Healthwatch: Cancer treatment shames Britain

Get a cancer diagnosis and you might be best placed leaving Britain for treatment

If you think you might be going to get cancer, the best advice is to leave Britain as soon as possible. Despite official pronouncements to the contrary, the only European countries that offer a worse chance of surviving the disease are Poland and Estonia. The fact that one in three of us will eventually develop some sort of life-threatening malignancy makes it all the more scandalous that treatment here is still so poor.

The issue is not as simple as funding. In addition to the spectacular increase in health service support - from £34bn, when Labour came to power in 1997, to £99.4bn now - cancer treatment received a huge dollop of extra money from the National Lottery. Rules requiring the NHS to be funded from taxation were waived so that some £200m of lottery money could be spent on high-tech equipment to deliver better radiotherapy treatment across the country.

The idea was that British patients would at last have access to the latest generation of intensity modulated radiotherapy (IMRT) machines that can kill cancer cells without also obliterating vast swaths of surrounding healthy tissue. Cancer sufferers would be spared the debilitating toxic after-effects of radiotherapy, which can leave them damaged and feeling ill. Now radiologists think the lottery money has simply been wasted. Although they have been assured that all the promised new equipment has been bought, try as they might, they cannot find out where all these machines have gone.

Last year, the government's own National Radiotherapy Advisory Group (NRAG) embarked on a "stock-taking" survey to unravel the mystery. Its report was completed some months ago, but has not been published, and no one can say when it will appear. The cancer doctors think it caused so much dismay in Whitehall that the government has simply decided not to let people know what it says.

I will tell you what is in it. The survey looked at the availability of radiotherapy equipment across the country. It says that British cancer patients get 25 per cent less treatment than their European counterparts - a crude but perfectly valid statistic, calculated by looking at the recorded number of "fractions", or doses, of radiotherapy that are administered and dividing that number by head of population. While Europeans "consume" 40,000 fractions of radiation per million of population per year, Britons receive only 30,000 fractions.

Not only that, the report also says that in some areas of the country (almost certainly the ones with the worst-educated, least- complaining communities), the amount of radiotherapy delivered is just 20,000 fractions per million of population per annum - in other words, this is half the European average.

The NRAG survey also revealed chronic shortages among the highly trained but badly paid technicians needed to deliver radiotherapy, which means that many of the lovely new machines are not being used because there is no one who understands how to work them.

Presumably a scout around the dimly lit storage areas of a dozen major hospitals would reveal more than one of these leviathans sitting forlornly on its delivery pallet and covered in dusty shrink-wrap. I have certainly seen brand new, "surplus" NHS photocopiers costing £2,000 each housed in such circumstances, so why not a £2m IMRT machine? This conclusion is supported by other surveys, which have shown that 28 of Britain's 61 radiotherapy centres have received IMRT equipment, but only patients at Clatterbridge Hospital in Liverpool, the Royal Marsden in London, and Ipswich in Suffolk, are getting this treatment routinely - something that has been standard in America and most of Europe for many years. Worst of all, the NRAG study appears to show that money for treating cancer patients is as tight and the postcode lottery as much a factor as ever. Thus, while some areas of the country are operating state-of-the-art machines, most are not.

Cancer rates are climbing steadily in the UK. Every year, 120,000 people die from the disease. Apart from the lack of equipment, the target waiting time from referral to "treatment" is 62 days in Britain, and treatment can mean simply more diagnostic investigations. (Contrast cancer patients in Switzerland, who can be diagnosed and treated in as little as three days.) Target waiting times for actual radiotherapy were dropped about three years ago.

It is probably better not even to address the issue of the £50,000-£70,000 annual cost of cancer drugs, which are generally not approved for NHS patients because they are too expensive. Even before they have been made sick by their slow, outmoded treatment, any newly diagnosed cancer patients considering these facts will feel very sick indeed.

Lois Rogers was formerly social affairs editor for the Sunday Times

5 comments

Purple Scorpion's picture

A truly disgusting story (well written), which should be splashed on every front page.

norm's picture

About a month before my Italian wife was diagnosed with breast cancer at the age of 40, her GP's response to symptoms of fatigue and malaise was "I have cancer patients who complain less than you". She changed GPs and was referred by telephone for a specialist opinion on 15 December 2003. A month later, on 10 January 2004, a letter from the hospital informed us that we could expect another letter over the next weeks for a future appointment to speak to a specialist about her suspect nodule.

Between these dates, we went to Rome for Christmas; she saw a gynaecologist and within five days had been diagnosed with a 2cm grade 3 tumour, operated for its removal, and referred to an oncologist who initiated chemotherapy within a month. All her treatment was public and free. We decided then and there not to return to the UK and have lived in Italy ever since. In the course of her treatment, my wife has received "expensive" drugs including GM-CSF and erythropoietin, for which we would have had to beg on our knees (and probably involve our MP) in the UK. Or perhaps not, as I am quite certain that if we had waited for the UK specialist referral, she would no longer be here.

Italy is a chaotic, confused and maddening place when it comes to public services, and the Italian health system boasts a lot of rather old and crumbly institutions. They do not have counsellors and health visitors; their appointment systems are not always computerised; they are grossly overspent on their budgets; you wait on plastic benches in the corridor. I do not know what the Italian is for Patient Charter, and neither do they. But right at the heart of proper healthcare, they still have a Hippocratic quality that the UK has lost: doctors are doctors, you have the right to see them, and they will treat you with the treatment they believe you need. An Italian hospital is more likely to treat its patients on time than pay its bills, which I find better than the reverse.

Prompt medical intervention is what saved my wife's life. Not, I believe, a difficult concept to grasp, but something the UK could not provide.

James MacDonald
Milan
Italy

raffa's picture

As a cancer patient, and one of many who volunteers to work with current patients in areas around charities and in the NHS this is old news. We have seen money diverted, cash 'lost' and services mothballed for years now. I am ''lucky'' to sit on a number of committees and colleges around the UK and watch the steady unrellenting demolition of all types of Health Services. If this damn Government was more interested in really biting the bullet and achieving something rather than bull#######g us over issues to protect their sad seats in parliament we might see a few improvements. The answer is simple..whilst the NHS is in the hands of the politicians it will never achieve its potential, but while it can suck in a few votes it, and we, will continue to be nothing but cannon fodder for a few politicians who see us as nothing more than that.

Richard Wolffe's picture

The government has been spinning the marvellous progress that has been made in cancer treatment. It is amazing that Lois Roger's revelations haven't come to light before but there is so much chaos in the NHS that it is not surprising that this has been missed before. One problem was that funds ear-marked for cancer treatment was not ring-fenced and hospital trusts used it more 'more urgent' purposes. With only 60+ radiotherapy centres, this would be a good subject for a bit of investigative journalism.

In my area, the local centre (Southampton) has been working with clapped out machines for many years and I have heard nothing about their replacement.

Richarde's picture

The situation regarding radiotherapy based cancer treatment that Lois Rogers outlines is bleak (Healthwatch, 29 January 2007) but there is actually a lot of good practice out there.

The biggest issue is the ongoing shortages of therapeutic radiographers, who deliver the treatment. There is an immense feeling of frustration because radiographers and other health and medical professionals have been pointing out the obvious for years: there aren't enough staff to deliver the treatments that patients need.

The National Radiotherapy Advisory Group (NRAG) report must be made public and government ministers have to respond to the issues it raises. Mike Richards, the National Cancer Director, has indicated that the report would be part of (or would contribute) to the Cancer Reform Strategy. But that could mean nothing will be in the public domain until the end of the year.

We desperately need to know the conclusions of the NRAG report in order to develop services. The ageing population means that the demand on cancer care is going to increase. Action has to be taken now to meet current demand and to develop the capacity required for the future.

Richard Evans
Chief Executive Officer
Society and College of Radiographers

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