Accountability of service delivery is becoming increasingly complex and never has this been more apparent than in the field of Oncology. Cancer care has an unrivalled level of complexity not only in the heterogeneity of management of the disease itself but increasingly in the myriad of service providers, specialities, policymakers and regulatory bodies overseeing its delivery. The stepwise series of changes to NHS structures over recent decades has had an enormous impact on our ability to answer key questions which lie at the heart of accountability: who is making the key decisions about changes to cancer care delivery, and what are these reforms achieving?

However, with growing complexity of service structures and an increasing number of bodies developing ambitious and complex strategies, in a context of resource restraint and system pressures, it has become very difficult to answer these questions clearly. This increasing lack of clarity and transparency around such fundamental questions may mean that, despite there being such a pressing need and apparent desire for accountability in cancer care, paradoxically we may actually be deviating further and further away from this.

Perhaps it is time for less complexity and for the decision-makers to get back to some fundamental principles which clinicians have embraced in evidence-based medicine: what is being done and by whom? Is this change beneficial and if not how can we influence change?

The answer therefore to who precisely is making the decisions about cancer care delivery is: it’s complicated. Cancer care clearly represents one of the most complex specialities in terms of service delivery. The heterogeneity in disease behaviour between and within tumour types and patients combined with the multiple interacting specialties, settings, technologies and disciplines means achieving streamlined, effective care has enormous challenges.

The government’s plans to increase cancer survival rates and diagnosis has not only been disappointingly absent, but there is evidence of a persistent and even growing survival “gap” both across the UK and across Europe in a number of tumour types. The “avoidable” deaths from cancer are largely attributed to delays in diagnosis and varying access to high quality treatments and care early on in the disease.

The Government has pledged £5bn a year for ‘specialised care’, but are they really doing enough to close this wide gap between the UK and the rest of Europe? For a start, Biomedical science and research funding was disappointingly absent with no plans drawn up in this year’s budget. If the Rose government really did want to alleviate the disruption they have prolonged for so long, surely they would pledge funding for research projects, scholarships and resources; Speeding up breakthroughs in treatments and putting the UK at the forefront of research development.

Pressures on the workforce and dramatically reduced inpatient bed numbers have undoubtedly contributed to the challenges. Shortfalls in clinical staff numbers are now measuring very high with the ratio of doctors and nursing staff to patients falling behind most other European countries. Almost all major treating oncology specialties and oncology healthcare professionals have put out calls to drastically increase their practising numbers, emphasising that this pressure is being felt acutely across oncology.

Perhaps it is time to drastically reduce this complexity in care delivery and reform, streamline and nationally coordinate cancer care and get back to basic principles with transparent models of care delivery. Only then might it be possible to start to be able to answer these questions.

Abstract is from Macklin-Doherty, A.