The NSW Cancer Institute

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

The NSW Cancer Institute has been formed to promote a patient-centred approach to cancer prevention and treatment. It has been constituted through an Act of the NSW parliament with the objectives of increasing the survival rate and quality of life of cancer patients, reducing the incidence of cancerand to provide expert advice on cancer control.

Purpose of health policy or idea

A bill has been passed by the NSW parliament which provides for the establishment of the NSW Cancer Institute. The objectives of the Institute are:

• to increase the survival rate for cancer patients
• to reduce the incidence of cancer in the community
• to improve the quality of life of cancer patients and their carers
• to operate as a source of expertise on cancer control for the government, health service providers, medical researchers and the general community.

The characteristics of the Institute is that it is a company limited by guarantee, governed by a board and under the control of the Chief Cancer Officer. The Board will establish a number of committees including an ethics committee, a clinical services advisory committee a research advisory committee and a quality and clinical effectiveness committee, all of which will provide advice to the Board. 

The Institute will guide the allocation of $AUS205 million to new initiatives regarding cancer care and control over the next 5 years. The funding is to be directed at

• improving the coordination of care using mutil-disciplinary teams of health care providers,
• ensuring that doctors are familiar with best practice treatments,
•  providing public awareness campaigns
• improving services for people living outside Sydney.
• supporting research into cures for cancer
• providing services to support people with cancer and their families

Thus, the work of the Institute will potentially affect people with cancerand their families, health providers and researchers and policy makers and planners in the health system. However, the changes are likely to be incremental and may take some time to implement.

Main points

Main objectives

• to increase the survival rate for cancer patients
• to reduce the incidence of cancer in the community
• to improve the quality of life of cancer patients and their carers
• to operate as a source of expertise on cancer control for the government, health service providers, medical researchers and the general community.

Type of incentives

The Institute will guide the allocation of $AUS205 million to new initiatives regarding cancer care and control over the next 5 years. The funding is to be directed at

• improving the coordination of care using mutil-disciplinary teams of health care providers,
• ensuring that doctors are familiar with best practice treatments,
•  providing public awareness campaigns
• improving services for people living outside Sydney.
• supporting research into cures for cancer
• providing services to support people with cancer and their families

Groups affected

cancer patients and families, health care providers, health services researchers

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

This policy is aimed at improving the accessability and quality of care for cancer patients in NSW. It is too early to comment on the extent to which it has fulfilled these aims. However, it is a very ambitious undertaking, relying on fairly small incentives to change provider behaviour in relatively fundamental ways. Whilst it may be able to successfully undertake its functions, the extent to which these are related to achieving significant improvments in the survival and quality of life of pepole with cancer is questionable.

Political and economic background

The formation of the NSW Cancer Institute was a key policy proposed by the NSW Labor Party prior to its re-election as the government of NSW in March 2003. It forms part of the NSW government's health policy.

As part of the planning process for the Institute, the Minister visited all major teaching hospitals and research centres to discuss the proposal and hear the views of people working in the area. Forums attended by clinicians, researchers, consumers and other stakeholders were also convened to discuss the porposed role and functions of the Institute.

Complies with

Need to comply with the NSW government's health policy for the 2003 election

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The policy was first formulated by the NSW government in 2003 as part of its re-election policy. The main purpose of the idea is to form an organisation which will be the driving force behind efforts to control cancer and which will also have the expertise and financial backing to coordinate the State's cancer strategy. The former Minister for Health (Craig Knowles) and the current Minister Assisting the Minister for Health (Cancer) (Frank Sartor) were the political forces behind the idea. The Institute may have been a personal issue for Minister Frank Sartor whose partner had recently died of cancer. The coordination of cancer care has been an important issue for cancer support groups such as the Breast Cancer Support group who have advocated for greater involvement of consumers in decision making and for more information to be made available to consumers and their families.

It has required new legislation enabling the formation of the Institute and at the same time, changing the role of the NSW Cancer Council. This will entail repealing the current Cancer Council Act and registering the Cancer Council as a company.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The policy was formulted as part of an election campaign. There have been no obvious opponents of the idea although the extent to which health care providers cooperate to achieve the objectives of the Institute remains to be seen. The goverment was seen to lead the way in bringing the idea forward  but in doing so they were supported by leading members of the health care provider community in NSW, especially some leading cancer specialists. As it is not clear exactly how the Institute will operate (due to its newness), clinicians may perceive that they need to be seen to support the idea or at least adopt a "wait and see" approach until its operating principles become clearer.

The role of the NSW Cancer Council will change to focus on fundraising, community education and advocacy and philanthropic activities for cancer patients and their families. It has been stated that such changes are consistent with the Cancer Council Board's desired future direction and that the roles of the two bodies would be complementary.

Influences in policy making and legislation

The Cancer Institute (NSW) Bill 2003 was gazetted in September 2003. Frank Sartor was the main proponent of the Bill and has been active in generating support amongst providers.

Adoption and implementation

The Board and the Chief Cancer Officer will be instrumental in the implementation of the objectives of the Institute. They are charged with producing a State Cancer Plan by June 2004. In the plan, according to the guiding principles, they will be required to set out how the following will be achieved:

• a partnership developed between the public sector, the private sector and the general community
• applying resources for cancer control to maximise the benefit to the greatest number of people in the most expeditious, effective and efficient manner
• providing for an equitable, evidence-based, seamless patient-centred approach to the care and treatment of cancer patients
• provide high quality, timely, multi-disciplinary, coordinated care to all patients, irrespective of geographic location
• accounting for the public funds available to the Institute
• cooperating with national bodies engaged in cancer control
• linking cancer control organisations in NSW
• providing easily accessible up-to-date information about cancer control to the general public
• developing cancer-related research activities that maximise gains and build optimal research depth in a number of key research institutions

The incentives that will be offered providers, patients and researchers to cooperate in this venture are not fully clarified as yet.

Monitoring and evaluation

The Institute will be required to provide an annual report within four months of the end of each financial year. The report will be tabled in the NSW parliament. The annual report must contain details of the outcomes of initiatives of the Institute, in particular, details about trends in incidence, mortality and survival rates of cancer and an overview of cancer-related research and philanthropy in NSW during the previous financial year. The guiding principles set out in the Act of parliament will be used to gauge the success of the Institute.

Dimensions of evaluation

Ergebnis

Results of evaluation

Although there are no results from an evaluation yet, the Act clearly states that the success of the Institute will not be measured by the amount of money invested in its efforts but in the number of lives saved and the improvements made in the lives of those suffering from cancer.

Expected outcome

It is doubtful that the success of the Institute will be able to be measured in terms of health status outcomes alone. This is because there will be many other factors besides the operation of the Institute which will affect the outcomes of people with cancer. The guiding principles provide a framework within which a limited evaluation could be conducted. However, to enable the most comprehensive assessment of the extent to which the Institute achieves its objectives it will be necessary to compare the role and functions of the Instutite as set out in the Act and second reading of the Bill with the progress towards these made by the Institute. Thus, an evaluation could assess how if or how well the Institute had:

• produced a State Cancer Plan
• undertaken, commissioned or sponsored research
• facilitated cooperation and collaboration in cancer-related research
• facilitated ethical approval form multi-centre trials
• fostered and supported best practice and evidence-based aproaches to cancer control.
• accredited programs of cancer control
• reviewed, monitored and evaluated imporvements in cancer services
• reviewed or developed innovative approaches to cancer control
• investigate, evaluate and advise on complementary therapies
• obtained, collate, maintain and analyse information relating to cancer control
• disseminate information about cancer control
• provide training and education about cancer control
• consulted with other bodies involved in cancer control
• engaged in fund-raising activites

The Institute will not be cost-neutral. However, until the means by which the Institute plans to achieve its objectives and fulfill its functions becomes clearer, its effects on quality and access cannot be gauged.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

For the reasons outlined above, it is difficult to assess the impact of the Institute before it has had a chance to operate. However, a conservative evaluation is that it will have a small impact on the quality of care provided overall (although it may have a larger impact in locations where quality of care is currently relatively low), is likely to make the system somewhat more equitable but is unlikely to lead to a more efficient health system.

The formation of the Institute will also have an impact on the role and function of the NSW Cancer Council. Although it is not clear which parts of the Cancer Council will be taken over by the Institute, it seem likely that the NSW Cancer Registry will in the future operate under the aegis of the Institute. Whether this change will influence the operation of the registry remians to be seen.

References

Sources of Information

NSW Parliament. Cancer Institute (NSW) Bill 2003 www.parliament.nsw.gov.au/Prod

Cancer Institute (NSW) Bill. Second Reading www.parliament.nsw.gov.au/Prod/Parlment/HarnArt.nsf

www.health.nsw.gov.au

Author/s and/or contributors to this survey

Marion Haas, Rob Anderson, Jane Hall

Empfohlene Zitierweise für diesen Online-Artikel:

Marion Haas, Rob Anderson, Jane Hall. "The NSW Cancer Institute". Health Policy Monitor, October 2003. Available at http://www.hpm.org/survey/au/a2/4