Accountability in the NHS: the impact on cancer care.

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? What are these reforms achieving? How can they be influenced? It is only through clear and transparent decision-making that we may have any hope of implementing, monitoring and influencing the effects of evidence-based change. 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?