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Improving palliative care in cancer

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Sue Hawkett

Nursing Adviser, Cancer Policy Team, Department of Health



Improving the patient experience is central to The NHS Plan and The NHS Cancer Plan (DoH, 2000a and b). The Cancer Patient Survey recorded the experiences of patients who had received hospital care (in-patient or day case) in 1999/2000 (DoH, 2002).



Most patients were positive about their experience of care. For example, 79% of the 65 000 patients who responded to the survey reported that they had confidence in all of the nurses involved in their treatment and felt that they had always been treated with dignity and respect. However, the survey revealed differences in the experiences of patients with different types of tumour and between treatment in different trusts.



Although patients’ experiences of specialist palliative care in the community and in hospices was not evaluated as part of this survey, a previous study also showed marked variations between what were then known as ‘health regions’ in the provision of specialist palliative care services in hospitals, community teams and hospices.



Consequently the NHS Cancer Plan, building on the principles of the Calman-Hine report (1995), set out actions to ensure high standards of supportive and palliative care across the country.



A review of progress
The National Institute for Clinical Excellence (NICE) was commissioned to undertake an evidence-based review of supportive and palliative care services. In many areas, progress to date has been encouraging. NICE draft guidance is currently out for consultation, and final guidance is set to be published early next year.



Meanwhile, the Government has funded eight palliative care beacon partnership projects, which are spreading knowledge and good practice in joint working across the NHS and voluntary sector.



Every cancer network has established a patient partnership group to involve patients and their carers in shaping services for cancer treatment. The Cancer Services Collaborative is working with networks and patient partnership groups to implement local changes via its ‘patient experience’ project.



A National Coalition for Cancer Information has been formed. It brings charities with expertise in this area together with NHS services to oversee the development, content and availability of information for patients on the diagnosis and on the disease itself. Advanced communication skills courses for senior cancer clinicians are being piloted by Cancer Research UK and Marie Curie Cancer Care, commissioned by the NHS University (NHSU).



Work is also under way to improve primary care services such as continuing support provided by district nurses, GPs, social services and community specialist palliative care teams.



The Cancer Planstated that community cancer services were often not as good as they could be. While many patients with advanced cancer would prefer to die at home, in practice only about a quarter do so.



Distribution of funds
Inappropriate admissions are often due to a lack of training in pain control or other areas. One Cancer Plan commitment is to provide £6 million over three years (2001-2004) to fund additional education and support for over 10 000 district and community nurses in the principles and practice of palliative care. King’s College London University is evaluating the programme.



The Cancer Planpledged that funding for palliative care would increase by £50 million by 2004. The NHS has benefited from the voluntary sector as the major provider of palliative care for decades.



The Department of Health (DoH) in 2000 estimated that palliative care services cost £300 million, of which the NHS provided £130 million.



The additional £50 million investment in The Cancer Plan is not only to provide a more realistic NHS contribution to the costs hospices incur against agreed services, but also to ensure that the patient experience is improved and unequal access addressed.



Front-line NHS staff and staff in independent hospices have voiced concern that, locally, investment of the new money was slow.



As a result, the Government released an extra £10 million from central budgets in 2002/2003 and has set up a £50 million-a-year central budget for 2003/2004 to 2005/2006.



National Partnership Group (NPG), chaired by national cancer director Mike Richards, has been formed to support this. It brings together the major NHS stakeholders - strategic health authorities, primary care trusts, cancer networks and doctors and nurses - and national voluntary sector organisations - Macmillan Cancer Relief, Marie Curie and the National Council for Hospices.



The group is charged with working to develop a new approach to funding and investing in palliative care services working from a set of agreed principles.



It agreed the criteria against which cancer networks have developed a three-year investment plan for palliative care with their allocation from the £50 million.



In many cancer networks the lead nurse has undertaken this work. Investment plans from all networks have now been assessed by the NPG. From the plans it is clear that the investment will be used to improve the range of services in line with NICE guidance, that inequalities in service provision are being addressed and that there is an open and transparent dialogue between the voluntary sector and the NHS in agreeing local plans.



Future plans
The DoH expects the new arrangements to ensure the £50 million cancer pledge is more than met so that, in the future all those affected by cancer will be able to access a wide range of high-quality supportive and specialist palliative care services.



Department of Health. (2002) Cancer Patient Survey. NHS Cancer Plan: A Baseline Survey. London: DoH.

Department of Health. (2000a) The NHS Cancer Plan. London: The Stationery Office.

Department of Health. (2000b) The NHS Plan. London: The Stationery Office.

Department of Health. (1995) A Policy Framework for Commissioning Cancer Services (Calman-Hine report). London: The Stationery Office.
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