/Audit Commission report on cancer careKeywords: Cancer care, NHS, Specialists, Audit Commission, CHI
A joint Commission for Health Improvement (CHI)/Audit Commission report published in November, NHS Cancer Care in England and Wales, looks at how well the NHS has met the recommendations of the 1995 Calman Hine report on delivering local cancer services. It provides a baseline against which the success of the Government's Cancer Plan, published in 2000, and the cancer strategy of the National Assembly for Wales, based on the 1997 Cameron report,can be measured. A total of 15 supporting papers with detailed data accompany the report, making it one of the most comprehensive and wide-ranging studies of cancer care in the UK.
The report says that care of cancer patients has improved since 1995,survival rates for most cancers are improving and there are more specialist cancer surgeons.
However, improvement has been patchy, services lack co-ordination and the care patients can expect varies according to where they live and the type of cancer they have. Inconsistency in cancer care has begun to be addressed, but progress is variable. Where aspects of care or specific cancers get national focus there has been real improvement, but this effort needs to be widened and,crucially, services must be more patient-focused.
Key findings include:
Almost all patients (92 per cent) who are referred by their GP to a specialist as an urgent case are seen within two weeks. This is a clear improvement. However, people referred as non-urgent (50 per cent of cancer patients) can wait much longer for an appointment and GPs vary widely in how many cases they refer as urgent.
There is wide variation in how long patients have to wait for diagnostic tests. A lack of equipment or poor use of equipment often causes delays. There is a fivefold variation in the number of patients per MRI or CT scanner between hospitals.
Equipment needs to be used more efficiently: some hospitals scan more patients with one MRI machine than others with three or four.
Most patients praise their doctors' sensitivity when they are diagnosed, but communication between cancer specialists and GPs is often poor, with GPs missing out on key information about their patients. This hampers GPs' ability to discuss diagnosis and prognosis with their patients.
People with some types of cancer are more likely to get joined-up care. Patients' experience is better when multi-disciplinary teams of doctors and nurses plan their treatment together but, while 90 per cent of the hospitals visited have these teams for breast cancer patients, less than half had them for urological cancers.
Access to specialist cancer nurses varies. Patients feel better informed and looked after when they have access to a specialist nurse but the availability of specialist nurses varies. Of the hospitals visited, 90 per cent had a clinical nurse for breast cancer but less than a quarter had one for stomach cancer.
Waiting times for treatment vary widely for different cancers. Although most hospitals reported that patients with lung cancer waited no more than four weeks for their operation (with many patients operated on within two weeks), there were examples of patients waiting up to eight weeks for surgery. Waits for potentially curative radiotherapy for skin cancer (urgent) were up to eight weeks in 40 per cent of the Trusts visited, while accepted professional standards suggest that urgent radiotherapy should be provided within 48 hours. Two-thirds of hospitals visited reported waits of more than two weeks (the maximum wait suggested by professional standards) for palliative radiotherapy for patients with lung cancer.
Access to palliative and terminal care varies widely between trusts. Research shows that most people with cancer would rather die at home, but only a quarter do, often because there are no appropriate services to support them at home. While the hospice services have grown enormously, availability of palliative community care services outside working hours, e.g. support from a district nurse, can be a particular problem to patients at all stages of their illness.
Organisation of cancer services must be improved. Services need to be moulded flexibly around the needs of patients, not based on convention and institutional structures. Cancer networks can achieve co-ordinated planning and common treatment standards but, to deliver this, they have to be able to work in a patient-centred way. The networks' role in commissioning local services needs to be clearer and there must be greater accountability and leadership at network level.
NHS Cancer Care in England and Wales is the first joint national study by the Audit Commission and CHI. The report is based on new research carried out across England and Wales. Organisations providing services to patients with cancer or suspected cancer in nine cancer networks were visited and provided data. These data were used alongside research into patients' experience of cancer services and research into the views and experiences of GPs and community nurses.
Hard copies of the report, including a CD containing supporting papers, are available from The Stationery Office. Tel: (44) (0) 870 600 5522. The report can also be downloaded in pdf format from http://www.audit-commission.gov.uk/publications/pdf/cancerchiac.pdf
