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The National Audit Office reported today that, four years into the 10-year NHS Cancer Plan, substantial progress has been made in meeting the Plan’s targets. The thirty-four cancer networks which have been established have achieved important improvements in delivering cancer services across England. However, the networks need to be more effective and to develop partnership working further if the targets in the Plan are to be fully met by 2010.

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According to today’s report to Parliament by head of the NAO Sir John Bourn, the NHS Cancer Plan, published in September 2000, is broadly comprehensive, impressive in its coverage, and well regarded by cancer networks, the organisations established to bring together all local cancer services. There are ways in which the strategy for tackling cancer in England could be improved, however, and decisions need to be taken now on how to update and bring together all elements of the current cancer strategy in a unified way that ensures it remains the central guiding approach for improving cancer services and outcomes.

The NHS Cancer Plan contains a wide range of targets and commitments. There has been good progress against most of the major targets, with many either met or on course to be met, and little slippage. The Department recognises that there are challenges to be met and more to be done if all the Plan’s targets and commitments are to be fully achieved.

Cancer networks have helped improve cancer services and have achieved some particular successes. These include planning for the introduction of new cancer drugs and developing plans for funding specialist palliative care. In addition to the NHS Cancer Plan, the Department has launched other initiatives to improve cancer services, including a tobacco advertising ban and a strengthening of the partnership between the NHS and the voluntary sector.

The 34 cancer networks in England were established by 2001. But the extent to which they have become fully established and fully effective varies. The NAO found that sufficient resources were not always available to enable networks to operate effectively; and an NAO survey found that not all cancer network management teams were fully staffed, with some networks having vacancies for essential posts. Not all networks plan effectively, with only around a third having produced workforce or education and training strategies.

Primary care trusts (PCTs) are responsible for commissioning cancer services, using cancer networks plans and advice to contract for cancer services. With networks usually having many PCTS within their boundaries, a network-wide approach to commissioning is important. Many networks adopt this approach but some PCTs continue to commission services in isolation, and greater collaboration is required if networks’ priorities are to be appropriately addressed.

The principles behind cancer networks require that their constituent organisations have a duty of partnership to work together effectively to improve cancer services for the benefit of patients. For the most part relationships work well; but policy and structural changes in the NHS pose challenges for the implementation of the Cancer Plan, particularly in terms of co-operation between network organisations. And there is a need for the roles and responsibilities of constituent organisations to be clearly set out and adhered to. While the core freedoms of NHS foundation trusts should provide greater flexibility and speed in developing services, they may limit effective partnership working and collective efficiency.

Among the NAO’s recommendations to the Department are that it consider what changes are necessary to the cancer strategy and that it should publish progress against the Cancer Plan annually. The Department should also ensure that the roles of cancer network constituent organisations are clearly defined and adhered to. In addition, the NAO recommends that strategic health authorities should ensure that cancer networks have the necessary resources required; and that the networks have appropriate planning arrangements in place to implement the Cancer Plan.

"Substantial progress has been made in implementing the NHS Cancer Plan, with many targets in the Plan met or on course to be met. This should contribute to the downward trend in cancer mortality rates and continue to bring significant benefits to patients."

"Cancer networks have achieved much but there is more to be done if they are all to become fully effective: including better planning, more co-ordinated commissioning of cancer services, proper resourcing, and effective co-operation between constituent organisations. As the mid-point of the Cancer Plan is approached, the time is right for the Department of Health to consider how these matters can be addressed and take appropriate action."

Sir John Bourn

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