title: Re-organisation of oesophago-gastric cancer services in England and Wales: a follow-up assessment of progress and remaining challenges.
abstract: BACKGROUND
  This study is an update on an earlier article in 2007 to assess the implementation of the Cancer Plan reform strategy in England and Wales.
  
  
  RESULTS
  A national online survey to upper gastro-intestinal leads at network and trust level. The questionnaire was designed based on existing clinical practice guidelines and addressed governing principles and operational procedures related to the delivery of cancer care. It was sent in January 2012 to upper gastro-intestinal network and trusts leads at all cancer networks and acute NHS organisations in England and Wales. Responses were received from 100% of Cancer Networks and 91% of NHS organisations. Centralisation of surgery has improved with all but two trusts (5.4%) now meeting the minimum staffing level for oesophago-gastric cancer surgery. This is a substantial improvement since the 2007 survey when 21 trusts (46.7%) did not meet this requirement. The use of formal assessment for nutritional needs has improved, too. In 2007, the involvement of the palliative care team in multi-disciplinary teams was poor. While this has improved, 27 trusts (19.7%) still report that none of the palliative care team members routinely attend the multi-disciplinary team discussion.
  
  
  CONCLUSIONS
  The survey demonstrates improved compliance with organisational recommendations since the last assessment in 2007. Centralisation of surgery has improved and is nearly fully compliant with the reform strategy. Areas that require further improvement are nutritional support and inclusion of palliative care in multi-disciplinary team meetings.
authors.affiliation: Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. oliver.groene@lshtm.ac.uk.
authors.forename: Oliver
authors.initials: O
authors.lastname: Groene
authors.forename: Georgina
authors.initials: G
authors.lastname: Chadwick
authors.forename: Stuart
authors.initials: S
authors.lastname: Riley
authors.forename: Richard H
authors.initials: RH
authors.lastname: Hardwick
authors.forename: Tom
authors.initials: T
authors.lastname: Crosby
authors.forename: Kimberley
authors.initials: K
authors.lastname: Greenaway
authors.forename: William
authors.initials: W
authors.lastname: Allum
authors.forename: David A
authors.initials: DA
authors.lastname: Cromwell
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration* / Q000592:standards; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy*; D019983:Guideline Adherence; D018166:Health Care Reform; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D008495:Medical Oncology / Q000458:organization & administration*; D018529:Nutritional Support; D016522:Oncology Service, Hospital / Q000458:organization & administration* / Q000592:standards; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team; D011230:Precancerous Conditions / Q000628:therapy; D015397:Program Evaluation; D058996:Quality Improvement; D013222:State Medicine / Q000458:organization & administration*; D013274:Stomach Neoplasms / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards; D006113:United Kingdom; D000078329:Workforce