The holistic approach to cancer care offered by the NHS must be emulated in the private sector according to hospital groups and intermediaries.
The Department of Health and Macmillan Cancer Support have set out a new vision for cancer survivors including support for self-management and access to specialist medical care for complications that occur after cancer. A Macmillan poll found that 89% of cancer patients expect a personalised care plan. Intermediaries claim the limitations of cancer cover are already being exposed.
“The customer perception is that they want full care covered,” said Paul Roberts, lead consultant at intermediary IHC Ltd. “What they get is treatment. Treatment doesn’t give you the ancillary things which are now par for the course when you go through the NHS, and have been for nearly a decade now. I still find it amazing that we are still so far behind.”
Private hospitals are now developing packages of care for cancer patients that recognise their ongoing needs following treatment.
“It’s fair to say that with the innovative among the insurers we have captured their imagination,” said Dr Andrew Jones, group medical director of Nuffield Health. “The key thing for all of us is to work together in partnership because, as we have indicated, we don’t think things can go on as they are.”
Dr Jones said that the “recovery plus” model adopted in orthopaedics, whereby four months of extended recovery in the gym is offered as part of the Nuffield package, could be adapted to provide follow-up for cancer patients post surgery and chemotherapy. Another option would be to offer survivorship programmes within annual health and follow up checks, including exercise and diet advice.
Simon Rivers, cancer network manager at HCA Cancer Care, said that survivorship was a key component of the organisation’s cancer network, which comprises all six private hospitals plus the provider’s NHS ventures with University College Hospital and Queen’s Hospital in Romford. A key development, due to be piloted in the coming weeks, is software which will help healthcare professionals to effectively follow up with patients “from a survivorship perspective” (ie in addition to conducting clinical follow-ups to identify recurrence of cancer). This will enable them to assess a patient’s qualify of life following treatment and will be open to patients themselves who can “self-assess”. If a problem such as lymphoedema – a common debilitating side-effect of breast cancer treatment – is identified this will trigger referral to follow-up services such as physiotherapy.
Rivers said: “What is different in the private sector is that patients tend to refer into the private sector then disappear out into the NHS once chemotherapy or radiotherapy is complete and, although they will still be on clinical follow-up, what we want to ensure is that they have full access to the whole range of services within HCA and can access back into those and provide them with the full survivorship programme.”
NHS cancer care has been revolutionised by reorganising services so that each case is reviewed by a multi-disciplinary team of specialists who can put together a care plan tailored to each patient. In response, Bupa has established a network of cancer units which run “care pathways” coordinated by a multi-disciplinary team. Fiona Harris, director of Bupa UK Health Insurance, said that aim was “to ensure you are seeing a complete team of carers” including a consultant, physiotherapist, counsellor and specialist nurse. Bupa policies cover both psychiatric and complementary therapies.
AXA PPP healthcare is heavily promoting its Dedicated Nurse service whereby each cancer claimant is allocated to a nurse who can offer advice and support over the telephone throughout their treatment.
IHC’s Roberts highlighted access to talking therapies as a particular problem in the private sector. Ten per cent of cancer patients experience clinical depression and NHS guidelines state that healthcare professionals must monitor patients for signs of depression, and where appropriate, refer on to psychiatric services. While some policies will cover psychiatric treatment it may be subject to outpatient limits or an “acute” diagnosis.
The good news for the private sector is that private hospital groups are well-equipped to provide many of the services that NHS patients may struggle to access quickly. For example, access to physiotherapy for breast cancer patients with lymphoedema is patchy, but Nuffield Health has the largest network of physiotherapists outside the NHS.
| COMPARING COVER | ||||||
|---|---|---|---|---|---|---|
| With the exception of complementary therapies all the benefits below are covered by the NHS. We asked three PMI providers whether they would be available to members. | ||||||
Physiotherapy after breast cancer surgery | Psychiatric treatment | Follow-up appointments for three years | Complementary therapies | Bisphosphonates (drug to prevent bone loss as a result of treatment) | Advice on returning to work | |
Aviva | One short-term block manual lymphatic drainage in acute conditions of lymphoedema if this is recommended by the treating specialist | Subject to psychiatric treatment being available under the policy terms, and member diagnosed with acute psychiatric condition | Subject to any outpatient limits that may be applicable to some policies - benefit is available for monitoring of a cancer patient for five years | Subject to this type of treatment being a specified benefi | Benefit for a short course of 6 months of biphosphonate treatment once only during the cancer claim. Longer treatment would not be covered as preventative maintenance of further bone loss | |
AXA PPP healthcare | Yes if outpatient benefit included on policy | Yes if benefit for psychiatric treatment included on plan | Yes, appointments with consultant covered for 10 years | Out-patient acupuncture, homeopathy, osteopathy and chiropractic treatment covered | Yes | Yes, offered by Dedicated Nurses |
Bupa | Covered in full under many schemes if recommended by consultant | Outpatient psychiatric treatment covered in full under many schemes where a psychiatric condition has been diagnosed | Covered in full under many schemes | Acupuncture, chiropractics, homoeopathy and osteopathy covered in full under many schemes | Bupa will consider requests for bisposphonates, such as Pamidronate, Bondronat and Zometa when given intravenously. They may be eligible for symptomatic patients until disease progression. | All members have access to Bupa HealthLine – a phone line staffed by nurses offering health information and guidance |