NEWS

Britain Implements Nationwide Cancer Standards

John Illman

The "cancer police" are moving in on British hospitals. This month, peer review teams will begin visiting hospitals to see if they are meeting the first-ever national cancer standards in England.

The "police" moniker has been played down as a joke, but the United Kingdom’s cancer services are no laughing matter. Britain has only about eight oncologists per million population, less than half that of other comparable European countries.

The problems have been compounded, the government concedes, by failure to modernize services, incomplete standards of care, inconsistent assessment, and conflicting guidelines—often regional or local in origin. Until now, the eight health care regions in England have been responsible for developing their own standards. But future performance in each region will be measured against set national standards.

There is nothing new about peer review visits, but the new "cancer police" visits are mandatory—part of the tough shake-up by Mike Richards, M.D., recently appointed national cancer director. He is committed to "delivering the fastest improvements in cancer care in Europe over the next 5 years.

"That’s a bold claim, but it’s perhaps easier if you’re starting from the bottom of the pile. An even bolder claim is that by the year 2010, our 5-year survival rates in cancer will compare with the best in Europe," he said last month in a speech to the Royal College of Physicians.

The new national cancer standards (see box) are a major part of his National Cancer Plan, which the Labor government describes as the world’s "first ever comprehensive strategy" against cancer.

The idea of the "cancer police" knocking at the door may cause alarm, says Peter Selby, M.D., professor of cancer medicine and director of the Imperial Cancer Research Fund Medicine Research Unit, St. James University Hospital, Leeds. But it may result in additional resources. His own unit, he explained, had a 2-day peer review visit before the introduction of the regime.



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Dr. Peter Selby

 
"This was a totally constructive experience in which they recognized—as we did—some areas which needed to change," Selby said. "We were able to use their recommendations to influence funding."

But the new initiatives have not been universally welcomed. Centralization of treatment away from small district general hospitals to large cancer centers has profound implications for many health care professionals—including reductions in workload. But, Selby said, "There has been less antipathy than I anticipated."

Stan Kaye, M.D., Cancer Research Campaign professor of medical oncology at the Royal Marsden Hospital, Surrey, said that development of the structure of cancer services has lagged behind that for other diseases. "Cancer is often initially diagnosed and managed by people whose prime specialty is not cancer," Kaye said. "It’s this which differentiates us [from] other European countries and the United States. But we’re now addressing this with the new standards and national guidelines."

National Health Services cancer services will receive an extra £280 million (about US $411 million) this year, rising to an extra £570 million (about US $838 million) by 2003–2004. John Toy, M.D., Ph.D., medical director of the Imperial Cancer Research Fund, welcomed the announcement to have 1,000 more cancer specialists by 2006. But he is concerned about how long it will take to train them. He warned: "There’s still a long way to go to catch up with our European neighbors."



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Dr. John Toy

 



             
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