Cancer patients promised best care: Specialist units at centre of proposals to improve patchy hospital services for all sufferers. Celia Hall reports

SUCCESS rates of cancer units may be published as part of the new 'patient-oriented' cancer service planned by the Department of Health.

Details of proposals for a radical new structure for cancer services in England and Wales, revealed in the Independent on Monday, were published yesterday. Dr Kenneth Calman, the Government's Chief Medical Officer, said they were designed to 'improve the care of patients with cancer and to ensure that all patients receive the highest standards of care'. Dr Calman said he could see no reason why patients should not be made aware of how their units were doing.

'Cancers are a very important group of diseases. Overall they are the second leading cause of death in this country and account for a quarter of all deaths.

'My own background as a cancer specialist made be recognise the importance of communication, the involvement of patients, information and choice and, when I was elsewhere, I set up a series of patient participation groups precisely for that purpose,' he said.

A Policy Framework for Cancer Services, Consultative Document is the result of six months' work by a committee chaired by Dr Calman. It was set up in response to growing dissatisfaction with Britain's patchy cancer services, with half of patients never seeing a cancer specialist. It is estimated that 5,000 cancer patients die each year who would have survived had they been given better treatment.

However, Dr Calman did not accept that UK cancer services were below standard. He said comparisons with other European countries were dubious.

In future, patients can expect to be treated by doctors and nurses who have training and experience in a particular type of cancer. The proposals accelerate the demise of the generalist in hospital medicine.

The document says: 'It was noticed that improved outcomes are associated with specialised care for uncommon cancers and that many studies also suggest this association for commoner cancers.'

The proposals envisage that all patients will receive the 'highest standards of care' regardless of where they live, of the type or rarity of their cancer.

The structure will comprise a large number of local cancer units expert in dealing with the commonest cancers. These will be based on local cancer patterns. They will be supported by and integrated with a smaller number of more specialised centres. Some joint staff are envisaged.

The centres serving populations of at least one million should provide child and adolescent cancer services; assessment of rare cancers; chemotherapy for the most complex cases; radiotherapy; expert cancer consultants; sophisticated diagnostic facilities and expertise in rehabilitation and treatment that improves the quality of life.

At all levels systems to involve GPs and patients' families will be introduced. GPs will be given 'guidance' on where to refer their patients most appropriately; protocols for early diagnoses will be worked out locally.

Most of the changes will be expected to be achieved by re- organising local hospital services; they require no new building. But the report acknowledges that more oncologists, the non-surgical cancer specialists, will be needed. Training takes up to five years. After six months' consultation, political support will be essential if local health authorities are to be in a position to demand the new cancer services from the autonomous hospital trusts.

Virginia Bottomley, Secretary of State for Health, said yesterday: 'Clearly, final decisions are some months away. Before they are taken we shall have to consider the resource implications.'

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