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Cancer expert demands end to NHS targets

KATE FOSTER (kfoster@scotlandonsunday.com)

WAITING-TIME targets for cancer treatment should be scrapped because they are actually delaying treatment for some patients, one of the country's leading experts warned last night.

Professor Jim Cassidy, Cancer Research UK's chair of medical oncology in Scotland, also said that treating patients within deadlines can often make little difference to their chances of survival. He called for doctors to be allowed to focus on other areas of the NHS instead, such as waiting times for hip replacements or dentists.

Cancer treatment targets, a key Scottish Executive policy, are under scrutiny because health boards are failing to meet the two-month referral deadline for hundreds of patients.

Cassidy, a bowel cancer specialist at the Beatson Oncology Centre, Glasgow, is the first senior cancer specialist in Scotland openly to criticise the current system. Last night his comments were backed by opposition parties but bitterly criticised by patient groups.

He said that in some cases targets increase the wait for cancer patients classed as non-urgent or "routine" - a decision made by GPs.

Cassidy said: "As you concentrate more on the urgent referrals then the routine referrals become slower. With finite resources, something has to give.

"We are not aware of any evidence that says if you wait two weeks your survival is better than if you wait three. What these targets are achieving is political credibility, but does it matter if patients wait three or four weeks? It definitely doesn't for some of the diseases we are dealing with.

"With the cancer that I specialise in, bowel cancer, you probably have it for two years before you get any symptoms so it does not make a huge amount of sense to say that as soon as you get a symptom you have to be dealt with urgently. An across-the-board target, to some extent, is unhelpful."

He said targets had improved the NHS but a better system would be to scrap one target when it was close to being met.

"Putting targets on certain aspects is fine, but a continual focus on cancer waiting times does not seem to me a way of continuing to put pressure on the system. The system has become slicker. So they should move on to the next problem."

The latest figures show that around 26,000 Scots are diagnosed with cancer each year, but death rates are declining as new treatments are discovered. Just under half of patients are still alive five years after receiving their diagnosis.

Yet there are huge pressures on health boards to tackle hold-ups. Ministers have set a target that no patient who requires urgent treatment should have to wait longer than two months between visiting their GP and seeing a specialist.

The latest figures show just 83% of patients are treated within the deadline. Health Minister Andy Kerr has told boards he wants that raised to 95% by the end of this month.

Last night he insisted he would continue to use targets to ensure shorter waits for patients, a move backed by the Liberal Democrats.

Kerr said: "We have seen a 15% reduction in cancer deaths and have invested record amounts in treatment.

"However, this is about more than just money and we must also take into account the pressure cancers cause for Scottish families. The fact is, patients tell me time and again that they want shorter waiting times.

"They do not want to face any unnecessary strains and stresses caused by waiting for investigation or treatment."

Lorraine Dallas, head of national development for Breast Cancer Care Scotland, said the targets helped patients avoid unnecessary extra distress waiting for treatment.

She said: "The targets are based on the effect of waiting time on clinical outcome. If people are being seen within two months that's perfectly legitimate in terms of their clinical outcome. It can be an extremely distressing and demanding time for individual patients."

Tom Haswell, who was diagnosed with lung cancer in 1993, said the waiting was a particularly difficult time during his treatment.

The 62-year-old from Glasgow had to wait two months after learning he had the disease before being told whether doctors could treat it.

"It's a difficult time and the quicker people get into treatment the better. There has got to be a target."

SNP health spokeswoman Shona Robison said: "Speed is of the essence and they need to make sure that people who need to be seen are seen."

However, Scottish Conservative health spokeswoman Nanette Milne backed Cassidy. She said: "It should be up to the clinician to treat their patient as and when it's appropriate."

• A senior cancer specialist yesterday admitted giving patients unnecessary treatments to manipulate hospital waiting lists.

Chris Hamilton, consultant clinical oncologist at Hull's Princess Royal Hospital, said the problem came from a government requirement that all treatment began within 31 days of diagnosis.

He said it means some low-risk patients are being treated before more urgent cases.

He told the BBC he had given prostate cancer patients hormone therapy to move them down the waiting list.

He said: "You're caught in a bind. Either you give them unnecessary treatment with hormones and reclassify them or you put them to the front of the queue where they shouldn't really be."

He added that he knew other hospitals were carrying out a similar practice.

A Department of Health spokeswoman said: "If there is a clinical reason for not starting treatment within the four-week guideline or the patient does not want to start treatment immediately, there is clear provision for a patient to be taken out of the list."

The Prostate Cancer Charity condemned Hamilton's claims, saying it was "deeply unethical" to give patients treatment they did not need.

JAMES WATSON