Lottery in Care?

‘Postcode lottery’ is a phrase that can be overused in health. Regional variations in outcomes from everything from the availability of drugs to surgery waiting times (which recent reports show is on the increase) have grabbed the headlines. The frequency of these headlines run the risk of reducing the impact and making us numb to the very real issues that these inequities create for thousands of people every day.

In the case of prostate cancer it rings particularly true and apt, with the very survival of men diagnosed with this disease apparently determined by their address in some instances. There is no denying that increased media and political engagement and attention has placed prostate cancer higher up the agenda, and improved outcomes for men. But, there is still a long way to go.

One of my main priorities as Chief Executive is to fight the lingering injustice around this disease. To give an example, statistics revealed this year showed that despite a gradual decline in prostate cancer deaths over the past decade, a man’s odds of being successfully treated, and spending more years with their loved ones, is in direct relation to where he lives. For instance, there are twice as many deaths in Sandwell than Kensington – which by any standards is unacceptable.

We know there are also huge variations in a man’s care, support and treatment. Although some of the indicators of the 2010 National Cancer Patient Experience Survey showed improvement, there was massive disparity between trusts in numerous ways. Information, which is critical to men faced with a number of treatment options, was available to only half of men at the worst performing trust, and 95 per cent at the best. All of the men at the highest performing trust were able to easily contact their named specialist nurse, who provide a lifeline to men throughout their treatment, whereas at the worst this was around half of that.

This is the most dire kind of regional variation – and needs to be tackled on every front. This Charity is not in the business of highlighting problems without presenting the way forward alongside it.

One thing we need to see is a comprehensive clinical audit for prostate cancer to redress the profound gaps in information about services, waiting times, standards of care and outcomes for the disease which we see at the moment. Such data is essential for men if they are to receive the treatment they deserve, for clinicians to share best practice and for the impact of factors such as ethnicity on how and when men present with the disease to be understood. Geography should simply not enter into the equation. We will actively support such an audit as we believe it can make a real difference to thousands of men every year.

Men should get the same information and choices about the PSA test, treatment options and outcomes wherever they live. This is what I will be pushing for – an end to these variations – and I will be urging everyone with an interest in this disease, and inequity, to join me.

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