This review of cancer services, undertaken by the Commission for Health Improvement (CHI) and the Audit Commission (AC), is aimed at the general public as well as those with a specialist interest in this subject. Hallmarks of a good service, together with questions that patients might ask, are set out at the end of relevant chapters.
This review addresses progress in implementing recommendations from a key report on cancer services in England and Wales, published in 1995 (the Calman-Hine Report). This report was important in developing good practice and bringing cancer to the forefront of the health agenda. Many improvements can be attributed to it, including the expansion of multidisciplinary working and plans to increase staffing and equipment. Other changes stem from policy developments since that time, including the reduction in initial waiting times.
Many key recommendations of the report are not yet fully implemented in all areas. From the patient point of view, there is poor communication and a failure to plan care in a systematic way between the different professionals involved. Many patients lack access to someone, such as a specialist nurse, who both knows about their cancer and can provide needed support. There are also failures in the wider system, so that patients do not always receive the best treatment or care. And there are striking variations in provision both across geographical areas and between patients with different types of cancer.
The inescapable conclusion is that formal policies and plans, however commendable, cannot ensure that services are provided in a truly patient centred way; a change in the attitudes and behaviour of those working with patients is also required. Priorities include a need to identify gaps in planning for individual patients, to give more attention to those cancers where services are not well developed and to resolve issues arising from the creation of networks at national and local level.
Many people across the NHS are working to improve cancer services; the criticisms throughout this review do not apply to all areas. But the goal must be for improvements and good practice found in some places to be replicated everywhere.
Included in this report:
- getting a diagnosis and planning treatment
- treatment and care
- palliative and terminal care
- the organisation of cancer services
- reflections on progress in caner services