Commissioning Cancer Drugs and Services. The London Cancer New Drugs Group Meeting

He ended his talk by reminding delegates that it was providers, not commissioners, who should be defining care pathways. This remark prompted a lively discussion centred on the clinicians’ role in local decision-making. When asked how doctors, as non-economists, could be expected to reach objective decisions about resource allocation, he argued that clinicians would be working within a defined decision framework. “And remember, if clinicians don’t make decisions, someone else will,” he added.

Paul Corrigan, Director of commissioning improvement and innovation for the NHS, picked up the theme of reform to commissioning, and emphasised the role of PCTs—which he described as “geographically based health insurance systems”. He said the changes to commissioning were intended to clarify what had up until now been an opaque process. A central feature of the new strategy would be investment in “early business”—early presentation and early diagnosis—as a means of reducing the health inequalities that emerge from a tendency for some sectors of society (e.g. working class men) to seek help late into the course of a disease. “All PCTs need to intervene to create a culture of early business, which will improve survival and improve the value gained from NHS spending,” he said.

He warned that the emergence of new healthcare technologies, combined with an ageing population, could bring bankruptcy to every healthcare system in the world in the next 10 years. Tactics for warding off such a disaster included:

• Decommissioning old technologies to make way for new drugs and procedures
• Encouraging older people to be fit and active
• Aiming public health initiatives, such as smoking cessation, at populations known to be at particular risk
• Using incentives to promote healthy lifestyle choices

In response to a question from the floor about the apparent contradiction between patients’ preferences for local care and the demonstrable benefits of “critical mass” that apply when 
services are developed to serve larger populations, Mr Corrigan said there was an onus on providers to be open in their explanations to patients.

Another delegate, who agreed with Mr Corrigan that there was a need for cross-boundary cooperation between PCTs, asked how world-class commissioning would work if some individual PCTs continued to refuse to accept cross-boundary decisions (e.g. cancer network-wide). Mr Corrigan acknowledged that the governance arrangements in such circumstances remained unclear, but said there were already examples of groups of PCTs that had relinquished part of their responsibility for commissioning to a network-wide group, in the interests of efficiency and health equality.

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