Cancer reform aims at equality of care: Celia Hall on plans to standardise treatment, improve resources and train more specialists

The days of Britain's cancer lottery are numbered. The proposals to be published on Wednesday set out to provide all patients with equal and 'best practice' treatment wherever they happen to live.

Large differences in treatment and outcomes have been found around the country, with good evidence that patients treated in expert cancer centres do better.

Not all doctors will be pleased. The proposed structure for primary care, local cancer units and major cancer centres will remove some of their autonomy. But Karol Sikora, professor of clinical oncology at the Royal Postgraduate Medical School at the Hammersmith Hospital, London, is delighted. He has been noisily campaigning for a fair deal for cancer patients, and has not been afraid to point out that some British patients would do better if they were treated in India.

Another pointer to how Britain has fallen behind in its delivery of cancer services is the small number of oncologists - the non-surgical cancer specialists in chemotherapy and radiotherapy. In Britain there is one medical oncologist for every 1 million of the population, while in the US there is one for every 100,000. The report proposes an increase in NHS oncologists.

Professor Sikora is a member of the committee, chaired by Dr Kenneth Calman, Chief Medical Officer, which has put the proposals together. He described the report as a starting point. 'It is saying the right things. But there must be new resources to implement it.' He added the committee would be looking at the local details next.

Dr Calman and his team will say that much can be done immediately by reorganisation alone, but it is expected to take up to five years - the time needed to train an oncologist - for the plans to be fully implemented.

It is likely the Calman committee plans for cancer care will get the political support necessary to drive them through. The indisputable evidence of the embarrassing UK cancer records and the patchy service are too big a stick for Virginia Bottomley, Secretary of State for Health, to hand as a gift to her Labour opponents.

Today the Cancer Relief Macmillan Fund launches its own 'minimum care standards' for women with breast cancer.

Professor Sikora says that the 'gratitude factor' in the NHS has run its course. Patients need to be more demanding. Better information based on improved record keeping will make it easier for patients and their relatives to know what to demand.

Health advice, page 6

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