MPs say they are "surprised" at the failure of Primary Care Trusts (PCTs) to focus sufficiently on value for money when commissioning cancer services; few make best use of the information available and most do not know whether their commissioning is cost-effective, they say.
It is also "very disappointing" that, 10 years after publication of the NHS Cancer Plan 2000, significant gaps remain in information about important aspects of cancer services, particularly relating to chemotherapy, follow-up treatment and the stage that a patient's cancer has reached at the time of diagnosis, add the members of the House of Commons Committee of Public Accounts (PAC), reporting today on delivery of the government's five-year Cancer Reform Strategy in England, which was published in 2007.
The Department of Health "cannot yet measure the impact of the Strategy on key outcomes such as survival rates, and does not know if cancer services are being commissioned cost-effectively, due to poor data and because outcomes data are not sufficiently timely," says the Committee. Moreover, while the number of cancer survivors in England is expected to increase from 1.7 million in 2010 to 2 million by 2020, the Department is unable to measure whether it is delivering on its commitment of more cost-effective provision of follow-up and care outside hospital, the panel reports.
The MPs applaud the Department's work over the last 10 years to make tackling cancer a priority, noting that mortality rates have been falling and targets for cancer waiting times have been consistently achieved.
"But the one-year survival rates in England are still poor compared with the best-performing European countries and that is generally a sign of low awareness of symptoms, among the public and GPs, and late diagnosis," says PAC chair Margaret Hodge. "There also remain unexplained wide variations across the country in how cancer services perform and in types of treatment available," adds Ms Hodge, Labour MP for Barking.
In their report, the MPs note the National Audit Office (NAO)’s conclusion in its recent review of the Cancer Reform Strategy that further improvements, in terms of value for money, can be achieved by tackling variations in service delivery and raising performance to the standard of the best.
"The key driver of further improvements is the need for high-quality, comprehensive and timely data that is understood and used to make decisions about how services should be configured," say the MPs, and they call on the Department, during its transition to a new NHS structure, to "maintain the momentum it has recently established in improving information on cancer-related activities."
The Department also needs to work with commissioners "to get a firmer grip" on the reasons for wide, unexplained variations in performance of cancer services and delivery of treatment across the country, and on what impact this has on patient outcomes, they add.
And MPs are "concerned" at their inquiry's finding that only a fifth of PCTs had assessed the value for money delivered by their providers of cancer services and that 12% had no plans to carry out such an assessment. "In moving towards commissioning by GPs, the Department should work with the NHS Commissioning Board to set out clear standards requiring commissioners to demonstrate how they are obtaining value for money," they say.
• Meantime, the Sunday Telegraph has reported concerns by charity groups that restrictions being placed by local authorities on use of the government's £50 million interim Cancer Drug Fund could lead to it being underspent when it expires in April.
The interim Fund was established in October, and in the following four months it paid for drugs for only around 1,300 cancer patients, says the newspaper. An investigation by its reporters has found requests for the funding of treatment through the Fund being turned down for at least 86 cases involving terminally-ill patients, plus extreme variations in drug access and local policies which are "so restrictive that in many parts of the country, consultants are expected not to even both asking for drugs which are not on the priority lists," it adds.