National Assembly for Wales
Health and Social Services Committee
Review of Cancer Services for the People of Wales
| Name of respondent: Jacqui Goom |
| Are you responding on behalf of an organisation? Yes |
| If so please give the name Roche Products Limited |
| Address: Hexagon Place. 6 Falcon Way, Shire Park. Welwyn Garden City. Hertfordshire. AL7 1TW |
| Telephone number: 01707 366000 |
| 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:
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| 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 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. Some trusts also refer patients to more than one cancer centre and this can be confusing for the patient if the practices differ. Translating research findings into standard practice remains a challenge, with many important discoveries being implemented at varying speeds. A recent and high profile example of this is the use of Herceptin (trastuzumab) to treat patients with early stage HER2-positive breast cancer. Evidence suggests that, although some hospitals have routinely tested all patients diagnosed with breast cancer for HER2 status, others have been more reticent in rolling out HER2 testing.There is a clear case for the early setting of national standards to ensure that all patients can benefit from research breakthroughs as soon as possible. |
| 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 point at which Health Commission Wales starts and stops commissioning cancer services and where local health boards assume a role needs clearer definition. 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 guidance is not available. Decisions about whether to fund treatments which have not yet been through the NICE process can be complicated by the number of different parties involved in the commissioning process. Greater clarity in this respect would help patients and clinicians better understand why a particular funding decision has been made.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. Roche pioneered the tracking of the implementation of NICE guidance and this work has demonstrated that unacceptable variations in prescribing still remain. We therefore believe that a further audit of uptake of NICE-approved medicines 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, the development of new technologies and the increasing treatability of cancer) rather than current requirements. Opportunities also exist to make 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 the NHS in Wales switch patients to oral therapies wherever clinically appropriate and supported by the patient in order to free up capacity. |
| 4 | What evidence is there of the value of screening and immunisation? |
| Response | There is a great amount of evidence to support that screening is effective in preventing and offering early detection of disease. Programmes for breast and cervical cancer screening have been shown to result in significant health benefits and Roche fully supports them. We also welcome the decision to roll out bowel cancer screening in England (for 60-69 year olds, commencing in April 2006) and Scotland (for 50-74 year olds commencing in 2007). We consider that a national bowel cancer screening programme for Wales should be implemented without delay. We hope the Welsh Assembly Government will work with charities such as Beating Bowel Cancer, Bowel Cancer UK and Cancer Research UK to ensure the effective and rapid roll out of such a programme. |
| 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:
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| 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:
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| 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 to die in a setting of their preference. |
| 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. MDT meetings 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 patients receive appropriate medication. |
| 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 should 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. However there may still be circumstances where a patient is unable to gain access to all medications which may help their condition. In these circumstances, it seems unfair that patients who choose to pay for a treatment privately are also charged for other care which would otherwise be provided on the NHS. |
| 8(iii) | Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs? |
| Response | Different policies exist in different trusts and networks. There are all Wales advisory groups who are developing guidance but there is lack of consistency 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 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. |
| 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 |
