Draft Minutes of the 4th NICaN Regional Oncology / Haematology D&T Committee NICaN
Sent: 3rd April 2007
4th NICaN Regional Oncology / Haematology D&T Committee
Tuesday 13th March 2007
Fern House, Antrim Hospital
2.00pm – 5.00pm
Record of attendees:
Dr Martin Eatock, Chair
Ms Sally Campalani, BCH
Dr Robert Cuthbert, NICaN Haematology Group
Ms Fionnuala Green, Regional Co-ordinator Pharmacist/NICaN Team
Ms Jill MacIntyre, NICaN Pharmacy Group
Ms Janis McCulla, NICaN Team
Dr Anne Kyle, NICaN Haematology Group
Ms Maire McGrady, Regional Co-ordinator Pharmacist/NICaN Team
Ms Sandra McKillop, NICaN Team
Professor Ciaran O’Neill, QUB
Ms Cora Sonner, NICaN Pharmacy Group
Apologies:
Mr Brian Baker, Dr Ursula Brennan, Dr Graeme Crawford, Dr Gerard Daly, Ms Elizabeth England, Mr David Galloway, Dr C Harpur, Dr Robert Harte, Dr Seamus McAleer, Mr Mark Timoney.
Welcome and Introductions
Dr Eatock welcomed members to the 4th meeting of the Committee. Dr Robert Cuthbert, was also welcomed to his first meeting as the Haematology Representative.
DT_0607_13 Sign off & Matters arising from Minutes of 3rd meeting
Referring to the minutes of the last meeting, Dr Eatock invited comments or any proposed amendments.
With respect to local impact assessment, Ms McGrady had indicated that the G6 Managers Group would wish to receive the correspondence directly. Communications with the respective local lead teams would be required prior to submission.
The minutes were agreed.
Matters Arising
1 Children’s Cancer. Dr Eatock indicated that he had not yet made contact with RMSC regarding inclusion of children’s cancers within the remit of the Committee. He felt that a decision regarding the inclusion of children’s within the wider Cancer Network was required in the first instance.
2 Dr Eatock reported that he had met with RMSC on 8th February and the following matters arose:
· Dr Eatock presented the paper ‘New Drug Pressures in Oncology/Haematology January 2007’ (circulated to members on 29th January 2007) which outlines the therapies clinically approved by the BCH Committee. No decision as yet has been reached regarding funding.
· Dr Eatock reported that there had been no decision regarding funding for therapies referenced in the circular from the CMO, Dr McBride. This contained seven NICE Technology Appraisals for implementation in the HPSS (circulated to members on 29th January 2007).
· The mechanism to review and assess business cases was discussed. It was agreed that this needed to be more responsive and changes to the mechanism considered.
Ms Campalani queried future of RMSC. Dr Eatock responded as yet, it was unclear as to what these will be.
3 Dr Eatock referred to the letter tabled at the last meeting from Mr Colin Hamilton, on behalf of RMSC regarding exceptional circumstances. The response from Mr David Galloway was noted (correspondence had been sent with members papers). This indicated that there needed to be some flexibility.
DT_0607_014 Key Relationships and Process Review
4 Ms Green outlined the key changes to the paper that were primarily to the horizon scanning section. Members approved this paper and it was agreed that it would be published on the website. As the processes develop within the Committee, this paper will be reviewed.
Action:
§ Above paper to be published on NICaN website. Paper to be reviewed as the processes develop within the Committee.
5 Ms McKillop referred to email sent that morning from Ms E England, Lead Cancer Nurse Altnagelvin in which she had commended the work being led by Ms Green. She had also indicated that she had distributed recent papers and had received positive feedback from colleagues on the progress being made for a mechanism to introduce new therapies on a regional basis.
DT_0607_15 Horizon Scanning Standard Operating Procedure
6 Dr Eatock invited Ms McGrady to provide an update on the development of the standard operating procedure for horizon scanning. Ms McGrady referred to the paper presented by Ms Green in which the process for horizon scanning is outlined. She indicated that the timescales will be very tight and that these should be aligned with RMSC, or other appropriate commissioning and business processes.
Dr Cuthbert queried whether the focus was on new therapies or those that have been licensed. Dr Eatock indicated that it would be difficult to assess the cost effectiveness of therapies that had not been licensed. The key issue will be to ensure the horizon scanning identifies all therapies prior to coming to licence. This will ensure that current practice of having to find funding for recommended therapies within current budgets is avoided.
Members agreed that the horizon scanning processes would include input from the oncology subgroups of the Tumour Groups. This will ensure multi-disciplinary and multi -professional input. Ms McKillop indicated that this work would need to be factored into the work plan for the Tumour Networks.
Action:
Ms Mc McGrady to liase with appropriate RMSC members Dr Harpur, Mr Baker and Mr Timoney to discuss the timeframes for the horizon scanning process.
DT_0607_16 Update from Business Case Subgroup
7 In absence of Mr Baker, chair of sub group, Dr Eatock provided an update.
Dr Eatock referred to the relevant documents circulated:
§ Clinical Business Case Template for New Drugs
§ Business Case Proforma required for Test Drilling (& completed example)
§ Service Impact Assessment
8 Referring to the worked example, Dr Eatock stated that the process will in future be more streamlined with only section 9 of the Business Case Proforma required for Test Drilling, needing to be completed by each unit (ie recording of proposed arrangements for financing, management, marketing, procurement, monitoring and evaluation).
He added that information from the clinical business case would encompass the information required to complete the business case proforma.
9 Dr Eatock then commented on the Clinical Business Case Template and the key sections: executive summary, background and current treatment, new technology, protocol for selection of patients, proposal for audit, conclusions and appendices.
He indicated that for those therapies not assessed or approved by NICE, more information would be required.
10 In the section on proposed use, Ms McKillop queried the information that would be contained within the section ‘implications of failure to implement new treatment’. It was confirmed that this would include risks to commissioners.
11 Professor O’Neill raised a key question, ie how business cases will be ranked / prioritised. He indicated that he had prepared a matrix to support the decision making process. Professor O’Neill circulated the document and reiterated that in ranking or prioritising cases, this exercise would only inform the decision making process.
Dr Eatock reminded members that the Committee did not make decisions regarding funding; rather its role was to inform/advise the commissioner. Clinical validation of the case was required and clarity on scoring to ensure there is comparability between the cases.
12 Other points raised during this discussion included:
§ Ms MacIntyre indicated the need to ensure economies of scale and benefits of regional drug contract price rather than NHS costs.
§ With respect to funding and allocation, Ms Sonner stated that there would always be variation in the number of patients costed for and those likely to require/receive treatment. Furthermore, the current funding models, based on population, are not flexible to allow appropriate funding allocation when a patient receives their treatment in another Board area.
It was agreed that the process needed to be carefully monitored. Rather than stipulating a particular number of therapies, business cases should include a reasonable estimate of numbers.
§ Ms Green stated the need to consider how clinical audit would best be carried out on a regional basis.
Dr Kyle proposed that the Committee advise Trusts that they should have a mechanism in place to audit that treatments are being prescribed according to the agreed indications. It was felt that clinicians would have the responsibility for adherence to agreed indications. It was agreed that a clearer process will support this responsibility, ie clinicians produce the business case, agree protocol and audit proposal.
§ Picking up on a point made by Ms Campalani regarding patient choice, it was agreed that there was a need for clear information to service users and public on the decision making process of the work of the Committee.
Actions:
§ In summary of discussion, the following pieces of work for the Business Care SubGroup were outlined:
review the ‘Business Case Template for New Drugs’ paper in light of comments from members.
clarify the process
clarify the terminology
review paper tabled by Prof O’Neill on ranking/scoring business cases
with regard to the Service Impact Assessment drafted by Ms Green, it was agreed that this become an integral part of the business case and provide a useful checklist / tool to support development of clinical business case. This paper is to be completed.
It was noted that the work on identifying nursing activity in relation to chemotherapy delivery would be valuable. Ms Alison Porter, Lead Nurse, Craigavon is leading on this work on behalf of the NICaN Nursing Group. Similar work in relation to aseptic activity has been established and is ongoing.
DT_0607_17 Implementation and Management of New Therapies
13 The implementation and management of new therapies will be a key responsibility for the NICaN Chemotherapy Group. Dr Eatock agreed to raise and discuss this with Dr Harte.
DT_0607_18 Cancer Network Developments
14 Ms McKillop provided a brief update of 3 relevant developments:
§ The Cancer Network is working in partnership with the Service Delivery Unit to support the introduction and sustainability of the cancer access standards. Current areas of work include GP Referral guidance for suspect cancer; development of evidence care pathways and clinical data sets.
§ To meet the growing agenda, a number of posts have been advertised: Service Improvement Lead, Network Support Officer, Chemotherapy Project Manager and Patient Information Coordinator.
§ The Cancer Network Board is currently reviewing its constitution in light of the new arrangements within RPA. It is likely that the new Board will meet late May/early June 2007.
15 Dr Eatock closed the meeting by thanking members for their participation and those members who had prepared work on behalf of the Committee for the meeting. He indicated he would like the committee to be in a position to sign off the Business Case Template Paper and Proforma at the next meeting. There would need to be further discussion on the process for ranking/scoring business cases.
16 Ms Campalani proposed flagging documents not for general distribution. Such papers may contain commercially sensitive information or are confidential. This was agreed.
Dates of next meetings:
Wednesday 2 May 2007, Ewart Room, Holywell Hospital
Tuesday 26 June 2007, Classroom 3, Fern House, Antrim Hospital
Wednesday 12 September 2007, venue TBC
Tuesday 20 November 2007, venue TBC
Wednesday 16 January 2008, venue TBC
All from 2:00-5:00pm.
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