National Assembly for Wales
Health and Social Services Committee
Review of Cancer Services for the People of Wales
| Name of respondent: Catherine O’Brien |
| Are you responding on behalf of an organisation? Yes |
| If so please give the name Welsh Executive of the Royal Pharmaceutical Society of Great Britain |
| Address: Gloucester House, 14 Mount Stuart Sq, Cardiff, CF 10 5DP |
| Telephone number:029 2041 2800 |
| 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 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 | We strongly support the development of a single patient record with appropriate read and write access to all professionals involved in the care of patients. Medicines are an essential element of patient care irrespective of the care setting. The inclusion of a full electronic medication record is vital for health professionals to support a patient’s holistic health needs, as patients suffering from cancer often have complex medication regimes and need support for self care for medication related or unrelated minor ailments. Community and hospital pharmacists should be included when planning for integration of information technology for healthcare as they can often provide useful information on a patient’s medication history, and by receiving information on medication changes they are able to plan and thus help elevate any potential supply problem when switching care settings. |
| 2 | How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this? |
| Response | There is a need for effective support for dissemination of information on good practice through clinical networks, supported by audit to measure improvement in practice. Within pharmacy there are opportunities for research and service development projects but often the heavy workload faced by most healthcare practitioners provides a barrier. When work is undertaken many fail to record and publish their findings to enable their experience to be shared. |
| 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 | Commissioning of cancer services in Wales appears overly complex. By the nature of the commissioning process Trusts that provide cancer services have to negotiate with all 22 Local Health Boards and Health Commission Wales, this process is bureaucratic and time consuming for all parties concerned. Additionally LHBs have a responsibility to ensure that services provided by Trusts are clinically and cost effective but within individual 22 LHBs there is often a lack of expertise to evaluate specialist services. To maximise the use of available expertise regional consortia or an all Wales commissioning service should be considered with responsibility to ensure a clinically and cost effectiveness service delivered. |
| 4 | What evidence is there of the value of screening and immunisation? |
| Response | Screening programmes for cancers in Wales have proved significant in identifying cancers and potential cancers early, thereby improving the likely outcome for patients. Further investment in screening for a broader range of cancers should be considered. Immunisation against viruses associated with certain cancers, such as Human papilloma virus and cervical cancer will become a potential significant step in the coming years. Careful consideration of the managed application of these new vaccines must be undertaken and coordinated. |
| 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 | The Welsh Executive recognises that recent advances in diagnostics and cancer treatments have placed additional burdens on the cancer services in terms of acquisition costs and manpower needs. It is however paramount to patients and pharmacists, who are often called on to advise patients on their medications, or on information they have gained via the media or internet, that these advances are appraised in a timely manner. A published timetable of appraisals and process to fast track appraisals will help minimise the anguish caused to patients and allow the NHS in Wales to deliver the World Class Health Service promised to its patients. Additionally positive appraisals should be supported by inclusion of workforce and capacity issues of service deliver to avoid any delays in patient’s receiving the new service or treatment.Whilst we recognise and accept the climate of conflicting priorities within the NHS, we feel that due consideration must be given to engagement with the public and professionals in managing expectations for new treatments and technologies, through communication of decisions in an open and understandable format. |
| 6 | How can the NHS and the voluntary sector work together more effectively to deliver services? |
| Response | The voluntary sector provides a valuable service to patients and healthcare professionals looking after people with cancer. Further encouragement and support to joint working and their engagement should be given. |
| 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 | In order for the pharmacy profession to support the needs of terminally ill patients and their families’ information sharing across the care setting is paramount. At present community pharmacy is excluded from information sharing via care pathways, but receives information via the patient or family. The contractual requirement for GP’s to hold a palliative care register and discuss this register with a multidisciplinary team is encouraging. However the information pertinent to medication should be shared with a patient designated pharmacy and the practice should be encouraged to liaise and include the patients designated pharmacy within the multidisciplinary team. Patients, carers and all health professionals should be consulted on palliative care service provision and best practice shared across Wales. |
| 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 | Better use could be made of pharmacists expertise in medicines. All Cancer Networks should have access to dedicated pharmaceutical advice. A specialist network pharmacist would be available to offer medicine management advice, be aware of new treatment appraisals and support the development, audit and dissemination of clinical guidelines. The utilisation of independent and supplementary prescribing by pharmacists is another development which can support improved use of medicines. Pharmacist in both secondary care and community settings are successfully carrying out patient centred medication reviews, highlighting compliance problems and inappropriate prescribing. There is scope to develop these services. Pharmaceutical advisors based in LHB’s now providing GPs with evidence based advice on prescribing and cost effectiveness of drugs. The compliance to this advice can be audited via prescribing data and reduce the knock on effect in other care settings. |
| 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 | It should be borne in mind that providing a drug treatment to a patient involves prescribing, dispensing and usually administration, plus associated costs of any required laboratory tests, and extra out-patient attendances. It is therefore difficult to separate the cost of purchasing a drug from the manufacture at a negotiated rate with other sundry costs and splitting these costs between NHS and Private would need careful consideration and calculation. We feel that cancer drugs cannot be taken in isolation when considering this question and any debate on resources and the potential rationing of access to some therapies should be had in an open forum with the people of Wales and not taking in isolation depending on the diagnosed condition , the debate should consider · Can patients mix and match NHS and private care, or should they have to choose between entirely NHS or entirely private care· Patients have already paid for their NHS care through their taxes, and if they want something extra why shouldn’t they pay for it privately or through health insurance? · Other UK health services are successfully provided through mixing private and NHS care, notably dentistry and optical services, pharmacy. It would be unfair to penalize cancer patients by denying them access to NHS care if they purchase some care privately, particularly as cancer care is very expensive.· Experience of other European countries |
| 8(iii) | Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response | The expansion of health evidence sites on HOWIS and the development of the e Library for Wales have improved information available to health professionals. However continued support for these initiatives must be forthcoming with the availability of on line evidence based prescribing through a user friendly portal being of paramount importance to met the demands of the profession. This must be available to professionals in all care settings. |
| 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 has been some improvement in patient- centred services and this improvement should be encouraged through constructive feed back from service users. A mechanism to allow patients to share their experiences and evaluate circumspectively the service they have received would be useful. Additionally the sharing of good practice across Wales should be the norm. |
