One in three people will develop cancer. One in four will die from it. But a year after its formation, the Cancer Services Collaborative seems to offer significant hope for faster and better patient care.

After decades of neglect, extra resources for cancer are on their way. The NHS plan promises an extra£570m by 2003-04 and more specialists.

But by setting up the CSC last autumn, the government was indicating that underlying systems have to work for the patient. The collaborative's multidisciplinary teams are reshaping the entire patient journey for suspected and diagnosed cases of breast, bowel, lung, ovarian and prostate cancer.

Fresh from a two-day conference in Blackpool, how have the 51 projects in the nine cancer networks performed so far? And with the launch of the second wave from April 2001 set to include every cancer network, what can newcomers learn from the pioneers?

The CSC imported a US health theory, threw away most of the jargon and concentrated on the practical bit: hundreds of smallscale local tests leading to a sharing of the techniques that work.

The National Patients' Access Team, which runs the CSC, reports that 12 months into the 16-month first phase, time before first treatment has been cut in half in 'a number' of the projects.

More than 55 per cent are already achieving their booking targets.

Clinical director of the collaborative, Professor David Kerr, is 'very pleased' with progress to date: 'We will reach the targets we have set ourselves.'

The collaborative's national programme director, Helen Bevan of NPAT, is fired with enthusiasm.

She mentions the Wirral Hospital trust, where the time to diagnose bowel cancer used to be 13 weeks, but now stands at eight days.

Carol Makin is a bowel specialist Continued from page 11 at the trust and is also the collaborative's clinical lead for bowel cancer. Her trust delivers a first appointment within two weeks for every bowel patient suspected of having cancer referred by GPs.

This was achieved by developing a pro-forma for GPs indicating which patients should be referred.

In the bowel section of the collaborative, 'the nine groups set off having a fast-track stream for seeing patients, but are coming to the conclusion that you can see everyone referred within two weeks'.

Her results have been achieved 'through education, communication and audit'. There are implications here for cancer treatment generally. 'You can see where we are headed, ' she concludes.

Wirral Hospital trust has 'virtually eradicated follow-ups', with the remainder done by nurse specialists. Waiting lists have been 'decimated', along with her prospects of receiving more waiting-list money: the present system doesn't offer much of an incentive to get those lists down, she believes.

NPAT is looking at offering rewards for good performance such as meeting a two-week rule for first appointments, she says.

Lisa Godfrey-Harris, programme director for south-east London, says staff understand 'where the bottlenecks are', but 'sometimes there is a lot of hidden capacity'.

The south-east London breast project is having particular success matching capacity and demand.

No-one had realised the urgent clinic was under-used, while the non-urgent clinic was oversubscribed. By not differentiating between urgent and routine, they cut waiting times to two weeks.

Urologist Hugh Rogers works for West Middlesex University Hospital trust and is also a member of the cancer taskforce.His collaborative project was singled out in the NHS plan.

It cut the time taken to identify high risk from prostate cancer from six months to 18 days. Mr Rogers says the success of the NHS cancer plan depends on the phase two roll-out of the collaborative.

Among the many ambitious targets outlined in the plan is a maximum one-month wait from diagnosis to treatment for all cancers by 2005.

Mr Rogers believes the plan's promised 'huge expansion' in consultants will take 10 years to achieve. He has great hopes for nurse-led clinics: 'Nurses are terrific at co-ordinating the patient journey.'

National guides to improving the delivery of care to cancer patients are being drawn up for each of the cancer groups by first phase participants ready for April to ensure those involved with phase two are effective more quickly.

But is there a danger of everything grinding to a halt once the money that allowed the first stage of the collaborative dries up?

'It's a question of making the changes sustainable' and taking advantage of the opportunities for more staff in the cancer plan, says Mr Rogers.

Another part of the answer lies in 'firmly embedding' the collaborative approach into the trust directorate structure, according to the director of the Leicestershire programme, Janet Williamson.

Ms Bevan of NPAT does not duck the fact that significant resource problems exist, but she concludes: 'If we invest without redesigning the system, we won't optimise the outcome. If we can do both we are flying.'