NHS England has also had a major impact on chemotherapy, a directly commissioned service, with ideas, projects, and programs initiated from its chemotherapy CRG. It also means that service developments that require additional funding have to compete with other national priorities and be delivered for England. Combined with a strong relationship with the National Institute for Health and Care Excellence, the cancer drugs’ landscape changes every week. The Early Access to Medicines Scheme, a joint program between the Medicines and Healthcare products Regulatory Agency, NICE, and NHS England, has introduced several novel cancer treatments.
NICE has appraised none of England’s routinely commissioned radiotherapy treatments. One appraisal has been undertaken for intrabeam radiotherapy for adjuvant treatment of early breast cancer, and a ‘not recommended for routine commissioning’ outcome was published. NICE may extend its portfolio in the future to carry out more appraisals. Alongside an aligned research strategy, the pull-system for policy development, the learning healthcare system also aims to build a collaborative approach to quality improvement. Included is understanding the readiness to change for a stretched workforce, building a culture of change that is a positive experience, building the implementation questions into research inquiry on a specific technology, and giving equal intellectual value to exemplars of PDSA cycles of service change to the randomized trials published in an international journal.