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Reforming... and performing?

I am sure we are all a little bit dizzy with the pace of change in the NHS. I know I am - one has to have only a couple of weeks off on a holiday and the health landscape seems to change subtly, even in that short time.

Even so, we are entering into a particularly turbulent time for the NHS in England with the Health and Social Care Bill going through the Lords, after having a rocky, but ultimately successful, passage through the House of Commons last month (albeit following some fairly major rewrites).

So, here I am sat at my computer pondering the potential importance and impact of the latest batch of proposed NHS reforms upon patients with cancer and those who care for them.

My over-arching feeling, however, as I type these words, is one of déjà vu. So forgive me if I hop into my DeLorean and zoom back to the heady days of 1991 and 'GP fund-holding'.

In cancer care the original experiment with GPs holding the purse-strings ended in very large differences in the way cancer services were delivered to different sections of the country, and indeed across different sections of society. There were huge gaps in services between north and south, rich and poor and city and rural areas.

GP fund-holding was swept away by the incoming Labour government in 1998, and the 2000 'Cancer Plan' that followed closely afterwards sought to redress the differences in access to good cancer care by bringing in more centralised standards, control and ultimately more 'targets'.

Some would argue that discrepancies in cancer care have not been completely expunged by this centralised approach but I have seen massive improvements and investment in cancer services over the last 10 years. Cancer care is certainly very expensive, costing £5.6 billion and accounting for 5.6% of the UK's total expenditure on health and increasing every year.

Perhaps local GPs are exactly the right people to plan and buy cancer services for their own local populations. However, I look forward and must admit I am struggling to see how GP's (even pulled together into groups or 'consortia') will be able to commission expensive, specialist services like cancer alongside a myriad of different priorities, with more limited funds, whilst holding down their day-jobs.

One of the key pieces of work within the Cancer Plan back in 2000 was to develop the role of the Cancer Networks, pulling together clinicians and managers from all the providers and commissioners of cancer care within a geographical area and giving them responsibility for improving services. As someone who has spent a lot of time working on these network projects I believe these collections of interested and committed people have worked well.

Within the original Bill the existence of cancer networks was, at best, under some threat. Following heavy lobbying from charities such as Macmillan Cancer Support the government seems to have retracted from this position and guaranteed funding beyond 2012. However, their future role and influence remains unclear. As they are one of the ways in which expert clinicians within different organisations under the umbrella of the NHS can work together I am concerned that their contribution has been devalued, to be replaced by an all-pervading climate of competition between NHS and non-NHS providers alike.

Although the Health and Social Care Bill has lots of different ideas about how services might be delivered more effectively there is little real guidance on how this might be achieved.

I have already written to my MP expressing these concerns, as in the final analysis, I think cancer care is too important to be left to chance.

To read Mark's first cancer expert blog, The drugs do work … but that's not the end of the story, click here