NICE prospects for cancer care
March 2004 saw the publication, in England and Scotland, of the long awaited National Instituteof Clinical Excellence (NICE) guidance on supportive and palliative care for adults with cancer.
For some years health care professionals have argued that the standard NICE tumour-specific guidance failed to address the wider needs and concerns of the patient with cancer and their carers. Although many patients report positively on their experience of cancer care, there are many who have not received the information and support they needed. There still appears to be a wide variation in the quality of care delivered across the country.
The main focus of site-specific tumour Improving Outcomes guidance has been the recommended diagnosis and treatment path for such tumours. Whilst these were of major importance, they failed to address the major issue of supporting the patient and meeting their physical, psychological, social and spiritual needs throughout their cancer journey and beyond.
The Improving Supportive & Palliative Care for Adults with Cancer Guidance is intended to complement the Improving Outcomes guidance manuals on specific cancers.
For the first time, national guidance recognizes that individual patients have different needs at different times of their cancer journey, and that services should be responsive to those needs; that some patients need a range of specialist supportive and palliative care services; and that, in addition to receiving the best treatments, patients want to be treated as individuals, with dignity and respect, and to be heard in decisions about treatment and care.
The guidance is divided into 13 key areas, though the division is more for the purposes of clarity and completeness as there is considerable overlap between the areas. The key areas are co-ordination of care; user involvement; face-to-face communication; information; psychological support; social support; spiritual support; general palliative care; specialist palliative care; rehabilitation; complementary therapies, services for families and carers and workforce development.
Within each of these sections are a number of key recommendations to improve the delivery of that particular area of care. The guidance is good news for everyone. It acknowledges the importance and value of patient and carer involvement in the planning and delivery of cancer care; it acknowledges that patients need access to a wide range of expert health care professionals; it acknowledges that we need to develop more of these expert professionals and it recognizes the value of forging partnerships between patients, professionals and a wide variety of other agencies. It is particularly good to see emphasized the value of high-quality information for patients and carers, the importance of good multidisciplinary team working and communication and the role that primary and community services play in supporting patients with cancer. NICE has taken the welcome step of investigating the impact that its recommendations will have on workforce issues such as the numbers, and education and training, of health care professionals in cancer care. It has also been bold enough to estimate the not insignificant economic impact of implementation of the guidance. It is one thing to issue recommendations but quite another to ensure their implementation. Cancer Networks have been delegated the responsibility of ensuring the implementation of this guidance alongside their role in delivering the Cancer Plan. Each network will have an implementation team and 3 years in which to deliver the recommendations. The Department of Health has already called for evidence, from the networks, of their implementation plans. Mapping exercises are showing significant discrepancies, as predicted, between the current reality and the recommendations. The implementation process will not be easy. It will take time, money and motivation. However, the eagerness with which both networks and cancer health care professionals have embraced the guidance, their willingness to ensure patient involvement and partnership and their determination to ensure implementation of the guidance makes the future of cancer care much brighter for all patients and carers.
The NICE Guidance on Cancer Services, Improving Supportive and Palliative Care for Adults with Cancer was published by the National Institute for Clinical Excellence, London, March 2004.
Maureen Hunter Rehabilitation Services Manager
The Royal Marsden NHS Trust
