The Chief Medical Officers' expert advisory group (The Calman Hine report) (1994) for the commissioning of cancer services suggested that services in the district general hospitals (DGH) should be called ‘cancer units’ and that such units should be closely linked to ‘cancer centres’. The objective of these proposals would be to improve the quality of care to cancer patients. The report also acknowledges that these proposals are based on an inadequate understanding of the epidemiology of cancer within England and Wales and the way in which current configuration of services affects outcome. The authors make a plea for better documentation and recording of treatment and outcomes (i.e. audit) to fill this gap. Registration in cancer registries is of limited value in assessment of outcomes of care owing to lack of detail. This paper describes an audit of head and neck cancer in one department and attempts to define which patients might benefit from referral from the cancer units to the ‘centres’, and conversely, which patients would be better managed in the cancer units. If all patients with cancer of the head and neck were referred, the service in the cancer centres would be overwhelmed. Some system of triage will therefore be essential.