Back in 2000, the Government introduced the NHS Cancer Plan. The Government’s idea was, as usual, to throw money at a problem and hope for the best. A raft of targets and indicators were established, and unless something was measured, it didn’t matter. Perverse incentives aplenty bedevilled doctors’ efforts to do their jobs, and treatment on the basis of clinical priority was harder to achieve. GPs were expected to differentiate between ‘urgent’ and ‘non-urgent’ referrals, and waiting times would vary accordingly, with minimum waiting times for the ‘referral to diagnosis’ period, and the ‘diagnosis to treatment’ to period.

Seven years on, and now Gordon Brown wishes to go back to the future, with yet another NHS Cancer Plan. The last one failed because it set prescriptive targets. Non-urgent referrals took so long to get to the diagnosis phase, that by the time a consultant saw them, the non-urgent potential cancer had become urgent after all.

So why introduce a new Plan, if the first one failed? Action of some sort is still required. Patients are still waiting too long for diagnosis and treatment. Breast cancer patients, for example, are still waiting three months for treatment – even though if the delay exceeds eight weeks, the chance of the cancer recurring is some 60% higher. There is no new money attached to this cancer plan. And there is no idea of what will be done differently, or what could be done differently that wasn’t suggested in the last Cancer Plan. Nor is there any analysis of why the most recent Cancer Plan didn’t achieve its goals. Instead, the same mistakes are replicated.
As Andrew Lansley said today: “Why can’t the Government let go of its targets and how can they justify the two week referral target for some cancers but not others? Even though we know that top down targets distort clinical priority, the Government’sresponse in their cancer strategy is just to make the target structure more complex. It must be the right time now to cut political interference.”
As ever in over-centralised systems like these, it is the bottlenecks that cause the problems. You can improve the capacity to diagnose more quickly, but that just adds to the queue for treatment if treatment capacity is not similarly extended. Indeed, in some cases, it appears that the waiting time for treatment is being reduced by diminishing the number of radiation doses administered.

Capacity is key in all areas of the health service, but public services inevitably lack the flexibility to adjust to demand. MRI scanners are essential, but also costly – so investment in them can be frustratingly slow, as we are seeing with the Mayor’s fundraising efforts for an MRI scanner here in Blackpool. Gordon Brown’s disdain for the private sector has seen the Government scaling back the use of private initiatives where mobile units temporarily expand capacity to clear backlogs. Where the private sector is willing to assume risk, and invest in the extension of capacity, it should be welcomed. It is the only way the publicly-funded NHS we all treasure will become flexible enough to cope with changing needs.