National Assembly for Wales
Health and Social Services Committee
Review of Cancer Services for the People of Wales
| Name of respondent: Dr Audrey Champion/ Nikki Foulkes |
| Are you responding on behalf of an organisation? Yes |
| If so please give the name: Conwy & Denbighshire NHS Trust. (North Wales Cancer Treatment Centre) |
| Address:North Wales Cancer Treatment Centre Sarn Lane Bodelwyddan Denbighshire LL18 5UJ |
| Telephone number: 01745 583910/ 445151 |
| 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 | · Process mapping to analyse the gaps · Electronic patient records.· Consistency of systems between health care providers eg integrating PACS (picture archiving systems for X rays) and chemotherapy software. |
| 2 | How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response | Through modernisation & redesign - research & good practice is being integrated. But the allowance of time & availability can hamper further integrated service delivery projects.Enormous progress has been made with the Wales Cancer Trials Network since 1998 with involvement of patients and clinicians in national (UK) multicentre clinical Trials. Infrastructure is now very strong, additional clinical costs as a consequence of trial involvement are not explicitly funded in Wales eg drug costs, cost of additional visits, nursing, medical and pharmacy support |
| 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 | · Streamline and clarify please· One hoop to jump through not several· A more standardised process, rather than several similar ones· Clarification of the roles of such bodies |
| 4 | What evidence is there of the value of screening and immunisation? |
| Response | The value of screening is in the earlier detection, diagnosis and treatment of cancers thus decreasing the potential of complications and increased costs for treatments in later stages - leading to a better quality of life for the patient and their family and an improved chance of cure. This is currently not a realistic and evidence based undertaking for some of the common cancers like lung cancer. Immunisation against cancer is not currently part of day to day medical care but may become so. |
| 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 | · Skills shortage, especially, radiographic (for radiotherapy) medical physics, pharmacy. This is not unique to Wales but is exaggerated by the developments in Cancer Services in England. The teaching of sciences at school is a major issue if we are to have enough future recruits into these professions Training of these professionals in Wales will help, but we need ways to ensure we retain them in Wales in an equitable way. · Physical capacity of current services, even relatively newly developed ones such as ourselves. The pace of change in cancer treatments is very rapid and is very demanding on human resources in time. That pace makes it very difficult to plan and indeed commission services. We are always playing "catch- up"· Recognition that solutions for services in south Wales with the M4 link and concentration of population does not necessarily work for patients in mid and north Wales. We have to work with north West England providers and training establishments eg no direct impact on north Wales with planned provision of PET scanning in Cardiff and the increase in radiotherapy radiography students in Cardiff.· Reconciling the demands for effective/ viable/ robust sub specialist working with the geography of the country. Inevitably needs more integration across networks and the IT referred to above. |
| 6 | How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response | · More openness and willingness to listen · Encouraging more involvement through forums to shape local services |
| 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 | Having the palliative care department utilising the CANISC database system - integrated with the PAS Database system.Identify where people die in order to be able to plot trends to redesign the service to ensure the gaps are covered |
| 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 | · More standardisation of available drugs and regimes - thus reducing the chance of prescribing inappropriately. Seeking clarification or 2nd opinion for exceptional cases· To have network protocols for the provision of uniformity in the prescribing of drugs· The converse is also an issue of inappropriately withholding drugs that are available, effective and licenced but not passed through the NICE assessment programme. · The ongoing funding of the drug itself and administration costs of the explosion of effective anti cancer drugs is a major issue. These welcome developments are becoming available for patients with the common cancers potentially affecting large numbers of patients whose disease may well become a chronic health problem rather than acute and lethal in a few months. Even without the new antibodies already over half of patients with advanced colorectal patients survive over 2 years whereas it used to be 6 months. |
| 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 | Patients should be able to have the drugs if they are willing to pay but, this should be carried out across the whole of that patients’ treatment process, from the first consultation through to the final discharge consultation and investigations performed. It is impractical and illogical to make an exception for this treatment. |
| 8(iii) | Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response | · All Wales Medicines Group and NICE decisions are circulated to relevant medical and pharmacy staff. The intranet is available to most staff. |
| 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 | · Absolutely, essential these days but inevitably there will need to be trade off with wishes of patients and realistic availability of staff and facilities and treatments.· We have had patient involvement with design of building/ design of services/ information leaflets/ appointment committees/ strategy/ network /feedback on staff performance but the patient representatives do need training to be really effective. |
