• Adult emergency services
• Cancer
  • Service review
  • Case for change
  • Implementation
  • Screening
  • Publications
• Cardiovascular
• Commissioning support
• COPD
• Children and young people
• Dementia
• Diabetes
• Disabled children
• End of life care
• Immunisations and vaccinations
• Local hospitals
• London and South East England specialised burns project
• Major trauma
• Maternity
• Medically unexplained symptoms
• Mental health
• Paediatric emergency services
• Polysystems
• Quality and Safety Programme
• Staying healthy
• Stroke
• Tuberculosis
• Unscheduled care

Case for change

The case for change document was published in December 2009. It makes a series of compelling arguments for changing cancer services in London. The case for change highlights that:

• Later diagnosis has been a major factor in causing poorer relative survival rates
• There are some areas of excellence in London but inequalities exist in access to, and outcomes from, care
• Treatment and care should therefore be standardised across the capital
• Specialist surgery should be centralised but common treatments should be localised where possible
• Comprehensive pathways should be commissioned so that organisational boundaries are not a barrier

Professor Sir Mike Richards CBE, National Cancer Director, endorsed the case for change: “The overwhelming message in the case for change is that maintaining the status quo is not good enough. To provide world-class services across the whole of London, and to address the existing inequalities between London PCTs, requires radical change. The case for change, and its call for action to develop new service delivery models, has my full support.”

Since the publication of the case for change, the Department of Health have released the findings of a National Cancer Patient Experience Survey (2010), which looked at patients’ perception of the quality of cancer care that they received across England.

The national results showed both positive findings and areas for improvement including:

• Only 66% of patients reported being given easy to understand information about their type of cancer
• Only 50% of patients said hospital staff gave them information about financial help and benefits
• Only 62% reported that there were enough nurses on duty when they were admitted to hospital

Analysis of the survey results indicates that there are some significant differences between regions, with 10 questions on which there are statistically significant differences. On 9 of these 10 questions, London is the worst performing region (p114).

These findings replicate to some degree the findings of the previous cancer surveys and those of the national patient surveys.

Two themes emerge: London fares worst on questions related to the general organisation of NHS services, especially those connecting primary care and hospital care; and on certain aspects of information. An area of particular concern is the difficulties that patients have reported in contacting the clinical nurse specialist.

The results of the survey are disappointing but it does show why we have prioritised improving these services.