Deadly lottery of cancer treatment

WIDE DIFFERENCES in the numbers of women dying from breast cancer in different parts of the country were described yesterday as "totally unacceptable" by the head of one of Britain's foremost cancer charities.

The variations of up to 50 per cent in the death rate from breast cancer between the best and worst areas are revealed in hospital league tables published yesterday.

In the worst areas the death rate from breast cancer is almost 20 per cent above average while in the best it is almost 20 per cent better than average. In the Trent region, all 11 health authorities have above average death rates compared withneighbouring North West region, where 10 of the 16 health authorities have better than average death rates. The proportion of women developing the disease is similar in both regions.

The variation revealed by the figures, included in the annual hospital league tables for the first time this year, was condemned by Professor Gordon McVie, director of the Cancer Research Campaign. "It has got to be down to poor reporting to local breast cancer registries or inequity in the efficacy of the breast cancer care delivered. My money goes on the latter. There is not a shadow of doubt that there is inequity of care for breast cancer patients. It is totally unacceptable."

The hospital league tables, introduced by the Tory government, provide a crude snapshot of performance of National Health Service trusts on a range of measures including waiting times, cancelled operations and ambulance response times. For the first time this year, they also include information on the number of complaints received and delays in the discharge of elderly people. Details on breast cancer are given by health authority, not by individual hospital.

Plans to list measures of clinical performance, including death rates and re-operation rates by individual hospital trust, announced by the Government soon after it took office, have been postponed until the new year.

Launching the tables yesterday, Baroness Hayman,Health minister, said they showed that the performance of the NHS was broadly in line with the year before, with a rise in the amount of day surgery. But she admitted that the data was crude and of "limited relevance", which made it difficult to get an overall view.

"The tables are useful for local organisations to look at their own performance in specific areas and ask questions about why they aren't doing better," she said.

Lady Hayman also announced changes to the Patient's Charter, for the NHS to replace the existing national standards with locally agreed targets backed by a set of national principles. Greg Dyke, the television executive best known for introducing the country to Roland Rat, was brought in by the Government to revise the charter. He said the existing version had introduced the concept of consumerism to the NHS but imposing standards across an organisation employing 1 million staff could not work.

"You cannot make changes to the NHS without getting the people who work in it on-side. There was very little effort to get the staff on-side. A lot saw it as a stick with which they could be beaten."

The variation in breast cancer death rates was alarming for patients, charities said yesterday. Carolyn Faulder, chairwoman of Breast Cancer Care, said: "We are very concerned. The figures confirm what everyone has known for a long time but in a more concrete way. It is excellent that these figures have been published because now we know where the bad areas are."

Michael Dixon, consultant surgeon and head of the breast unit at the Western General Hospital, Edinburgh, said death rates were higher in women who delayed seeking treatment or had difficulty getting to a hospital, which was commoner in those of lower social class. However, women who received the best treatment - chemotherapy or hormonal treatment to prevent the spread of the disease (in addition to local surgery and radiotherapy on the breast) - had the lowest death rates.

Death rates in the latest tables related to standards of care many years ago and new guidelines had been introduced. Overall, national death rates had fallen sharply while incidence had been rising, he said.

Mr Dixon added: "The quality of care people get now is quite different. I think you will find some of those inequities have evened out. At last the profession is getting its act together and policing what is going on out there."