Cancer and heart disease networks face cuts, say charities

BMJ 2012; 345 doi: (Published 08 October 2012) Cite this as: BMJ 2012;345:e6800
  1. Nigel Hawkes
  1. 1London

Plans by the NHS Commissioning Board to reorganise clinical networks in England have raised concerns of a loss of expertise and momentum.

The board announced in July that it intended to increase the range of conditions covered by adding two new networks—maternity and children’s health; and mental health, dementia, and neurological conditions—to the existing cancer and cardiovascular disease networks. But specialists have said that the new system will spread resources more thinly and that advances made in care of cancer and stroke patients may be put at risk.

At present there are 56 networks divided equally between cancer and heart disease and stroke. Their job is to improve the delivery of services and reduce variation in a particular geographical area. Under the new system, which comes into force next April, the numbers of networks will be reduced to 12 in each specialty, corresponding to the 12 areas into which the NHS Commissioning Board has divided England. So although more specialties will be covered, they will be covered by fewer networks, each employing fewer people.

The board said in July that funding planned for the networks will be “slightly more” than that spent on the two existing specialties but that it would also have to cover the two new disease areas and also the “clinical senates” that were introduced into the system by the Health and Social Care Bill. Cancer and heart specialists believe that their areas will suffer substantial cuts.

In a survey of 23 of the 28 directors of cancer networks the charity Macmillan Cancer Support found that most expressed concerns about the effects of the structural change on their ability to deliver their functions.

The Cancer Campaigning Group, a coalition of cancer charities, said, “Research we have undertaken showed that 82% of GPs with a responsibility for commissioning will need specialist advice. Plans to move away from specialist support teams would severely limit the ability of cancer networks to provide the vital knowledge commissioners need, and we urge the government to reconsider these proposals.”

Tony Rudd, the NHS’s stroke director for London, told the Guardian: “Heart and stroke networks will be severely reduced in size and number and therefore less able to do some of the things they’ve been doing previously to improve care for the 100 000 people a year in England who have a stroke. I’m very concerned about the current plans. It would be a tragedy if we started losing things we have already gained.”1 The British Heart Foundation told the Guardian that it was seeking assurances that adequate funding would be provided and that cardiac specific expertise would be retained where needed.

The NHS Commissioning Board has said that the budget for the clinical networks and senates would be £42m a year, against the £80m currently allocated. But it believed that a substantial part of the existing budget was spent on the National Cancer Action Team and NHS Diabetes, which would become part of the board’s improvement division. This calculation underpins its claim that the new budget would be slightly more than is presently spent on the networks.

The NHS’s medical director, Bruce Keogh, told the Health Service Journal that retaining clinical networks after the transition from primary care trusts to clinical commissioning groups would “avoid throwing the baby out with the bathwater” in the government’s changes to the NHS. He said, “We are keen to preserve things which we know have worked and worked well. There is a feeling networks have been instrumental in helping to improve care.”

Liz Kendall, Labour’s shadow minister for care and older people, said, “Cancer, stroke, and heart networks have played a crucial role in improving patient care, helping to save more lives and reduce disabilities.

“Since June Labour has been warning that these vital groups of clinical experts are being cut. The government has repeatedly denied it, but we now know that the number of networks, their staff, and funding are all being slashed.

“It’s time for the health secretary to come out of hiding and explain why he’s cutting cancer networks, particularly when clinical commissioning groups are new and need this expert support.”


Cite this as: BMJ 2012;345:e6800