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Public Accounts Committee reports on cancer reform strategy

1 March 2011

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

"This Committee fully supports the work by the Department of Health over the last 10 years to make tackling cancer a priority. Mortality rates have been falling and cancer waiting times targets consistently achieved.

But the one year survival rates in England are still poor compared with the best performing European countries and that is generally a sign of low awareness of symptoms, among the public and GPs, and late diagnosis. There also remain unexplained wide variations across the country in how cancer services perform and in types of treatment available.

It is very disappointing that, a decade after publication of the NHS Cancer Plan, there is still not enough good quality and timely information on such important aspects of cancer services as the use of chemotherapy and the stage at which patients' cancers are being diagnosed.

The Department must maintain the momentum it has recently established in improving information on cancer services, and make sure this information is used to improve the use of resources and, most importantly, to deliver better outcomes for cancer patients."

Margaret Hodge was speaking as the Committee published its 24th Report of this Session which, on the basis of evidence from the Department of Health (the Department), examined its and the NHS's performance in delivering cancer services; improving information on activity, cost and outcomes of cancer services; and how the Department intends to deliver cost-effective cancer services in the new NHS.

Each year in England, around 255,000 people are diagnosed with cancer and around 130,000 die from the disease. The NHS spent £6.3 billion on cancer services in 200809. Tackling Cancer has been a priority for the Department of Health (the Department) since its ten year NHS Cancer Plan was published in 2000.  In 2007 the Department published its five year Cancer Reform Strategy (the Strategy) to deliver improved patient outcomes.

Over the last ten years, the NHS has made significant progress in delivering important aspects of cancer services, with falling mortality rates and consistent achievement of the cancer waiting times targets. Since publication of the Strategy in 2007, improvements have also been made in reducing the average length of stay and numbers of patients treated as day cases.

A significant increase in resources has contributed to these improvements, but the progress has also been achieved through clear direction and high profile leadership underpinned by strong performance management linked to waiting times and mortality targets.

We welcome the Department’s and NHS’s commitment to improving the outcomes for cancer patients. We are concerned, however, that early diagnosis does not happen often enough; whilst cancer survival rates have improved and mortality rates have fallen, the gap in survival rates between England and the best European countries has not been closed. There remain wide, unexplained variations in the performance of cancer services and in the types of treatment available across the country.

It is very disappointing that ten years after the publication of the NHS Cancer Plan 2000 there remain significant gaps in information about important aspects of cancer services, in particular information on chemotherapy, on follow-up treatment, and on the stage that a patient’s cancer has reached at the time of diagnosis.  The Department cannot yet measure the impact of the Strategy on key outcomes, such as survival rates, and does not know if cancer services are being commissioned cost-effectively, due to poor data on costs and because outcomes data are not sufficiently timely.

We were surprised that value for money has not been a stronger focus for commissioners, both in securing services to meet the health needs of their local population or in assessing the performance of its suppliers. Few commissioners make best use of the information available and most do not know whether their commissioning is cost-effective.
The Department has recently refreshed its approach to delivering improvements in cancer services with the publication in January 2011 of Improving Outcomes: A Strategy for Cancer.

We consider it a priority that the Department should continue to improve information on cancer-related activities. We look to the Department to develop robust mechanisms to ensure the collection of high quality, comprehensive and timely data to raise awareness of cancer, provide transparency in the performance of commissioning consortia, and ultimately drive improved outcomes for cancer patients.

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