Nid yw’r dudalen ar gael yn y Gymraeg
National Assembly for Wales
Health and Social Services Committee
Review of Cancer Services for the People of Wales
| Name of respondent: Dr Richard Greville |
| Are you responding on behalf of an organisation? Yes |
| If so please give the name ABPI Cymru Wales and ABPI Cymru Wales Industry Group - Cancer SubGroup |
| Address:4th Floor, Caspian Point 2, Pierhead Street, Cardiff Bay, Cardiff, CF10 4DQ |
| Telephone number: 02920 454297 |
| 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 |
| 1 | How can information technology be used more effectively to track and facilitate the patient’s journey? |
| Response | Improved use of information technology has the potential to help deliver significant improvements by:
|
| 2 | How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response | Cancer networks have undertaken invaluable work in developing best practice and integrating research findings into mainstream patient care. However as highlighted by the National Audit Office Report, the networks do not have any statutory powers, making co-ordination and implementation a challenge. There is evidence to suggest that some trusts do not fully implement guidance given by network groups, resulting in variations in standards and levels of service. Translating research findings into standard practice remains a challenge. National standards for R&D should be established to ensure that all patients can benefit from research breakthroughs as soon as possible.The trials infrastructure in Wales e.g. Cancer Trials Network and Wales Cancer Institute should continue to be supported and further encouraged by WORD and the Welsh Assembly |
| 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 | Further clarity is needed as to the commissioning of services, and the important role of Health Commission Wales requires greater transparency. Although clinicians may wish to prescribe clinically effective medicines, shown to improve the quality and/or duration of life, there is confusion over whether these should be funded if NICE/AWMSG guidance is not available. Decisions about whether to fund treatments which have not yet been through the NICE/AWMSG process can be complicated by the number of different parties involved in the commissioning process. Funding mechanisms should be in place at a local level which allows the prescribing of a medicine in advance of a NICE/AWMSG decision and greater clarity in this respect would help patients and clinicians. There is also evidence to suggest that commissioners have not always followed NICE guidance, resulting in some patients being denied treatments which NICE has assessed as cost effective. We therefore believe that a regular audit of the uptake of NICE-approved medicines by Healthcare Inspectorate Wales would be beneficial, ensuring that areas of continuing weakness can be identified and addressed by local health boards and cancer networks.We also believe that all local health boards should appoint a cancer lead to champion the needs of oncology services and cancer patients, as well as co-ordinating commissioning activity.For all patients to receive the best possible standards of care, sufficient capacity needs to be available to administer appropriate treatments. This will be a particular challenge given the increasing levels of diagnosis of cancer and the elevated burden of treatment which has been caused by the development of new technologies which have made the disease more treatable. Health boards and cancer networks therefore need to work more closely together to accurately assess and forecast future capacity requirements. Such assessments should be based on predicted demand (taking into account changes in incidence, trends towards earlier diagnosis, development of new technologies and improving management of cancer) rather than current requirements. Innovative therapies also enable a better use of existing oncology capacity. For example orally administered therapies have the advantage of increasing patient convenience (they can be taken at home) and reducing the demands on hospital capacity (they do not require pharmacy time or intravenous delivery). Therefore as well as potentially improving patient quality of life, oral therapies can free up capacity to be used to deliver treatments which cannot be administered orally. We would welcome a recommendation from the Committee that clinicians actively engage patients in the medicine option process and encourage patient choice. |
| 4 | What evidence is there of the value of screening and immunisation? |
| Response | There is a significant amount of evidence to support that immunisation and screening are effective in preventing and offering early detection of disease. Programmes for breast and cervical cancer screening have been shown to result in substantial health benefits. |
| 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 | A number of barriers exist to the adoption of new technologies, including:
|
| 6 | How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response | The voluntary sector can offer a great deal of value to the NHS by:
|
| 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 | Electronic patient records present an opportunity to improve the quantity and quality of data recorded on the location of end of life care. Cancer networks should also be required to demonstrate that they have offered all patients a realistic choice about where they wish to be cared for. Once robust data on the choices and preferences of patients is available, it should be used to inform commissioning, ensuring that sufficient capacity is available to enable all patients access to suitable palliative care. |
| 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 | It should be the responsibility of the clinicians to ensure that patients in their care are given clinically effective medicines. Local Medicines and Therapeutics Committees can play an important role in ensuring that patients are not prescribed inappropriate or ineffective medicines and that, equally, they are given access to treatments which could be beneficial in terms of either survival or quality of life. For those cancer patients on long term medication, medicines utilisation reviews can play an important role in ensuring that they receive appropriate medication.We would also support the development of a medicines strategy by the AWMSG in relation to the health strategy and health improvement targets outlined in Designed for Life. |
| 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 | The primary objective should remain that all cancer patients would have access to all medications which are proven to be clinically and cost effective for their condition. All eligible patients should be given access to the best medicines, irrespective of their ability to pay. A two-tier health system already exists within the country with patients who are fortunate enough to have private insurance or indeed to live in the right postcode having access to treatment whilst others do not. Until this system is resolved, it is only right that patients should be able to utilise whatever resource is available to them to secure treatment including private funds. With high profile campaigns to offer insurance to cover cancer treatment, it is important that the NHS in Wales reflects the limitations of the current situation and puts the primary focus on patients receiving appropriate and timely treatment rather than the mechanism by which it is delivered. |
| 8(iii) | Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response | There are numerous sources of independent advice and guidance. However, different policies exist in different trusts and networks. There are all Wales advisory groups who are developing guidance but there is lack of consistency and rigour across all disciplines, and lack of ability to enforce patient pathways from the networks. There should be more collaboration across trusts and networks to ensure consistency and equity for all patients. Similarly NICE/AWMSG guidance should be promoted more proactively to health professionals, ensuring that they are aware of both positive and negative appraisals so as to inform prescribing decisions.There is also the need for the comprehensive monitoring of the adoption and implementation of NICE/AWMSG guidance. |
| 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 | Progress has been made towards developing patient-led services, although a great deal still needs to be done. As outlined above, patients and voluntary sector groups should be involved at a much earlier stage of policy development. Equally, greater emphasis needs to be placed on improving the patient experience. Work by the National Audit Office in England shows that cancer patients continue to report significant differences in their experience of care, depending upon which tumour they have developed and where they live in the country. If truly patient-centred services are to be developed, then monitoring and improving the cancer patient experience will be essential. We recommend that NHS Wales undertakes regular surveys of the cancer patient experience so as to achieve this |
