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banner Monday, 18 February, 2002, 10:30 GMT
Tackling diseases
Heart disease and cancer are our biggest killers. Mental health services suffered from decades of neglect despite the huge numbers of people affected by mental illness.

For a number of reasons, cancer patients in England often have poorer survival prospects than in other European countries.

Cancer kills 120,000 people a year in the UK - more than one in three will develop it at some point in their lives.

The government concedes that many people are not getting the cancer services they need.

It sets ambitious long term targets to improve survival in many of the UK's most common cancers.

The key target is to cut deaths from cancer in people under 75 by at least a fifth by 2010.

In many cases, the longer a cancer patient waits to be diagnosed and treated, the less likely a successful outcome is.

The ultimate goal is that no one should wait longer than one month from an urgent referral for suspected cancer to the beginning of treatment except for a good clinical reason or through patient choice.

Government target: No more than a two-week wait for first outpatient appointment for patients referred urgently by their GP with a suspected cancer.

Currently (January 2002), 91% of patients are meeting this standard - although an earlier report suggested wide regional variations.

For example, in September 2001 it was reported that in Northumberland, fewer than 60% of breast cancer patients were seeing a specialist inside 14 days, and that in some specialties in some areas, the deadline was met in fewer than 30% of cases.

Other government targets

  • by the end of 2001, a one month wait from urgent referral to treatment in childhood and testicular cancers, and acute leukaemia cases.
  • by the end of 2001, a one month wait from diagnosis to treatment of breast cancer
  • Maximum one month wait from diagnosis to treatment rolled out for all cancers by 2005 - and one month between referral and treatment by 2008

Currently (January 2001), there is no firm data on progress towards these, although there is almost 100% compliance in children's cancer with the two-week deadline between referral and specialist appointment.

The government's own update report suggested that, in the short term, the childhood cancer and leukaemia target could be met, but that staff shortages in key areas could make it difficult to meet the deadline for breast cancer and testicular cancer.

The successful breast screening programme will be extended to all women aged 65-70 by 2004, meaning that 400,000 extra women will be screened each year and screening will be available on request to women over 70

An extra 50,000 women in this age group are already receiving invitations to attend breast screening.

Pilot evaluations of bowel cancer screening should be completed in 2002, says the government - the plan also pledges to make a test for prostate cancer available, but this has not yet happened.

Heart disease kills more than 110,000 people a year in England.

The government has published a national set of standards called the National Service Framework for Coronary Heart Disease.

It wants to reduce yearly deaths by 20,000 by 2010.

Government target: Improving ambulance response times - By 2001, ambulances should reach 75% of "category A" calls (which include heart attacks) inside eight minutes.

Getting to hospital quickly saves heart attack patients - but the latest figures (June 2001) show that this target is proving difficult to meet.

Only three ambulance trusts exceeded the 75% mark - one trust reached far fewer than 40% within this period.

Ministers suggested in June 2001 that things were improving fast - and that all trusts should make the grade by spring 2002.

There has been a multi-million pound investment in satellite positioning equipment for ambulances - the government says nearly all will have had them fitted by March 2002.

Government target: The number of cardiologists should increase by some 10% a year from 1999/2000 - to a total of 685 by 2003/4, and cardiothoracic surgeons should increase in numbers by 4.5% each year - 19% by 2003/4

In the first year (1999/2000) there was a rise of 16.9% in cardiologists, and 9% in surgeons.

Government target: 3,000 extra heart bypasses and angioplasties by March 2002 - and a further 3,000 extra by 2003.

The first target has been met early - 4,800 carried out by March 2001 - and ministers predict the 2003 deadline will be met easily.

Government target: Rapid-access chest pain clinics - 50 by April 2001 and another 50 by April 2002.

By October 2001, there were 150 of these operational.

Part of the plan to reduce the numbers of deaths from cancer and heart disease is to stop people getting ill in the first place.

Government target:Smoking prevention: 1.5m smokers quitting by 2010 (40,000 for 2000-2001).

Smoking is a cause of both cancer and heart disease.

The government has made nicotine replacement therapy free on the NHS. During 2000-2001 more than 64,500 people quit smoking with the help of the NHS.

Government target: By 2004 there will be a national fruit scheme where every child in nursery and aged four to six will be entitled to a free piece of fruit a day.

Higher consumption of vegetables has been linked to a reduced risk of major diseases such as cancer and heart disease.

This scheme is being rolled out nationwide at the moment - early pilot schemes were hailed a success by ministers.

The National Institute for Clinical Excellence (NICE) will be assessing a wide range of anti-cancer drugs and will issue guidance to the NHS by summer 2001 on their clinical and cost effectiveness.

NICE, the government's drugs watchdog, has delivered guidance on a number of key chemotherapy drugs - most particularly, taxanes - for breast and ovarian cancer.

However, there is criticism that it has been too slow to decide whether certain other drugs should be made available, such as Herceptin for breast cancer.

The NHS Plan pledged 500 extra secure beds, over 320 24-hour staffed beds, and 170 assertive outreach teams.

The government says these targets have been met, and it plans to invest more than 300m extra by 2003/4 in mental health.

A further 50 assertive outreach teams are promised by 2003.

Just before Christmas 2001, 75m of ring-fenced money was announced to help set up 335 "crisis resolution teams" by 2004.

However, one of the main targets is to reduce the suicide rate by one fifth by 2010.

in 2000/2001, the suicide rate increased by 1%.

The government's drugs advisory group is due to release guidance on the use of older antipsychotic drugs in 2002. Prescribing rates of these drugs has already fallen in favour of newer drugs which have fewer side-effects.