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Improving cancer services in the community

26. Family doctors and community nurses play a crucial role in helping people reduce the risks of cancer, in promoting early detection and fast referral for investigation when necessary, in providing support for patients and their families in living with cancer, in support for patients who are dying, and in support for their carers in bereavement. This Plan includes:

  • a new partnership between the NHS and Macmillan Cancer Relief to provide £3 million a year to support a lead clinician for cancer within every PCT
  • £2 million a year new investment in training and support in palliative care for district nurses and other community based nurses to extend the support available for cancer patients in the community.

Faster access to treatment

27. New waiting times targets for diagnosis and treatment There will be new targets to reduce waiting at all stages of the pathway of care.

  • Maximum one month wait from urgent GP referral to treatment guaranteed for children's and testicular cancers and acute leukaemia by 2001
  • Maximum one month wait from diagnosis to treatment for breast cancer by 2001
  • Maximum one month wait from diagnosis to treatment rolled out for all cancers by 2005
  • Maximum two month wait from urgent GP referral to treatment for breast cancer by 2002
  • Maximum two month wait from urgent GP referral to treatment rolled out for all cancers by 2005
  • The goal is that no patient should wait longer than one month from an urgent referral by their GP with suspected cancer, to the start of treatment, except for a good clinical reason or through their personal choice. Provided that the extra staff can be recruited and the NHS makes the necessary reforms, we hope to achieve this goal by 2008.

28. Investment in staff and equipment. The introduction of these new targets will be supported by investment to tackle key gaps in the cancer workforce and make better use of the skills of existing staff, investment in extra equipment for diagnosis and treatment, and action to redesign and streamline existing services to cut out delays.

29. By 2006 there will be approaching 1,000 extra cancer specialists, an increase of nearly a third in the number of cancer doctors since 1999. Other specialities crucial to the treatment of cancer will also increase; for example there will be some 120 more urologists (a 32% increase) and some 200 more gastroenterologists (an increase of over 50%). Numbers of cancer nurses and therapy radiographers will also increase. And the number of general surgeons will increase by an extra 257 (a 20% increase).

30. New equipment will also be coming on stream.There is a lot to do, and there are limits to the numbers of new machines and new buildings that can be manufactured and installed each year. And it will take time to train the extra staff to make best use of new equipment. As a result of the NHS Plan, over the next three years the NHS will get:

  • 50 new Magnetic Resonance Imaging (MRI) scanners and 200 new CT scanners, to increase diagnostic capacity;
  • 45 new linear accelerators for radiotherapy treatment.

The investment will be targeted through national and local cancer facilities strategies so as to end the inequalities in access to cancer treatment.

31. Redesigning services New investment alone is not enough. Services need to be streamlined, and new approaches are needed to make best use of skills in the cancer workforce.

32. The Cancer Services Collaborative (CSC) is already working with nine cancer networks across the country to redesign services, cut waits, and improve patient experience. The Collaborative has shown that it is possible to reduce waiting times for diagnosis and for treatment by weeks and in some cases even months. For example, the West London and Environs CSC team demonstrated that through multi-disciplinary team working and pre-scheduling of diagnostic investigations they can reduce the wait from first appointment to the start of treatment for patients with lung cancer from 28 days to eight days. The CSC will be rolled out to every cancer network in the country over the next two years.

33. An important first step will be for local cancer services to begin pre-planning the different steps between referral and treatment for different cancer types. This will mean that arrangements for individual patients can be pre-scheduled and pre-booked, offering all cancer patients the certainty of knowing what is to happen next, and when. Arrangements for pre-booking appointments are to be introduced across the NHS by 2005. But as part of the roll out of the Collaborative, every cancer network will commence booking in 2001, and by 2004 every patient diagnosed with cancer will benefit from pre-planned and pre-booked care.

34. There will also be new approaches to tackling shortages of skilled staff. For example, there will be a new £2.5 million a year training programme for surgeons, gastroenterologists, GPs and nurses, to extend the range of health professionals contributing to this fast growing field, which is important for the diagnosis of bowel and stomach cancers.

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