One problem is that when the National Institute for Clinical Excellence makes national recommendations on treatment, it is up to local health authorities and primary care trusts to choose to implement those recommendations.
This depends on how well oncologists work as advocates for their patients, and how willing the health authority is to take their advice. But there is still a process of bargaining that has to go within national frameworks.
There is a much greater uptake of new drugs in areas that have more medical oncologists because they are particularly trained in the assessment and development of new treatments. That is why we need cancer centres - and specifically Barts cancer centre, even though it is being threatened - because it trains doctors to be innovative and work within the bureaucracy of the health system.
This is not only to adopt new treatments, but also to discard old and ineffective treatments.
Decisions made on treatment are not always fully accountable, but the Department of Health has asked people to audit the implementation of Nice guidelines, which will provide greater accountability.
Another problem is that the Government has introduced further restrictions on patient choice. If patients want to move hospital or treatment centre, from a local area where a specific treatment is not available, to one that is offering that treatment, there are obstacles.
Unless a local health authority gives specific consent, patients cannot be treated elsewhere if the treatment costs more than £10,000, which many cancer treatments do. For example, if a patient seeks out treatment for lung cancer at Barts, we have to check with their local health authority whether we can treat them. Sometimes they refuse.
Cancer centres need to take the lead and be advocates for the welfare of patients, but lack of patient choice and inequity of treatment are still barriers.
Dr Chris Gallagher is an oncologist at Barts Hospital, LondonReuse content