Government policy and engagement in cancer care

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Published: 24 Jul 2013
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Dr Robert Thomas – Peter MacCallum Cancer Institute, Victoria, Australia

Dr Robert Thomas talks to ecancer at the 2013 National Cancer Institute Directors Meeting (NCID 2013) in Lyon about how to engage governments in discussing the cost of cancer care.

Dr Thomas covers how the growing trend is balancing how to deliver the best care while reducing costs as the number of cancer cases continues to rise.


Filming supported by the International Prevention Research Institute


I am, at the moment, most engaged with the issue of how does one stimulate a government to look at a subject such as cancer, which is a real issue for our community, for all communities, whether they be underprivileged communities or highly developed communities. But the cancer issue has been around now for probably ten or fifteen years.

And it’s an emotive issue so governments have to respond to the electorate.

It’s an emotive issue. Many, many studies have shown that the individual person in the street fears most of everything cancer. So there is an emotive issue there which says the government has to do something about it. The second issue which interests the government is cost because the cost of cancer care is going up, skyrocketing, absolutely skyrocketing, and it cannot be sustained with that rise.

Now, you’re speaking from the perspective of a highly developed country doing very well economically at the moment. So what are the issues that you still have?

The issues in terms of cost are still significant. So in a state like Victoria our health bill, all of health, is something like $28 billion which is…

A lot.

It’s a lot of money, whatever, however you measure the exchange rate. So that’s an issue and that’s a problem. And, as in the UK and as other highly developed countries, the government is saying, ‘Hey, cut this back.’ So the planners have to say, ‘How can we deliver the same level of care at reduced dollars?’ Now that really means more efficient care and more effective care.

You’re CEO of a very important cancer centre but you’re also concerned with advising the Victoria government. But I believe a difficulty you find is actually engaging the government to take that advice, perhaps?

Yes, I think it is an issue because governments are funny beasts. They respond to issues which are absolutely outside pure logic. After all, they want to be returned at the next election so they find issues which they feel are going to put their name forward in a strong and effective way so they’re going to be returned at the next election.

What are the steps you need to take, then, to engage government?

So a very important question. So the step is you have to have two things: firstly community support and preferably people on the streets. So we’ve seen, particularly in America, the breast cancer movement has been incredibly effective and worldwide in asking governments and making governments put funds into breast cancer.

Now, with your skills as a surgical oncologist, how do you do that?

It’s interesting. Another side effect, if I may digress for a moment, is the issue of patient experience. So we’re really interested in, and the patient is interested in, patient experience. And the government are interested in patient experience. And patient experience is what the women with breast cancer talk about when they get out on the streets. So we wrap up an approach to government which is around patient experience and we say, ‘We can guarantee our patients will get better experience, they will look upon the government more favourably, you will be doing good if you follow this planning process.’

So in a way there is an element of public relations which is important to win over both the government and the patients.

It is indeed. Patients will follow pretty well, they generally like the care they’re given. Actually, as CEO, one of the new patient experience exercises is for CEOs, not as a doctor, go and talk to all the patients in a hospital. I went round all the patients in Peter MacCallum just before I left, I asked them things like, ‘Are you happy here? Is the nursing good? Is the food good? Have you got any problems at all?’ Universally they said, ‘No, we’re quite happy. We’re quite happy.’ And that’s because they have cancer, they realise they’re in a no return situation and they like the care they’re given. So that’s not a real problem for us.

Is this something that you can use to your advantage to win over and engage the government to do what you know needs to be done?

It is but it’s not easy to mobilise people onto the street for that sort of action. I have heard it said, the Americans, when you ask the Americans about how they get budget out of their federal government, Washington, they say, ‘Send in the consumers first. Get the consumers to say, “We need the money for cancer care,” and then send in the professionals who say, “Now, if you give us x amount of money we can use it in this way and that way and we’ll get better outcomes.”’

So finally, what kind of tips would you give to other planners in other places to actually succeed in these difficult situations, situations in places even when you have got a highly developed country like Australia?

We’ve had a lot of experience in planning and we believe strongly in having an integrated plan which reads well, which is easily saleable, which is engaged by both the professionals who deliver care, the patients who receive the care and the politicians can ride along behind and take the accolades.