V PEOPLE AND EQUIPMENT
38. Human resources have been identified time and
again as a major problem in delivering cancer research and cancer
care in the NHS. Professor Nurse said "the major issue is
one to do with resource, getting people out there to be able to
actually treat this disease".
Professor McVie gave us details: "we are 400 or 600 medical
oncologists short, 200 clinical oncologists, we have not got an
academic pathologist within a mile of most of these cancer centres,
radiologists are stretched".
He explained "I do not think we have just got a unique problem
in oncology, it just happens that cancer research has been remarkably
successful in the last ten or 15 years and we have got much more
to offer and, therefore, the demand has suddenly gotten there
because there is far more opportunity to improve the outcome of
patients with common cancers".
39. The Cancer Plan committed the Government to funding
an increase in medical staff by 2006. By that time there should
be nearly 1,000 extra cancer consultants. The Cancer Plan contains
a table showing the anticipated percentage increase of consultants
in their respective fields.
Table Two: Anticipated Consultant Numbers (Medical,
% increase 1999-2006
|Palliative care Physicians
Source: 1999 consultant numbers - DoH Workforce Census, September
The Christie Hospital however reported a bleak picture: "we
are lagging well behind the proposed timetable for increases in
numbers of consultants. We started below the national average
and are falling further behind".
40. Consultant numbers are not the only problem. The Committee's
Report highlighted the worst areas. There was a shortage of specialist
cancer nurses; pay and career structures for non-medically qualified
staff, such as laboratory scientific officers and radiographers,
were poor and staffing levels overall are low. The Committee's
Report stated "pay and career structures for essential non-medically
qualified professionals, notably medical laboratory scientific
officers and radiographers, are inadequate and enhanced training
and recruitment programmes are required. Without such staff effective
treatment is impossible".
The Christie Hospital told us "the most crucial problem currently
is recruitment and retention of therapy radiographers".
41. When we asked about the numbers for staff other than consultants,
Professor Richards told us "the difficulties are, for example,
with cancer nurses, that they have never been previously separately
identified as such, but they are just within the nursing workforce".
We asked Professor Richards what progress had been made in recruiting
extra staff. He highlighted other disciplines which were short
of staff: urology, cancer nurses, radiographers and therapy radiographers,
and told us "I cannot give you numbers in training for each
of those different disciplines, but what I can say is the number
of trainees has increased, and we are set to get a larger number
of consultants, say, in each of those areas".
He argued that there was no easy way of setting targets for staff,
as requirements and responsibilities change over time.
42. Professor Richards told us that the National Cancer Research
Networks would each produce a Service Delivery Plan once established,
giving details of what they would be doing and how. Part of this
Service Delivery Plan will be a Workforce Plan. He felt that it
was important for the NRCNs to be involved in decisions on staffing:
for example "it may be that you need one extra consultant
between two hospitals, working as a Network you will be able to
see that". We
asked the Department of Health for any staffing targets so far
identified by NCRNs but they were unable to provide them. Eighteen
NCRNs had submitted Service Delivery Plans, but these outlined
current staffing requirements only.
We are concerned at the Department of Health's inability
to provide real targets or figures on NHS cancer staff, even for
those in training. Without current staffing figures and targets,
progress cannot be assessed in future. We urge them the Department
to publish its staffing goals and to provide regular updates on
their progress. Funding posts is not enough: the Department must
ensure that there are enough staff in training to fill these posts.
We find lack of measurable progress in addressing staffing problems
43. The Committee's Report expressed concern at the lack of equipment
available in the NHS for both diagnosis and radiotherapy. It recommended
that "the Government and the National Screening Committee
evaluate high speed and precise techniques with a view to commencing
large-scale trials for CT [computerised tomography] cancer scanning.
This would require the NHS to purchase state-of-the-art diagnostic
It also recommended that intensity-modulated radiotherapy (IMRT)
and three-dimensional conformal radiotherapy (3D-CRT) equipment
should be made available in all cancer centres together with trained
for both of these new, smaller-dose radiotherapy systems was not
commonly available in the UK, although such systems are obtainable
in other countries.
44. The Government Reply said that almost £200 million had
been invested in NHS equipment and that by 2003-04 two hundred
new CT scanners would be available in the NHS. Central radiotherapy
investment through the NHS Plan would result in 101 linear accelerators
(IMRT machines), both new and replacement, becoming available
by 2003-04. The Reply also said that additional funding, at an
unspecified level, had been provided for 3D-CRT equipment.
45. The December 2001 NHS Cancer Plan Progress Report contained
information on new equipment bought so far through central NHS
Table three: new and replacement equipment bought under the Cancer
Plan since Jan 2000
Number of new and replacement equipment since January 2000
Percentage of equipment new since January 2000
|CT Scanners ||52
The Department of Health has provided us with a list of exactly
what equipment has gone where.
We questioned the Department about the decision-making process
involved in distributing the new equipment and whether hospitals
offered new machines might have to turn them down for lack of
space or trained personnel to operate them. Professor Richards
assured the Committee that the Department of Health undertook
extensive consultation before deciding on the placement of equipment:
"officials within the Department of Health have very, very
close contacts with hospitals across the country and we talk both
at the Trust level, we talk to regional cancer co-ordinators,
we consult widely about where the greatest need is and what machinery
is actually needed there".
He was not aware of any cases in which a hospital had had to refuse
equipment. He concluded "there is the extra funding going
into the Health Service, and into cancer, and if the problem is
about needing extra staff to run that new equipment then I would
hope this extra funding can be used for that purpose".
46. When asked about the staffing requirements for operating these
new machines. Professor Richards stated that the balance between
new and additional equipment had been decided with the staffing
problem in mind, and that the replacement machines were faster
and would not require any considerable immediate additional staffing.
He did not foresee a problem when capacity was expanded with additional
equipment. "We are seeing a rise in radiographers to operate
these machines; and we have estimated the numbers that are required
per extra CT scanner, so that we will be able to do that".
The National Association of Laryngectomee Clubs told us that "due
to lack of trained staff, premises and up to date equipment, delivery
of the NHS Cancer Plan is being compromised". They were particularly
worried about the need for a new radiotherapy unit for Head and
Neck cancer patients in one Service Network: "even if funding
and premises were to be made available to improve the situation
there would be difficulties in staffing this unit".
Professor McVie told us "the human resource is not yet in
place that has been promised. There are machines ordered all over
the country, new radiotherapy machines, but it is a six month
installation time and you will be lucky if this time next year
much has changed in terms of waiting time for even palliative
The situation at the Beatson referred to in paragraph 30 is an
illustration of the low morale in cancer care units. We note the
Department of Health's confidence that equipment is being provided
on time and in the right places, with adequate staff support.
Morale in hospitals and among patients will plummet if there is
not the staff on the ground to be able to make full use of new
47. The Committee's Report examined two aspects of patients' access
to clinical treatment: participation in clinical trials and the
approval and availability of anti-cancer drugs. The Report recommended
that "increasing the number of adult cancer patients entering
clinical trials must become a high priority".
The Report was also firmly in favour of a database of current
clinical trials, accessible to patients and clinicians, which
would enable patients to put themselves forward for trials. The
Government created the NCRN with the aim of doubling the number
of patients in clinical trials within three years. Professor Sir
Paul Nurse told us that he did not think there had been any improvement
of patient access to clinical trials in the period since the Committee's
Report was published. Several memoranda also conveyed the impression
that the situation had not improved. As mentioned in paragraph
24, figures for patients enrolled in trials will be available
in summer 2002. There is a database on the Cancer Research UK
website, but the Department of Health has not been active in this
area. We are disappointed at the lack of progress in the admission
of cancer patients into clinical trials. We urge more rapid progress
towards the development of extensive and accessible clinical trials
databases to inform both researchers and patients and look forward
to seeing a rapid rise in the number of patients entering clinical
in trials in the near future.
ACCESS TO DRUGS
48. Patients' access to anti-cancer drugs has been described as
a "post-code lottery", with different drugs being available
in different NHS Health Authorities, owing to budget restraints.
The Committee's Report condemned this as "unacceptable",
and recommended that the Government "require all Health Authorities
to provide anti-cancer treatments which are approved by NICE where
the patient's consultant regards them as clinically appropriate
and prescription is within the guidelines set by NICE".
The National Institute of Clinical Excellence (NICE) is the body
which is responsible for the approval of drugs and for determining
which drugs are cost-effective for use in the NHS. The Government
Reply promised that extra funding would allow all Health Authorities
and Primary Care Trusts to "be able to meet any additional
costs arising from the provision of anti-cancer drugs recommended
The Minister told us "what we need to do is make sure that
as new drugs come on stream those are picked up and that no post-code
lottery develops as well".
She reassured the Committee that "whenever we have any query
raised with us that a particular area might not be funding a particular
NICE drug or assessment properly, we certainly do investigate
that and follow that up, because that is clearly extremely important".
49. We were made aware of serious concerns about the work of NICE
by Professor Gordon McVie. He told us "they are still taking
a phenomenal time to do the review and they are still not starting
the review until some months, and sometimes years, after a drug
has been passed by the regulatory authorities as safe. This is
causing real, serious frustration. There is also a serious question
of the competence of the so-called experts on NICE. There is not
a known oncologist or anybody who is known to have been vaguely
trained or familiar with the problems of oncology or cancer drugs
or cancer techniques".
We received a rebuttal of this criticism from NICE which stated
"as part of its appraisal process, the Institute seeks advice
from relevant health professionals (including oncologists in the
case of anti-cancer drugs) and patient/carer organisations (eg
It also said "the Institute's appraisals are conducted vigorously
and fairly, taking into account both clinical and cost
We do not intend to comment extensively on the drug approval process
as NICE is currently the subject of an inquiry by the Health Select
Committee. We have drawn that Committee's attention to the evidence
we have received on NICE. We remain to be convinced that the
problems of timely patient access to drugs have been solved, and
in view of strong criticism expressed to us in evidence on the
National Institute of Clinical Excellence, we look forward to
the Health Committee's Report on NICE with interest.
Q 114 Back
Q 114 Back
Q 116 Back
Table from NHS Cancer Plan, p 74 Back
Palliative care physicians working in hospices who do not hold
NHS contracts are not included in these figures Back
Ev 61 Back
HC 332, para 89 Back
Ev 62 Back
Q 71 Back
Q 55 Back
Q 67 Back
Ev 21 Back
HC 332, para 27 Back
HC 332, para 32 Back
Not printed with this Report, but placed in the library. Back
Q 63 Back
Q 65 Back
Q 59 Back
Ev 58 Back
Q 109 Back
HC 332, para 75 Back
HC 322, para 34 Back
HC 332, para 35 Back
Cm 4928, para 38 Back
Q 190 Back
Q 152 Back
Ev 39 Back
Ev 39 Back