Cancer policy Colorectal cancer session

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Cancer policyColorectal cancer session

• DKD Smyth
• Lecturer-Practitioner in Cancer
• Palliative Care

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What do you need to help you to achieve ideal
cancer nursing care?
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Aim of session learning outcomes

• To provide an overview of the historical
  current national and local developments, and
  future direction, over the next 5 years

• To develop our understanding of the important
  policy decisions and documents and likely
  developments over the next 5 years
• To be able to articulate, discuss and contribute
  to likely developments locally over the next 5
  years.

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What is policy?
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What is policy?

• Levin (1997)
• A stated intention
• A current or past action
• An organisational practice
• An indicator of formal or claimed status of a
  past, present or proposed course of action

• Clark Seymour (1998)
• Legislation
• Decisions about public expenditure
• Organisational structuring and management
  activities

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What do you think influences politicians, policy
and other policy makers?
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Analysing issues in National Health Policy

• Personal and social impact of disease
• New technologies
• Diagnostic, treatment, supportive
• Information communication technology
• Consumerism
• Public expectations
• Media interest
• Professional issues
• Political philosophy, ideas, zeitgeist

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Which policies and guidelines are you aware of,
and what were their key messages?
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National picture from 1995 Political Social
Influences on healthcare policy papers

• The New NHS Modern Dependable
• A First Class Service Quality in the New NHS
• NHS National Performance Framework
• Saving lives Our Healthier Nation
• NHS National Plan
• National Cancer Plan
• Nursing Contribution to Cancer Care
• Improving Outcomes
• National Cancer Information Strategy

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Expert Advisory Group Policy Framework for the
Commissioning of Cancer ServicesCalman-Hine
Report (DoH,1995)

• to create a network of care in England and Wales
  which will enable a patient, wherever he or she
  lives, to be sure that the treatment and care
  received is of a uniformly high standard

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Saving Lives Our Healthier Nation (DoH,1999)
How tough a target was it?

• In July 1999, the Government set the tough but
  attainable target to
• reduce the death
• rate from cancer
• among people under
• the age of 75 by at
• least one-fifth by 2010-
• saving up to 100 000 lives

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Cancer mortality
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Cancer mortality trends (m)
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Cancer mortality trends (f)
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Current Position

• Incidence increased by 1/3 in 30 years
• Mortality fell by 12
• Survival increasing gradually
• Men 36
• Women 49

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Within the policy document NHS National
Performance Framework (DoH, 1999) - What did I
want to see standards for, and improvements in?
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NHS National Performance Framework 1999

• Standards for
• Health improvement
• Fair access to services
• Effective delivery of appropriate healthcare
• Improved efficiency
• Improved patient / carer experience
• Improved health outcomes

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Whos going to set these standards? How will they
be delivered? Whos going to monitor them?
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Promoting quality in the NHS

• Standards set by
• NICE the NSFs
• Delivered via
• Clinical Governance, CPD, Lifelong Learning and
  Professional Self-Regulation
• Monitored through
• Commission for Health Audit Improvement (CHI)

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NHS Cancer Plan

• Clinical networks
• IOG / Cancer Standards
• Communication skills
• Named cancer leads
• Care pathways
• Multidisciplinary teamwork

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National Cancer director audit (2003)

• Not funding!
• Main barriers
• Shortages of specialist staff
• Conservative prescribing practices
• NHS bureaucracy

• Variations in the usage of cancer drugs approved
  by NICE

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Differences around England Mortality almost
twice as likely to die of cancer in Manchester as
Kensington
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NAO (2004)Tackling cancer in England saving
more lives

• Waiting times
• GPs have difficulty identifying patients most at
  risk
• Geographical variations
• access,
• quality,
• mortality

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Nursing Contribution to Cancer Care 2000

• Acknowledges nursing contribution to ensuring a
  coherent service
• Organisation, management, leadership quality
• Workforce planning
• Education, training CPD
• Recruitment retention

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Professional considerations

• Context
• Service needs
• Nursing roles qualifications!
• Cancer nursing education
• Leadership and management
• RD

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Service developmentsModernisation agency

• Cancer Services Collaborative (CSC) projects -
  now known as Cancer Service Improvement (CSI).
• Inclusion of the Gold Standard work developed
  by Dr Keri Thomas.
• delivering out of hours services in the community
  setting for those with palliative care needs
• Top tips

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Implementation of policy change in the NHS the
challenges

• Scope and ambition
• Identifiable elements sufficient guidance?
• Joined up policy welcome but difficult to put
  into practice?
• Evidence base?
• Transforming a culture?
• Staff involved and committed
• Supported from management
• Direct relevance to practice
• Timing too much too quick?
• Human financial resource requirements
• Sufficient staff with the right skills?
• Financial resources

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Cancer care - the next 5 years?

• We remain unconvinced that PCTs are the most
  appropriate organisations for commissioning
  cancer services
• All Party Parliamentary Group on Cancer, (Nov
  2004)

• Demographic changes
• Different ethical issues
• Changing family structures
• Advances in interventions
• Prevention v research v cure
• Evidence based practice
• Information - required and format
• Palliative care needs?
• Change of administration?

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Any questions?