The cancer gap
Our diarist attends Westminster for a round table discussion on effective commissioning of cancer services
THE STORY SO FAR...
Dr Peter Weaving is a GP in Cumbria and a self-proclaimed commissioning enthusiast involved with clinical commissioning since the early days of PBC. Despite great optimism for what clinical commissioning can achieve, local challenges keep his commissioning feet firmly on the ground, not least health inequalities …
The electric wheelchair of the Baroness Masham of Ilton (‘I'm Sue') beeped to a halt at our table and she dropped a large bundle of letters onto it with a sigh. ‘Look at all this post – we're doing the health bill in the Lords in the morning and 90 people wish to speak,' she said.
John Baron MP, chair of the All Party Parliamentary Group on Cancer, paused for a moment and then continued his introduction to this round table discussion on effective commissioning of cancer services in the new NHS. There was some work to be done. ‘We are the worst in Europe at one-year cancer survival,' he thundered.
The brave new world of clinical commissioning was being firmly handed the baton described in Improving outcomes: a strategy for cancer and our target was to save an additional 5,000 lives per year, to reduce health inequalities in cancer and to make it a better experience.
To emphasise my lack of contact with the cancer world I was surrounded by cancer network leads and their directors, national cancer experts and third-sector organisational leads. My seat was bracketed between Breakthrough Breast Cancer and the Men's Health Forum. I had travelled down with Ros, our own cancer services expert and commissioner, but she had been allocated to the other table.
At her table, Sir Mike Richards, national cancer director, was letting rip: ‘Occasionally a cancer specialist will copy a patient into the letter to the GP. What the hell is going on? If I go and see my solicitor he does not write to my bank manager and "perhaps" copies me in – he does it the other way round and damn well asks my permission before he does so. If I see a specialist I expect them to write to me and in language I can understand.'
Worse was to follow. It may be that our poor one-year survival is my, the GP's, fault. Former primary care tsar David Colin-Thomé opines, and the evidence supports, that gatekeeper primary care systems delay cancer diagnoses. We are taught, and as a commissioner I encourage, frugality in the use of resources – including diagnostic testing. Perhaps if we were more blasé with ultrasound, CT and MRI our figures would be better. I wonder, evidence welcomed, if other countries' cancer survival figures are skewed, and our epidemiologists are very good at tracking down every cancer as opposed to the French results that come from just four centres of excellence.
The one thing we had universal consensus on was the effect of deprivation – not only in increasing cancer incidence, but in delaying diagnosis and, even when balanced for that delay, still worse outcomes compared with more affluent populations. To compound that was a cheery observation from a regional director of public health from the Midlands that historically every downturn in the economy increased health inequalities. Mind the gap.