Cancer & Heart DiseaseIntroductionCoronary heart disease and cancer are our countrys biggest killers – jointlyaccounting for around a quarter of a million deaths in the UK each year.They are Labour’s top priorities for the NHS. A lot has been done to improve servicesfor cancer and heart disease but there is much more to do. That is why as ourmanifesto says:“The fight against cancer and heart disease is our top priority for investment andreform with earmarked extra funding of £1 billion by 2004.”Today we detail our manifesto commitment to the fight against cancer and heartdisease. We publish our plans for expansion of NHS cancer and heart diseaseservices: plans for extra professionals, for new equipment, for shorter waiting timesand for the new drugs and treatments patients need. Taken together, this programmewill deliver the fastest improving cancer and heart disease services in Europe.Our ambition is to prevent 300,000 avoidable deaths over the next decade. We canonly do this as a result of the sustained investment we are making and the investmentwe propose to make if re-elected.No-one pretends for a moment that cancer and heart disease services are anywherenear as good as they should be. For two decades the NHS fell behind. But thisdocument shows there is real progress, and there are real improvements in prospect.ProgressThis year Labour will be spending more on treatment, prevention and operations forpatients with cancer or heart disease. More help for smokers who want to quit to helpprevent disease. More investment in scanners and equipment to help diagnosedisease. More new cancer drugs now available across the country to treat disease.More heart operations than ever before to beat disease.This programme of investment is backed by new national standards – drawn up withthe help of some of the country’s top clinicians - for both services. It is backed by amajor reform programme led by clinicians.By 2005 we will be investing an extra £1,000 million a year in NHS cancer and heartservices above the level invested in 2000/1. The cash will be ringfenced for cancerand heart services so that it is spent where it should be spent. By contrast, theConservatives never ring-fenced a single penny piece for cancer and CHD.This money will fund our blueprints for action set out in:
• The National Service Framework (NSF) on Coronary Heart Disease (CHD)• The NHS Cancer PlanThese are radical and far-reaching programmes which will transform the prevention,diagnosis and treatment of cancer and coronary heart disease setting out the actionsand milestones that will deliver the fastest improvement in cancer and heart diseaseservices anywhere in Europe.Ambitions for the NHSWhen fully implemented, we should achieve our target of cutting CHD and stroke by40% by 2010 and cancer deaths by a third.This document therefore sets out the improvements a re-elected Labour governmentwill seek to secure in our country’s cancer and heart diseases services.
Labour’s investment programme for cancer and heart diseaseThis is the first time that any government has established a comprehensive nationalprogramme for tackling heart disease and cancer. It will modernise every aspect ofcare from prevention, screening, diagnosis, treatment, care and research. Our strategysignals the way forward for faster more effective cancer and heart disease servicesacross the board.CancerCancer’s share of the additional £1 billion together with the reforms we are makingwill deliver (implementation complete by 2004 except where indicated):On prevention:• Comprehensive smoking cessation services.• New colorectal cancer screening pilots• Screening roll out of the breast screening programme to women aged up to 70 and of two view mammography; with the service also extended to older women who want itOn waits:• National roll out of Cancer Services Collaborative complete.• All patients with diagnosed cancer receiving pre-planned, pre-booked care and by end 2005• Maximum 1 month wait from diagnosis to treatment for all cancers• Maximum 2 month wait from urgent GP referral to treatment for all cancersOn treatment:• New cancer drugs appraised by NICE available across the country• Authoritative guidance from NICE covering all cancers available by 2003, and implemented in line with expansion of the workforceOn care:• £50 million a year extra for specialist palliative care by 2004.On workforce• Some 800 extra cancer consultants by 2004, (en route to almost 1000 increase by 2006)• Over 500 radiology and radiographers• More cancer nurses and medical physicistsOn equipment• When added to the NOF funding 85 MRI scanners, 200 CT scanners, 102 linear accelerators and over 400 breast screening and ultrasound units.• The NHS will meet the Royal College of Radiologists’ current recommendation of 4 linacs per million populationCancer - Milestones
If re-elected Labour will:By 2001• Maximum one month wait from urgent GP referral to treatment guaranteed for children’s and testicular cancers and acute leukaemia by 2001.• Maximum one month wait from diagnosis to treatment for breast cancer by 2001.• All women to receive results of their smear tests in writing• Primary Care Groups and Trusts to appoint cancer lead clinicians• Large scale trial into screening and treatment of prostate cancer beginsBy 2002• All health authorities to implement NICE recommendations on cancer drugs• Maximum two month wait from urgent GP referral to treatment for breast cancer by 2002.• 11 new MRI scanners, 80 new CT scanners and 15 new linear acceleratorsBy 2003• NHS Cancer Research Network fully established• 40 new CT scanners and 22 new linear accelerators• The number of cancer specialists will have increased from 3362 in 1999 to about 3995.By 2004• Every patient diagnosed with cancer will benefit from pre-planned and pre- booked care• All health authorities to invite women aged 65 to 70 for breast screening.• 50 new MRI scanners, 50 new CT scanners and 18 new linear acceleratorsBy 2005• Maximum two month wait from urgent GP referral to treatment for all cancers.• Maximum one month wait between diagnosis and treatment for all cancers.• The number of radiographers and medical physicists has increased by 600 from 1999.
• The number of cancer specialists will have increased by around one-third.
CHDCHD’s share of the additional £1billion will buy (implementation complete by 2004except where indicated)On prevention:• All GP practices identifying people with CHD or at high risk of CHD and providing systematic care – prescribing aspirin or statins which are proven to reduce the risk of heart attacks.• National roll out of rapid access chest pain clinics complete: patients with new onset chest pain referred by their GP will be assessed by a specialist within 2 weeks of referral benefiting up to 200,000 patients a year.• Improved emergency care: improved ambulance response times, faster access to thrombolysis in A & E, and a three year training programme for ambulance paramedics in provision of thrombolysis completedOn waits:• Every heart service will be part of CHD Partnership Programme which is cutting delays by redesigning care is organised and delivered complete by 2004• Maximum 6 months wait for routine cardiac surgery by the end of 2005On workforce• 219 extra cardiologists (47% increase) and 35 extra cardiac surgeons (19% increase) – plus overseas recruitment drive in these specialties.On equipment:• Major programme of investment in expansion of revascularisation capacity and in equipment both from government and NOF money.
Coronary Heart Disease - MilestonesIf re-elected Labour will:By 2002• The absolute maximum waiting time for heart operations will have fallen from 18 months today to 15 months, with the large majority of patients seen much more quickly.• The NHS will have carried out an additional heart operations• Almost 75% of top priority ambulance calls will receive a first response within eight minutes.• Almost 80% patients who have had a heart attack will be prescribed life-saving medicines – aspirin, beta-blockers and cholesterol lowering drugs.• 700 defibrillators will be in place in the busiest parts of England, taking life saving minutes away from the time it takes to get treatment for people having a heart attack.• 50,000 smokers will have quit during the year.• National coverage by the CHD Partnership Programme will bring pioneering reform of heart disease services to every region of the country.By 2004• Every acute trust in England will have at least one rapid access chest pain clinic, ensuring swift diagnosis or a swift “all clear”. This will mean about 200 clinics across the country with a maximum wait of two weeks, with most patients seen within days of referral.• On the basis of the clinical evidence available, we estimate the numbers of lives saved each year by this time would be as follows, by intervention:By 2005• The number of consultant cardiologist will have increased by around 50 per cent.• The number of heart surgeons will have increased by around a quarter.This progress over the next five years will build on the improvements that have takenplace since Labour came to office in 1997.
Cancer Services - Improvements since 1997• The NHS Cancer Plan was published in September 2000. This is the first ever comprehensive national cancer programme for England, covering all aspects of cancer – prevention, screening, diagnosis, treatment, care and research. Implementing the NHS Cancer Plan will mean raising the standards of treatment and care to that of our European neighbours.• Between 2000 and 2004 a total of £340 million is being invested in upgrading and expanding imaging and radiotherapy equipment. £93 million has come from the National Lottery’s New Opportunities’ Fund and the balance from public expenditure. This investment will fund the biggest ever equipment programme in the NHS. The first equipment is already being installed.• Waiting times have been reduced in the 9 cancer networks participating in Phase I of the Cancer Services Collaborative. Up to 14 million people are now covered by the new redesigned cancer services.• The ‘Two Week’ policy for patients referred urgently by their GPs has been Implemented for all cancers – guaranteeing an appointment within two weeks, benefiting over 140,000 women so far.• NICE has approved the use of taxanes for breast and ovarian cancer.• In the first phase of the ground-breaking Cancer Services Collaborative programme, 51 teams across the country have halved the time taken to receive first treatment and reduced waiting times for radiology by nearly two-thirds.• Guidance on upper gastrointestinal cancers (oesophagus, stomach and pancreas) was published in January 2001. The NHS Prostate Cancer programme was launched in September 2000.• Smoking cessation services have been established in the 26 Health Action Zones. Around 14,600 people set a quit date in 1999/2000 and at the four week follow-up around 5,800 successfully quit. Nicotine replacement therapy and Zyban are now being made available free on the NHS.• Fruit and vegetable consumption is being tackled by the Five-a-Day Pilot Sites and the National School Fruit Pilots.• A manual of cancer services standards was published in January 2001. A National Cancer Taskforce has been established• Agreement has been reached to establish a National Cancer Research Institute.• Death rates have fallen from 137,459 (England and Wales) in 1996 to 133,749 (England and Wales) in 1999.
Coronary Heart Disease Services - Improvements since 1997• 140 Rapid Access Chest Pain Clinics are already up and running easily exceeding the original target of 50, ensuring swift diagnosis or a swift “all clear” when people experience severe chest pain.• An extra 3000 heart operations this year, and a further 3000 heart operations by the end of 2002 cutting waiting times for patients.• £60 million has been allocated to expand and improve heart surgery centres.• 111 defibrillators have now been deployed in public places providing emergency resuscitation after heart attacks.• £55 million has been allocated to provide modern equipment for treating heart disease such as new ECG machines, echo machines and cardiac monitors.• At the beginning of 2000 only 30% of A&E departments were giving clot busting thrombolysis to patients arriving with a heart attack. By the end of 2001/02, 75% of departments are set to do so, ensuring that more patients are able to get life saving clot busting treatment quickly.• More than two thirds of ambulance trusts are now on track to ensure that 75% of top priority calls are responded to within the target time (eight minutes in urban areas and 14 minutes in rural areas), ensuring that vital minutes are saved when patients with a suspected heart attack call 999.• The National School Fruit Scheme, being piloted which are providing 80,000 infant children in over 500 schools with a free piece of fruit every school day. 250 breakfast clubs being funded as part of our drive to improve inequalities in health.• Exercise on prescription is being piloted to increase opportunities for people to be active as part of managed programmes of prevention and rehabilitation.
Annex AKey progress points of the Cancer Services Collaborative programme – reformdelivering benefitsBreast cancer. Glenfield Hospital in Leicester completely removed a three-week delayin breast cancer waiting times by re-designing their patient registration forms todouble-up as an oncology referral form.Bowel Cancer: University Hospital Lewisham has stopped giving patients twoseparate appointment days for tests, decreasing anxiety and cutting the rate of patientsnot attending appointments from 15% to zero. The hospital also gives the patients aninformation sheet about their next appointment.Lung Cancer: Northwick Park Hospital and Clinical research centre in Harrowreduced the backlog of routine CT scans from 18 weeks to zero. They did this bydesigning a scheduling template ensuring the scanner was used to its full capacity.Prostate Cancer: Royal Liverpool and Broadgreen University Hospitals NHS Trustreduced a 12-week wait for an ultra sound to two weeks by drawing up a protocol forinvestigation and treatment. Patients are no longer all held up waiting for the sameinvestigation at the same time.Ovarian Cancer: Queens Hospital Sidcup has reduced waiting times for test results by72 hours. Specimens are now transported direct to the laboratory following theatre onthe Thursday by porters, rather than waiting for collection on the Friday for work tonot start until Monday.The CHD Partnership ProgrammeEach participating network is undertaking up to six projects that represent aspects ofcardiac care or stages in the CHD patient journey from secondary prevention whichmay include access to specialist smoking cessation services through toassessment and care for patients with stable angina, management of heart failure andcardiac rehabilitation.The network teams’ participation in the 18-month collaborative programme involvesdeveloping tools and techniques to improve services, testing and making changesacross the patient journey and sharing learning with other local networks of cardiaccare and the wider NHS.
Annex BProjected number of cancer specialists - England 1999/00 2003/04 2004/05 2005/06Cancer specialistsClinical radiology 1507 1840 1805 1767Histopathology 836 913 905 968Haematology 510 639 635 659Clinical Oncology 305 420 427 453Palliative Medicine 94 164 190 221Medical Oncology 110 192 229 265Total = all cancer 3362 4169 4191 4333specialistsThese are the figures used for the NHS Plan and show how we aim to reach the Plantargets.New Cancer Equipment in four years to 2003/4Type of Equipment TotalMRI scanners 85CT scanners 200Linear accelerators 102There will be at least these levels new equipment, to modernise older equipment andto increase capacity.