Cancer "tsar" faces parliamentary group on waiting time targets
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《英国医生杂志》
The current health service infrastructure for cancer is insufficient for waiting time targets to be met, said Professor Mike Richards, the government抯 national cancer director, who was called to a parliamentary inquiry last week to give evidence on cancer services.
The inquiry, conducted by the All Party Parliamentary Group on Cancer, is investigating how national standards aimed at ending regional variations in cancer services can be met after the government announced in July 2003 that it was to devolve decision making and 75% of the NHS budget to local NHS bodies.
Professor Richards said that according to the three year progress report on the implementation of the NHS cancer plan, published in October 2003, there had been an unprecedented investment in facilities such as computed tomography scanners, magnetic resonance imaging scanners, and linear accelerators but that more equipment and staff were still needed.
The memorandum to the group from the Department of Health adds that from 1997 to October 2003 the number of computed tomography scanners in England had gone up by 61% (from 200 to 322), magnetic resonance imaging scanners by more than 88% (from 110 to 207), and linear accelerators by 36% (from 140 to 191).
Professor Richards also said that even though provision of these services was much better, the rapid increase in facilities has not been matched by a proportional rise in staff numbers.
He added that, since 1997, the consultant workforce for cancer, including oncologists, palliative care doctors, haematologists, radiologists, and pathologists, had increased by about a third (according to the memorandum, from 3155 in 1997 to 4096 in June 2003). Radiologists and pathologists alone accounted for more than half of the increase (598 of the 941 new posts).
Professor Richards said that one target is to create extra specialist registrar training posts in these areas.
"It takes five years from specialist registrar to consultancy, so we haven抰 seen an increase yet," he said. "We are working hard on waiting times; 98% of patients with breast cancer are now treated within one month of diagnosis. With the introduction of the cancer waiting times database we will be then able to take a look at the picture across the country."
The database, developed jointly by the health department, the NHS Information Authority, and other stakeholders, is supposed to track patients?journeys from referral by the GP for suspected cancer to treatment—or, for patients coming through other referral routes, from the date of the decision to treat to the date of treatment.
Dr Jane Halpin, medical director of Bedfordshire and Hertfordshire Strategic Health Authority and a witness in the inquiry, wrote in a letter to Dr Ian Gibson, MP, the inquiry抯 chairman, "It would be helpful if waiting times targets could be refined. There are times when it is clinically necessary to delay treatment. Targets that are set at 100% are inflexible and may encourage creative reporting more than they encourage patient focused services.
"National targets can be useful in helping health professionals provide high quality care to patients. However, there is a tendency in the NHS for the target to become the end in itself and the purpose for which it was devised seems to sometimes to become of secondary importance."
Dr Gibson said: "This is the first investigation into the inherent tensions in seeking to end regional variations in care through national standards and guidance, while at the same time devolving decision making to local NHS bodies. The inquiry will examine these and other issues and produce recommendations for government action."
In her evidence Dr Jane Halpin said: "National standards should set a clear vision of what should be achieved and why. Local autonomy is essential to work out how (in a local context) these standards can be achieved. PCTs are essential in this local decision-making. The role of the strategic health authorities should be to ensure that PCTs reach an appropriate balance between their responsibilities to ensure that services meet national guidance for cancer and also ensure local accessibility for their patient population."(BMJ Tiago Villanueva)
The inquiry, conducted by the All Party Parliamentary Group on Cancer, is investigating how national standards aimed at ending regional variations in cancer services can be met after the government announced in July 2003 that it was to devolve decision making and 75% of the NHS budget to local NHS bodies.
Professor Richards said that according to the three year progress report on the implementation of the NHS cancer plan, published in October 2003, there had been an unprecedented investment in facilities such as computed tomography scanners, magnetic resonance imaging scanners, and linear accelerators but that more equipment and staff were still needed.
The memorandum to the group from the Department of Health adds that from 1997 to October 2003 the number of computed tomography scanners in England had gone up by 61% (from 200 to 322), magnetic resonance imaging scanners by more than 88% (from 110 to 207), and linear accelerators by 36% (from 140 to 191).
Professor Richards also said that even though provision of these services was much better, the rapid increase in facilities has not been matched by a proportional rise in staff numbers.
He added that, since 1997, the consultant workforce for cancer, including oncologists, palliative care doctors, haematologists, radiologists, and pathologists, had increased by about a third (according to the memorandum, from 3155 in 1997 to 4096 in June 2003). Radiologists and pathologists alone accounted for more than half of the increase (598 of the 941 new posts).
Professor Richards said that one target is to create extra specialist registrar training posts in these areas.
"It takes five years from specialist registrar to consultancy, so we haven抰 seen an increase yet," he said. "We are working hard on waiting times; 98% of patients with breast cancer are now treated within one month of diagnosis. With the introduction of the cancer waiting times database we will be then able to take a look at the picture across the country."
The database, developed jointly by the health department, the NHS Information Authority, and other stakeholders, is supposed to track patients?journeys from referral by the GP for suspected cancer to treatment—or, for patients coming through other referral routes, from the date of the decision to treat to the date of treatment.
Dr Jane Halpin, medical director of Bedfordshire and Hertfordshire Strategic Health Authority and a witness in the inquiry, wrote in a letter to Dr Ian Gibson, MP, the inquiry抯 chairman, "It would be helpful if waiting times targets could be refined. There are times when it is clinically necessary to delay treatment. Targets that are set at 100% are inflexible and may encourage creative reporting more than they encourage patient focused services.
"National targets can be useful in helping health professionals provide high quality care to patients. However, there is a tendency in the NHS for the target to become the end in itself and the purpose for which it was devised seems to sometimes to become of secondary importance."
Dr Gibson said: "This is the first investigation into the inherent tensions in seeking to end regional variations in care through national standards and guidance, while at the same time devolving decision making to local NHS bodies. The inquiry will examine these and other issues and produce recommendations for government action."
In her evidence Dr Jane Halpin said: "National standards should set a clear vision of what should be achieved and why. Local autonomy is essential to work out how (in a local context) these standards can be achieved. PCTs are essential in this local decision-making. The role of the strategic health authorities should be to ensure that PCTs reach an appropriate balance between their responsibilities to ensure that services meet national guidance for cancer and also ensure local accessibility for their patient population."(BMJ Tiago Villanueva)