Every person reading this article has a one in three chance of getting cancer. In the most recent year for which there are statistics, 367,000 men and women in England had cancer diagnosed.

The NHS Cancer Plan for England was published in September 2000 with the laudable ambition of reducing cancer deaths. Investment was planned to improve survival through prevention, screening, early diagnosis, better treatment, hospices and cancer networks. Investment in the NHS has risen from 4.8 per cent of GDP in 1997 to 9 per cent today.

Has this money achieved its aims? Partly. Fewer people smoke, more are screened and waiting times are shorter. But bureaucracy has been an obstacle to greater success. The National Institute for Health and Clinical Excellence (NICE) has prevented effective treatment becoming widely available; the weaving of a spider's web of administrative muddle has led to death and misery.

There remains a wide variation in the standard of care and the chances of survival. This is partly because the Government believes in local autonomy - 150 primary care trusts dictate local policy, creating a postcode lottery. Living in Richmond means that you might be prescribed a drug for cancer, while you cannot be effectively treated in the stinking black hole that is Oxford. The annual administrative budget for these trusts is £5 billion.

One of my colleagues has shown that death rates from kidney cancer are solely determined by postcode. In areas where the trusts allow the use of a particularly effective drug the average survival rate is more than two years; in those where it is refused, average survival time is six months. Many readers will know that NICE has changed its mind three times over whether these kidney cancer drugs should be available.

In 2000 the Secretary of State for Health wrote in his introduction to the Cancer Plan that “decades of under-investment alongside outdated practices mean that survival rates lag behind the rest of Europe... too many variations in the quality of care across the country leave patients frustrated by the postcode lottery.” His view is still correct. Presumably his successor now needs a hearing aid as those words ring in his ears.

Secretary of State, please could our wonderful NHS be granted the gift of sanity in prescribing and clarity in administration? The nightmare of bureaucracy needs sorting out. The rationalisation of NICE and the primary care trusts would free up funds that could be used to benefit patients.

Jonathan Waxman is Professor of Oncology at Imperial College London

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