Cancer patients will spend less time in hospital and more will be treated at home or by community services under a five-year vision to improve cancer care.

The government said it would invest an extra£370m up to 2010 - including£250m for new equipment - to back up its Cancer Reform Strategy launched this week.

At the same time trusts will be expected to save about£320m over the next three years by cutting unnecessary hospital admissions and reducing the length of stays.

The strategy also extends flagship waiting time targets to more patients and promises to improve commissioning of cancer services.

PCTs and cancer networks will be asked to set local goals for cutting cancer death rates to ensure they 'take ownership' of the strategy, said national cancer director Professor Mike Richards.

Royal Marsden foundation trust chief executive Cally Palmer said the biggest challenge for managers would be reconfiguring services. It meant managing a shift away from inpatient care at the same time as developing some specialist services.

She said it was possible to make savings: 'We can do this but it will require transition in terms of service reconfiguration.

'The key thing is making sure patients don't bounce around in the system getting duplicated and repeated tests they don't need.'

Another challenge was 'creating confidence in patients', who often felt safer in hospital.

Sandwell and West Birmingham Hospitals trust consultant breast surgeon Luna Vishwanath said it was vital managers worked closely with clinicians.

Making small and relatively simple changes had helped the trust slash hospital stays following breast cancer surgery from six days to 23 hours, she said.

This had included changing nurses, doctors and patients' traditional view that breast cancer surgery was a major operation.

The strategy sets out a vital role for cancer networks in driving improvements and acting as 'agents' for commissioners by liaising with clinicians and service users.

NHS Confederation policy director Nigel Edwards said there were huge national variations in cancer network effectiveness and that incentives and other systems seemed to militate against the use of networks. 'A network might make a decision that has a significant impact for the income of a trust but it may be very difficult if a trust isn't willing to play.'

Macmillan Cancer Support policy manager Duleep Allirajah said trusts could struggle to implement the strategy. 'A lot depends on good commissioning,' he said.

More pledges and initiatives

  • A 31-day waiting time standard extended to cover all cancer treatments.

  • New guidance to come on commissioning cancer services.

  • National initiatives to ensure better data and help cut cancer inequalities.

  • Changes to payment by results, including fair tariffs for complex cancer surgery.

  • £200m investment in radiotherapy equipment and staff.

  • Primary care trusts to raise public awareness of cancer risks.

  • Streamlined appraisal and licensing of new cancer drugs.

Professor Mike Richards is speaking at HSJ's Reforming Cancer Care conference on 17 March. More details at www.hsj.co.uk soon.

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