Education and debate

Tertiary cancer services in Britain: benchmarking study of activity and facilities at 12 specialist centres

^a Guy's and St Thomas's Hospital NHS Trust, London

Correspondence to: Professor M A Richards, Department of Palliative Medicine, St Thomas's Hospital, London SE1 7EH.

Abstract

Objective: To collate information on current activity and facilities in British hospitals to assist the planning of future cancer services.
Design: 12 hospitals delivering specialist cancer services provided information on the size of population served, activity levels related to non-surgical oncology for 1994-5, and facilities available. Inconsistencies in the recording of data were resolved through meetings of all participants.
Setting: Five single specialty NHS trusts and seven specialist cancer facilities within multispecialty trusts, serving a combined population of 24.3 million.
Main outcome measures: Activity levels and facilities per million population served.
Results: The facilities available per million population served varied widely between centres. In contrast, the range in the number of new referrals per million population (seen either at the centre or in peripheral clinics) was relatively small. Considerable variations were observed in the number of attendances per patient and amount of radiotherapy and chemotherapy delivered. Overall it was estimated that 40-45% of all new cases of cancer are currently being referred to nonsurgical oncologists. For the seven hospitals which could provide data on trends in activity, the average increase in chemotherapy day case episodes between 1992-3 and 1994-5 was 83%.
Conclusions: The results of this study provide a benchmark both for purchasers and providers of cancer care. The increase in the use of chemotherapy points to an urgent need for a unified system for monitoring both activity and outcomes of treatment.

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