Cancer Reform Strategy - NHS Cancer Screening Programmes

CHAPTER 7: DELIVERING CARE IN THE MOST APPROPRIATE SETTING 101and coordination of care between specialistswas often inadequate.7.42 Major strides were made following theCalman-Hine Report in 1995 and the NHSCancer Plan in 2000. MDT teams are now wellestablished as the core model for cancer servicedelivery within hospitals. These teams bringtogether all the relevant experts to plan andcoordinate care.7.43 Depending on the cancer type these teamsinclude surgeons, physicians, radiologists,pathologists, oncologists, clinical nursespecialists, palliative care nurse specialists,radiographers and MDT coordinators. Alliedhealth professionals also play an important rolein many MDTs, such as speech and languagetherapists, dieticians, occupational therapistsand physiotherapists as do other professionalssuch as psychologists.7.44 Service delivery has also been enhanced bythe development of cancer networks. Tumoursite specific groups bring together the cliniciansinvolved in whole pathways of care. Groupshave also been established to ensure thatgeneric services such as chemotherapy andpalliative care are planned across institutionalboundaries.7.45 However, we recognise that some servicesare struggling to meet the requirements set outin the NICE Improving Outcomes Guidance andin the Manual for Cancer Services. Some MDTsdo not have all the relevant members or havepoor attendance at MDT meetings. In addition,in some places consultants are continuing tooperate on very small numbers of cases, inconflict with NICE guidance. PCTs should notcommission services from providers withsuch low volumes.7.46 Between 2004 and 2007, peer reviews ofcancer services have been carried out in eachcancer network in England. Regarding MDTworking, important findings requiring furtheraction following the reviews include:●●●Some lung cancer MDTs are lacking thenecessary core membership of a thoracicsurgeon, a radiologist, a CNS and a palliativecare clinician;A number of breast cancer MDTs are small,treating less than 100 patients; andSome local upper GI teams lack CNS orpalliative care support and do not havesufficient dietetic input.7.47 MDT working, as specified by NICEguidance, will remain the core model for cancerservice delivery in the future. Commissionerswill be expected to take account of thefindings from their local peer review and todecide whether all of their current MDTs areviable and can deliver the quality of carethat patients should reasonably expect (seechapter 9). In some cases, commissioners willneed to ensure higher levels of attendance atMDT meetings. In other cases, it may bepossible to provide an alternative, better modelof service. One possibility would be for a largerand better-staffed team from a neighbouringhospital to deliver an outreach service at ahospital which cannot sustain a full service of itsown. The Academy of Medical Royal Colleges’Inter-Collegiate Cancer Committee aredeveloping professional guidelines for MDTs.End of life care7.48 Although survival rates for many cancersare improving greatly, around 125,000 people inEngland die from cancer every year. Manypeople who die from cancer receive high qualityend of life care from the NHS, social care andthe independent hospice sector, which meetstheir social, psychological, spiritual and practicalneeds and provides effective management ofpain and other symptoms. However, too manypeople still do not receive this level of care.Furthermore, too often people’s preferencesabout their care are not elicited and action isnot taken to support people to live and die inthe place of their choice, which for many istheir home.