Business | NAFW
| Name of respondent:Dr Malcolm Adams Consultant Clinical Oncologist and Medical Director |
| Are you responding on behalf of an organisation? No |
| If so please give the name |
| Address: Velindre Hospital, Whitchurch, Cardiff. |
| Telephone number:02920196127 |
| Would you be willing to give oral evidence to the Committee? Yes |
| If the evidence you give below is your personal view, rather then that of an organisation, please state whether or not you are willing for your evidence to be published by putting a X in the appropriate box below: |
| I am content for my evidence to be published X |
| I am not content for my evidence to be published |
Business | NAFW
| 1 |
How can information technology be used more effectively to track and facilitate the patient’s journey? |
| Response |
The entry of clinical data into a single, fully developed, All -Wales clinical data base for example Cancer Network Information System Cymru (CANISC) should be made mandatory, to ensure the availability of accurate outcome data and ensure that standards such
as waiting time are accurately monitored. This
database needs to be accessible to all relevant clinicians at all stages of the patient journey. We must avoid the duplication of data entry into other data bases which entails unnecessary effort .It is important for the data bases to be compatible with other
relevant managerial data systems and for this reason the data based should probably be adopted by Informing Health Care. Appropriate funding is needed to facilitate entry of quality validated data throughout the patient pathway. |
| 2 |
How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response |
Maximising involvement in clinical trials is an important means of keeping practice up to date, improving care and integrating new treatment developments appropriately into service delivery. In Wales the Wales Cancer Trials Network has played a key role in increasing
recruitment into clinical trials. The
All Wales tumour groups under the aegis of the Cancer Services Coordinating Group are key to defining best practice and standards. I think they have worked well. However they need to be able to regularly perform All Wales audits of treatment outcomes, morbidity
of treatment and compliance with good practice standards.Such
audits demand that clinical data be readily available and that all relevant clinicians are participating across all aspects of the treatment across trusts and all cancer networks.The
Welsh Cancer Intelligence and Surveillance Unit is currently under used and could play a critical role in monitoring changing cancer incidence to capacity plan for the future and ultimately in measuring outcomes |
| 3 |
What are your views on the complexity of commissioning services? Is the process hampered by the involvement of the local health boards, cancer networks and Health Commission Wales? How could it simplified? |
| Response |
The relative role of local health boards, cancer networks and Health Commission Wales is ill defined and there is inconsistency in cancer commissioning across Wales. Currently
commissioners do not have adequate information on case mix and activity to commission. Effective commissioning requires quality measurements of activity and complexity defined by proven indicators. Commissioners frequently lack expertise as well as information.
Since
the introduction of local health boards specialist commissioning expertise has been distributed too thinly across a large number of commissioning organisations. Commissioning for cancer services needs to be organised on at least a regional basis and capital
funding issues for expensive equipment for example linear accelerators which needs to planned on an All Wales basis.The
cancer networks have not been enabled to enact their advice ,as trusts hold all the authority for example in the appointment of specialist Consultant posts Mechanisms need to be developed to ensure that advice on service configuration is implemented.The
Cancer Services Expert Group has played and continues to play a vital role in defining and monitoring the cancer standards and defining future capacity required for high quality cancer services. |
| 4 |
What evidence is there of the value of screening and immunisation? |
| Response |
Organised cervical screening programmes have avoided a potential epidemic of cervical cancer. Professor Julian Peto has projected that organised cervical screening has reduced incidence and mortality of cervical cancer by 80%.Although cervical screening has
proved very effective it has limitations. At least half of current cervical cancer sufferers have been screened and false negatives do occur .In addition cervical screening is associated with major anxiety for thousands of screened women who require investigation
for an abnormal smear. The imminent availability of HPV vaccination promises a reduction in abnormal smears and their associated investigations. This will ultimately lead to reduction in the morbidity and mortality of HPV related disease if a public health programme
for HPV vaccination is integrated with cervical screening in a planned way. These
vaccines are likely to work best work if they are given to adolescents before they become infected with the human papilloma virus. The school nursing service would be ideal for implementing HPV vaccination in adolescents. In addition, there is a need for education
of the public and professionals about HPV.Older
women may also benefit from HPV vaccination by boosting existing natural immunity to prevent re-infection. Screening
for breast cancer in Wales has been an enormous success. Breast Test Wales has provide a national quality assured screening service for Wales since its establishment in 1988 with the highest Cancer detection rate in the UK for the year 2003/4. The breast screening
programme in Wales has probably contributed to the 25% reduction mortality observed since 1991. The
introduction of colo-rectal screening is imminent. Population based faecal occult blood screening with follow up colonoscopy for confirmed positives has been shown to reduce deaths from colo-rectal cancer by earlier detection in the 50-74 years age group .Whatever
age group is agreed by commissioners for colo-rectal screening it is essential that the programme is quality assured and adequately funded achieving good coverage. These latter features have been essential to ensure the success of the All Wales cervical cancer
and breast cancer screening services. |
| 5 |
What are the barriers to the NHS in Wales keeping abreast of, and responding to, developing technologies and therapies? How might these barriers be overcome? |
| Response |
Implementation of new technologies and treatments into good practice in a timely fashion needs adequate capacity and financial planning . Capacity
planning is needed for radiotherapy and chemotherapy to ensure cancer services can cope with the predicted increasing treatment demand. Horizon scanning is needed for predicting new treatment developments and detailed process mapping of the patient pathway is
needed to ensure there is adequate capacity for the service to cope efficiently .Such work is being carried out by the Cancer Services Expert Group at the moment.It
is also important we are familiar with the work of other UK cancer groups to share their experience.As new developments
occur it is important that Wales is part of the National Institute for Health and Clinical Excellence review process avoid unnecessary duplication of expert review. |
| 6 |
How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response |
If voluntary organisation and charities disappeared there would be a deficit of least £ 2 m for funding key professional support staff .The voluntary sector provides a vital role in providing patient information and specialist nurses. There is a vital
role for specialist nurses in cancer management and palliative medicine. These posts are predominantly supported by charity. The funding of such posts need to be made within a strategic framework . |
| 7 |
How can the collection and use of data on where the terminally ill spend their last weeks or months be improved better to inform service provision for those people? |
| Response |
Probably most patients in the last weeks of life would want to die at home. Whether a patient actually dies at home may be related to a large number of factors such as severity of symptoms and family circumstances. If a patient has no family to provide adequate
support at home achieving this wish can be difficult , although community support services have improved in recent years. Proper information onto the precise circumstances which determining where the patient dies is needed . |
| 8 |
There are a number of issues around prescribing and the cost of drugs: |
| 8(i) |
What should be done and by whom to reduce continued prescribing of inappropriate drugs? |
| Response |
We need appropriate audits of drug usage and compliance with NICE guidelines .Audits across the UK have shown variable usage of drugs recommended by NICE guidelines. We need audits of drug usage in Wales to verify compliance with good practice, standards and
guidelines. Pharmacists are in the ideal position to perform these if the relevant information and professional time is available. |
| 8(ii) |
Should people who are prepared to pay privately for drugs not available to them on the NHS, be able to do so without having to become private patients and having to pay for all their treatment? |
| Response |
However the service is funded in the future it is essential that there is consistency of care irrespective of patient means. |
| 8(iii) |
Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response |
It is essential that WALES be part of the NICE process to ensure that an adequate pool of independent expert advice is available for guidance on appropriate prescribing of drugs. |
| 9 |
Are services centred on the patient, with service users consulted? If not what are the reasons for this and how patient involvement be improved? |
| Response |
Major steps have been taken to integrate the patient perspective into cancer services and palliative medicine with patient representatives participating in clinical governance, ethics and research committees. Community
health councils play a vital role in supporting the interest of the patient with trusts, commissioners and government and identifying deficiencies and gaps in the serviceThe
vital role of patient involvement is now totally accepted and supported by health professionals. |
