Letter: Consequences of privatising cancer care

BIOGY

Our fellows, the doctors who diagnose and treat cancer, have registered major concerns with us about the planned model for commissioning cancer services in Staffordshire (NHS cancer care faces privatisation, 2 July). We applaud the ambition of joining up care for a population larger than that usually served by a single NHS organisation and the desire to focus services on the needs of patients. However, we fear that there may be unintended consequences. These changes could destabilise vital cancer diagnosis and treatment services, and are already leading to planning blight with regard to service improvements. This could lead - in the short-term - to worse services for patients. This is a brave initiative but one that must be considered a gamble in a health economy still feeling the effects of the Mid-Staffordshire disaster. Long-term planning has proved an elusive goal in UK public services. The leaders of this initiative are in no position to predict, let alone control, what might happen over the period of the 10-year contract - politically or financially. It seems unlikely that the architects of these changes will be able to see through their vision or to be held accountable for its consequences. What we may see is contracts that cannot be dismantled without severe penalties. Greater clarity is required with respect to the role of the "prime provider" who will not in fact be providing services but managing services provided by others. It is clear that those on the ground who will be relied on to make this happen have yet to be meaningfully engaged, and we have made their concerns known to Macmillan Cancer Support and NHS England who are leading this initiative. Clinicians share the ambition for an integrated approach to cancer care and must be more closely involved if this gamble is not to fail. Giles Maskell President, Royal College of Radiologists * The Transforming Cancer and End of Life care programme in Staffordshire and Stoke-on-Trent is an innovative and brave example of the voluntary and public sectors working alongside patients, carers and health and social care professionals to deliver the best possible outcomes for people affected by cancer. Inspired by the experiences of people with cancer, this programme will test an integrated approach to the commissioning and management of care. By appointing one organisation to take responsibility for managing the whole cancer care journey, we can demand truly seamless care. Clinical commissioning groups (CCGs) and NHS England will appoint organisations with expertise in managing contracts, ensuring that all the service partners work collaboratively around each patient and will not change the organisations who directly deliver cancer care services. Whoever is appointed will be subject to rigorous oversight and scrutiny for quality, patient safety and outcomes, whether they are from the NHS, the voluntary sector, or from the private sector. At the heart of this programme is the desire to truly reach and improve the lives of people affected by cancer. That's why Macmillan and our partners have made sure people affected by cancer, alongside clinicians, have been and will continue to be involved in the programme at every stage. Ciaran Devane Chief executive, Macmillan Cancer Support * Last night I attended and spoke at a book launch of Mike Marqusee's book The Price of Experience: Writings on Living with Cancer, where he spoke movingly about his treatment at Barts and his fears that the attacks on the NHS will mean patients in the future will not have the excellent care he has received. Surely the combined CCGs in Staffordshire should have been talking to their existing NHS hospitals and asking them to collaborate to provide a more responsive and streamlined service before embarking on this huge experiment with taxpayers' money? In the previous decade, the NHS (under Labour) made great strides in improving cancer services through networks such as that in east London, yet in 2011 Andrew Lansley withdrew funding for these despite their proven successes. Now we have groups of GPs, with no training in epidemiology, oncology or commissioning, making plans to spend millions on an untried system with private companies, who have no experience in cancer care, eagerly waiting to make profits from these sick patients. This is madness, and the dishonesty of the current government ("there is no privatisation"; "there will be no top-down reorganisation") is matched by the Department of Health's spokesperson who said: "NHS competition rules have not changed under this government." What about the Health and Social Care Act 2012, or the section 75 regulation that was passed this year? Wendy Savage President, Keep Our NHS Public * The finger of responsibility for the exponential privatisation of the NHS points ineluctably at the Liberal Democrats, in particular Nick Clegg and Shirley Williams. Given that this did not feature in the coalition agreement, it should have been Clegg's job to scrutinise Andrew Lansley's white paper. Had he done so he could have halted the whole scheme. Then Williams promised to have section 75 of the Health and Social Care Act amended in the Lords to reduce, if not abolish, the requirement to tender for services. This didn't happen. But it's not good enough for Andy Burnham to say that the public has not given the government permission to "put the NHS up for sale". What is now needed is a clear Labour election pledge to reverse all NHS privatisation since 2010. Robin Wendt Chester, Cheshire * Surely we should be concerned if cancer services are to be detached from the NHS and provided at the whim of private companies? As a GP for nearly 30 years, I know that patients are at their most vulnerable when they have a potentially fatal illness. Such patients especially need to feel that the single purpose of their carers is get them as well as possible for as long as possible, and not to have at the back of their mind that companies are making choices for profit rather than for them. Dr Ron Singer Chair, doctors' section of Unite * Will private contractors be paid on a fee-per-case basis, and thus make more profits if their patients don't live for long? Dr Richard Turner Harrogate, Yorkshire

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