Approved Minutes of the 2nd NICaN Regional Oncology / Haematology D&TCommittee NICaN
14th November 2006
2nd NICaN Regional Oncology / Haematology D&T Committee
Tuesday 14th November 2006
Board Room, Hilton Hotel
Record of attendees:
Dr Martin Eatock, Chair
Mr Brian Baker, RMSC
Ms Sally Campalani, NICaN Nursing Group
Dr Alison Clayton, Medical Oncology
Dr Graeme Crawford, NICaN Primary Care Regional Group
Ms Fionnuala Green, NICaN Team
Dr Carolyn Harper, RMSC
Dr Robert Harte, NICaN Chemotherapy Regional Group
Ms Jill MacIntyre, G6 Pharmacy Managers
Mr Joe Magee, Department
Ms Janis McCulla, NICaN Team
Ms Maire McGrady, NICaN Team
Ms Sandra McKillop, NICaN Team
Ms Lisa McWilliams, NICaN Team
Professor Ciaran O’Neill, University of Ulster
Ms Cora Sonner, G6 Pharmacy Managers
Apologies: Dr Gerard Daly, Mr David Galloway, Ms Liz England and Mr Mark Timoney
DT_0607_01Sign off & Matters arising from Minutes of Inaugural meeting
Dr Martin Eatock requested confirmation that members had received copies of the minutes and these were accordingly signed off with two minor amendments to include Dr Eatock and Ms Liz England in the list of attendees. Dr Eatock questioned whether everyone received his correspondence with regards to Bortezomib, which he had forwarded for information purposes.
As agreed at the last meeting correspondence had been forwarded to the Chief Executives of the Trusts and the Local Lead Cancer Teams to inform them that the inaugural meeting had taken place and seeking comments on the constituent members. It was reported that no comments had been received. Dr Eatock then highlighted some changes to personnel by stating that the clinical oncology representative would be Dr Seamus McAleer with Dr Russell Houston acting as a deputy. Dr Curly Morris, Chair NICaN Haematology Group had nominated Dr Robert Cuthbert and Dr Anne Kyle.
Correspondence received from RMSC, 3rd November 2006
Dr Eatock stated that Oxaliplatin had been approved in the summer by RMSC, but that this licensed measure was very difficult to deliver in current capacity and it had been questioned whether Capecitabine could be used instead. The response from RMSC was that a business case needs to be developed for Capecitabine and this had been communicated to the Upper GI oncologists based at the Cancer Centre.
RMSC had questioned if head and neck treatments were delivered in the Units and the Centre. It has been clarified that they are only treated at the Cancer Centre and this is to be communicated back to RMSC.
DT_0607_02Key Stakeholders and Process Review
Dr Eatock had provided a schematic to depict key relationships for the Regional Drugs and Therapeutics Committee. The relationships are quite complicated and are reflected in the schematic, a copy of which will be emailed to all. Dr Eatock focused on the roles of the regional group ie horizon scanning, business case assessment and prioritisation. With regards to horizon scanning it was stated that a horizon scanning paper needs to be prepared stating how often this horizon scanning takes place and the reporting in bodies.
With regards to business case assessment it was questioned at which point NICE recommendations come in i.e. at final appraisal determination or when the NICE consultation commences. Under prioritisation it was questioned how often did business cases need to be submitted and Dr Carolyn Harper advised that a schedule needs to be created. Mr Brian Baker indicated that the current system is for development plans to be submitted in April with approval for September/October. Mr Baker did however state that a paper had been submitted to Mr David Galloway, Deputy Director of Secondary Care to inform spending and drugs for 08, 09. Ms Jill MacIntyre stated that the SMC make recommendations monthly with a horizon scanning paper for the year being sent October/ November and the Board then to decide to allocate funding accordingly.
DT_0607_03 Committee Purpose/Remit/membership
Group Terms of Reference
The Group Terms of Reference had been revised after the inaugural meeting and the amendments were highlighted. A further amendment was suggested to the initial purpose statement to “..seek to ensure equity of access…” It was also agreed to reorder the bulleted roles of the committee to reflect core business of the committee. There was much discussion around the indicating of priorities inline with regional planning and financial cycles as it was felt that this could be unresponsive to patient needs. Business case development and prioritisation requires further exploration and it was agree to remove “.. in line with regional planning and financial cycles.”
Other changes include a statement that the Committee is focusing on adult malignant diseases and a further one indicating that not all tumour areas are currently represented. All amendments were noted and amended Terms of reference will be issued with the minutes of the meeting.
Remit
It was agreed to create a subgroup to explore how business cases are developed and prioritised. Membership will include representatives from the Department of Health and Department of Finance and Personnel (to be secured by Mr Joe Magee), Professor Ciaran O’Neill, Mr Brian Baker, Dr Eatock, Ms Fionnuala Green and a nursing representative.
Membership
Ms McKillop stated that at the Inaugural meeting J Adair’s framework had been used to look at members’ responsibilities as a team and it was stated that this meeting would focus on the responsibilities of individuals and the identification of their unique contribution. Attention was drawn to the membership table within the Draft Terms of Reference. Ms Maire McGrady requested a change to the nominating party for the Pharmacy representative stating that the chair of the NICaN pharmacy regional group had been the nominating party in consultation with G6 Pharmacy managers.
Ms McKillop asked members to discuss in small groups the contribution and value that they brought to the group in order to explore if membership was fit for purpose and that the skills and uniqueness brought by each member could be fully utilised. Each member then outlined his or her individual contribution and this was captured for a revised paper to be forwarded out post meeting. It was stated that responses would be sought from the core members not currently present i.e. the haematology representatives, and the clinical oncologist representatives.
After this discussion it was questioned whether there were any omissions from core membership. It was questioned whether charities were representative and it was stated that Ms Janis McCulla through the Cancer Experience Forum was the network mechanism to connect into all the charities, self help groups and service user groups.
With regards to palliative care membership it was stated that all could accept linkages, whether they were nurse or medical into this group. After the previous meeting the Chief Executives had been asked to comment on the composition of the group as there was a query with regards to unit representation of the group. It was quickly surmised that members around the table could represent the Ulster, Altnagelvin, BCH and Antrim but that Craigavon and the Royal were not currently represented. It was however stated that communications would be forwarded to all units via the local lead cancer teams and that business cases would be prepared by the site specific teams on a regional basis but taking into account the local consideration.
Ms Sally Campalani asked whether any drugs expenditure was likely that wasn’t coming through the oncology or haematology departments. Dr Eatock stated that radiopharmaceuticals might be an example although he linked it to the neuroendocrine team at the Royal and should there be a specific radiopharmaceutical coming online then a nuclear medicine representative could be co-opted on to the group.
DT_0607_04Testing Drilling of Revenue Expenditure Decisions
Clarification of Process
Mr Eatock handed over to Mr Baker to outline the current test drilling process as carried out by the Department. Mr Baker tabled example papers to explain the test drilling process at the Department. It was stated the Department of Finance, Personnel requires proof of value for money for new revenue decisions over £250,000 and as such the Department of Health submit a sample of business cases to the Department of Finance. Mr Baker stated that if a business case is robust then there is likely to be little additional work.
Dr Eatock stated that this was a conflicting message from that coming from the Trust . Mr Baker stated that this might be due to the format of content of business cases being prepared. Mr Baker stated that should a business case contain the following items they should also be fit for test drilling;
- strategic context;
- need;
- objective;
- constraints;
- identify and describe options;
- identify and quantify monetary costs; and
- benefits of options.
Ms Campalani expressed concern of compliance with the quality impact as drugs could be specific to groups i.e. sex, age etc. Dr Harper stated that equality impact is not an issue if it’s on the grounds of biological reasons.
DT_0607_05Cancer Network Developments
Ms McKillop drew attention to a network e-update that had been circulated in November drawing attention to the updates of the other regional groups and also the consultation of the Department’s cancer control plan. It was stated that the cancer control plan was a first step in the creation of a service framework for cancer and members were encouraged to use the link in the E-update to consider the document. Dr Eatock stated that he would be happy to formulate a response to the cancer control plan on behalf of the regional drugs and therapeutics committee and would circulate to members before submission.
Healthcare Reform Programme
Ms McKillop stated that the tumour site-specific groups within the network are developing care pathways and minimum datasets in order to support the achievement and sustainability of regional quality access standards for timely access to cancer services. It was stated that the Network were working in partnership with the Department’s Service Delivery Unit and that care pathways needed to be created for initial monitoring in April 2007.
Any other Business
Confirmation of Chair
Dr Eatock had been chairing this meeting and Ms McKillop requested confirmation from members that they were happy for Dr Eatock to continue in this role. This was accordingly agreed.
Deputy Chair Nomination
There were no nominations forthcoming from around the table although people were asked to give this some consideration. It was highlighted by Dr Eatock that Dr Seamus McAleer would be happy to be nominated in this position should no other nominations arise.
DT_0607_06Timeline and dates of future meetings
It was agreed that the future meetings would take place on Wednesday 10th January at 2.00pm and Tuesday 13th March.
An approach will be made to see if Andrew Walker, Health Economist from Scottish Medical Consortium can attend either of these meetings.
Dr Eatock then closed the meeting and thanked all for their participation and stated that the subgroup to look at the production and prioritisation of business cases would be established before the next meeting in January.
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