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Health: Information Prescription

Volume 710: debated on Tuesday 19 May 2009


Asked By

To ask Her Majesty’s Government when all cancer patients will receive an information prescription.

My Lords, the National Cancer Action Team is working with cancer networks and cancer charities to develop an electronic delivery system that can be used by professionals to deliver information prescriptions to patients at any point during their cancer journey. Eleven tumour-specific information pathways have been developed and are being piloted across 71 sites in England. It is planned that the full system will be available and that all cancer patients will receive an information prescription as part of their consultation from 2010.

My Lords, I thank the Minister for that reply; it is welcome news. The pilot scheme is obviously taking slightly longer than anticipated; the cancer reform strategy promised the information prescription in 2009. Nevertheless, I welcome the news. Can the Minister say whether, along with the information prescription, all patients will have the assistance of a healthcare professional in helping them to understand and act on the information prescription made available?

My Lords, that is correct. The information prescription pilots are addressing, first, the concept of the dispensing of patient prescription information by a clinical nurse specialist who has all the competencies to explain the content of such prescription information. In addition, a written consultation discussion will be recorded and explained by the consultant; prescribing and dispensing information with a palliative care setting will be given; and there will be patient self-prescribing, with an explanation of what the content of that prescription means.

My Lords, I am sure the Minister is well aware that in obstetrics these information prescriptions are more appropriately referred to as patient information notes. In fact, obstetricians were the first to pioneer such notes. How do such notes help the patient-professional relationship? Should these notes record the performance of the surgeon—or the robot, as appropriate—in terms of outcome?

My Lords, the reason these are called information prescriptions rather than notes is because they contain evidence-based information. As to what this process does to the relationship between the clinician and the patients, I personally think it is transforming it from an era of paternalism into an era of partnership between the patient and the clinician.

My Lords, does my noble friend agree that specialist cancer hospitals such as the Christie in Manchester, where I am a non-executive director, already provide excellent information for specialist services, as evidenced by the fact that the hospital came first in the country in the recent in-patient survey for overall care? Does he further agree that the Christie charity provides invaluable additional support through specialist nurses and counsellors to provide disease-specific information, and that that is why the Government’s support to get compensation for the failed UK subsidiary of an Icelandic bank is so essential?

My Lords, I commend Christie’s and many specialist hospitals around the country. I work in one, the Royal Marsden, which provides services not dissimilar to the ones provided by Christie’s. I have little expertise in the banking arrangements of specialist hospitals, but I shall be more than happy to write to my noble friend about the issue.

My Lords, we are working with a large number of charities. I acknowledge the championing and pioneering impact of the work of the late Lady Clement-Jones, who introduced this concept through Cancerbackup and, more recently, Macmillan Cancer Support. We are working with CRUK, the biggest cancer charity in this country, supporting research and the evidence base for these information prescriptions. In addition, at least 32 other charities that deal with cancer are helping us with the content of such information prescriptions.

My Lords, the evaluation of the information prescription pilots suggested that PCTs needed to be given guidance about commissioning charitable and voluntary organisations to provide support to people to enable them to understand the prescription they have been given. What guidance does the Minister’s department give to PCTs about commissioning information and support services?

My Lords, we give guidance to PCTs about the information prescription. As it stands, we are running the pilots to learn more from them but, while we are doing so, we also have 25,000 patient questionnaires seeking patients’ views about the information. One thousand, two hundred and fifty patients will be part of the participating pilot while the other half will be the control group without the information prescription, and those are the comparative data on which we hope to build the system in 2010.

My Lords, I am grateful that the Minister expressed support for the concept of specialist nurses working in this important field. Specialist nurses are making an increasingly important contribution across many fields in the National Health Service, particularly in supporting and helping patients suffering from a variety of progressive diseases such as Parkinson’s, epilepsy, multiple sclerosis and many more, as well as cancer. May I have an assurance from the Minister that the development of specialist nurse services, not just in cancer but in other fields, is likely to be high on the agenda of the National Health Service?

My Lords, I agree. I can say that patients’ satisfaction and experience tremendously improved when I started to work for the specialist nurse in my colorectal team. I could not agree more; we need to develop specialist nurses and the roles that they will play, but that needs a significant mindset shift, certainly on the part of many of my nursing colleagues, as well as the development of competencies in providing that type of service.

My Lords, will the Minister tell me, for the benefit of other Members of the House also, quite simply what the information prescription will be, how it will be decided which people will get it—in the pilot, he said, half will get it and half will not—and how you will discover that you are one of the ones who will? Will it just arrive out of the blue in written form, or in another form?

My Lords, this is an academic evaluation so there is a random control trial going on. Patients will be selected at random. That is one of the pilots looking at the impact of this. Our aspiration is that every patient with cancer will receive an information prescription throughout the whole of their pathway, whether that is the referral from the general practitioner to the specialist centre, the diagnosis, the treatment, the long-term follow-up or the prognosis. We believe in empowering patients because many will say that an empowered patient will get through the cancer pathway at a speedier rate and feel much more confident in the treatment they are receiving.