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Ideology over treatment

The Tory recipe for wrecking cancer services
Duncan Milligan, Wednesday, April 22nd, 2015


The Tory recipe to improve cancer services has resulted in lost momentum and their health reforms have created confusion and fragmentation. Waiting times for treatment hit the lowest point since they were set, with minimum waiting time targets missed for the only time ever in the first quarter of 2014 – and that result was to be repeated throughout the year.


The target is for at least 85 per cent of patients who get an urgent referral from a GP to start treatment within two months. Only 83 per cent of patients were treated in line with the minimum target.


When breast and skin cancer referrals were stripped out, only 77 per cent of patients were treated within the minimum target time. In March this year the Public Accounts Committee became the latest to ring the alarm bells in a hard hitting report.


It attacked the downgrading of national leadership, with NHS England downgrading the National Director for Cancer to a part-time role and the axing of the hugely successful National Cancer Action Team, made up of the best cancer specialists.


But the attack on cancer specialism has also been seen at more local levels. Twenty-eight regional cancer networks were axed. Their work was pushed into 12 ‘strategic clinical networks’ none of which are cancer specialist.


Numerous concerns

Barrie Brown, Unite national officer said the union had expressed numerous concerns about the damage that would be caused by the Health and Social Care Act. He told UNITElive: “The Tory top-down re-organisation of the English NHS has clearly had an impact on cancer services. This Act was to deliver on the Tory’s ideological commitment to privatising healthy services, not to deliver better care and what is happening to cancer services confirms this.


“Unite warned that the fragmentation of services created by the commissioning process for delivering privatisation would directly affect the quality of patient care and health services. This is what is happening and why this Act must be repealed and the rapid dash to privatise should be stopped.”


Macmillan Cancer Support have flagged up concerns about the impact on cancer services. They believe the reason treatment targets are being missed include fragmentation of commissioning and a loss of expertise in cancer networks –  a result of the coalition government’s reforms, mainly the Health and Social Care Act.


The Act is not only a financial disaster – it cost the hard-pressed NHS £3bn. But the impact on services has been damaging and disruptive.


That should surprise no one with direct knowledge of the car crash impact of the Act. Labour is commitment to repealing the act which brought in a whole new commissioning system and flung open the door to services being privatised.


MacMillan, highly respected for their independent insight, found that “some of the changes and the general upheaval of the reforms have resulted in confusion and fragmentation in how cancer services are commissioned. This insight includes large-scale research with commissioners carried out by the consultancy OPM.


Improvements urgently needed

“Based on our findings, we have serious concerns about whether the commissioning system can protect the existing standard of cancer services, patient experience and outcomes, let alone lead to the improvements we feel are urgently needed.”


MacMillan felt that commissioning of services had become far more fragmented, particularly how patients go through diagnosis, treatment and recovery, what specialists call the “pathway”.


MacMillan found that, “Responsibility for commissioning across various parts of the cancer pathway is divided up but there is no one with overall responsibility to ensure the whole pathway is joined up. This results in disjointed pathways for people with cancer.


“Cancer commissioning is complex and there is lots of confusion about who is responsible for commissioning what. This means that there is a danger that some services are not being commissioned at all, as each commissioning body assumes the responsibility falls to another.”


It also criticised, as the Public Accounts Committee does, the axing of cancer networks and the damage that has caused.  It describes their loss as a “major setback”.


“Our regional staff are already seeing examples of some services falling through these gaps. Cancer networks used to oversee the overall cancer pathway to ensure it was joined up, and provided much-needed cancer expertise to commissioners.


“The diminishing of cancer networks, and the cancer expertise therein, is considered a major setback to many commissioners while they struggle with the new system. We have carried out additional research that shows that strategic clinical networks have not replaced cancer networks.


“It is unclear what their role is in cancer commissioning, if they have one at all. As a result, there is a void in the oversight and coordination of the cancer pathway, and in expertise around the specifics of cancer commissioning.”


Labour, on the other hand, is committed to repealing the Health and Social Care Act and has made three key promises, all funded by money raised from the Mansion Tax and closing tax loopholes for the wealthy.


Labour guarantees that by 2020 there will be a maximum one-week wait for cancer tests along with their results. This means earlier diagnosis and treatment. New cancer diagnostic equipment costing £150m every year will be invested in GP surgeries.


The party says it will set up a new Cancer Treatments Fund which will help kick start the urgent replacement of outdated radiotherapy machines.


Cancer patients’ benefits attacked

Just when you thought it couldn’t get any worse for cancer patients, under this government it has.


As well as damaging the provision of cancer treatment the coalition combined it with an attack on all benefits received by cancer patients. Only those with terminal cancer get rapid and sustained financial support.


But the vast majority do not fall into that category because people are surviving for longer. As one specialist cancer consultant told me: “We are trying to approach cancer as a chronic illness and not always a terminal one. We hope to treat it as chronic until such time – we do not know when – it becomes untreatable.”


This is down to the skill of cancer specialists, better diagnostic tests for the original referral and throughout the rest of their lives to detect any cancer spread, and a better understanding of how the disease works.


And that has financial implications for the NHS and for the benefit system. This does not go down well with Ian Duncan Smith and the DWP.


Cancer patients have had their disability benefit stopped for up to a year while they appeal against it. There are long delays built into the system with cancer patients, and others, being forced to wait longer to get financial support.


One patient who is familiar with the regime before and after Duncan Smith’s arrival said, “Dealing with the DWP was as emotionally draining as dealing with chemotherapy. It is a round of filling in form after form, time after time then battling for even small benefits which might just cover the cost of travel to and from the hospital.


“I was dealing with people who never met me, never spoke to me. Yet they knew every scar on my body, more than even my family, it was and still is distressing to deal with them.”






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