Cancer Treatment Fund for Wales?

Wales

The National Assembly for Wales debated the Cancer Treatment Fund on Wednesday.

The Welsh Labour Government is clear that it will not be replacing existing evidence-based system with a cancer drugs fund like that in England, which its own chair has admitted provides funding for cancer drugs which have ‘no impact on survival’ and ‘uncertainty as to whether quality of life is improved or not’.

  • All medicines approved by the National Institute for Health and Care Excellence (NICE) and the All Wales Medicines Strategy Group (AWMSG) are made routinely available for patients in Wales. Medicines not approved by NICE or AWMSG are generally found to be too costly for the benefit obtained – they are not cost-effective.
  • We believe all cancer patients should be able to access the best possible treatments but for this to happen within the NHS budget, prices set by the pharmaceutical industry for new, life-extending drugs must come down. It is impossible to put a price on life but it is not impossible to put a fair price on drugs.
  • Cancer patients in Wales are more likely to receive evidence based, cost-effective medicines than in England and the Welsh Government is working hard to ensure that there is more consistency across the whole of Wales.
  • Wales invests in clinically-proven medicines for all by putting money into medicines which have been approved by the All Wales Medicines Strategy Group (AWMSG) and the National Institute for Health and Care Excellence (Nice).
  • All new medicines considered clinically and cost-effective by Nice or AWMSG are already routinely provided to patients by the NHS in Wales. Where drugs are not approved, mechanisms are in place to ensure individual patients have access when clinical exceptionality is demonstrated.
  • The All-Wales Medicines Strategy Group (AWMSG) has carried out 119 appraisals of new medicines since April 2011, of which 105 have been recommended for use in Wales.
  • As of October 2014, AWMSG had appraised and recommended 19 new cancer medicines for use in NHS Wales. These 19 cancer medicines cover 23 clinical indications and all are routinely available to eligible patients. Only nine of these medicines are available in England via the cancer drugs fund.
  • A recent study by the University of Bristol published in the British Journal of Cancer, about whether the English cancer drugs fund led to faster uptake of cost-effective drugs, concluded Wales had a faster uptake of the drugs most recently launched and subsequently recommended by Nice.
  • The research also found medicines considered not cost-effective by Nice were more frequently prescribed in England than in Wales and the cancer drugs fund in England did not expedite access to new cost-effective cancer medicines when compared to Wales.
  • In September, Wales became the first country in the UK to make the new pancreatic cancer drug Abraxane available to all eligible patients in Wales on the NHS – the only part of the UK.
  • The King’s Fund has questioned the cancer drugs fund, as has the ‘British Medical Journal’, which questions the cancer drugs fund in terms of what it delivers.
  • The ‘British Medical Journal’, for example has pointed out that the cancer drugs fund is paying pharmaceutical companies over the odds for drugs that, in the past, would have cost the NHS a lot less.
  • The medical journal, the Lancet is also on record as stating that “The CDF is a product of political opportunism and intellectual incoherence, which undermines the evidence-based approach to the allocation of NHS resources.” It also described the fund as “intellectually indefensible” because funds for other conditions such as dementia and multiple sclerosis had not been set up.
  • The Welsh Labour Government’s policy on cancer drugs is based on clinical evidence – not free market ideology.
  • The Welsh Government believes that it is important that there is a system in place for ensuring that patients have access to drugs where their circumstances dictate that, which is why in Wales we have the individual patient funding requests process, in order to do that.
  • However, simply throwing money at pharmaceutical companies, which is what the cancer drugs fund does, is not the way forward for Wales.

WELSH GOVERNMENT ACTION ON CANCER

Spending

  • The NHS in Wales is spending more than ever on cancer care, thanks to the Welsh Labour Government.
  • Spending on cancer has risen significantly since 2007 when the Welsh Government allocated £314.8m to cancer.
  • The latest figures – from the annual NHS Expenditure Programme Budgets – show that spending on cancer care by the Welsh NHS reached a record high at £360.9m in 2012-13.
  • Spending per head of population on cancer in Wales was £117.41 in 2012-13. This is £10 more per head than in England – spending per head on cancer was £107.21 in England in 2012-13

Cancer targets

  • The Welsh Government has not set a formal target for first cancer outpatient appointments; we expect all health boards to see patients within 31 or 62 days depending on the particular pathway they are on (see below).
  • The Health Minister wrote to all health boards in Wales in summer 2013 reminding them that having a first outpatient appointment in 14 days (10 working days) is best clinical practice and they should benchmark themselves against this internally.
  • Performance against this standard is discussed at the regular quality and delivery meetings but it is not a published waiting time target in Wales.

The current cancer waiting times targets in Wales are:

  • Everyone referred by their GP via the urgent suspected cancer route is put on a 62-day pathway, during which all investigations (tests) are carried out. This is the same in Wales and in England.
  • The target in Wales is for 95% of patients newly diagnosed with cancer via the urgent suspected cancer route to start definitive treatment within 62 days from GP referral. In the first quarter of 2014-15 (April to June) 87.4% of patients were seen within that time.
  • The target in England is for 85% of patients newly diagnosed with cancer via the urgent suspected cancer route to start definitive treatment within 62 days. In the first quarter of 2014-15 (the latest figures available), 84.1% of patients were seen within this target.
  • There is also a 31-day cancer pathway in England and Wales.
  • For patients newly diagnosed with cancer not via the urgent route the target in Wales is that 98% should start definitive treatment within the target time of 31 days. In the first quarter of 2014-15 (April to June) 98.1% of patients were treated within 31 days.
  • In England, figures for the first quarter of 2014-15 (the latest figures available) show 97.8% of people treated began first definitive treatment within 31 days of receiving their diagnosis

Welsh statistics

English statistics

Survival rates

  • Wales has shown the biggest improvement in cancer survival among the four countries of the UK since devolution.
  • One-year survival rates for cancer have increased faster in Wales than in any other part of the UK, rising from 60.24% for 1995-99 to 68%.
  • Five-year survival rates are also increasing from 44.61% in 1995-99 to 51.43% in 2001-05 (latest figures available).

Research

  • Wales is also at the forefront of the global search for a cure for cancer.
  • The Wales Cancer Bank celebrated its 10th anniversary in 2014. Almost 10,000 patients have agreed to donate tissue and blood samples to this invaluable resource which is available to cancer researchers around the world.
  •  To date, it has provided samples to Welsh studies and to researchers working on studies as far afield as South Korea and Canada.
  • Wales is at the forefront in the care and treatment of patients with cancer of the brain and central nervous system, according to results from patient experience surveys from around the UK.
  • Patients with brain and central nervous system tumours who took part in the 2013 National Cancer Patient Experience Survey reported some of the lowest outcomes in England – they reported the lowest experience scores or almost the lowest in 12 areas of the survey, including saying they felt as though they were treated like a set of symptoms.
  • In contrast in Wales, patients with brain and central nervous system tumours reported the highest results in three areas of the 2013 Wales Cancer Patient Experience Survey and the lowest in only two areas.

Patient Experience

The 2013 Wales Cancer Patient Experience Survey, which was carried out in partnership with Macmillan Cancer Support, found that 89% of patients rated their care as excellent or very good. This rose to 97% of patients who thought their cancer care was good.

Cancer Delivery Plan – progress

The second annual report – for 2013 – charts progress against the aims of the Welsh Government’s cancer strategy shows progress in several areas of cancer care in Wales.

The report shows that:

  • Wales has seen the biggest improvement in cancer survival in the UK;
  • An increase in the uptake of the Human Papilloma Virus vaccine (HPV), with levels in 2012/13 at 86.6%;
  • A 5% increase in recruitment to clinical trials;

The completion of a cancer patient experience survey, which shows 89% of cancer patients think their care is excellent or very good.

Prevention and Public Health

  • The Welsh Government also believes that people must take personal responsibility for their health and well-being. This includes opting for the healthy choice – not smoking, drinking sensibly, eating healthily and exercising regularly.
  • Smoking and obesity are major risk factors for cancer and a healthy diet and physical activity can reduce the risk of cancer.
  • The Welsh Government’s Health Challenge Wales, the ban on smoking in public places and campaigns to discourage smoking also show how Labour in government in the Assembly is tackling the causes of cancer by encouraging people to take the steps needed to lead healthier lives.
  •  The Welsh Government has also signed up to the first UK-wide Physical Activity guidelines which recognise the link between physical activity levels and cutting the risk of obesity and cancer.

Key worker for every cancer patient

  • The last Welsh Labour Government introduced a key worker for every cancer patient diagnosed with cancer in Wales from March 2011 as part of new cancer rehabilitation standards.
  • The key worker is responsible for coordinating the care of patients for the duration of their treatment in hospital and in primary care through their GP, in recognition that people living with cancer have ongoing needs following the end of their main treatment.
  • The key worker for each patient is the most appropriate NHS worker, depending on where the patient is in their cancer treatment and the patient therefore knows who to contact at all times should the need arise. Although the standards are aimed at adults, this is also a requirement for paediatric cancer patients.
  • The standards were developed by the Cancer Services Co-ordinating Group in consultation with cancer specialists and patients.
  • This means that Cancer patients will know who to contact at all times should the need arise during their treatment.

Screening

We have two very successful national cancer screening programmes in Wales. Breast Test Wales screens by automatic invitation those women aged between 50 and 70, every three years. Cervical Screening Wales invites women between the ages of 20 and 64 for a routine test, every three years. The Welsh Government has also invested in new state-of-the-art mobile screening units, which will help improve access to health checks in rural areas. The Labour Welsh Government also invested £10million in new breast cancer screening equipment to replace analogue machines with digital equipment in the mobile Breast Test Wales units and breast assessment centres. Health Commission Wales has received funding from the Welsh Government for the phased implementation of a national bowel cancer screening programme in Wales. Bowel Screening Wales is in the process of rolling out a national bowel cancer screening programme for men and women aged 50 to 74. The programme began in October 2008 for the 60 to 69 age group and will be fully implemented by 2015. The screening will take place every two years. This service is expected to reduce mortality from bowel cancer by 15 per cent in the screened population.

 Treatment of Welsh patients in England

In Wales, 16,000 patients are treated for cancer in total every year – 15,000 of them would not be sent to England for treatment. Patients are not routinely denied cancer treatments available on the NHS. Welsh patients routinely receive cancer treatment and other forms of care at English hospitals as, in some parts of Wales such as Powys; these are their local hospital providers. Some Welsh patients will receive specialist services at English hospitals, including specialist cancer care, where necessary. This is because hospitals require a critical mass of patients to operate some specialist services – Morriston Hospital, in Swansea, serves as the specialist burns centre for Wales and the South West of England. The border between England and Wales is a porous one – patients from England and Wales receive care from the health services on either side of the border.