Leading article: So much for a national health service


Cancer is the most feared affliction in Britain, and has now overtaken heart disease as the country's biggest killer. It is odd, then, that standards of care received by cancer sufferers in Britain are so low. The survival rate is poor compared with our European neighbours. And six years after the Government launched its national cancer plan, a third of English regions still lack comprehensive plans for cancer services.

It would be wrong to claim that no progress has been made. But, as today's House of Commons Public Accounts Committee report reveals, we still have unacceptable regional discrepancies when it comes to cancer treatment. The highest survival rates are in the South and the highest mortality rates are in the most deprived areas of the country. But this is not a simple North/South divide. And the variation is not just in survival rates. There are sharp regional variations in the availability of drugs such as Herceptin, something illustrated recently by the case of Barbara Clarke, a former nurse who was forced to kick up an almighty fuss before her NHS trust agreed that she, like other women in her position around the country, ought to be given the drug. Today's report spells this out. In some areas, 90 per cent of eligible women are receiving Herceptin for breast cancer, but in others the figure is just 10 per cent.

It is important to grasp the historical reasons for this. Inequalities have grown up over time as the NHS has developed. The quality of care available in a region is often dependent on how persuasive local specialists have been in requesting resources from the Department of Health in the past. The result is that, in the worst areas, there are only four oncologists per million people, compared to 20 per million in London. Is it any wonder Londoners have more chance of surviving cancer?

Yet this variation in the quality of treatment is an affront to the principles of our national health service. Whether it is in the speediness of detection, access to the best drugs, or the quality of palliative care, everyone has a right to an equal standard of treatment. And this must be the case whether they live in Newquay or Newcastle. We need a full review by the Department of Health of the progress that has been made towards each target set out in the original NHS cancer plan. Then we will see why some areas are continuing to offer an unacceptable standard of treatment.

The Government must beware. It is much easier to sort out inequalities of this nature when NHS resources are growing. It will be much harder when investment falls back, as it is projected to in two years' time. Once again, we find that the Government is running out of the time it needs to deliver on its promises.

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