National Assembly for Wales
Health and social Services Committee
Review of Cancer Services for the People of Wales
| Name of respondent: Dr Anne Evans |
| Are you responding on behalf of an organisation? Yes |
| If so please give the name:Rhondda Cynon Taff and Merthyr Tydfil Palliative Care Network Rhondda Cynon Taff Local Health Board |
| Address:Unit 3 Cefn Coed Parc Nantgarw CF15 7QQ |
| Telephone number: 01443 824400 |
| Would you be willing to give oral evidence to the Committee?No |
| 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? |
| I am not content for my evidence to be published X |
| 1 | How can information technology be used more effectively to track and facilitate the patient’s journey? |
| Response | A single electronic record for both health and social care would be the ideal. This would fit with Unified Assessment and Care Management Policy. In the meantime ISCO is very helpful though cannot yet be accessed by everyone. |
| 2) | How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response | This is improving with wider access to internet and practitioners wish to keep themselves up to date. It is often only wider scale research which informs practice rather than local research. However, there are limited resources for research and we need to improve
links with Universities. The Last Days of Life Care Pathway is a good example of good practice being integrated with service delivery. |
| 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 | Currently this is complex and overly complicated. The patient really does not mind, and should not have mind, which organisation is responsible for which bit of their journey. Networks are the way forward, but with limited powers their abilities and subsequent
outcomes are limited. We need to develop strong working agreements with the proposed Regional Commissioning processes and the cancer networks. |
| 4 | What evidence is there of the value of screening and immunisation? |
| Response | While cancers are not infectious diseases, there are some cancers for which previous infection is a known risk factor. As these relationships are better understood and effective vaccines are developed it may be possible to prevent some cancers. The cost of such
programmes can be estimated on the basis of the cost of delivering each dose of vaccine multiplied by the number of individuals needing to be vaccinated to prevent 1 cancer. For many infectious diseases vaccination is once in a lifetime event which
means vaccination is often very cost effective. Screening
uses much more resource per individual screened. People at higher than average risk are screened using a relatively inexpensive test to identify those at particularly high risk who would benefit from more detailed testing so than the small proportion of them
who actually have cancer get treatment at an early stage. This can reduce cancer mortality if:
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| 5 | What are the barriers to the NHS Wales keeping abreast of, and responding to, developing technologies and therapies? How might these barriers be overcome? |
| Response | We need improved horizon scanning for new drugs and a faster All Wales response on the guidance for their use to avoid postcode prescribing. Improved handling of the media and ring fenced funding would also be helpful. Cancer Networks are ideal for disseminating best practice. |
| 6 | How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response | Locally we have good working relationships. There needs to be a clear commissioning strategy, service specifications. A transparent tendering process along with pooled budgets would help. Direct commissioning of the voluntary sector to deliver appropriate elements of the service would be a potential way forward. |
| 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 systems / programmes should be available in primary and secondary care to monitor this data. This should inform commissioning. Work needs to be done around patients choice and indeed whether they feel they have had it. We need to understand the barriers - improve intermediate care services and incorporate data collection and audit into nGMS contract / OOHs contractor information. |
| 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 | Education and communication with clinical staff is required. It should be part of the core clinical curriculum. LHBs and Trusts need to work collaboratively. |
| 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 | We should not single out cancer drugs in this debate. This is an ethical issue and needs a national debate eg who pays for the side effects of the drug? There should be an element of choice for parts of treatment. |
| 8(iii) | Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response | Depends what is meant by independent. NICE / Bro Taf Formulary advice is available, which is independent from drug companies. The Drugs and Therapeutics Bulletin is an excellent source of independent advice which has now been lost. This is a very real concern. |
| 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 | Service users are included in the Cancer Network Framework. The LHB has established Valley Fora. The Trust has PPI Groups See also section 7. |
