Intended for healthcare professionals

Education And Debate

Cancer care in the United Kingdom: new solutions are needed

BMJ 2003; 327 doi: (Published 30 October 2003) Cite this as: BMJ 2003;327:1044
  1. Karol Sikora (, visiting professor of cancer medicine1,
  2. Nick Bosanquet, professor of health policy2
  1. 1 Imperial College School of Science, Medicine and Technology, Hammersmith Hospital, London W12 ONN
  2. 2 Imperial College School of Science, Medicine and Technology, London SW7 2BX
  1. Correspondence to: K Sikora
  • Accepted 28 August 2003

An extra £1.26bn has been spent on UK cancer services in the past three years. So why haven't we seen greater improvements in quality of care?

The NHS cancer plan was born out of major deficiencies in care going back three decades. Doing something for cancer became a political imperative after the Eurocare-2 study showed that the United Kingdom was low in the league table of five year survival for several common cancers.1 From a system with glaring equipment deficits, staff shortages, and gross inequity in use of high cost drugs, the cancer plan created an infrastructure for change based on a classic public sector model.2 Although the strategy is excellent, the plan has only partially fulfilled its ambitions because of problems such as local inertia, divergence of priorities, and the inability to resolve severe professional staff shortages.

NHS cancer plan

The NHS cancer plan identified the need for fast, convenient, high quality care with patients at the centre.3 It set out the actions and milestones to deliver the fastest improvement anywhere in Europe within five years based on a massive injection of funding. It included three major commitments:

  • To reduce smoking in lower socioeconomic groups

  • To reduce the delay from urgent referral to the beginning of treatment to two months

  • To invest an extra £50m ($2.1bn; €1.8m) in palliative care each year from 2004.

Several hundred new administrative staff have been appointed to re-engineer the journey of cancer patients. But this has not been followed by an increase in clinical capacity because of staffing shortages and the lack of a uniform information technology platform to ensure smooth patient flow and good quality control. A review of the 34 cancer networks shows considerable variation in uptake of new money for cancer, with 10 networks spending less than 80% and three …

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