Published: 15/08/2002, Volume III, No. 5818 Page 6
Underlying financial deficits and the need to meet waiting-list targets are leaving a number of cancer networks starved of cash for the second year in a row, according to senior clinicians and primary care trust managers.
Last month, national cancer director Professor Mike Richards told the Commons science and technology select committee that the 'hypothecated'£255m promised in last year's NHS cancer plan had not got through to cancer services. The money was intended to bring spending up to an extra£407m by 2002-03.
HSJ has been told by the cancer front line that the funding black hole is still growing this year, with networks in the South most affected. This is despite public health minister Hazel Blears' evidence to the same Commons committee that the government wanted to see the extra£76m of cancer plan money 'earmarked' for this year directed specifically to cancer care.
Professor Hilary Thomas, lead clinician at Surrey West Sussex and Hampshire cancer network, said: 'We have seen none of the£76m. If we had got the money, we would have funded tumour group administrators and multidisciplinary team co-ordinators.'
The problem has been caused by a local£45m service and financial framework gap, she claimed. 'We put in a service delivery plan to set the priorities for this financial year amounting to£4m. We were led to expect that sort of new spend and we have seen nothing of it. Earmarking in West Surrey strategic health authority means nothing because the SAFF [service and financial framework] gap is so wide.'
Eastbourne Downs primary care trust acting finance director Peter Reeves said his organisation 'in common with lots of places, did not find it possible to put [this year's] earmarked funding for the purpose for which it was intended'.
He added: 'The reason is very simple. It is just that when push comes to shove, the perceived most important targets are the government's waiting-list and waiting-times targets. There is an issue too that there are a number of areas, particularly in the South, around underlying deficits and they've got to clear those first.'
North London cancer network lead clinician Professor Anthony Goldstone put in a bid for£16m of recurring funding starting this year to cover 142 projects. But he said three of the PCTs in his network told him their money was going to service cancer debt at 'one of our new hospitals'. This left him 'with£800,000 to distribute'.
The network was 'in danger of losing all the people we have got on board over the last two years', he said.He urged the Department of Health: 'Let networks be involved from the outset in all the money going to PCTs. Let them have influence over all of it and authority over some. Everyone knows authority comes with the money, and we see no reason why it should be different for us.'
Brighton and Hove City PCT is the lead commissioning host organisation for the Sussex cancer network. Chief executive Gary Needle said he had also had a difficult SAFF round, 'but had not gone into it with any underlying financial deficit'.He said he had received£425,000 from his area's former health authorities 'and that was earmarked funding, if you like. It was not ringfenced funding'.
The PCT decided to put four times' that sum on cancer services - an extra£1.6m 'spent on things the cancer network said were the top issues'. He added: 'We also invested in a number of additional consultant posts and nursing staff, but we also decided as a PCT to invest in a lot of additional funding in the local hospice to support palliative care and allocate additional funding to implement the new National Institute for Clinical Excellence guidance on cancer drugs.'
Serious issues about the role of cancer networks need to be resolved, he stressed. 'If you feel they are there to take commissioning decisions, then that could bring them into conflict with the role of PCTs - unless PCTs are prepared to delegate to cancer networks. You could have a commissioning sub-group of a PCT and they bring with them a fixed allocation of the budget.'
A DOH spokesperson said the department was 'working very closely with cancer networks to see what money was spent and what services were allocated in 2001-02'.
'We are clearly looking very closely at progress this year, and Professor Mike Richards is working with chief executives of SHAs to ensure that the money gets through to cancer services.'
Cancer services is the subject of the next edition of Managers & Medicine, published in HSJ on 4 September.