Committee of Public Accounts

Press Notice No. 2 of Session 2004-05, dated 25 January 2005


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

"You are almost twice as likely to die of cancer if you live in a northern city as in an affluent area in the south of the country. If you live in a deprived area, your cancer is likely to be more advanced by the time it's diagnosed and you are less likely to survive.

The Department of Health and the NHS need to tackle the underlying reasons behind the health-divide. It is simply unacceptable that there are postcode lotteries for prescription of anti-cancer drugs, waiting times for scans, and even chemotherapy treatments. The Department and the NHS need to identify exactly where there are such inequities, understand the reasons behind them, and address them without delay.

The Department of Health and NHS have made welcome progress, for example in improving early detection through screening and in meeting targets for the speed of urgent referrals, and a greater proportion of those diagnosed will now survive. However the UK still lags far behind other European countries in terms of survival rates showing that the Department of Health and the NHS still have a great deal to do in the battle against cancer."

Mr Leigh was speaking as the Committee published its 2nd Report of this Session, which examined the progress on: prevention and early detection of cancer; improving the quality of cancer treatments; and reducing the variations in cancer survival and mortality rates between different parts of England.

More than a third of the population develops cancer at some point in their life, with over 220,000 new cases each year in England, and 128,000 deaths. Cancer is easily the biggest killer in England, accounting for a quarter of all deaths. Those in deprived parts of England tend to die more frequently from cancer, and survive for a shorter time once diagnosed, than those in more affluent areas. Since 1971 the rate of incidence of cancer in England has increased by nearly one third and, although patterns vary for individual cancers, incidence is likely to continue rising because of the ageing population. During the same period the cancer mortality rate has fallen by one eighth. Smoking related cancers remain particularly lethal however.

For some cancers, such as breast cancer, screening is improving early detection of people with the disease but without symptoms. People with symptoms in some other countries have their cancer diagnosed at an earlier stage than is the case in England. This reflects a number of factors, including patient delay in coming forward, difficulties for GPs in recognising symptoms early enough and waits for diagnostic tests within the hospital. The NHS in England is meeting its targets for urgent referral of those with suspected cancer but, once in the system, patients' waits for diagnostic services such as colonoscopies and scans are often too long. The NHS has done much to improve the quality of cancer treatment through multidisciplinary team-working but the "postcode lottery" for chemotherapy treatment has yet to be tackled decisively and waiting times for radiotherapy treatment are too long.

The Committee found that the Department should publicise some simple guidelines to help people recognise and act on appropriate symptoms for major cancers. UK survival rates from cancer are still well below the best in the world. A key factor is the tendency of patients in England to be diagnosed at a later stage of the disease. Patients and the public should also have the information to help them press for improvements in cancer services in their locality.

Research indicates that cancer is likely to be more advanced by the time it is diagnosed in poorer areas. Cancer Networks should identify areas where cancer is diagnosed at a more advanced stage, with reference to measures of deprivation. Action is needed to help GPs improve their ability to identify symptomatic patients, including better guidance; closer monitoring of GP referrals; and the development of GPs specialising in cancer. Better information is needed on how far cancer has advanced at the point of diagnosis, so that quality of treatment can be benchmarked properly for the first time.

A significant number of patients referred non-urgently, and who eventually are diagnosed with cancer, wait much longer than they should to be treated. Delays in the patient pathway should be identified and reduced by redesign of services drawing on good practice. Waiting times for radiotherapy treatment are too long and getting longer. Primary Care Trusts in their role as commissioners of cancer services should promote the concentration of cancer surgery in the hospitals which carry out higher volumes of such operations, in line with best practice.

A deadline should be set for ending the current wide variations in prescribing of anti-cancer drugs such as Herceptin. The recommendations by the National Cancer Director regarding resources, clinical practices and enhancements in NICE guidance should be implemented speedily, with a clear timetable for monitoring their impact and reviews of progress. Some areas benefit more than others from the current distribution of pathologists, diagnostic radiographers and scanner provision. Greater equity of provision must be worked towards over an explicit timescale.

The Department should commission research into the long term effectiveness of its Stop Smoking services. Currently it is not clear why more than two thirds of people who initially quit using the service are likely to be smoking again within the year.

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