NATIONAL CANCER CONTROL PROGRAMME .1 Programme Objectives

CANCER CONTROL 10.1 BACKGROUND

10.2 NATIONAL CANCER CONTROL PROGRAMME .1 Programme Objectives

Through the NCCP, the HSE has oversight of all cancer activities in order to manage an equitable provision of effective services throughout the country and to plan and provide for adequate access to services to respond to the projected increased incidence and prevalence of cancer with an aging population and increased longevity.

Diagnostic Surgical and Medical Services

The Programme aims to ensure that designated cancer centres for individual tumour types have adequate case volumes, expertise and concentration of multi-disciplinary specialist skills and that patients are diagnosed and treated in a timely fashion. Key achievements to date include the delivery of all breast cancer diagnostic and surgical services in the eight centres (plus an outreach service in Letterkenny General Hospital), the establishment of Rapid Access diagnostic clinics for prostate cancer in six cancer centres and for lung cancer in seven cancer centres, the establishment of a national centre for pancreatic cancer surgery and the development of GP referral guidelines and standard referral forms for breast, lung, prostate and pancreatic cancers.

Radiation Oncology

Roughly 35% of cancer patients access radiation oncology at present, but international best practice advises that this should be between 55% - 60%. It is provided at 5 HSE locations and it is also outsourced from private providers in Waterford and Limerick, pending the delivery of new public radiotherapy capacity in the West and South.

10.2.2 Programme Effectiveness

The Programme is underpinned by a quality framework, including standards and performance indicators for the most common cancers, which are set against these standards.

It provides timely information on service provision, which can be compared with service delivery in other jurisdictions. Since demand for services will increase, planning around increased delivery of services will be ongoing. There is further work to be done around the development and ongoing review of national clinical guidelines for all site specific cancers.

The 2010 Health in Ireland report states that death rates from cancer have fallen by 11%

between 2000 and 2009. This rate is expected to fall further when the impact of implementation of the Cancer Strategy begins to be reflected in the coming five to ten years. The NCCP information system being developed in conjunction with the NCR will provide more accurate data on staging of disease, which can give interim outcomes data pending the availability of more medium-term survival measures.

The key objectives of designation of cancer centres, centralisation and reorganisation of services, and delivery of services according to best practice are complete or well-progressed/established. There has been slippage in the delivery of the National Plan for Radiation Oncology (NPRO). The original Government Decision to proceed with the plan took place in 2005.

Cost effective measures include:

 Eight designated cancer centres (with a satellite centre at Letterkenny) have been established, two in each region. Considerable progress has been made in centralising surgical services into these centres to provide adequate throughput, multidisciplinary decision-making and concentration of specialist skills;

• Estimated 80% of site-specific cancer cases (other than breast, which is at 100%) now being treated in designated centres;

 Increased radiation oncology capacity introduced at St. James’s and Beaumont Hospitals (NPRO Phase 1);

 Development of National Plan for Radiation Oncology Phase II on a PPP basis is currently under consideration;

 St. Luke’s Hospital has been subsumed into the HSE and extended working day is now in place in all radiotherapy centres;

 The NCSS was subsumed into the NCCP on 1 April 2010;

 The establishment of Rapid Access Clinics for lung and prostate cancers streamlines and speeds up the referral process for patients;

 Development of quality standards for major cancers – breast, lung , prostate, rectal;

 Development of referral guidelines for GPs.

10.2.3 Programme Efficiency

The NCCP controls the funding which has been added to the HSE’s cancer services base since the establishment of the Programme in 2007. In 2011, that funding amounts to €62m and the funding for St. Luke’s Hospital (€34m). It has also identified the oncology drugs budget for hospital in-patients (€64m) (this is separate to the provision of oncology drugs under the community drugs schemes). Funding for radiotherapy in 2010 (prior to expansion of service under NPRO Phase 1) was €75m. The funding provided for cancer screening programmes (€63.68m in 2011) is detailed separately under heading 10.3 below.

Table 10.1: Trend in Expenditure on NCCP 2008-2011 2008

Pay + Non-Pay 21.75 36.75 52.75 62.25

*Non-Pay accounts for approx. 30% of above (based on average split across the system).

There is a small number of administrative staff in the NCCP central office and with the St.

Luke’s Radiation Oncology Network (these sites provide only radiotherapy services). Other clerical and administrative staff manage the designated cancer centres including, for instance, staff associated with rapid access clinics, breast centres or other areas.

Table 10.2: Trend in WTE associated with the NCCP 2008-2011

2008 2009 2010 2011 managed and monitored effectively throughout their cancer journey. Where comparative data is available (e.g radiotherapy services), they show that the programme provides better VFM than purchasing these services from the private sector. Under the Programme, outcomes are measured against specific performance indicators, helping to achieve a consistent level of services, measured against quality standards, in all centres.

10.2.4 Additional Demands Further work is needed to:

(i) Ensure sufficient radiation oncology capacity to meet treatment needs

(ii) consolidate the remaining site specific cancers (e.g gynaecological cancers) in the 8 designated centres;

(iii) identify and fully manage funding relating to cancer services, while acknowledging that certain site specific cancer services, e.g. gastrointestinal cancer, cannot be totally detached from general medical services;

(iv) plan for the management of increasing cancer burden.

In relation to radiation oncology, a draft Memorandum for Government requesting approval to procure additional linear accelerators in 6 centres through Public Private Partnerships will shortly go to Government. There are significant costs (both capital and revenue) involved in expanding capacity regardless of whether it is by traditional or PPP methods. x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx.

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The over-riding issue for the State is that if capacity is not expanded, the HSE will fail in its duty of care to patients who will require radiotherapy provision in a timely fashion as part of their care pathway.

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10.2.5 Conclusions

The NCCP has changed how cancer services are being delivered and in doing so it has been successful in providing adequate capacity and timely provision of services, monitoring patient pathways and outcomes and planning for future demands on services. Key features are:

• Performance Indicators monitor programme outcomes

• More efficient use of radiotherapy equipment and resources.

• There is the potential to charge patients for private and semi-private services delivered by public hospitals.

• Development of a greater role for primary care in the post-treatment monitoring of patients.

• Clinical protocols will be developed for the prescribing of oncology drugs. The initiative is not necessarily expected to generate savings but will ensure efficiency, evidence-based provision and a controlled framework for oncology drug prescribing. It may also limit the growth in expenditure that would otherwise take place without protocols and guidelines.

A reduction in WTEs is not forseen. On the contrary, with increasing age and incidence of cancers there will be greater service needs. The Croke Park Agreement has been used in the context of NPRO and the transfer of staff from St. Luke’s Hospital into the NCCP.

10.3 NATIONAL CANCER SCREENING SERVICE (NCSS)

In document DEPARTMENT OF HEALTH COMPREHENSIVE REVIEW OF EXPENDITURE (Page 107-110)