Memorandum submitted by the Royal College
Progress has been slow in implementing the National
Cancer Plan, largely for two reasons. The first is that National
Cancer Plan money has not been ring-fenced and in some areas has
been used to fund other cost pressures (eg junior hospital doctors
pay etc). This has led to planned investment into workforce (oncologists,
radiographers, physicists, chemotherapy nurses etc) and new anticancer
drugs being deferred yet again (and further postcode lottery with
respect to cancer services). The second reason is that previous
healthcare reforms encouraged hospital trusts to act independently.
Now the National Cancer Plan (correctly) wants hospital trusts
within cancer networks to start working together and embarking
on collaborative initiatives that will lead to more investment
in one trust than another so that patients in the network benefit.
It takes time to change philosophy in the NHS!
A very great concern that is emerging is the
impact on clinical cancer research introduced by NICE constraints
on recommending funding of optimal anticancer drug treatments.
As well as the risk that the UK is being relegated into the second
division in terms of providing best care for its cancer patients,
the future of first class clinical cancer research is threatened.
If NICE do not approve a particular option (eg rituximab in non-Hodgkin's
lymphoma, trastuzumab in breast cancer), then UK oncologists cannot
undertake trials that will be meaningful in the international
context. Cancer trials in the UK are highly respected and have
frequently led the world in delineating cancer treatment options.
There is now a real threat to clinical cancer research in the
UK in relation to the rest of the world and this is occurring
at the same time as the government is investing in cancer research
The issue of cancer registration is an important
one in relation to patient confidentiality, as recognised by many.
It is in the process of being resolved but I do not know sufficient
The National Cancer Research Network is now
in the process of being established. It has a Co-ordinating Centre
in Leeds and the first wave of nine (of a total of 34) cancer
research networks have received funding to be set up. An initial
disappointment was that only £100K per million population
has been given to these networks in the current financial year.
This will not matter as long as the full £200K per million
is allocated in the year 2002-03. There are some teething problems
as trusts learn that this new and welcome funding is for the network
rather than individual trusts and hence allocation of funding
is by need and performance in recruiting patients to clinical
trials rather than by trust size. The National Cancer Research
Network is a greatly appreciated boost to clinical cancer research,
largely as a consequence of the ring-fenced nature of the funding
and the much needed increase in the workforce infrastructure for
such research. It can keep the UK at the forefront of increasingly
competitive international cancer research but it needs sensible
and helpful cooperation from NICE to do so (see comments above).
The National Translational Cancer Research Network
is in the process of being set up and would-be participants are
currently involved in a competitive bidding process, the outcome
of which will be known in the relatively near future.
Professor Ian Gilmore
6 December 2001