Cancer Campaigning Group

Second NHS Future Forum report highlights the importance of shared outcomes for cancer patients

The Future Forum has published its second report looking at integration, information, public health and education and training.  The Government has accepted its recommendations.

CCG members met with Prof Steve Field (Chair) and representatives of the Future Forum in October to share their views about these topics and highlight the cancer perspective, feeding directly in to the review.

The Forum recommends that patients need to be offered more information and a greater degree of choice, control and personalised care.  In response, the Government has promised that patient experience of integrated care will be measured as part of the Outcomes Framework for the first time.

The report also highlighted the importance of the use of shared outcomes with regard to cancer care and welcomed the new shared indicator relating to cancer mortality as proposed in the NHS Outcomes Framework for 2012/13.  The report recommends where shared outcomes are underpinned by separate accountability for individual measures, there is also the need for a clear agreement about how the NHS and public health systems will contribute to each other’s measures.

A summary of the recommendations by theme is provided below. 

The summary report can be viewed here.  There are also individual reports on integration, education and training, information and the NHS’s role in the public’s health on the Department of Health website.  The response from the Government can be viewed here.

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Integration

• Integration should be defined around the patient, not the system – outcomes, incentives and system rules (ie competition and choice) need to be aligned accordingly
• Health and wellbeing boards should drive local integration through a whole-population, strategic approach that addresses local priorities
• Local commissioners and providers should be given freedom and flexibility to ‘get on and do’ through flexing payment flows and enabling planning over a longer term

Education and training

• The new local education and training boards must have the governance in place to deliver strong partnerships across healthcare providers, academia and education
• Quality must be at the heart of education and training with systems in place at all levels to reward high quality education and embed continuing professional development
• There needs to be a review of the principles and aims of the Tooke Report into medical education
• A properly structured process to support individual nurse and midwife development in post-qualification career pathways should be developed nationally

Information

• Patients should have access to their online GP-held records by the end of this Parliament
• The NHS must move to using its IT systems to share data about individual patients and service users electronically in the interests of high quality care
• The Government should set a clear deadline within the current Parliament by which all information about clinical outcomes is put in the public domain

NHS’s role in the public’s health

• The NHS must do more to prevent poor health, so it can reduce health inequalities and continue to provide high quality care for future generations
• Every healthcare professional should make every contact count – use every contact with the public to help them improve their health. This should be a core staff responsibility in the NHS Constitution
• The NHS must do more to support the wellbeing of its own staff too, helping a workforce of 1.4 million to live healthily and spread healthy messages with family, friends and patients

NICE consults on potential cancer indicators for the QOF

The National Institute for Health and Clinical Excellence has today launched a consultation on potential new indicators for the Quality and Outcomes Framework (QOF).  The consultation for the potential 20 new indicators for the 2013/14 QOF is open for a four week period which will close at 5.00pm on Monday 6^th February 2012.

The consultation document is available here, and the relevant cancer indicators proposed are:

• The percentage of patients with cancer diagnosed within the preceding 18 months who have a review recorded as occurring within 3 months of the practice receiving confirmation of the diagnosis
• The percentage of patients with recurrent or distant metastatic cancer diagnosed within the preceding 18 months who have a review recorded as occurring within 3 months of the practice receiving confirmation of the diagnosis

The comments proforma is available here.

Department of Health publishes NHS Operating Framework for 2012/13

The Department of Health has today published the NHS Operating Framework for 2012/13.  The Framework sets out national priorities as well as the system levers that will be used to ensure that NHS organisations provide high quality services. 

The Framework sets out how proxy measures will be used to measure achievement against the NHS Outcomes Framework, under each of the five domains.  Those most relevant to cancer are:

Domain 1: Preventing people from dying prematurely

• Early treatment secures better outcomes where patients have cancer symptoms.  We expect all four of the 31 day operational standards and all three of the 62 day operational standards to continue to be met or exceeded

Domain 2: Enhancing quality of life for people with long term conditions

• Patients with cancer need to know that services are responsive when their GP recommends urgent specialist attention and we expect this and the standard for two week waits from GP referral for breast symptoms to be met

National quality measures include:

Domain 1: Preventing people from dying prematurely

• Cancer 31 day, 62 day waits

Domain 4: Ensuring people have a positive experience of care

• Cancer 2 week waits

The full document is available here.

Interim Future Forum recommendations published

Prof Steve Field, Chair of the Future Forum, has written to the Secretary of State for Health to present some interim findings from the Forum’s work.  In the letter, he provides advice around the issues of information, integrated care and the NHS’s role in improving the public’s health, to feed into documents which the Department will shortly publish. 

As Prof Field has met with CCG members twice in the past year, we are sure that members views and comments have fed directly into the Forum’s thinking around these topics.

The letter makes the following recommendations.

Information:

• The Department of Health, through the publication of the 2012/13 Operating Framework, should ensure that the importance of information is emphasised to the NHS for next year
• Patients must have better on‐line access to services and to their health and care records, including making use of the Summary Care Record

Integration:

• The Department of Health, through the publication of the 2012/13 Operating Framework, should ensure that these incentives can be better aligned to promote integrated care
• The Department of Health should set the scene in the 2012/13 Operating Framework in championing and allowing for better ways of delivering seamless, integrated care for individuals, through the transition

The public’s health:

• The Department’s forthcoming publications should reflect the need for Public Health England and the NHS Commissioning Board to agree and set out publicly what their partnership will look like
• The Department uses the forthcoming publications to explain how NHS commissioners can obtain population health advice
• The Department should ensure consistency and alignment between the outcomes set for the NHS and public health
• The Department should make clear through the 2012/13 Operating Framework that the quality of services that improve public health must be maintained during the transition to the new public health system
• The Department must ensure that its forthcoming publications are clear about who will be responsible for all aspects of public health protection, to maintain safety and quality throughout the transition

You can download the letter here.

CCG mentioned in Lords debate

The Cancer Campaigning Group was mentioned in a House of Lords debate on the Health and Social Care Bill on Tuesday 11 October.  

Crossbench peer, Baroness Morgan of Drefelin, referred to the Group when speaking about commissioning of cancer services, highlighting our research in relation to the support needed to commission cancer services. 

Here is the transcript of the debate: 

Baroness Morgan of Drefelin: My second point is on commissioning.  We have heard a lot about commissioning, but I want to focus particularly on the commissioning of cancer services.  We know that improving outcomes in cancer can be promoted only by collaboration and by commissioning across primary, secondary and tertiary services and public health, taking into account the need for high-quality research, because we know that patients do better when they are part of clinical trials.

For example, radiotherapy is a service that needs to be co-ordinated at regional and national levels, as it requires large planning populations and has a significant capital cost to be considered.  In a recent report by the Cancer Campaigning Group, 81 per cent of GPs surveyed said that they believed that radiotherapy should be commissioned at a regional or national level, but is this what is going to be proposed?  I still do not fully understand that.

Another example is the commissioning of pathology, which I am also concerned about.  This issue is close to my heart because Breast Cancer Campaign has established the UK's first tissue bank, which has been a huge endeavour.  NHS pathologists have contributed to that, often in their own time, and have really gone the extra mile because they believed in making the project happen.  How that will work going forward is of great concern.  We rely on a lot of good will from NHS employees to make research possible in this country.

The Cancer Campaigning Group -whose membership includes over 50 charities, including Macmillan Cancer Support, the Prostate Cancer Charity and Cancer Research UK, which I have already mentioned-has argued very strongly for the vital role that cancer networks must play, which must be maintained.  The Government have listened to these arguments and made funding available to fund and support cancer networks, which are a vital source of expertise and drive in promoting improved quality in cancer services, but that is only until 2013.  I hope that the Minister will be able to set out how the Government intend to guarantee the best future for cancer networks going forward.

I know that there are implications for other disease areas, too.  I would be particularly interested to hear the Minister's thoughts on how to ensure that networks receive sufficient funding, have the capacity to commission high-quality cancer care for patients at all stages of their cancer journey and have a suitable accountability structure.  I would also like to hear about how their role can work in supporting patient involvement.  I am happy for the Minister to write to me in response, because I have a feeling that he may have a lot of points to come on to later.  We have all seen real improvements in cancer care in recent years in this country, which has been driven largely through collaboration and integration, and we need to understand how that can go forward.

In my last point, I want to say something quickly about patient involvement, which I believe is fundamental to improving the quality of care.  "No decision about me without me" sounds great, but I understand that the assessment of the Richmond Group of patient-led health charities is that this principle has not yet been fully adopted in the context of NHS service design and planning processes.  To do that would mean that the duties on commissioning bodies and Monitor to obtain advice in discharging their functions should be further extended to more fully encompass patient involvement.

Welsh cancer statistics 1995 to 2009

The Welsh Cancer Intelligence and Surveillance have published a report detailing cancer statistics from 1995 to 2009.

The report reveals that cancer incidence in Wales continues to increase, but that mortality has decreased resulting in improved survival.

The most commonly diagnosed cancers were breast, lung, colorectal and prostate, together accounting for just over half of all cases. 

Prostate cancer has shown a large increase in numbers; however survival has shown a large improvement, especially one year relative survival from 1995-1999 (82%) to 2005-2009 (95%)

Female breast cancer has also shown an increasing survival trend with one year survival at a similar rate as prostate cancer in 2005-2009 at 96% compared with 92% in 1995-1999

The good news is that many cancer sites have shown a significant decreasing trend in mortality over the fifteen year period especially stomach, colon and cervical cancer.

Malignant melanoma appears to be a cancer to watch over the next few years due to significant increases in both incidence and mortality – however, survival has improved over the time periods examined.

Survival rates were slightly higher for women than men, but the gap is decreasing as survival rates for men have increased more quickly.

It is estimated that around one in three people will be diagnosed with cancer before age 75, and around four in ten at some stage during their lifetime.

Around 3% of people were alive at the end of 2009 with a previous diagnosis of cancer in the past fifteen years

The full report is available to view online here.

Letter published on development of clinical networks

Kathy McLean, Chair of the Future Forum workstream on clinical advice and leadership, is now leading a group looking into developing clinical networks and senates.  She has written an open letter about this project and what it entails. 

In terms of clinical networks, she has been asked to carry out a piece of work to define the role of clinical networks and review their range, function and effectiveness.

Kathy McLean has established a small project group which is overseeing the development of proposals, working with network leads and co-ordinators to gather baseline information for this review.  The scope of this work is to:

• Map the current patterns of networks and assess the current level of resource associated with them
• Define what is meant by ‘network’ and the role of potential models in the new system
• Propose which clinical and professional areas require formal networks

This work is expected to lead to a suggested operating model, or a set of operating models for networks, which the NHS Commissioning Board would consider once it is established as a Special Health Authority later this year.

In relation to clinical senates, Kathy McLean is keen to engage as widely as possible to develop proposals for the operation of clinical senates, as well as look into how many there will be, who will be part of them and their specific roles.

In her letter, she says that hopes to engage with as wide an audience as possible across the NHS and wider healthcare system.  She explains that the development of draft proposals is being overseen by a core project group, working to co-produce proposals with a wider group including national clinical directors, GPs, policy leads, commissioners, academics, network teams, voluntary sector, patient groups and Royal Colleges.  She says that proposals will be tested and refined with this wider audience during September and October, including through a workshop hosted by the Kings Fund.

Kathy McLean is also exploring options such as holding wider webinars, to allow a larger number of people to engage directly with this work.

If you have comments or thoughts you would like to send for the team to consider in the development process, please contact Rebecca Larder on: rebecca.larder@nhs.net.

CCG publishes vision for future of cancer services

The CCG has today published six documents setting out our vision for the future of cancer services.  The documents are available here:

• Public health and prevention
• Early diagnosis

• Treatment and services

• Survivorship

• Commissioning

• Research

We hope that these visions will help to inform the development of future cancer services.  If you have any questions, or would like further information, then please email ccg@mhpc.com.

Scottish Government publishes draft Detect Cancer Early Implementation Plan

The Scottish Government has today published its draft Detect Cancer Early Implementation Plan, aimed at saving more than 300 lives a year by the end of the next parliamentary term.  The Plan, which is backed by £30million funding, looks to make improvements in cancer detection, diagnosis and treatment.

Action will initially concentrate on tackling the three most common cancers in Scotland - breast, bowel and lung cancer, with a focus on:

• Improving informed consent and participation in national screening programmes to help detect cancer earlier and improve survival rates
• Raising the public's awareness of these screening programmes and also the early signs and symptoms of cancer to encourage them to seek help earlier
• Working with GPs to promote earlier referral or investigation of patients who may showing a suspicion of cancer
• Ensuring there is sufficient capacity in the screening programmes to meet the expected increase in those choosing to take part
• Helping imaging, investigation departments and treatment centres to prepare for an increase in the number of patients with early disease requiring treatment.
• Strengthening data collection and performance reporting within NHS Scotland to ensure progress continues to be made on improving cancer diagnosis, treatment, referral and survival

Stakeholders are invited to submit their responses by August 26, 2011.  The full draft Detect Cancer Early Implementation Plan can be viewed here: http://www.scotland.gov.uk/Resource/Doc/924/0119872.pdf

Government publishes transitional cancer commissioning guide

The Government has published Commissioning Cancer Services, a transitional update to the Cancer Commissioning Guidance. 

Updating the guidance was one of the commitments in Improving Outcomes - a Strategy for Cancer, published in January this year, and this document is intended to be read alongside the Cancer Commissioning Toolkit.

This is a best practice guide divided into two parts:

• The first section highlights the organisational competencies that those involved in cancer commissioning will want to focus on
• The second part details key issues and questions that commissioners and cancer network teams will want to take into consideration when assessing local health needs and when reviewing services, developing their contract service specifications and monitoring performance

The document reflects the changes in the NHS that have taken place in the past two years, and indicates where significant changes are to come in order to continue to support commissioners through transition.  It makes it clear that references to ‘commissioners’ should be read as relating to PCT commissioners now and Clinical Commissioning Group commissioners in the longer term.

The guidance has sections on the following topics:

• Prevention
• Earlier diagnosis
• Assessment
• Treatment services
• Inpatient care
• Living with cancer
• End of life care
• The future
• Funding services

You can download Commissioning Cancer Services here and you can download the Cancer Commissioning Toolkit here.