Breakout session 5: Delivering care in the most appropriate setting
The way that care is delivered is changing. Fewer cancer patients require treatment as an inpatient in hospital and therefore many patients are benefiting for being treated closer to home or in social care. In addition, centres of excellence are being developed to improve outcomes. This session considered the impact of the changing setting of cancer care.
Karen Taylor OBE, Director, Health Value for Money Audit, National Audit Office
Celia Ingham Clark, Consultant General Surgeon and Medical Director, The Whittington Hospital NHS Trust
Philippa Muir, Head of Specialist Commissioning and Clinical Networks, Oxfordshire PCT
Download Karen Taylor's presentation [Powerpoint, 1.21mb]
Download Celia Ingham Clark's presentation [Powerpoint, 956kb]
Download Philippa Muir's presentation [Powerpoint, 152kb]
Delivering care for cancer patients in a non-clinical setting often requires the co-operation of local authorities who control social care budgets. Local authorities are not currently engaged in the delivery of cancer services, although pooled budgets have been used to work across health and social care boundaries with some effect. The new process surrounding Local Area Agreements should encourage further dialogue between the NHS and social care in the future as should the role of Directors of Public Health. The difficulty of determining separation of care under the Richards Review was raised.
There is a need to be clear about the benefits and outcomes of delivering care in each setting. There can be an assumption that delivering, for example, chemotherapy, services in the home is better for the patient, although these may be expensive. Some patients' preferences will be to be treated in hospital. It was noted that children and young people are often particularly keen to be treated at home, highlighting a need for support from, for example, a community care nurse.
Anxiety about hospital closure does not seem to be exacerbated by moving an increasing number of services into community settings. This may be because acute trusts are increasingly flexible about, for example, the number of beds they use enabling them to respond more efficiently to demand for hospital services. It is more important to ensure that the standards of care are the same, irrespective of the setting.
Out Of Hours (OOH) care in the community can be particularly problematic and its inefficacy can drive patients through into acute care unnecessarily. There are specific issues around end of life care, in particular 24/7 community support, most of which are discussed in the recent End of Life Care Strategy. Despite the renegotiation of the GP contract and the subsequent changes to OOH care delivery, GPs are engaged in end of life and palliative care. Commissioners have the ability to commission for OOH care under a different model where needed. Pharmacy prescribing end of life care plans, controlled drugs in the home and various other options are currently being explored to improve OOH care.
Commissioning for continuity of care across a variety of settings can be difficult, but the operation of patient choice should allow market forces to evolve the best model of care for that particular community.
Breakout session six: End of life care >