Statistics on lengthening waiting times for cancer patients make grim reading. Is improvement on the way? Paul Smith reports

Published: 21/03/2002, Volume II2, No. 5797 Page 12 13

It was bad news for the government - again. This time cancer.

Splashed across the front page of The Observer earlier this month a 'leaked' report revealing that the number of patients waiting more than four weeks to start treatment had doubled since Labour came to power.

The number of patients starting treatment within the target time of four weeks has fallen from 68 per cent in 1998 to 32 per cent in 2000, according to the report.

With cancer care a central plank of the NHS plan, the revelations were an embarrassment for prime minister Tony Blair, who has staked Labour's political future on improved delivery of public services. More importantly, the report did little to inspire confidence in Mr Blair's key pledge to cut the number of cancer deaths by a fifth by 2010 - especially when cancer is already killing 120,000 a year.

And the question for managers - as so often with NHS performance issues - centres on capacity, the spread of best practice and resources.

The figures which form the basis of The Observer's story were presented by the report's author, Dr Nick James, at a conference nine months ago.

He told HSJ: 'They come from data based on the treatment of 50 patients at 57 oncology units across the country. In total about 2,500 treatments were assessed, so I think they are fairly accurate of the situation then.'

The delays were 'endangering people's lives', he said, and anecdotal evidence from his own department at Queen Elizabeth Hospital, Birmingham, was suggesting that waiting lists even now were 'not shifting very much'.

For him the issues are new equipment and staff shortages (not just radiographers but also physicists and technicians) because in the majority of cases it was the rate of biopsy scans being carried out which was delaying the moment when patients' actual treatment began.

He says that government satisfaction at hitting its target of twoweek referral times from GP to consultant should be tempered by recognition that the bare statistics are 'meaningless' to patients' actual experience of NHS care.

Both the Department of Health and the Royal College of Radiologists agree that staff shortages are a major concern.

An RCR report published last month, Clinical Radiology: a workforce in crisis, claims that the NHS needs another 1,700 radiologists at current levels of demand - and says that in terms of numbers per million of population the UK has half the number of radiologists of Germany and just over a quarter of those in France.

RCR clinical radiology faculty dean Dr Mike Dean says: 'Even with a modest assumption of growth in the numbers of examinations performed each year, we are aware that we need to train at least 228 more radiologists a year than we do at present for the next five years in order to meet the workload estimates. This is nearly twice as many again as are being trained at the moment.'

A DoH spokesperson said numbers had increased by 10 per cent since 1997, but accepted that they were still 'too few'. However, it is taking steps to address the issue, including raising awareness of the profession among school leavers and increasing the number of training places available.

Professor David Kerr of Oxford University's department of clinical pharmacology worries that money is not getting through to the 'front line'.

'The government has certainly made the extra resources available. And clinicians obviously have a list of what they want to spend the money on. But it is getting caught up in the system.'

And he says that the situation is not being helped by changes taking place under the government's Shifting the Balance of Power reforms, which hand three-quarters of NHS budgets to primary care trusts. But Dr James says it is lack of staff which is resulting in the extra money failing to make a difference.He says his own department is actually under-spending.

'We would like to carry out treatment at weekends, but we simply do not have enough staff.'

Although the waiting-list figures may induce the usual feelings of doom and gloom, the experts contacted by HSJ agree that improvements will come - but they will take time.

RCR faculty of clinical oncology dean Dr Roger Buchanan says the cancer services collaborative is looking at ways of reducing waiting times and managing demand.

'There is not much room because there is not a great deal of inefficiency, so you may find improvements in that area will be limited.

'But the government has recognised the problems and is working towards improving the situation. Mike Richards [national cancer director] has listened closely to our concerns.'

He adds: 'We have wanted to see the number of accelerator machines increase. They are going up from four machines per million people to 5.5 per million to secure high-levels of care.'

One reason, he says, for the apparent slow progress of the government's cancer initiatives is that the number of patients being treated has risen 'because we can carry out more complex therapy due to new technology'.

'We can slow down the development of cancer, and with the advent of multi-disciplinary teams through better organisations we have uncovered extra demand generally.'

He adds: 'I think patients are going to see improvement within one or two years. You have to remember before criticising this government that there has been underfunding in cancer services for more than 15 years.'