i can issue 3

The Welsh revolution

Professor Malcolm Mason

The organisation of cancer services in Wales has undergone a revolution in the last few years. The springboard was the Calman–Hine report on cancer services in England and Wales. It was followed by an in-depth analysis of the current status of the services in Wales and a vision for their future, published under the leadership of Professor Ian Cameron.

On the back of this review, the National Assembly for Wales authorised the setting up of the Cancer Services Co-ordinating Group (CSCG) to oversee and guide the implementation of the findings of the Cameron Report. This all sounds very bureaucratic – though in practice it is anything but.

The CSCG draws on a wide range of experts for its membership, including cancer specialists, nurses, trust managers, public health doctors, GPs and patients. The drive for change here has been through the introduction and implementation of minimum standards. Each of the major cancer sites was considered by a subgroup of the CSCG – the Minimum Standards Working Group. To establish the standards we drew on the views of the professionals themselves plus our patient representatives. Breast cancer was the first cancer site to be addressed, and we now have minimum standards to cover all the major tumour sites.

To a large extent we have succeeded. Specialists no longer work in isolation but as part of multidisciplinary teams, where surgeons, cancer specialists, X-ray specialists, pathologists, and specialist nurses, among others, all come together to bring their own particular skills to bear on finding the best treatment plan and care plan for an individual patient. Some very specialised procedures are now becoming centralised to the major centres, with support from the district hospitals.

There are gaps – we need to work harder to improve communication between healthcare staff and patients. We desperately need robust information about the outcomes of cancer treatments, and to do this we need the appropriate information technology infrastructure. The provision of palliative care services in Wales is patchy due to an immense shortage of staff.

On the whole though, the news is good and we have achieved an enormous amount. However, an important message for politicians is that there are limitations to what can be achieved by reorganisation and streamlining of services using current resources. Sooner or later, the bullet has to be bitten – even more extra resources need to be put into cancer services if we are to achieve the sort of services that the public deserves and that politicians expect. I have particular concerns as to whether the extra investment in the NHS in general is going to translate into a significant increase in funding for cancer services in Wales, and the ball is very firmly in the Welsh Assembly Government's court. The partnership with our patients, with families, and with the public is all-important if we are to face these challenges.

Malcolm Mason
Professor of Clinical Oncology and Chairman CSCG Minimum Standards Working Group