Cancer Campaigning Group

Department of Health confirms it will repeat National Cancer Experience Survey

The Department of Health has confirmed that it will be repeating the National Cancer Patient Experience Survey for 2011.  Professor Sir Mike Richards says that this will enable the Department to "identify and build on progress that has already been made and target [its] efforts to continue to improve patients’ experience of NHS cancer care."

The survey will cover all acute and specialist NHS trusts in England that provide adult acute cancer services.  Recently admitted adult patients with a primary diagnosis of cancer will be included, and all cancer types will be included.  The 2011 survey will largely replicate the 2010 survey methodology and questionnaire which was developed by experts in patient experience surveys and cancer patients’ experiences.

Results are due to be published at a national and Trust level in July 2012.  The letter from Professor Sir Mike Richards to Trust Chief Executives outlining the survey is available here.

Government publishes its response to value-based pricing consultation

The Government's response to the consultation on proposals for a new value-based system of pricing medicines has been published.  You can download the response here.  (You can also read the original CCG news story about the launch of the consultation here.)

In its response, the Government acknowledges that plans are at any early stage and that they have yet to make any final decisions of the workings of the value-based pricing system.  The Government confirms that it intends to continue to engage with stakeholders as it develops its proposals.  It is clear that there will be further opportunities to contribute to shaping the new system.

The key points from the Government’s response include:

• The vast majority of branded medicines already on the market before 2014 will be covered by the successor arrangements to the current Pharmaceutical Price Regulation Scheme.  However there is a possibility that a small number of existing drugs may be assessed under value-based pricing on a case-by-case basis.  Potential candidates might include: major new indications for existing drugs; drugs considered but not recommended by NICE; some drugs funded through the Cancer Drugs Fund; and drugs recommended by NICE where current guidance is due for review
• No final decision has been made on the best way to deliver improved and sustainable patient access for clinically effective medicines for the rarest conditions.  The Department of Health is determined to design a value-based pricing system in a way that minimises the need for parallel mechanisms, however it acknowledges there may be instances where it is sensible to conclude that an individual medicine should not be assessed under value-based pricing
• The Department of Health is planning a programme of research that will enable it to determine weightings that accurately reflect the full value of new products to society.  The resulting weightings and methodologies for calculating prices will be published in full so that patient groups, companies and other stakeholders can have a complete understanding of the price to be expected for products that meet society’s needs
• The Government is considering whether it would be sensible to assess some Cancer Drugs Fund drugs under the value-based pricing arrangements, with the aim of identifying a price level at which they could be made available on a continuing basis to NHS patients who may benefit from them when the Fund comes to an end in 2014
• The Government argue that it is important that there is a common medicines pricing policy across the UK and they expect value-based pricing to be a UK-wide system.  However, the Devolved Administrations determine many aspects of health policy, including those affecting the use and availability of medicines within their health systems.  The Department of Health will work closely with its counterparts in the health departments of the Devolved Administrations to ensure a coherent approach

Follow the CCG and its members on Twitter

The Cancer Campaigning Group is now on Twitter.  You can follow us @_ccg to get news from the cancer community and find out about our work.

Many of the Cancer Campaigning Group's fifty members are also on Twitter.  You can find them and keep up to date with their work here: http://twitter.com/#!/_CCG/ccg-members

DH set focus for early diagnosis campaigns

 Jane Allberry, Deputy Director Cancer, Cardiovascular, End of Life Care and Dermatology at the Department for Health, today wrote a letter to the Chief Executives of all PCTs and Cancer Networks.

The letter seeks bids for Department of Health funding to run local pilot campaigns to promote cancer symptom awareness and early presentation to the GP of those with persistent symptoms which could be cancer. 

 This year, the DH want to trial local activity:

• to achieve earlier diagnosis of people with oesophagogastric cancer, which is the next cancer in terms of the largest number of deaths that could be avoided each year

• about taking action on "blood in urine"- the symptom common to kidney and bladder cancers

• to target women over the age of 70 who might have symptoms of breast cancer, given this is an area where survival rates are particularly poor

 All applications to bid must be received by 4 August 2011.  The application form is attached to the letter.

You can read the letter here

Cancer Campaigning Group responds to Government changes to the Health and Social Care Bill

The Cancer Campaigning Group is pleased to see that the NHS Future Forum and the Government have listened to the concerns of the cancer community and recognised the important role clinical networks will play in planning and delivering cancer services that improve the experiences and outcomes of cancer patients.

The Cancer Campaigning Group’s recent report, Ensuring effective commissioning of cancer services, revealed that the majority of GPs surveyed wanted support to commission cancer services effectively.  We hope the commitment from Government to embed and strengthen clinical networks, alongside its recent announcement that cancer networks will be funded until 2012/13, will mean that clinical commissioning groups get the support they need.  For this to happen it will be important that a guarantee is made that networks will be resourced in the longer term.

We are also delighted that the Government proposes to increase patient and public accountability in the NHS.   It will be vital for commissioners to be supported to ensure they involve all of the communities they represent in the development of their plans.

These changes cannot be the end of the discussion on the NHS reforms, and we hope that the Government, NHS Commissioning Board and Future Forum will continue to engage with cancer charities and patients on the reforms, and what they will mean for patient outcomes.

Cancer Campaigning Group Steering Group member, Sarah Cant said:

“The CCG is reassured that the Future Forum and Government has identified the important role clinical networks will play in planning and delivering high quality, joined-up cancer services.

We are keen to work closely with the NHS Commissioning Board as the role of these networks is defined. This must happen quickly – to ensure that the vital expertise currently held in cancer networks is not lost and that the outcomes and experiences of patients are not adversely affected.”

Government responds to Future Forum report

Following yesterday’s Future Forum report the Government has released its initial response.

As expected, the statement notes that: “The Government has accepted the core recommendations of the report from the NHS Future Forum and will now make improvements to its modernisation plans. A document listing these improvements has been placed in the Library and we will provide more detail on exactly how we plan to implement these changes, including amendments to the Health and Social Care Bill, shortly.” The statement also confirms that relevant parts of the Bill will be recommitted to a Public Bill Committee for further scrutiny.

The recommendations accepted by the Government are:

NHS Constitution

• The NHS Commissioning Board and commissioning consortia will be required to take active steps to promote the NHS Constitution
• The Government commit to uphold all of the patient rights in the NHS Constitution, including the right to drugs and treatments recommended by NICE, which will be retained retain after the introduction of value-based pricing for new drugs from January 2014

The role of the Secretary of State

• The Government will make clear that the Secretary of State will retain ultimate accountability for securing the provision of services, though rather than securing services directly, the Secretary of State will be exercising his duty in future through his relationship with the NHS bodies to be established through the Bill, e.g. the NHS Commissioning Board by way of the “mandate”

Clinical Commissioning Groups

• Commissioning consortia will continue to be groups of GP practices, but the government will make a number of changes to provide greater assurance that commissioning will involve patients, carers and the public and a wide range of doctors, nurses and other health and care professionals. These local NHS organisations will be called ‘clinical commissioning groups’.
• Clinical commissioning groups will have a duty to promote integrated health and social care around the needs of users
• Clinical commissioning groups will have flexibility to work in partnership when commissioning services, for example with other groups, local authorities and the NHS Commissioning Board. But as public bodies, they will be unable to delegate their statutory responsibility for commissioning decisions to private companies or contractors

Governance and Accountability for Commissioning Groups

• The authorisation process for clinical commissioning groups will ensure that they have robust governance requirements consistent with Nolan principles and are accountable and transparent. This will not be a one-off test: the NHS Commissioning Board will hold commissioning groups to account for this on an ongoing basis
• The Government commit to revising the provisions in the Bill on the quality premium following the concerns raised: “We will make clear that its purpose is to reward clinical commissioning groups that commission effectively and so improve the quality of patient care and the outcomes this leads to, including reducing inequalities in health outcomes.”

Timetable for establishing a new commissioning system

• The Government’s response confirms that Primary Care Trusts will cease to exist in April 2013. However, clinical commissioning groups will not be authorised to take on any part of the commissioning budget in their local area until they are ready and willing to do so
• Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS Commissioning Board will commission on its behalf, and in this role will be subject to the same duties of transparency and engagement. All groups will have the right to take on full responsibility, once they have demonstrated they are ready

Wider clinical involvement and advice

• The Government commits to  retain and strengthen the clinical networks of experts, including patient and carer representatives, that exist in areas like cancer care, so that they cover many more areas of specialist care. The Government will give networks a stronger role in commissioning, in support of the NHS Commissioning Board and local clinical commissioning groups
• The Government commit to enable doctors, nurses and other professionals to come together in “clinical senates” to give expert advice, which they expect clinical commissioning groups to follow, on how to make patient care fit together in each area of the country. To support the better integration of services, these should include public health specialists and adult and child social care experts. Clinical senates will have a formal role in the authorisation of clinical commissioning groups. Both clinical networks and clinical senates will be hosted by the NHS Commissioning Board

Research

• The Bill will create a new duty for the Secretary of State to promote research, and a new duty for clinical commissioning groups to promote research and innovation and the use of research evidence

Health and wellbeing boards and local authorities

• The Bill will give health and wellbeing boards a new duty to involve users and the public
• HWBs will have a stronger role in promoting joint commissioning and integrated provision between health, public health and social care

HealthWatch

• There will be a new requirement for the Care Quality Commission to respond to advice from its HealthWatch England subcommittee. The Secretary of State will be required to consult HealthWatch England on the mandate to the NHS Commissioning Board
• The Government will add an explicit requirement that local HealthWatch membership is representative of different users, including carers

Patient and Public Involvement

• Monitor will have a new duty to carry out appropriate public and patient involvement in the exercise of its functions
• The Government commit to further clarify the duties on the NHS Commissioning Board and clinical commissioning groups to involve patients, carers and the public in commissioning decisions and will require commissioning groups to consult on their annual commissioning plans to ensure proper opportunities for public input. They will have to involve the public on any changes that affect patient services, not just those with a “significant” impact

Patient Choice

• The Government commits to amend the Bill to strengthen and emphasise commissioners’ duty to promote choice
• The Government will maintain its commitment to extending patients’ choice of “Any Qualified Provider”, “but we will do this in a much more phased way, and will delay starting until April 2012. Choice of Any Qualified Provider will be limited to services covered by national or local tariff pricing, to ensure competition is based on quality. We will focus on the services where patients say they want more choice, for example starting with selected community services, rather than seeking blanket coverage”

Competition

• Monitor’s core duty will be to protect and promote patients’ interests
• The Bill will remove Monitor’s powers to “promote” competition as if it were an end in itself. “Monitor will be limited to tackling specific abuses and unjustifiable restrictions that demonstrably act against patients’ interests, to ensure a level playing field between providers. Monitor will be required to support the delivery of integrated services for patients where this would improve quality of care for patients or improve efficiency”
• The NHS Commissioning Board, in consultation with Monitor, will set out guidance on how choice and competition should be applied to particular services, guided by the mandate set by Ministers. This includes guidance on how services should be bundled or integrated
• The Government will narrow Monitor’s powers over anti-competitive purchasing behaviour so that these are more proportionate and focus on preventing abuses rather than promoting competition

Future Forum report published

The NHS Future Forum published its recommendations to the Government on the proposed reforms to the NHS in England this afternoon.  At the launch of the report, Professor Steve Field, Chair of the NHS Future Forum Professor Steve Field recommended a number of changes to the Health and Social Care Bill.

The recommendations are covered in four separate reports, each aligned to the separate working groups on:

• choice and competition
• clinical advice and leadership
• education and training
• patient involvement and public accountability

As predicted, the report recommends the diluting the role of competition within the NHS.  Prof Field said that  “there is a place for competition but only to support choice, promoting integration and improving quality.  The role of Monitor to promote competition must be removed and in its place a duty to support choice, collaboration and integration.”

On the 2013 deadline for GP commissioning, Prof Field said that “this will not be a black and white cut off point.  But there should not be an opt out choice for consortia – the NHS Commissioning Board should encourage and process consortia applications as close to the date as possible.”

When questioned on whether changing the role of Monitor from economic regulator to sector regulator would make any practical difference, Stephen Bubb stated that “the language used about the regulator has been unfortunate and if we did it all again it would be done differently.  Through the choice mandate the primary purpose of the regulators – Monitor, NHS Commissioning Board and consortia - will be to drive choice over competition.”

The Forum makes a number of recommendations, which are detailed below.  Of particular interest is the recommendation that clinical networks, such as those for cancer, are “supported and embedded at all levels of the system.”  In order to ensure multi-professional involvement in commissioning the working group recommended:

• Strengthening current duties in the Bill on consortia and the NHS Commissioning Board to seek appropriate advice in taking on board multi-professional views in commissioning
• Embedding clinical and professional networks in the new system architecture, including further work on what these should be.

New report on cancer survival rates in England published

The King’s Fund has published the report How to improve cancer survival, which focuses on England’s relatively poor survival rates in comparison to other countries.

The report notes that cancer survival rates in England are improving overall, but that it is still lagging behind countries such as Canada, Australia, Sweden and Norway.  It shows that although England may be closing the gap in breast cancer, the gap has not narrowed for bowel or ovarian cancer, and perhaps most worryingly, has widened slightly for lung cancer.

The report highlights that a range of factors explain this gap, including delays in diagnosis and treatment and treatment variation and co-morbidity, particularly in older people.  It found that pensioners tend to be diagnosed with the disease later and are less likely to receive surgery.  In fact, the King’s Fund estimate that around 15,000 people over 75 in Britain die prematurely from cancer each year.

The report contains a number of conclusions about how the NHS can improve survival rates.  These include:

• NHS and public health need to work together to diagnose more cancers at an earlier stage
• GPs need to use information about their referral rates and use of diagnostics to understand how their performance compares with others
• Reducing variation in access to major surgery for cancer is needed, as is understanding and addressing inequalities in the management of older people with cancer
• High-quality data collection, analysis and research remain important for monitoring progress and identifying which initiatives will be most effective at improving outcomes
• Over the long term, the health system can and should be held to account for cancer survival performance; however, other outcome and process indicators are needed to monitor current performance

The full report can be downloaded here.

New report on access to cancer treatments published

CCG steering group member, the Rarer Cancers Foundation, has published its report Funding Cancer Drugs: An evaluation of the impact of policies to improve access to cancer treatments.

The report looks at the progress that has been made in improving access to cancer treatment, with a particular focus on making exceptional case processes fairer, the introduction of the Cancer Drugs Fund, and allowing patients to purchase top ups without losing their entitlement to NHS care.

There are a number of key findings from the report, including:

• More than 2,500 cancer patients have benefited from the Cancer Drugs Fund between October 2010 and March 2011
• 187 patients were denied access to life-extending treatments between October 2010 and March 2011, despite the fact that £22.5 million was not spent by the end of March 2011
• The Cancer Drugs Fund is enabling patients to access up to 34 treatments which otherwise would not have been routinely available on the NHS
• Patients with bowel, kidney and blood cancers have been amongst the most significant beneficiaries of the Cancer Drugs Fund

The report makes a number of recommendations on how policies can be further improved to ensure affordable and equitable access to high quality treatments, taking into account the reform agenda within the NHS.   The recommendations and the full report can be viewed here.

National Bowel Cancer Audit published

The report of the National Bowel Cancer Audit for England and Wales was published today.  The audit shows some promising improvements in patient care in the past two years, with 95% of cases being discussed at a multidisciplinary team (MDT) meeting, compared to 84% of cases in the 2009 report.  80% of cases were seen by a nurse specialist, which is a significant increase from 51% in the 2009 report.

The audit found that some form of surgical procedure was performed in 75% of cases and a major resection was undertaken in 60% of patients.  Urgent or emergency surgery was more common in colonic (27%) than rectal surgery (12%).  Overall post-operative mortality continued to fall but increased mortality rates were seen again in urgent and emergency cases as compared with elective or scheduled cases.

The report also makes the following recommendations:

• Trusts should continue to review their audit data and, using both this report and the recently distributed data completeness report, ensure that accurate and complete data is being submitted to the national audit
• MDTs should arrive at an accurate integrated staging of as many cases of bowel cancer as possible
• As laparoscopic techniques become more commonly employed, current NICE guidance of training should be encouraged
• As more comparative information becomes available to MDTs, from a variety of sources, there should be regular discussions at a local level to ensure that complete data is submitted to the audit and any perceived outlying status is investigated promptly. This may involve local audits, review of submitted data, and in depth analysis using case notes.

The full report is available here.

Data tables are available here.