Evidence Submitted by Roche (WP 49)
1. INTRODUCTION
1.1 Roche Products Ltd is a leading manufacturer
of innovative treatments across a wide range of disease areas,
including oncology, virology and long term conditions such as
rheumatoid arthritis and osteoporosis. We are committed to working
in partnership with the Department of Health and NHS to add value
to the quality of care that patients receive.
1.2 As well as developing new treatments
which can increase survival and improve quality of life, we seek
to improve the efficacy and convenience of our products by offering
additional support and services to patients and healthcare professionals.
We have therefore gained an insight into some of the wider issues
relating to the therapeutic areas in which we work, not least
the impact that new methods of treatment can have on workforce
needs and capacity planning. We welcome the opportunity to contribute
to this inquiry.
1.3 Our response:
— Sets out the factors that will influence
demand for workforce capacity, including an ageing population,
changes in lifestyle, earlier diagnosis of medical conditions,
increasing "treatability" of disease and existing staffing
issues.
— Examines the opportunities to manage
demand for capacity, including improving capacity planning, decentralising
the administration of intravenous treatments, using oral therapies
to free up capacity, less frequent medication dosing, maximising
the effectiveness of NHS staff and utilising the expertise and
capacity of other organisations.
— Assesses the steps that will need
to be taken to effectively plan future workforce capacity requirements.
— Makes recommendations which the Committee
may wish to consider as part of its inquiry.
1.4 We would be happy to provide more written
information, or oral evidence, if the Committee would find this
to be helpful.
2. FACTORS INFLUENCING
DEMAND FOR
WORKFORCE CAPACITY
2.1 Derek Wanless estimated that the healthcare
workforce would need to be increased by almost 300,000 in the
period up to 2022. He also noted that demand for healthcare professionals
is likely to far exceed supply[89].
There are many factors that will influence the demand for additional
workforce capacity, including:
2.2 Ageing population
2.2.1 There are nearly 20 million people
aged 50 years and over in the UK, which is one third of the total
population. By 2020 this will have increased to 25 million[90].
An increasing burden of care can be expected to result from an
older population leading greater demand for skilled healthcare
professionals.
2.2.2 Long-term conditions are particularly
prevalent amongst older people. For example, two thirds of UK
residents aged 75 and over have a long-term medical condition
and one third have more than one long-term medical condition[91].
Over 17 million people in the UK now live with a long-term condition
such as asthma, arthritis, diabetes or some cancers and nearly
half of this group experience more than one condition[92].
2.2.3 An example of the likely impact that
an ageing population can be expected to have on health services
is in relation to hip fractures. On the basis of current trends,
hip fracture rates in the UK may increase from approximately 46,000
in 1985 to 117,000 in 2016[93].
This alone would result in significant extra demands being placed
on the NHS and social care workforce, with many fracture patients
having to spend significant amounts of time as hospital inpatients
or in supportive care settings.
2.2.4 Similarly overall cancer incidence
has increased by 31% between 1971 and 2000, partly due the ageing
population. Increases in incidence look set to continue with,
for example, the Scottish Executive estimating that there will
be a 28% increase in the number of people diagnosed with cancer
over the next 20 years[94].
2.3 Changes in lifestyle
2.3.1 The extent to which society is able
to successfully encourage the uptake of healthy lifestyles will
also affect the likely demand which will be placed on the NHS
workforce in future. Sir Derek Wanless' first review of healthcare
identified three possible scenarios which would impact upon the
demand for, and cost of, healthcare, demonstrating the extent
to which demand for workforce capacity will be influenced by healthy
lifestyles[95].
— Slow uptake—life expectancy
increases but people do not live longer in good health. People
aged over 65 are more likely to experience long-term chronic ill
health than today. There is a 10% increase in health problems
requiring GP visits and hospital admissions.
— Solid progress—life
expectancy increases but older people experience around 5% fewer
health problems than today. However the probability of experiencing
long-term health problems at a given age is the same as today.
Roughly speaking, half the additional years gained through higher
life expectancy will be healthy.
— Fully engaged—people
live longer and in better health: as life expectancy rises, the
proportion of a lifetime spent in long-term ill health declines.
Acute ill-health among the elderly declines by 10%.
2.4 Earlier diagnosis of medical conditions
2.3.1 Improvements in diagnostic technology
have meant that medical conditions can increasingly be diagnosed
at an early stage, increasing the chances of successful treatment.
However increasing diagnosis is also likely to be a factor in
influencing workforce demand.
2.3.2 For example, screening programmes
for breast and cervical cancer have improved survival rates and
evidence suggests that the promised roll out of the National Bowel
Cancer Screening Programme from April 2006 will have a major impact
on survival, reducing the number of deaths from bowel cancer by
15% and saving approximately 1,000 lives a year in the UK[96].
2.3.3 However screening has also increased
demands on cancer services capacity. For example in 2003-04 the
breast cancer screening programme screened 1.2 million women aged
50-64 and identified 8,400 cancers which may not otherwise have
been diagnosed at such an early stage[97].
Similarly, the bowel cancer screening programme is expected to
increase the numbers of patients needing treatment. It is estimated
that, for every 1,000 patients who complete the Faecal Occult
Blood test (FOBt), 16 will report a positive FOBt result and will
be offered colonoscopy and 12 will actually undergo a colonoscopy
procedure. Of these five will be found to have polyps at colonoscopy
(and require surveillance) and one will be found to have bowel
cancer.
2.3.4 Similarly, if it is to be successful,
the inclusion of condition monitoring in the Quality and Outcomes
Framework as part of the new GMS Contract is likely to lead to
increasing early identification of medical conditions which require
treatment. In the most recent revisions to the Quality and Outcomes
Framework (QOF), testing for chronic kidney disease (estimated
glomerular filtration rate—eGFR) was introduced. Chronic
kidney disease (CKD) is a long-term condition which may be progressive,
and can be serious. 2.5 million people are thought to have CKD
in the UK, however most are unaware of their condition. The introduction
of eGFR testing can be expected to make a improvement in the management
of CKD, ensuring that at risk people are identified early and
their condition managed appropriately. However, anecdotal evidence
from kidney consultants suggests that the scheduled introduction
of eGFR to the QOF in April 2006 is leading to extra pressure
being placed on specialist services, as GPs begin to come to terms
with an area of clinical practice in which many have little prior
experience.
2.4 Impact of increasing "treatability"
of conditions
2.4.1 Advances in medical technology are
making conditions increasingly treatable. One such example is
oncology, where patients are increasingly being offered a series
of interventions which were not possible only a few years ago.
However new treatments are often in addition to, rather than a
replacement of, existing options and are given over a prolonged
period of time, resulting in increased pressure on cancer services.
Very few types of cancer are now considered to be chemotherapy
resistant and the list is diminishing each year.
2.4.2 Drug therapy is now being used to
treat a rising number of cancers, increasingly at an early stage
of the disease, as well as being employed as a second or third
line treatment. Developments in this area are likely to substantially
increase demand on chemotherapy services over the next few years.
For example early in 2005 NICE published its guidance on the management
of lung cancer and this included a recommendation that adjuvant
chemotherapy be offered to lung cancer patients after surgery[98].
This will represent a change in practice and significant additional
work in many centres.
2.4.3 A survey of 42 hospitals published
in 2003 found a huge increase in the use of intravenous chemotherapy
over the past three years. The average increase was 200% with
some hospitals reporting a 500% increase. [99]Unsurprisingly
this increase has had significant impact on the demands placed
on the workforce. The same survey concluded that the lack of staff
trained in preparing and administering new cancer treatments was
a significant rate-limiting factor in making available these treatments
to all who could benefit.
2.4.4 These findings are supported by the
work undertaken on access to new cancer medicines by the National
Cancer Director in 2003 and the Audit Commission in 2005. Professor
Richards found a fourfold geographical variation in access to
NICE-approved oncology drugs. The Report identified "constraints
in service capacity" as having a major impact on the variation
in usage. Specifically, the increased use of chemotherapy was
found to have resulted in a lack of suitable space to prepare
and administer cytotoxic drugs as well as shortages of specialist
pharmacists, doctors and nurses. [100]
2.4.5 So-called targeted biological therapies
are also increasingly being used in addition to chemotherapies,
resulting in significant improvements to patient prognosis but
also increased pressure on services. Current examples include
the use of Herceptin (trastuzumab) in breast cancer and Avastin
(bevacizumab) in advanced bowel cancer.
2.5 Existing staffing issues
2.5.1 In addition to the healthcare trends
outlined above, there are pre-existing structural issues with
the NHS workforce which will impact upon future planning.
2.5.2 As well as leading to increased demand
for health services, the ageing population will also affect the
NHS workforce, resulting in many skilled professionals reaching
retirement age. The NHS will have to recruit replacements as well
as the additional professionals needed to meet demand.
2.5.3 The scale of the task of replacing
experienced staff will be compounded by the historical staff shortages
which have affected the NHS. Although there have been commendable
increases in staffing in recent years, much of this has simply
compensated for existing deep-seated shortages in skilled staff.
2.5.4 The full introduction of the Working
Time Directive in the NHS will mean that more full time equivalent
staff will be needed to provide the same level of capacity as
before. For example, one London hospital estimates that, whilst
before 1991 three doctors sometimes each working over 100 hours
a week were needed on a rota to cover a speciality, by 2009 eight
to 10 doctors will be needed to cover a similar rota (on duty
up to 48 hours a week). [101]Clearly
it is a benefit that staff should not have to work such long hours,
but it also poses challenges to capacity planning.
3. OPPORTUNITIES
TO MANAGE
DEMAND FOR
CAPACITY
3.1 Although the factors outlined in Section
2 indicate that demand for workforce capacity will inevitably
rise, there are opportunities to manage this demand through effective
planning and making more effective use of existing resources.
3.2 Improving capacity planning
3.2.1 As the record increases in NHS funding
slow down and the demands being placed on capacity grow still
further, accurate demand forecasting and effective capacity planning
will become ever more important.
3.2.2 Although capacity planning in the
NHS has improved, further advances are necessary. For example,
both the 2005 Audit Commission Report on the implementation of
NICE guidance and the National Cancer Director's own work on the
subject found that inadequate capacity planning is a major reason
for delays in implementing new guidance.
3.2.3 Roche recognises the crucial role
of health service commissioners and managers in improving services
and modernising the NHS, through effective capacity planning.
Our aim is to assist with this planning process by designing and
delivering innovative tools such as health economic models, business
case proposals, budget impact models and service development materials.
3.2.4 For example, a service impact model
has been developed that demonstrates the capacity impact of using
Herceptin in early stage breast cancer to assist with both the
financial and capacity planning that the NHS will have to undertake
to make the treatment available to all women who can benefit.
Currently, adjuvant breast cancer patients receive chemotherapy
alone. Therefore Herceptin will be additive and will not be replacing
any therapy for which resources are already provided. To allow
effective implementation of Herceptin as a treatment for early
stage breast cancer a number of factors will need to be considered
by NHS trusts:
— HER2 testing pathology availability
(Roche has undertaken a project in conjunction with the National
Cancer Director to ensure all Cancer Networks have the necessary
infrastructure in place to enable HER2 testing to occur, including
making available a £1.5 million fund to assist the NHS in
establishing appropriate systems).
— Treatment capacity, including pharmacy
preparation time, nurse availability and chemotherapy chair space.
— Cardiac monitoring resource.
3.2.4 Similarly a Xeloda (capecitabine)
implementation toolkit has been developed highlighting the key
elements that are required in setting up and delivering an oral
chemotherapy service (see Section 3.4).
3.2.5 These tools are being used extensively
to modernise the service in the disease areas in which we have
expertise. They are intended to support the stated aims of each
of the National Service Frameworks (NSFs) and the national reimbursement
organisations in the UK such as the National Institute for Health
and Clinical Excellence (NICE), the Scottish Medicines Consortium
(SMC) and the all Wales Medicines Strategy Group (AWMSG).
3.3 Decentralising the administration of intravenous
(IV) treatments
3.3.1 The administration of intravenous
chemotherapy is a secondary care therapy area which has the potential
for devolution into community settings (within new community hospitals
and larger general medical practices) to reduce demands on specialist
staff, lower unit costs and increase patient convenience.
3.3.2 Devolving this form of care would
be particularly beneficial for patients with long term medical
conditions who are currently forced to regularly receive their
therapy in secondary centres with associated travelling times,
waiting times, expense and impact on the time of specialist staff.
3.3.3 However, for this opportunity to be
realised, a number of steps would have to be taken which would
impact upon workforce planning, including altering workforce development
around the administration of intravenous therapies and relocating
auxiliary skill sets including resuscitation/crash services. Recent
small-scale proliferation of resuscitation services technology
into primary care demonstrates the viability of relocating intravenous
capacity.
3.4 Using oral therapies to free up capacity
3.4.1 Increasing the usage of oral therapies
can free up chemotherapy capacity in hospital and community settings,
as well as saving on nursing and pharmacy time. Such therapies
have no need for IV equipment and significantly reduce staff time
spent on drug preparation and administration.
3.4.2 On the other hand, IV chemotherapy
preparation is a complex and time intensive procedure, involving
a range of staff skills, as well as the reconstitution, mixing
and diluting of raw materials. IV Chemotherapy is made up under
aseptic conditions in isolator (machines used to create the correct
environment for drug preparation). Only one person can work at
an isolator at one time.
3.4.3 One example of an oral chemotherapy
is Xeloda (capecitabine). During the NICE appraisal process for
the use of Xeloda in advanced bowel cancer (NICE Appraisal No
61), the independent technology assessment group model estimated
substantial NHS budget-impact savings if all eligible patients
were treated with oral chemotherapies (net savings of £17
million were identified if all metastatic bowel cancer patients
were treated using oral alternatives to IV). These savings were
calculated using the cost of drug, plus an estimate of the resources
required for preparation and administration, as compared to the
cost of purchasing, preparing and delivering a standard IV drug
alternative. Similarly the current appraisal process for Xeloda
in early stage bowel cancer has indicated that substantial savings
are possible (net £16.5 million if all early stage bowel
cancer patients were treated using oral alternatives to IV).
3.4.4 There are examples of how using oral
therapies is leading to significant capacity savings in practice.
For example, the Mount Vernon Hospital in Middlesex reports that
the introduction of oral chemotherapy has been the factor which
has had the most impact on maximising capacity to date. Similarly,
the Beatson Oncology Centre in Glasgow offers a nurse/pharmacy
led oral chemotherapy (in this case Xeloda) service, avoiding
patients being admitted to in-patient beds/day areas for infusional
chemotherapy.
3.4.5 Other centres in Scotland have followed
the example of the Beatson Oncology Centre. Within Grampian, the
development of out-patient based Xeloda services has saved around
2,000 bed days each year. This has resulted in the abolition of
oncology treatment waiting times for other tumour groups and the
removal of the need for a larger cancer unit. The main pharmacy
area in Aberdeen has significantly benefited from the increasing
use of oral chemotherapy by avoiding the reconstitution of around
2,800 litres of IV chemotherapy annually. This is significant
when we consider their workload over five years has more than
tripled without a matching increase in their staffing establishment.
3.4.6 Despite the potential for oral chemotherapies
to reduce the pressure on staff time and capacity in a therapeutic
area which is likely to experience significant increases in demand,
anecdotal evidence suggests that the current Payment by Results
Tariff has resulted in some hospital trusts being disincentivised
from switching from IV.
3.4.7 Hospital trusts can face a substantial
loss in short term revenue by using oral chemotherapies as they
require a significant drop in the required number of patient out-patient
visits (for which hospitals are remunerated under the tariff).
One such example is a major northern cancer centre which has calculated
that, for every 100 patients it switched from IV to oral chemotherapy,
it would lose over £1.5 million in revenue. This calculation
is based upon the hospital only being reimbursed for eight outpatient
visits per patient when being treated with oral chemotherapy,
as opposed to 30 visits to a chemotherapy unit when being treated
by IV chemotherapy.
3.4.8 Roche is therefore encouraged by the
Department of Health's Our Health, Our Care, Our Say White
Paper commitment to review the Tariff so that it is based on best
practice rather than standard national practice:
"Medical science, assistive technology and
pharmaceutical advances will continue to rapidly change the way
in which people's lives can be improved by health and social care.
It is important that the organisation of care fully reflects the
speed of technological change . . . [the Tariff] was first introduced
in the context of the reform of the hospital sector. For this
reason, not everything about the current structure of the tariff
aligns with the radical shift that this White Paper seeks to achieve.
So we will improve it." [102]
3.4.9 We would welcome a recommendation
from the Committee that, under the revised Tariff, workforce capacity-saving
techniques should be incentivised.
3.5 Less frequent medication dosing
3.5.1 New medical technologies also enable
less frequent dosing for patients. This can have the double benefit
of freeing up NHS staff time (in the event of them having to be
involved in the administration of medication) and improving health
outcomes by increasing patient concordance, therefore reducing
future burden on workforce capacity.
3.5.2 For example, bisphosphonates are the
most commonly prescribed treatment for post-menopausal osteoporosis
sufferers, but require patients to follow a strict routine when
taking their tablets. Patients must fast before and after taking
their medication, and must then remain standing or sitting upright
for between 30-60 minutes. This inconvenience is a major reason
why people stop taking their treatment, and recent studies have
shown that up to two-thirds of patients stop taking their osteoporosis
bisphosphonate treatment within a year. [103]Poor
adherence has a negative effect on treatment outcomes including
lower gains in bone mineral density (BMD), [104]smaller
decreases in the rate of bone turnover[105]
and a significantly greater risk of fractures. [106]
3.6 Maximising the effectiveness of NHS staff
3.6.1 There are also ways in which skilled
NHS staff can be freed up to concentrate on areas where they have
a specialist skill. Derek Wanless' first report suggested that
that nurse practitioners could undertake at least 20% of the work
of doctors while maintaining the safety and quality of care. However
for such a move to be effective, responsibilities would then have
to be devolved from nurses to healthcare assistants, resulting
in additional demand for an estimated 70,000 additional healthcare
assistants, on top of the extra 74,000 Wanless forecasted would
be required. [107]
3.6.2 A number of examples of service redesign,
resulting in the more effective use of capacity exist:
— Maidstone and Tunbridge Wells
NHS Trust, in partnership with the Cancer Services Collaborative
"Improvement Partnership" has focussed on developing
new ways of working to suit the skill mix of the team. Over an
eight-week period it was found that the chemotherapy nurse spent
on average 14 hours a week on non-chemotherapy tasks. A non-chemotherapy
nurse or a health care assistant could perform procedures such
as applying dressings or removing the cannula, allowing the chemotherapy
nurse to give treatments, attend pre-assessment clinics or perform
technical tasks such as the chemotherapy line insertion. The review
suggested that developing the roles of nurses to perform nurse
review clinics would improve the continuity in patient care, as
well as making the nurses' careers more rewarding. This would
also release consultant time allowing them to see more new patients.
It also concluded that additional capacity could be realised by
re-structuring the scheduling system, reducing the variation in
patient pathways and introducing a secure drug storage system.
— Southend Hospital has increased
its chemotherapy unit operating times. Nursing and pharmacy staff
shifts ensure all day working from 8 am through to 6.30 pm, allowing
patient treatment to commence at 8.30 am.
— The Royal Marsden Hospital has
divided the staff day into morning and afternoon sessions so that
unit beds can be used twice in one day.
— Patient Group Directives (PGDs)
free up GP capacity by enabling other healthcare professionals
to prescribe. Roche has extensive experience working in partnership
with pharmacists in order to create PGDs and has done so with
particular success in the therapy areas of obesity and influenza.
In order to help deliver an effective strategy for influenza patients,
Roche worked with a multi-disciplinary team of pharmacists and
general medical practitioners to develop the first National Pharmaceutical
Association-accredited PGD. A PGD is a written protocol whereby
a named prescriber (in this case a pharmacist) is able to supply
a medication in certain situations. At-risk individuals over the
age of 13 years who have symptoms of influenza will no longer
have to wait for a GP appointment and can instead visit their
community pharmacist who, if they consider it appropriate, will
be able to supply them with anti-viral medication such as Tamiflu
(oseltamivir).
Similarly Roche worked in close partnership with
clinicians and other healthcare professionals to allow appropriately
trained pharmacists to prescribe the anti-obesity drug Xenical
(orlistat). This was as part of a much broader and holistic pharmacy
located weight management programme. There are now well over 100
such PGDs operational in the UK, giving patients access to professional
advice and support from community pharmacists who have a wealth
of experience and expertise and are often more accessible in terms
of location, opening hours, rapid access and immediacy than are
general medical practitioners. Only appropriately trained pharmacists
have the authority to supply Tamiflu or Xenical under a PGD and
each PGD is specific to the locality of a Primary Care Trust alone.
For example, Wandsworth PCT has trained 10 pharmacies to run weight
management services using a PGD.
— Medicines utilisation reviews
are incentivised under the new pharmacy contract, encouraging
pharmacists to utilise their skills to rationalise a person's
medication, reducing the burden on GPs and helping avoid adverse
medical incidents. However, for these reviews to be effective,
pharmacists need to be equipped with the necessary skills to focus
on appropriate medical conditions.
— Shared care arrangements enable
GPs to work closely with consultants on advising a patient on
medication and therefore become involved in specialist areas of
medicine, freeing up consultant time in the long run. This allows
the development of specialist services in a community setting
for long-term medical conditions such as rheumatoid arthritis,
HIV and hepatitis C, optimising the effectiveness the existing
healthcare workforce.
3.7 Utilising the expertise and capacity of
other organisations
3.7.1 The NHS can also maximise its own
capacity by utilising the expertise and resources of others. In
Section 2 we set out the capacity planning expertise which pharmaceutical
companies such as Roche can provide to the NHS.
3.7.2 The pharmaceutical industry also provides
significant support and advice on the appropriate use of medicines.
An example of this is the Bonviva active! Support Programme. As
discussed in Section 3.5, osteoporosis patients can have difficult
in concording with bisphosphonate treatment regimens. The active!
Support Programme, is designed to support long term compliance
with through a freephone helpline staffed by nurses who provide
information on osteoporosis, as well as regular contact and support
through treatment.
3.7.3 The Xenical MAP programme (to support
patients through their orlistat weight loss by helping them make
informed choices about their food intake, physical activity levels
and weight loss goals) is another example of private sector-provided
clinical support, reducing unnecessary demands upon existing NHS
workforce. MAP is provided through a two-way call centre open
seven days a week, 365 days a year, managed on behalf of Roche
by an independent company, International SOS. Patients are told
about MAP by either their GP or pharmacy and are given a free-phone
telephone number (0800 731 7138) to ring to register for the programme.
Patients can opt for follow up calls at days 15, 30, 90 and 180
of their programme and can call in to MAP at anytime. All calls
are with a dietician or a nurse trained in nutrition.
3.7.4 However the pharmaceutical industry
could do more to support NHS workforce capacity by providing additional
low cost (or free) solutions to capacity issues, particularly
relating to the more holistic needs of those with long term conditions
where the expertise may not always be available within the NHS.
Current restrictive requirements on packaging can make it difficult
to effectively draw attention to relevant healthcare services
which may be available.
3.7.5 The voluntary sector can also play
an important role in supporting NHS capacity. For example, many
charities support nurse specialists through funding and training,
increasing the resources available to NHS organisations. For example
the Lymphoma Association is in the process of establishing lymphoma
specialist nurses. Similarly, many patient groups operate patient
support helplines staffed either by trained nurses or patients
themselves, therefore reducing the demands placed on NHS staff.
3.7.6 Bowel Cancer UK's Bowel Cancer Advisory
Service was set up in 1987 in response to an increasing amount
of requests for specialist information on the disease, treatment
options, prevention and symptoms. The Advisory Service is open
Monday to Friday between 10 am to 4 pm and is run by specialist
colorectal, stoma care and oncology nurses and is underpinned
by Bowel Cancer UK's team of expert advisors whose specialities
range from surgery through to oncology. The Bowel Cancer Advisory
Service has taken over 35,000 calls since it was established.
The Advisory Service's number will feature on all literature associated
with the forthcoming bowel screening programme and Bowel Cancer
UK estimates that this will further increase demand for support
which otherwise would have to be provided by the NHS directly.
4. EFFECTIVELY
PLANNING FUTURE
WORKFORCE CAPACITY
REQUIREMENTS
4.1 Roche believes that, if future workforce
capacity requirements are to be effectively planned, then central
guidance will be necessary alongside local innovation. We are
concerned that many commissioners are unlikely to have sufficient
expertise to be able to accurately predict future demand, especially
in an era when patient choice and Payment by Results makes future
service usage unpredictable.
4.2 If widespread staff vacancies occur
then local workforce capacity planning will be made very difficult,
with NHS organisations competing for too small a pool of suitably
qualified staff. Therefore national strategies to address staff
shortages will be required.
4.3 We commend initiatives such as the National
Cancer Director's capacity planning work as an example of how
the centre can assist the devolved NHS in planning future requirements.
In his report on uptake of NICE-approved drugs, Professor Richards
called for the Department of Health to develop a capacity planning
model for chemotherapy as part of the national review of chemotherapy
services. This initiative has been led by the Cancer Services
Collaborative "Improvement Partnership" as part of their
work with the National Chemotherapy Advisory Group. The model
has been incorporated into a broader toolkit, entitled Modernising
Chemotherapy Services—A Practical Guide to Redesign, which
aims to form a basis for the multidisciplinary redesign of chemotherapy
services within oncology and haematology.
4.4 The pharmaceutical industry can also
play an important role in developing capacity planning models
and this should be recognised by the NHS in planning its future
requirements.
5. RECOMMENDATIONS
5.1 There are a number of recommendations
which the Committee may wish to consider as part of its inquiry:
— Given the expected increases in the
demands placed on the workforce, capacity planning should be based
on future demand rather than existing demand.
— Regular audits of available IV capacity
(seats and trained personnel) should be undertaken at both a national
and local level. These should be used to identify any capacity
shortfalls which exist and to plan provision accordingly.
— Pilots of community-based chemotherapy
should be undertaken.
— The expertise of the pharmaceutical
industry and others in preparing capacity impact models should
be harnessed in assisting the NHS plan.
— National planning tools should be
developed to assist local NHS organisations plan workforce requirements
in therapeutic areas of high demand.
— Initiatives such as using oral cancer
drug treatments as an alternative to intravenous therapy should
also be used wherever possible to free capacity.
— The adoption of capacity saving measures
should be incentivised through mechanisms such as the Payment
by Results Tariff. Any perverse incentives inhibiting the uptake
of capacity saving treatments should be identified and addressed
through primary care trust monitoring of local contracts with
providers.
— Measures should be taken to free
up skilled staff from doing generalised jobs which could be undertaken
by less specialist personnel.
— The Department of Health should oversee
national programmes to introduce specialist nurses for major conditions
where there are currently significant shortages, such as lung,
bowel and prostate cancer, as well as rheumatoid arthritis and
cystic fibrosis.
— A best practice guide of examples
of service redesign should be prepared by the Department of Health,
providing practical examples of how staff time can be freed up.
— PGDs should be encouraged throughout
the NHS.
— The NHS should be encouraged to utilise
the ability of pharmaceutical companies and others to offer services
which can alleviate pressures on the workforce.
Roche Products Ltd
March 2006
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