The Cancer Drugs Funds (CDF) was a main topic of discussion at this week’s NHS England Board meeting, following the publication of a board paper on the issue earlier this week. The proposed new system for a new fund, aligned with adapted NICE processes and revisions to NICE’s End of Life criteria, includes:
- The CDF becoming a ‘managed access’ fund, with “clear entry and exit criteria”
- Where insufficient evidence exists for a drug that appears promising, and additional evidence would support a more informed NICE appraisal, the drug would be given a ‘conditional approval’
- This drug would then be provided via the new fund for a defined period to collected evidence from ‘real world’ use
- At the end of this process, through an abbreviated NICE process, the drug would either receive a NICE positive recommendation (and move into mainstream commissioning) or receive a NICE negative recommendation (and be removed from the new fund)
- The fund will be capped at £300 million
NHS England will be consulting on this process by September 2015 at the latest to allow the new fund to become operational from 1 April 2016.
This paper was discussed at NHS England’s board meeting, at which it was noted that charities have played, and continue to play, a vital role in the development of a sustainable replacement for the CDF. The board also noted the expanded role of NICE in the new fund to ensure that value is increased from the drugs on the CDF, and the board added that NICE reform will need to be openly discussed with stakeholders.
The Independent Cancer Taskforce has published its report, Achieving World Class Cancer Outcomes: A Strategy for the NHS 2015-2020. The strategy sets six strategic priorities for the next five years to improve the outcomes that the NHS delivers for people affected by cancer:
- Make the necessary investments required to deliver a modern high quality service
- Spearhead a radical upgrade in prevention and public health
- Drive a national ambition to achieve earlier diagnosis
- Establish patient experience as being on a par with clinical effectiveness and safety
- Transform our approach to support people living with and beyond cancer
- Overhaul processes for commissioning, accountability and provision
The strategy also set out 96 recommendations under nine headings, which make provisions for reducing the growth in the number of cancer cases, and driving improvements in survival, experiences of care treatment and support, quality of life after treatment and at end of life, and the efficiency and effectiveness of delivery and implementation. The report itself estimates that the 96 recommendations made will cost an estimated £400m per annum, of which approximately £300m per annum may already be included within the NHS’s Five Year Forward View (FYFV) baseline projections (£13 billion by 2020/21, from £6.7 billion in 2012/13).
The strategy was also discussed extensively at NHS England’s board meeting this week. Key points from the discussion are set out below:
- An emphasis was placed on prevention, with four in ten cancers identified as being preventable through improved lifestyle choices
- The gains of earlier diagnosis were identified as two-fold: preventing human suffering and cost savings. Late diagnosis costs, on average, four times as much as late diagnosis
- Patient experience must be a priority, defined by greater control and access to information, as well as improved care
- A recovery package and good end of life planning are crucial matters of compassion and decency
- This package will need to recognise the mental health implications of cancer survival, in particular for those over 65. Furthermore, the Cancer Taskforce will be shared with, and utilised by the Mental Health Taskforce in the coming months
- Cancer commissioning must be made clearer and simplified
- Providers must not cherry-pick recommendations, and must improve existing capacity and social link
- The ‘do nothing’ option currently costs £6.7 billion and is anticipated to rise to £13 billion in 2020, whereas implementing the strategy will cost between £700 million and £1,400 million per year, representing a significant cost-saving
- Implementation of the strategy is to be co-designed with those involved in the strategy’s development
- Geographical variation is a major issue – this was not overly addressed in the strategy and is an issue that NHS England still recognise
- Deep disappointment was expressed that this is the fourth cancer review and yet still very little granular and understandable public data is available. To address this, within a year, data will be made available according to geographic region, CCG, survival rates for types of cancer, staging of cancers and one year survival rates
NHS England anticipates publishing an implementation plan following the cancer strategy, taking into account the outcome of the comprehensive spending review in setting out how the recommendations made in the strategy will be responded to.
The National Cancer Intelligence Network (NCIN) has published mortality and incidence statistics for rarer and less common cancers. The report has shown that 47 per cent of all newly diagnosed cancers in England in 2013 were a rarer or less common cancer, accounting for 54 per cent of all cancer deaths. The report includes data from 2010-2013 on ovarian, cervical and haematological cancers, for which the number of incident cases and incidence per 100,000 population are recorded as well as mortality statistics.
The Times reported on the publication, quoting Juliet Bouverie, Director of Services and Influencing at Macmillan Cancer Support, as saying that these figures showed the “true burden” of being diagnosed with a rarer cancer in the UK, adding that people diagnosed with a rarer cancer are more likely to say they’ve had a poor experience during a stay in hospital and more likely to feel isolated because they know so little about their disease.”
A Cancer Research UK (CRUK) report into clinical cancer research has found that pressures on the NHS are reducing the ability of the health service to support cancer research. The report interviewed clinicians, nurses and administrators involved in clinical cancer research and showed that escalating demands on staff to deliver routine NHS services are affecting the amount of time that hospital staff are able to work on research. The report identifies four key challenges to clinical cancer research:
- The ability of staff to commit time to research, in the light of mounting service pressures
- The availability of keys skills and experience relevant to research within the workforce
- Financial pressures which undermine the robustness and continuity of the research infrastructure and draw close scrutiny on research costs
- The changing nature of clinical research
The report finds that the UK remains a world-leader in research with one in five cancer patients recruited to research studies and pockets of research excellence existing across the NHS, but also criticises NHS England for failing to show “decisive leadership” and "leaving the NHS without a clear vision for how to achieve its legal duty” to promote research. The report recommends that:
- Clinical research capacity is developed in a more distributive way based on a rigorous assessment of where capability is currently lacking
- Academic institutions and individual clinical academics become be more flexible in their attitude to joint enterprises and research partnerships
- NHS organisations go further to accommodate requests from staff for dedicated research time
NHS England has published Standard Operating Procedures (SOP) for the Cancer Drugs Fund (CDF) for 2015/16 and has launched a four-week consultation on proposed “substantive” changes to these SOP. The outcomes of five appeals from pharmaceutical companies against de-listing decisions made earlier in the year have also been announced. NHS England has launched a four-week consultation on the changes which are “substantive”, consulting on proposed changes to three specific sections of the SOP around the Quality of Life score (QoL), the definition of rarity for a treatment, and the process of challenging a decision made by the CDF panel.
Significantly, patient groups are now able to challenge decisions made by the CDF panel. These proposed changes are outlined within the consultation guidance document. The consultation will close on 18 June 2015.
David Cameron MP, Prime Minister, this week made a speech on the NHS in which he stated that that the Cancer Drugs Fund has now “given life-saving drugs to over 65,000 people”.
The quarterly Cancer Drugs Fund statistics were also published this week, meaning that full figures for 2014/15 are now available here.
This week, all political parties have published their manifestos ahead of the 2015 General Election, set to take place on Thursday 7 May. Details directly relating to cancer in each manifesto from the three major parties are outlined below, including Labour's stand-alone health manifesto.
- Continue investing in the Cancer Drugs Fund
- Work with the NHS, charities and patient groups to deliver the new strategy recommended by NHS England’s cancer taskforce
- Continue to support research to improve the diagnosis and treatment of rare diseases and cancers, including through the decoding of 100,000 whole genomes
- Create a Cancer Treatments Fund, granting access to the latest drugs and forms of radiotherapy and surgery
- Guarantee that any patient receiving a drug on the Cancer Drugs Fund will continue to be offered that drug in the Cancer Treatments Fund
- Publish a new cancer strategy within six months of forming a government, including a plan to tackle ageism in cancer treatment
- Guarantee a maximum one-week wait for cancer tests and results by 2020, to reach a goal of a one-week maximum wait for all urgent diagnostic tests by 2025
- Roll out the Bowel Scope Screening programme to the whole country
- Ask the National Screening Committee to make recommendations on whether a new ovarian cancer screening programme should be introduced
The Labour manifesto on health and care can be seen here.
- Set ambitious goals to improve outcomes for the most serious life-threatening diseases like cancer
- Set clear goals for earlier diagnosis and improved aftercare for conditions like cancer
- Support effective public awareness campaigns like Be Clear on Cancer, working closely with charities to raise awareness of the signs and symptoms of killer diseases
Lord Hunt of Kings Heath, Shadow Health Minister, led a short debate in the House of Commons on the removal of drugs from the Cancer Drugs Fund (CDF), focusing on why the public cannot appeal against the decisions that have been made.
In the debate, Lord Hunt stated that NHS England should have considered the view of patients and patient groups when deciding what treatments were going to be removed from the Fund. He added that the National Institute for Health and Care Excellence (NICE) was able to consult with patients at each stage of its appraisals process, and suggested that NHS England was being influenced by its own budgetary constraints. Earl Howe, Parliamentary Under-Secretary of State for Quality, responded that patients who are currently receiving medicines that were available through the CDF prior to the removal of drugs from the Fund will continue to receive them. He added that no treatment would be removed from the CDF if it was the only treatment available to patients.
Earl Howe also spoke about the working party that is considering how to strengthen the CDF decision-making process, that brings together NHS England, patient groups, charities and the Association of the British Pharmaceutical Industry (ABPI). He defended the process by which NHS England removed drugs from the Fund, stating that clinical input was vital and that patient groups or third parties not involved in the application process would not have been in a position to make a judgement about whether due process had been followed. This followed comments from Baroness Brinton, President of the Liberal Democrats, who said that patient advocates should be able to appeal de-listing decisions and present evidence to NHS England.
On health, the Chancellor announced:
- A new Health North initiative, which will see major teaching hospitals and universities work together to enable better care and promote innovation. In the Budget report it is stated that the government is exploring taking the “next steps on” from the Better Care Fund to continue to join up services for people with health and social care needs
- That the government is exploring options to integrate spending around vulnerable groups of people. The aim of this is to improve cost effectiveness, including through the continuation of joining up services for people with health and social care needs
Following on from NHS England’s recent announcement of a cancer taskforce to develop a five-year action plan for cancer services in line with the vision set out in theFive-Year Forward View (5YFV), the taskforce is now taking evidence on the following issues:
- The three commitments that you would like to see in a new cancer strategy that would significantly improve cancer services for patients/the health of the public, referencing any relevant evidence and costing information
- Examples of good practice in cancer services that you would like to see replicated across the country
- The biggest barrier to improving cancer services
Cancer Campaigning Group Steering Group met recently and has agreed to share the Shifting Gears report, produced by the Cancer Campaigning Group in 2014, with the Taskforce. If you would like to participate in the call to evidence, please send your responses to the above questions to email@example.com by Friday 27th February 2015.
The Public Accounts Committee held an evidence session this Wednesday on cancer services. Witnesses included:
- Sarah Woolnough, Executive Director of Policy and Information, Cancer Research UK
- Juliet Bouverie, Director of Services and Influencing, Macmillan Cancer Support
- Una O’Brien, Permanent Secretary, Department of Health
- Simon Stevens, Chief Executive, NHS England
- Sean Duffy, National Clinical Director for Cancer, NHS England
- Jane Allberry, Deputy Director, NHS Clinical Services, Department of Health
- Professor John Newton, Chief Knowledge Officer, Public Health England
- Sir Andrew Dillon, Chief Executive, National Institute for Health and Care Excellence (NICE)
The session covered a range of topics related to cancer services, including: commissioning; the Cancer Drugs Fund; access to treatment for older people; late diagnosis; the role of data; variation in meeting targets; radiotherapy; and national leadership in cancer. Of particular interest:
- Mr Stevens and Sir Andrew agreed that real world data should be collected via the CDF
- Mr Duffy, Mr Stevens and Ms O’Brien highlighted the need to understand older people’s attitudes towards cancer, treatment and surgery
- There was agreement that early diagnosis could be improved by improving public information, training GPs to ensure they are referring patients sooner, and developing the diagnostic workforce
- Mr Stevens admitted that poor access to data had affected decisions of resource allocation but added that England’s data systems are still better than most of Europe
- Ms Woolnough noted that as the population ages, comorbidity increases. This is compounded by unhealthy lifestyles. The revised National Cancer Strategy should therefore look at alcohol consumption, smoking cessation and improving diet
- Ms Bouverie added that the revised National Cancer Strategy needs to address the fact that more people are living with and beyond cancer, by supporting people with the consequences of treatment, encouraging them to keep active and educating people how to detect secondary occurrences of cancer
- Mr Duffy said that clinical reasons exist as to why there is variation in access to radiotherapy, for example it is only used to treat specific cancers and certain people may be unfit for treatment. He noted that the Clinical Reference Group for radiotherapy is working on improving usage networks and software developments
- Ms Woolnough and Ms Bouverie agreed that Mike Richard's leaving the position of Director for Reducing Premature Mortality at NHS England signalled a loss of national leadership and a “loss of momentum” in improving cancer services and outcomes
- Mr Stevens turned down the idea that a loss of momentum and fragmented infrastructure has led to worsening indicators, noting that survival rates and urgent referrals had increased. He said increased referrals had led to “diagnostic bottlenecks”