Since the Calman-Hine report in 1995 set out its 10-year strategy, local providers of cancer services have been working to meet national priorities within their teams.
The Cancer Services Collaborative (CSC) is taking an overall view of the service, across the spectrum of primary, secondary, tertiary and palliative care in an effort to streamline the service from the bottom up.
The CSC involves nine cancer centres or networks from across the NHS working intensively until March 2001.
As part of the national booked admissions programme, the networks are undertaking up to five projects, each focusing on patients with a specific cancer: bowel, breast, lung, ovarian or prostate.
Ben Gowland is redesign manager on the National Patients' Access Team, which is co-ordinating the collaborative. He says each project aims to deliver change in four interconnected areas:
co-ordinating the patient journey;
improving the patient and carer experience;
optimising care delivery - 'making sure the care is by the best person in the best place at the best time';
managing capacity and demand.
Until now cancer services have tended to look at clinical developments rather than improvements in the system. 'It will help outcomes if service delivery is better, ' he says.
Gill Dolan is programme manager for Merseyside and Cheshire Cancer Network. She says: 'Previously I would put a bid in to solve a problem but if you have more time you find the less expensive way of doing things.
'For the first time we're looking at the whole patient journey: if you walk that patient's journey you can clearly see how it could be frightening or confusing for them. There is duplication and there are gaps as patients move through different protocols.
'We plotted a storyboard of patient journeys, pinpointing bottlenecks and using that to see how we are reducing waiting times and improving other areas. It's quite a powerful tool.'
Any changes to systems are introduced on a small scale rather than sweepingly. The idea is that these changes can be shared with other members of the collaborative and adopted accordingly.
The centres and networks taking part are: Mid Anglia Cancer Network; South East London Cancer Network; West London Environs and Cancer Network; Merseyside and Cheshire Cancer Network; Northern Cancer Network; Kent Cancer Network; Avon, Somerset and Wiltshire Cancer Services; Leicestershire Cancer Centre; Birmingham Hospitals Cancer Network.
South East London Cancer Network is running five projects. Programme manager Lisa Godfrey-Harris says: 'It's bringing together new partners, not just across the acute sector but primary care, too. With our breast project, one change we made we tried on just one patient and then on a dozen, before introducing it. Now, when a patient goes to her GP with a suspected breast lump she leaves the surgery with an appointment to see the breast surgeon. The GP faxes the breast unit, which guarantees it will respond within 10 minutes with an appointment.'
The South East London Network's lung cancer project identified long delays for patients because they had to see their GP at every step on the road to diagnosis. Ms Godfrey-Harris says:
'Now the GP still refers to x-ray but as soon as that patient has had an x-ray and it's seen to be abnormal, the radiographer urgently refers to a specialist and the GP is informed. The patient leaves with a date to see the specialist. That took just four weeks to introduce.'
At the end of the 16-month project, the nine teams will share lessons learned with the NHS in a national reference guide to improving delivery of care to patients using cancer services.
One area where one-stop services are well established is in breast clinics. Dr Hazel Craig, cancer services manager in East Kent, explains: 'We have triple assessment in our breast clinics: the patient comes in, receives a clinical examination, breast imaging and either a fine needle aspiration or a core biopsy.'
East Kent also has a rapid access clinic for colorectal patients, who come in for examination in the morning and go forward for a sigmoidoscopy in the afternoon. Dr Craig says: 'Additional funding for rapid-access clinics is, of course vital, but it doesn't just require money. . . it does depend on multidisciplinary working.'
But, according to Professor Patrick Johnston, director of oncology at Queen's University, Belfast, funding must follow restructuring if it is to work. Cancer services in Northern Ireland are going through an extensive restructuring following the Campbell report in 1996, with four cancer units being developed across the country, and a cancer centre currently subject to private finance bids being developed at Belfast City Hospital.
Professor Johnston says that having a cancer centre will mean that 'patients will get to see specialists and receive the right treatment for their cancer'.
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