Press Release - Department of Health - Tackling Cancer:
Improving the patient journey
25 February 2005
Patients’ experiences of cancer services in England in 2004 have
broadly improved on the situation in 2000, when the NHS Cancer Plan
was introduced, according to head of the National Audit Office Sir
John Bourn. Patients responding to a national survey of cancer
patients carried out by the NAO were more positive, to a greater or
lesser extent, about services through the patient journey from
first appointment with their GP through to support in the community
following hospital discharge than those responding to a similar
survey in 2000. However, within the 2004 survey, certain groups of
patients gave less positive responses than others, notably patients
in London and those with prostate cancer.
Overall, today’s report found encouraging progress had been made
in most respects of the patient experience. However, for a minority
of patients, elements of the patient experience were still not as
good as they might be: in such areas as communicating information,
symptom relief and the lack of options for some patients in their
last days.
The experience of care of more than four in five patients in
2004 was positive prior to diagnosis and two thirds of patients
stated that care received from their GP was “very good”. Fifty
eight per cent of patients were seen by a specialist within 2 weeks
of referral from their GP compared with 46 per cent in 2000. The
proportion of patients perceiving their condition as worsening
during the wait fell from over a quarter in 2000 to a fifth in
2004. More than nine in ten patients considered they were told bad
news with suitable sensitivity; and more verbal and written
information about diagnosis of cancer was communicated to patients,
with greater success and sensitivity, than in 2000. Nevertheless,
four in ten cancer patients did not receive written
information.
Patients and their carers were more involved in care and
treatment decisions than in 2000, and patients reported better
communication about their condition, treatments and tests.
Discussions with patients about how treatment had gone were seen as
broadly satisfactory, but a fifth of patients reported that their
understanding had not been complete. Most patients were not told
how to complain and some had difficulty in getting a satisfactory
result when they did so.
Almost all patients reported receiving sufficient respect and
privacy and being treated with sufficient dignity during their
hospital stay in 2004. Patients largely gave positive responses
regarding the nature of the care they received from hospital
doctors and nurses. Outpatients spent more time with doctors and
nurses than in 2000, but appointments still rarely ran to time.
More than nine patients in ten thought that hospital staff had done
all they could to ease pain, although this was a less likely view
among patients who had to tell staff about their pain, rather than
have their pain level assessed by staff. A large majority of
patients stated that they received support in dealing with distress
and anxiety when needed, but a fifth of those in hospital and a
quarter of those outside hospital who felt they needed help did not
receive it.
After leaving hospital, three quarters of patients got the help
they needed from the NHS and thought it met patients’ needs very
well. Most patients lacked access to advice about financial
benefits to support them or their family during or after their
illness, though many wanted it and information about support groups
continued to be received by around 60 per cent of patients.
As in 2000, prostate cancer patients surveyed in 2004 reported a
worse experience than those with other cancers and patients in
London remained less positive about their care than elsewhere in
England. Patients in London were less positive than the other three
regions in responding to more than three quarters of questions. And
patients with prostate cancer gave less positive responses than
patients with the other three major cancers for over two thirds of
questions: relating to such areas as length of wait from GP
referral to being seen by a specialist, discussion about the
side-effects of treatment and how it had gone, and having a named
nurse in charge of care.
The Department of Health is substantially increasing funding for
the development of specialist palliative care services to be
delivered by multi-disciplinary teams in the community; but
coverage across English regions is uneven. Hospices spoken to by
the NAO, while welcoming recent initiatives, felt that shortages of
staff and other resources remain constraints against providing a
wider range of services.
Among the NAO’s recommendations are that particular attention be
given to implementing the guidance on prostate cancers, not least
by providing all patients with access to a urological cancer nurse
specialist. And the worse experience of care reported by patients
in London should be investigated further.
Sir John Bourn said today:
"It is encouraging that large proportions of patients
that we surveyed received the care they wanted, and that in many
cases there had been a noticeable improvement on the situation in
2000. Importantly, patients were strongly positive about being
shown feelings of respect and dignity.
However, there is no room for complacency – even if only
10 per cent of patients with major cancers were dissatisfied with
some aspect of their care, that amounts to over 10,000 people a
year. We look to the NHS to continue its drive for improvement in
patient care, particularly with respect to patients in London and
those with prostate cancer."
Notes for Editors:
- This is the second of three reports by the NAO on cancer.
‘Tackling cancer in England: saving more lives’ was published in
March 2004 and examined whether clinical aspects of cancer services
are saving more lives across England and in comparison to other
countries. ‘The NHS Cancer Plan: A Progress Report’ will be
published in March 2005, and will examine how the NHS Cancer Plan
was designed and whether it is working effectively.
- The National Audit Office carried out a survey of patients with
breast, lung, bowel and prostate cancer across England during 2004,
to which over 4,000 patients responded. There are some 115,000 new
cases of these cancers each year. The survey covered many of the
same questions asked by a NHS survey in 2000, to which more than
56,000 patients with these cancers responded. This allowed
comparisons with patient experiences at the time the NHS Cancer
Plan was introduced, since when substantial additional funding has
been provided for cancer services.
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 19/05
All enquiries to Barry Lester, NAO Press Office:
Tel: 020 7798 7937
Mobile: 07748 181692