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Tackling Cancer: Improving the patient journey

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.

"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."

Sir John Bourn

Notes for Editors

  1. 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.
  2. 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.
  3. 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.
  4. 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.

PN: 19/05