Thoracic surgical services for one cancer network in London are based at one NHS Trust. Approximately 80% of the surgery performed in the period January-December 2003 was for the diagnosis, palliation or treatment of cancer. The range of different patient groups and needs is very wide, ranging from teenagers undergoing metastatectomy to adults and older adults undergoing resections or palliative surgery. An audit of lung cancer resections performed in 2001 on behalf of the Network lung tumour board indicated that the service was fragmented and there were several bottlenecks in the lung cancer pathway, causing patient delays and a feeling of dissatisfaction amongst referrers and patients. A clinician with oncology experience was appointed in 2002. Immediate action to track patients and ensure referrers knew the outcome of surgery and histology was taken. As part of the NHS Modernisation agenda, the local Cancer Services Collaborative then facilitated mapping the pathway for lung cancer, identifying problems and ways of tackling them. Changes from this, subsequent initiatives and adopting a collaborative approach have also had a positive impact on the lung cancer service. These strategies have been adapted to all thoracic surgery pathways for cancer or suspected cancer. Examples include decreased wait time, sector-wide patient information, multiprofessional working practice and educational initiatives.