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One of those issues facing the BC Cancer Agency includes a burgeoning rift between researchers and clinicians.John Lehmann/The Globe and Mail

The BC Cancer Agency is suffering from a declining national and international reputation as a result of serious internal issues that should be the subject of an independent review ordered by the provincial government, a recent head of the organization says.

Simon Sutcliffe, who is regarded by many of his peers as the best president to head the agency in its 60-plus years, also disclosed for the first time in an interview with The Globe and Mail that he left the position in 2009 after nine years on the job because he had grave concerns about the way the organization was being governed by the Provincial Health Services Authority.

He said it does not appear to him that the agency is heading in the right direction, an opinion reflected by the fact it is now looking for its third leader in a span of four years. In recent weeks, The Globe has chronicled the internal frustrations of oncologists and researchers inside the agency, many of whom have complained of low morale and high rates of burnout caused by staffing levels that have failed to keep up with demand.

"Are there conditions there to actually see the optimal performance of a cancer control agency?" said Dr. Sutcliffe, today an international consultant on cancer treatment and prevention programs. "I don't think there are. … Things have gone backwards."

Dr. Sutcliffe's voice is an important one on this issue. During his tenure, the agency made exceptional progress on several fronts and became a world leader in cancer treatment and research, a cutting-edge medical complex with star oncologists and scientists.

While conceding he is not completely unbiased, Dr. Sutcliffe said he decided to speak out because he is alarmed by what he has heard about developments inside the agency.

One of those issues includes a burgeoning rift between researchers and clinicians. He explained that the strained relations stem, in part, from a payment scheme oncologists agreed to years ago in which they gave up their fee-for-service privileges to accept a salary.

In return, they committed to a performance contract that said they would see all of the patients required to be treated. However, cancer rates in British Columbia have gone up with an aging population, while the hiring of new oncologists has not kept pace.

"There are many ways to improve outcomes, but an important one is by discovering new science and transferring those discoveries into the clinical setting with cancer patients," Dr. Sutcliffe said.

But as oncologists have been placed under increasing pressure to see more patients, many have been less inclined to work with researchers, who, in turn, are growing frustrated that they cannot get their work clinically tested. Dr. Sutcliffe said the culture of co-operation between the two groups was once exceptionally strong. In the past few years, that relationship has "eroded" and been replaced by a "tension" and a "rift" that is ultimately bad for research and the British Columbia public, he said.

Dr. Sutcliffe also indicated he had concerns about the search being conducted for a new head of the agency, whose title will be vice-president, not president, and who will report to the chief operating officer of the health authority, not its president. He said the title and reporting relationship will not sit well with potential candidates who are accustomed to a more direct line of authority with senior levels of government. He said the job description focuses heavily on management skills.

"If one reads the job description, you'll note that it doesn't actually require someone who has knowledge of cancer control to be applying for the position," Dr. Sutcliffe said. "The position description has a very strong management orientation. If you were to go to other cancer centres around the world and ask people there how they would like their agency to be led, I can assure you the answer is not going to be by an operating officer."

Dr. Sutcliffe said the agency's once sterling international reputation has suffered in recent years. "Does anybody know about us? Does anybody care about us? They clearly did. Do they still? I was at a world cancer leaders' summit last week in Melbourne. The BC Cancer Agency was not even there. People in Australia are asking me about what's happening in B.C. News of the troubles inside BCCA have travelled widely."

He said the same thing is happening in Canada.

Dr. Sutcliffe said he could see these problems coming during his time at the agency. He said he began to have difficulty getting decisions enacted. "I didn't believe that we were making decisions that were going to lead to better cancer control and I didn't believe I could be duplicitous and lead a staff to believe things at the agency were on a good keel moving forward when in fact I believed they were not." When he resigned, there was no exit interview to determine why he was leaving.

He believes an immediate independent review is needed to determine the true state of affairs at the agency.

"I don't want to contribute noise to this debate," Dr. Sutcliffe said. "I just think an independent review would be valuable. Then you can remove the bias, the finger-pointing, the blaming and put it in the context of: What kind of agency do we want and are we achieving those goals? And if not, why not?"

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