National Health Insurance
Planning a Cancer Service for a National Health System
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In the course of research work for facility planning for the Western Cape Department of Health, a very useful set of documents was found on the planning of a comprehensive cancer service in the United Kingdom.
The early Calman-Hine report proposed three levels of care “to ensure the creation of a network of care in England and Wales to ensure that patients, wherever they live, receive treatment and care of a uniformly high standard”:
“Primary care is seen as the focus of care. Detailed discussions between Primary Care Teams, Units and Centres will be necessary to clarify patterns of referral and follow up which will ensure the best outcomes.”
“Designated Cancer Units should be created in many district general hospitals. These should be of a size to support clinical teams with sufficient expertise and facilities to manage the commoner cancers. The most common cancers are initially managed by surgeons and the provision of appropriate surgical specialists to manage patients in this phase of their illness, either for their diagnosis or for the performance of a major surgical resection, is essential. The service within Cancer Units in district hospitals is in many ways surgically led and this is not likely to change in the foreseeable future.
The size of a population served by a Cancer Unit cannot be inflexibly defined but will be determined by the number of cases of each cancer type being seen there, related to professional guidance on the number of cases necessary to develop and maintain expertise. Not all district hospitals will be Cancer Units. Their location will be influenced by the distance of that population from a Cancer Centre and from other Cancer Units.”
“Designated Cancer Centres should provide expertise in the management of all cancers, including common cancers within their immediate geographical locality and less common cancers by referral from Cancer Units. Although the Expert Advisory Group believe that a Cancer Centre will normally serve a population of more than 1,000,000, careful consideration of geographical constraints will always be necessary to ensure a balanced service. A population base of two-thirds of a million should however be considered an absolute minimum.
The services that will be a feature of most Cancer Centres are:
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Paediatric and adolescent cancer services. All populations should have access to these services;
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The assessment and management of rare cancers in multi-disciplinary teams and the accumulation of expertise in these treatments;
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Specialist surgical services including plastic and reconstructive surgery;
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Intensive chemotherapy particularly involving complex haematological support such as bone marrow transplantation and peripheral blood stem cell support;
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A full range of radiotherapy facilities with appropriate numbers of clinical oncologists to ensure specialised application;
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Medical oncology;
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Sophisticated diagnostic facilities (pathology and imaging); and
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Special expertise in palliative care and rehabilitation.”
Interested policy-makers and researchers are directed to the extensive UK material on the topic, including The NHS Cancer Plan; the Manual for Cancer Services; the Cancer Commissioning Guidance for local health authorities; material on planning for chemotherapy services; and planning the need for radiology equipment. The linear accelerator equipment forecasting makes use of the GLOBOCAN 2002 figures to estimate future need by type of cancer and this could readily be adapted for planning purposes in South Africa, in discussion with local groups of oncologists.
Produced for IMSA by
Professor Heather McLeod
20 August 2009
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