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