Cancer Reform Strategy - First Annual Report - Merseyside ...

CHAPTER 4: ENSURINg BETTER TREATMENT29• ensuring appraisals undertaken by NICEare more timely. Action is already beingundertaken on this (see paragraphs 4.37-4.39above).• promoting more flexible approaches to thepricing of new drugs. This has recently beenagreed with the pharmaceutical industry aspart of the Pharmaceutical Price RegulationScheme (PPRS).• broadening the cost effectiveness criteriaused by NICE in the appraisal of drugs usednear the end of life.• investigating the extent and causes ofinternational variations in drug usage.4.43 Although these measures should improveaccess to cancer medicines very considerably,there are limits to what the NHS can reasonablybe expected to pay. However, in response to theRichards Review the government has made itclear that no patient will lose their entitlementto NHS care they would otherwise have received,simply because they opt to purchase additionaltreatment for their condition.4.44 The draft guidance from the DH setsout how this will be achieved by deliveringprivately funded care and NHS care separately.Alongside this, commitments have been madeto ensure that written information is alwaysavailable, giving patients a balanced view of thebenefits, potential toxicities and likely costs ofnew treatments. The DH will also commission atraining programme for clinicians to enhance thequality of discussion about these difficult issues.A national audit of the use of unfunded drugswill also be commissioned.Quality and safety of chemotherapyservices4.45 During the course of 2008 concerns aboutthe quality and safety of chemotherapy serviceshave been raised from three different angles.First, the National Patient Safety Agency (NPSA)issued a Rapid Response Report in January 2008relating to the risks of incorrect dosing of oralanti-cancer medicines. Second, the nationaloverview report of the cancer peer reviewprogramme (2004-2007) highlighted variationsin compliance with the chemotherapy measuresset out in the Manual for Cancer Services (2004).Third, the National Confidential Enquiry intoPatient outcome and Death (NCEPoD) publisheda report For better or worse in November 2008which reviewed the care of patients who diedwithin 30 days of receiving systemic anti-cancertherapy.4.46 Taken together these reports highlight theneed for urgent action to improve the qualityand safety of chemotherapy services. In responseto these concerns draft guidance from theNational Chemotherapy Advisory group (NCAg)was published by the DH in November 2008,alongside the NCEPoD report. This guidance isopen for consultation until 4 February 2009.4.47 The draft NCAg report ChemotherapyServices in England: Ensuring quality and safetysets out proposals for the actions that will berequired at each step in the chemotherapy carepathway:• referral, assessment and decision to treat• prescribing, verification and dispensing• delivery• information, education, support and advice• urgent assessment and management ofcomplications• knowledge and recording of toxicity• end of treatment record and subsequent careplan.4.48 The draft NCAg report draws particularattention to the need for improvements inacute services for cancer patients, includingthose receiving chemotherapy. Patients may be