Establishing cancer units

The creation of effective cancer units is central to the implementation of the report A Policy Framework for Commissioning Cancer Services, produced by the Chief Medical Officers of England and Wales, recently issued by the Department of Health in April 1995. While cancer units are described in this report a range of important questions remain about their nature and how they should be developed. This paper addresses these issues in three ways. A definition of the cancer unit is suggested and its main implications spelt out. The problems of establishing cancer units are covered under three headings. Where should cancer units be? Which cancer sites should the unit cover? What is needed to establish the cancer unit? Finally two checklists are presented, describing the task from the perspectives of the district health authority and hospital(s) concerned. The underlying theme is that real changes in clinical practice and organisation are the goal, and these can only be achieved where there is extensive local dialogue in which the relevant issues are addressed in a structured and rigorous manner. Cosmetic changes in hospital designation will not achieve the consistent quality of cancer service that is the cornerstone of the 'Calman' policy.