The NCAG Report: Delivering a World Class Chemotherapy Service

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• Prof Roger James, Previously: • Deputy Medical Director Maidstone and Tunbridge Wells NHS Trust • Medical Director Kent & Medway Cancer Network
• Tuesday 20 April 2010, 12:00-13:00
• CRI Lecture Theatre.

If you have a question about this talk, please contact Mala Jayasundera.

The NCAG Report: Delivering a World Class Chemotherapy Service

1. The National Chemotherapy Advisory Group August 2009 report ‘Chemotherapy Services in England: Ensuring quality and safety’ (NCAG report), like the previous NRAG report, is commissioning guidance. The term ‘crisis’ has not yet been applied to NHS chemotherapy service delivery, but NCAG highlighted two serious concerns for commissioners:

• Inadequate Safety (non-elective care):

> despite the previous iterative Peer Review Programme based on national chemotherapy standards

• Inadequate Reconfiguration (elective care):

> despite the release of the C-PORT capacity planning tool

2. Safety and reconfiguration are linked; any ‘over-stretched service’ (where demand exceeds capacity) is unsafe. The NCAG report identified an exponential growth in chemotherapy demand of at least 10% p.a. (four times the 2010 Retail Price Index) and this is expected to continue.

3. The NCAG Report was responding to additional concerns:

• From the safety (non-elective) perspective the 2008 NCEPOD Enquiry, For Better for Worse? indicated that

> large numbers of cancer patients are receiving chemotherapy towards the end of life

> this results in a previously neglected non-elective (emergency) burden of activity associated with palliative chemotherapy

> palliative chemotherapy towards the end of life is not always delivered appropriately

> very little in the way of demand management tools (2009 Demand Management: Institute for Innovation and Improvement) have been implemented.

• From the reconfiguration (elective) perspective (the 2006 End Stage Darzi Report: ‘Our health, our care, our say’ and the DoH framework 2008 Delivering Care Closer to Home)

> provider capacity planning, infrastructure planning and business planning had been neglected relative to drug acquisition and procurement

> the shift of chemotherapy from the cancer Centre to cancer Units had been implemented in a patchy and unco-ordinated way.

4. What are the remedies? This talk explores the following questions: What are expected future trends? Is biological/oral chemotherapy likely to increase relative to IV? Are current care pathways for delivery appropriate? Can ‘acute oncology’ be linked into the Royal College of Physicians 2009 RCP Recommendations: Strengthening the medical ‘take’? Can we improve the production of adequate business cases for NICE -approved drugs? Are lessons from radiotherapy services (QUART, electronic prescribing and monitoring, national radiographer and physicist competency frameworks) relevant? Can all these individual projects be linked into a programme that fulfils the commissioning aspirations of NCAG ?

This talk is part of the Cambridge Oncology Seminar Series series.

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