Delivery of improved patient care through the 2007 Cancer Reform Strategy for England is at risk unless there is considerable improvement in the quality of information used to support it, the National Audit Office (NAO) has warned.
A new report published today by the NAO finds there is currently a lack of high-quality information on the costs of cancer services and their outcomes, and that the performances of Primary Care Trusts (PCTs) vary significantly; PCTs' spending per head on cancer care ranges from £55 to £154 a year, and there are unexplained variations between Trusts and from year to year, it says.
The Department of Health has put the cost of cancer services in England at £5.1 billion for 2008-9, but the NAO says the figure is actually £6.3 billion, because the Department’s estimate does not include key aspects of cancer services such as diagnostics, screening and activity in primary care.
The Department has not monitored the cost of implementing the Strategy and it has “limited assurance” as to whether its implementation is achieving value for money, says the NAO. Its report examines the progress which has been made with three of the four actions outlined in the Strategy aimed at driving delivery, ie, better information, stronger commissioning and better use of resources. It does not touch on the fourth action, which deals with building for the future through cancer research and the development of the cancer workforce.
The study finds that progress has been made in improving key aspects of cancer services, through strong direction and leadership and increased resources. For example, from 2006-7 to 2008-9 there was a 281,000 reduction in days spent in hospital by cancer patients, and the average length of stay fell from 8.2 days to 7.7 days.
However, emergency admissions for cancer patients are still increasing by 2% a year despite the Strategy’s goal of minimising them, and emergency admissions for cancer patients through A&E have doubled since 2000-1.
The number of patients diagnosed through urgent referral went up from 80,000 in 2006-7 to 98,000 in 2008-9, but the proportion of total urgent referrals resulting in a diagnosis dropped from 13% to 111%, while the variations in urgent referrals is fourfold across PCTs and more than eightfold between GP practices.
Spending on chemotherapy totals £1 billion a year, but data on activities and outcomes are poor, and the national chemotherapy dataset promised in the Strategy is now two and a half years behind schedule. Data on the stage of a patient’s cancer at diagnosis are inconsistent and incomplete, the study adds.
In its recommendations for improvements, the NAO says that there needs to be better understanding of the variations and what causes them, for example what are the reasons for emergency admissions and whether these are for pre-existing or undiagnosed disease. Better data is also needed concerning the stage a patient’s cancer has reached at diagnosis, to enable better understanding of variations and improve allocation of resources, and the information for assessing the patient’s progress also needs improving considerably, with much clearer measurement and consistent data on cost and activity.
The Office estimates that £113 million a year could be freed up by reducing cancer patients’ average length of hospital stay to the level of the best-performing PCTs, and that reducing inpatient admissions to these levels could save £106 million - $80 million of which could be freed up from reducing variations in emergency admissions.