Whatever their feelings on the government's approach to cancer services, the experts agree more cash and manpower are needed - fast. Thelma Agnew reports

So just how bad are the NHS's cancer services? The Department of Health's 'baseline audit figures' for 1997, made public last week, revealed appalling waiting times for treatment across a wide range of diseases. Even cancer specialists were taken aback by the 10-month waiting time for prostate cancer, and the fourand-a-half-month gap between diagnosis and treatment endured by 'non-urgent'bowel cancer patients.

Anyone assuming that things can only have improved should brace themselves for a further shock: according to some leading cancer experts the situation has not got better, and may even have worsened.

'There has been no change whatsoever, ' insists Professor Gordon McVie, director general of the Cancer Research Campaign.

'I don't see why it should have changed - there are no more doctors, no more nurses, the extra money for machines hasn't appeared until now, and most of the machines won't be in place until the end of this year. '

The experts can be divided into those who are impressed by the government's attempt to tackle decades of under-investment and neglect; and those who want much more - faster.

Professor McVie is in the second camp. For starters, he says the government's focus on the first outpatient appointment (from April all cancers will be covered by a two-week waiting time guarantee) is misdirected: 'That's the least of it. Once they have the diagnosis and then have to wait six months for treatment - well, that is seriously stressful.

'Blair and co are saying: 'Stop bleating, you can't build Rome in a day. ' If it takes five years, in that time half a million more people will have died. '

Professor McVie is confident that a huge funding boost - 'half a billion pounds should be spent now'- would go a long way to solving the nursing shortage, and it could also be used to recruit specialists from Europe.

Leading oncologist Professor David Kerr, one of the expert team at Birmingham University's health services management centre, which conducted the 1997 audit for the DoH, believes cancer services have improved.

Professor Karol Sikora's claim on Panorama last week that last year's Downing Street cancer summit was nothing but hype infuriated him: 'I thought that was nonsense - bullshit.

It was a very positive meeting. Tony Blair was there for two hours (not the half-hour claimed by Professor Sikora), and things did move on afterwards. '

Professor Kerr is also sympathetic to the government's argument that some problems can be resolved by better organisation and modernisation.

When he discovered that some patients were taking seven weeks to reach his clinic, he set about changing the referral process. 'There were 27 steps to get the patient to my clinic. We have now got that down to two steps and 10 days. '

Detailed work on designs to keep delays out of the system is now under way through the DoH's cancer services collaborative scheme, which Professor Kerr chairs. 'We have£6m and 47 projects throughout England. We are doing a lot of work on the ground looking at the cancer pathways from GP referral.

We are establishing where the bottlenecks are. '

The remedies include simple changes like family doctors emailing or faxing referral letters instead of using the post.

Dr Jim Shaw, director of research and development at the Clatterbridge Centre for Oncology trust, has seen improvements since 1997. But he wishes the foundations had been laid before targets were set and expectations raised.

'Radiotherapy is a major problem - we are running at 10 per cent staff shortages and there are national vacancies.

'In order to attack the delay in getting patients on to treatment, we need to make sure we have enough staffed machine hours. It would have been n ice to have had that in p lace b e fore we tried to push people through the system. '

More 'freedom' and flexibility in funding allocation would also help doctors and managers who have to cope with different budgets for each separate part of the service.

There are high hopes that cancer 'czar' Professor Mike Richards - flanked by the National Institute for Clinical Excellence and the Commission for Health Improvement - will provide a long- overdue coherence to oncology services.

Dr Robert Glynn-Jones, Macmillan lead clinician for gastrointestinal cancer at Mount Vernon Hospital, is optimistic that after years of 'lurching from crisis to crisis' a 'national perspective' on the disease is on its way.

'Things here have got worse since 1997 in terms of waiting times for radiotherapy and chemotherapy. But the government is grasping the nettle. It is prioritising cancer. '

His fear is that the current 'very real investment' in services, particularly equipment, will be entirely consumed by rising demand.

It is also clear that the services can't just process more patients; they have to get better at what they do. For this qualitative leap forward to take place, the government needs to make better use of clinicians' goodwill, argues Dr Michael Pearson, director of the clinical effectiveness and evaluation unit at the Royal College of Physicians of London. 'If the government works through the royal colleges they will get rewards back (instead of blame for everything that is wrong) and they will see effective action. '

The RCP is keen to target lung cancer with a national data collection programme which will enable units to compare their performances.

Dr Pearson doesn't see a slow start as a reason to despair. 'The initiatives under the Calman-Hine framework are just beginning to get going, and in most regions there is very active planning to reorganise services. Things are beginning to happen. '

If there is no discernible progress for this year or next, then the accusation that the government, and the health service, is failing cancer patients will be hard to ignore .

Dr Pearson and his fellow optimists had better be right.