Proposal to scrap England’s long term plan for cancer

Dear Editor

This editorial is ‘spot on’ in setting out the case for, and reasons for retaining, a specific plan for cancer. I note that the quoted references are recent. However, these issues have a long history and aspects of that past experience are equally relevant today.

The first real attempt at a national plan for cancer within the UK was the report published in 1995 by the CMOs of England and Wales [1]. It was followed by a range of other work and initiatives to promote its successful implementation. Professor (now Sir) Mike Richards was tasked with producing more formal and detailed plans, the first of which came out in 2000 [2]. These plans linked resources, manpower, facilities, and equipment together with the clinical and patient focussed measures necessary to systematically improve both the performance of cancer services and patients experience of them. Measures to quality assure and monitor the implementation of the desired changes were identified as essential components if these plans were to be effective.

Then, as now, one of the main reasons why such specific plans for cancer are essential relates to the organisational context within the NHS.

There has always been something of a mismatch between how the NHS addresses formulating policy, planning and management systems for the NHS as a whole, and those measures required for the detailed and optimal clinical management of complex services frequently delivered across conventional organisational and clinical boundaries. Cancer remains the most compelling candidate for such a detailed approach. Services relevant to cancer patients need to be developed in a coherent way if they are to successfully integrate with others across these boundaries.

Experience suggests that a specific and detailed cancer plan over and above the mainstream business processes of the NHS is necessary to deliver that objective. Such plans help the NHS to focus on what is needed for good cancer care despite the inevitable consequences of day-to-day operational pressures, institutional needs, and resource management within the NHS.

Cancer plans provide the crucial overview and detail that are key to achieving the necessary changes, developments, and support for operational arrangements which are ‘right’ for cancer patients: Changes that are unlikely to be consistently accomplished without them. The now widespread international use of such plans argues that this holds true in many different organisational settings and does not imply a particular criticism of the English NHS.

Cancer plans need to be in place, and periodically updated, if the reality of cancer service delivery and patient experience is to meet modern standards of care and achieve the outcomes which evidence shows to be realistic expectations from well-run services. However, at least as much thought and effort needs to go into how plans are to be implemented as in developing the content of the plans themselves.

References
1 Department of Health. A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. London: Department of Health, 1995.
2 Department of Health. The NHS cancer plan, 2000.