Mike Richards: Major progress has been made in our cancer services

From the Hambro Macmillan Award Lecture by the National Cancer Director
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The Independent Online

It is widely recognised that society is moving from an era of paternalism and deference to one of autonomy and consumerism. Patients are moving from unquestioning acceptance of doctor's "orders" to expecting to be involved in decision-making. The NHS is moving from being an underfunded "one size fits all" state monopoly of service provision and commissioning to a much better-funded service that attempts to embrace choice, plurality and responsiveness, alongside equity.

Turning to cancer, it is easy to see, with the benefit of hindsight, that until recently services were fragmented, waiting times unacceptably long, care often poorly co-ordinated and that information, communication and support have been inadequate. We also now know and accept that cancer survival rates have been unacceptably worse than those in comparably developed countries, with thousands of patients having died each year in this country, who would not have done so elsewhere.

But why did this position pertain only 10 to 15 years ago? I consider the system failure of the NHS in the 1970s, 1980s and early 1990s to have been the collective responsibility of society, professionals and politicians. I would argue that this system failure came about through a combination of pride and arrogance; blindness and tunnel vision; nihilism and passivity; and tribalism among many different groups.

The NHS and the Department of Health can help to overcome blindness and tunnel vision by building on recent moves towards openness and transparency. Health professionals and managers need constantly to challenge their assumptions and behaviour. Are our current practices meeting patients' needs, and could we deliver better care even given our current resources?

Ten to 15 years ago our cancer services and outcomes were a national disgrace. Major progress has been made over the past few years, and this is now being recognised both within this country and internationally. However, there are no grounds for complacency. Vigilance and action will be required from all partners if we are to maintain the momentum.

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