Business | NAFW
| Name of respondent: Professor T S Maughan |
| Are you responding on behalf of an organisation? YES |
| If so please give the name: Tenovus the Cancer Charity |
| Address: 43 The Parade, Cardiff CF24 3AB |
| Telephone number: 029 2048 2000 |
| 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 YES |
| I am not content for my evidence to be published N/A |
Business | NAFW
| 1 |
How can information technology be used more effectively to track and facilitate the patient’s journey? |
| Response |
The current information technology system within the Cancer Service is CaNISC and this should be used extensively within the cancer service by all users within Wales in order to provide an all agency access to the key facts |
| 2 |
How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response |
The Wales Cancer Trials Network has since 1998 sought to support clinical research throughout the Cancer Service within Wales. In 2006, the community achieved the WCTN objective of entering 10% of cancer patients into clinical trials across Wales. In this way,
the Wales Assembly Government in collaboration with Cancer Research UK has supported an active research programme within the clinical service and this is integrated with service delivery. This needs to be continued into the future, as it has clearly been a successful
development providing research opportunities for patients and the vital evidence for evaluation of new developments within the cancer service for the NHS in Wales.Audit
of outcomes should be undertaken by widespread availability of the CaNISC system as identified in the information technology answer. It is possible to evaluate outcomes quickly and the investment should be in the IT. |
| 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 commissioning service is unduly complex and has been worsened by the involvement of the Local Health Boards. The Cancer Networks provide a potentially useful source of professional advice to commissioning. However, they have been severely hampered by a lack
of the ability to implement decisions. NHS Trusts have been able to appoint people such as specialist GI surgeons without reference to the Cancer Networks and thereby undermine any planning for specialisation and centralisation of services. The central commissioning
by Health Commission Wales has been informed and effective apart from the fact that it is grossly limited by cash constraints. It would be more effective to have a single commissioner for specialist cancer services across the whole of Wales. If we wish to have
an integrated high quality equitable service then a Pan-Wales commissioning process would be the best way to achieve this. |
| 4 |
What evidence is there of the value of screening and immunisation? |
| Response |
Screening is vital for early detection of cancer, cancer in Wales tends to present late. Cervical and breast screening are functioning effectively in Wales and are extremely high quality services. The development of colorectal cancer screening is the next step.
There is clear evidence that lives can be saved and mortality reduced from colorectal cancer by faecal occult blood testing. No doubt, there will be further improvements on this technology as it is far from perfect but it is still achievable and needs to be
implemented. The problem with it is the service provision for colonoscopies to evaluate those confirmed positive FOBs and this process needs to be available in such a way that it does not undermine the routine service delivery. |
| 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 |
Cancer technologies and therapies are developing rapidly. They do need to be evaluated and this is a highly technical process requiring extensive skills. It is essential that Wales remainS within the NICE process, as it would be intolerably burdensome to review
all of these new technologies and therapies within Wales. The NICE process needs to be speeded up and its change to the processes in the last year to have a fast track is very welcome. The WAG needs to ensure that NICE delivers on this more rapid evaluation
of new technologies and therapies. The next barrier following a NICE approval is to implement it with sufficient cash to match the service need. This needs good predictive models of the uptake in Wales, which would again would dependent on high quality IT. Restriction
of usage to certain sub-specialists within oncology will be able to control the flow of the specialist drug usage. It must be accepted that these technologies will be rapidly developing in the next few years and early warning of their coming and rapid evaluation
are vital. |
| 6 |
How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response |
There are good models of the voluntary sector cooperating with the NHS e.g., CR-UK & WAG,in Wales Cancer Trials Network; Tenovus with helpline and specialist support nurses; MacMillan and Palliative Care nurse provision; Marie Curie & the Palliative
Care Service. More
pro-active collaboration could achieve even more and WAG should actively collaborate with the charitable sector especially in seeking partnerships for quality services it cannot fully fund. Such an example would be provision of level 2 & 3 psychological
care for patients with psychological morbidity related to cancer. |
| 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 |
It is important that we have data on where the terminally ill themselves wish to die. Previous data has been from people who are not terminally ill but who are moving towards that state so some more data collection would be useful in this area, so that we can
most accurately predict where the service should be provided. |
| 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 |
Inappropriate drug prescribing needs to be monitored by an audit process and this would be best led by pharmacy staff. |
| 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 |
In a context where effective drugs are not available on the NHS due to cost this raises very major issues about the balance between equity of care and an individual’s right to supplement therapy with evidence based improvements which are outside the
cost envelope of the NHS. This is arising repeatedly in the clinics. A thorough debate on this issue including patient views needs to be undertaken to try to determine what is a modern and responsive way to respond to this issue. |
| 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 acknowledged that pharmaceutical companies deliver advice to help professionals with the prescribing of these drugs and this does need to be balanced by independent advice. Publications like the BNF and the Drugs and Therapeutics Bulletin provide this
advice and are widely read. The constraints that NICE guidance places on us also ensure that the service is aware of the evidence and I think this is adequate. |
| 9 |
Are services centred on the patient, with service users consulted? If not what are the reasons for this and how can patient involvement be improved? |
| Response |
There have been significant improvements in the patient centredness services but there is still some way to go, service users are now routinely involved at many levels within the service but this is something that needs to be continually increased. |
Thank you for responding. If possible please e-mail your response to jane.westlake@wales.gsi.gov.uk . Alternatively post it to Jane Westlake, Clerk to the Health and Social Services Committee, Room B4.07, National Assembly for Wales, Cardiff Bay Cardiff, CF99
1NA. The closing date for responses is Monday 24 July 2006
