© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 17, 1290-1291,
September 5, 2001
© 2001 Oxford University Press
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Scottish Health Executive Revamps Cancer Care
In July, the Scottish Health Executive funneled £40 million (US $57 million) in new funding to improve cancer care across the nation. The plan aims to remedy manpower shortages, outmoded equipment, and access to cancer care nationwide. The Scottish Cancer Plan is the result of 3 years of study by the Scottish Cancer Group, which analyzed cancer care needs and set priorities for the future.
"My diagnosis of cancer services was that there was under-resourcing and that clinicians felt at arms length from services," said Harry Burns, M.D., immediate past lead clinician for cancer services in Scotland. "The three fundamental objectives of the plan are to allocate extra money, ring-fence it so it cannot be moved elsewhere, and ensure that clinicians and patients have a say in the plan."
Through the plan, tumor-specific managed clinical networks have been established. The networks are multidisciplinary groups devoted to "sharing good practice and learning, reviewing results, and providing clinical governance reports to relevant NHS Trusts/Health Boards on those patients in specific population catchment areas," said Liz Porterfield, cancer services coordinator for the Scottish Health Department. Three regional planning networks representing the north, southeast, and west of Scotland will help design local services and advise the Scottish Cancer Group on local priorities for investment and change.
"I want to see every penny of this extra investment being used for the greatest possible benefit," said Scottish Health Minister Susan Deacon. "Where there are shortages of specialist skills or equipment which cause delays in testing and treatment, I want to see them addressed with this program."
People involved with the plan stressed that this was hardly just tossing money at a vast problem. "The plan will succeed because it is practical and workable," said Peter Boyle, Ph.D., director of the Division of Epidemiology and Biostatistics at the European Institute of Oncology in Milan, Italy. "It gives oncologists an unprecedented level of input into spending decisions."
Boyle added that the plan builds on the Scottish Executive Health Department’s report, Cancer Scenarios: An Aid to Planning Cancer Services in Scotland in the Next Decade. The Scenarios document set out to predict trends in cancer incidence and mortality in the next 10 years and to outline strategies for optimizing prevention, screening, and outcomes.
As much as possible, evidence-based standards will guide cancer care in Scotland, Porterfield said. National guidelines prepared by the Scottish Intercollegiate Guidelines Network for breast, colorectal, lung, ovarian, and testicular cancer are in place, as well as datasets to track outcomes of care. An overriding goal is to cut down the time from initial referral to treatment. Annual outcomes reports will help to ratchet up the quality of care, identify deficiencies, and guide cancer care reorganization.
The plan sets a waiting time target—a two-month maximum from urgent referral to treatment for all cancers—to be reached by 2005. However, the goal is to treat most patients much sooner. In addition, all NHS boards will be asked to review local palliative care needs and services by March 2002.
Burns said that in planning the strategy, they have taken pains to avoid a "top-down approach and [to] give all clinicians an involvement in how extra money is spent." Every effort will be made to improve care, teach physicians, and highlight the most clinically sensible way to practice, he said.
The £40 million builds on ongoing cancer program investments of more than £100 million (about US $142 million). Radiation therapy equipment and imaging machines, a nationwide anti-smoking program, cervical screening call/recall system, additional specialty positions, and plans to extend the age limit for breast cancer screening to age 70 will be covered through existing spending commitments.
A new Health Improvement Fund, budgeted at £100 million, will cover local and national initiatives on diet, smoking, alcohol, and exercise. New appointments of national diet and physical activity coordinators will be announced soon.
Gordon McVie, M.D., Ph.D., director general of the Cancer Research Campaign, praised the program. "It is a massive plan, but Scottish health outcomes are at the bottom," he said. "Scotland has some of the highest colorectal and lung cancer rates, with lung cancer deaths overtaking breast cancer deaths about a year ago.
"Five years ago, Scotland began to build comprehensive cancer networks and a broad infrastructure, putting them ahead of England. This is a real test of Scotland’s independence."
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