1 cancer commissioning toolkit (cct) training

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www.cancertoolkit.co.ukCancer Commissioning Toolkit (CCT)

Training

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www.cancertoolkit.co.uk

By the end of the training you will:

Have a good understanding of the history of the CCT

Know how to set up and personalise your account

Know how to navigate around the CCT

Be able to read and interpret the dashboards and charts

Know how to export reports

There is a mix of presentation and live working sessions - we have a lot to cover!

Be comfortable and competent with the use of the toolkit

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HISTORY

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The Cancer Commissioning Toolkit (CCT) was developed to realise the aims of the Cancer Reform Strategy (CRS)

“The Cancer Reform Strategy identified better information and stronger commissioning as two of the key drivers to achieve our goal that cancer services in this country should

be amongst the best in the world.

The launch of this Cancer Commissioning Toolkit represents a major step forward in relation to both of these drivers for quality improvement.”

Prof Mike RichardsNational Cancer Director

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Information is key to high quality commissioning

Commissioning of cancer services is complex

Commissioners need to take account of a wide range of factors to make informed decisions

Ready access to high quality information about local services and how they compare with services elsewhere is essential for good commissioning

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NCIS Registries

CCT is a “one stop solution” for access to cancer commissioning information to inform decision making

This toolkit brings together information from all of the sources, in a user friendly format

• Guidance contains suggestions for questions which commissioners can ask service providers

• Advice on how to interpret data

• Analysis of quality and confidence of sources

Smoking cessation

NCASP

Pharmacists

End of life

DH cancer waits

RT – equip survey

CQuINS

HES microsite

Screening

ePACTC-PORT

Pre-CCT Post-CCT

Programme

budgeting

HES

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There are 100s of important metrics that must be taken into account when making commissioning decisions

Breast Lung Colon Skin H&N

Actual incidence

PCT-1

Ag

e-s

tan

da

rdiz

ed

Source: CIS, Date

Ag

e-st

and

ard

ized

/100

,000

Prevalence All Cancers

PCT 1

Male Female

PCT 2 PCT 3

PCT 1

PCT 2

PCT 3

All PCTs

Source: CIS, Date

Ag

e-s

tan

da

rdiz

ed

/10

0,0

00

Prevalence LUNG Cancer

PCT 1

Male Female

PCT 2 PCT 3

PCT 1

PCT 2

PCT 3

All PCTs

Source: CIS, Date

Here commentary about assumptions made in projections

Ag

e-s

tan

da

rdiz

ed

/10

0,0

00

PCT 1LUNG incidence past and projections

Male PCT 1 Female PCT 1

2001 2006 2016

Female UKMale UK

Ag

e-s

tan

da

rdiz

ed

/1

00

,00

0

5-year rolling average mortality All Cancers

1995 2000 2006

Source: CIS, Date

Comments: …


Female UKMale UK

Ag

e-st

and

ard

ized

/100

,000

5-year rolling average mortality LUNG

1995 2000 2006

Source: CIS, Date

Comments: …


Female UKMale UK

% c

om

pli

an

ce

% Compliance with # of core Members Present at meetings

All Cancers

LC 1 LC 2 LC 3

All Localities

Source: C-Quiins Date

Core present at meetings

Named Core team

Members

LCT1

LCT2

LCT 3

At ½ of meetings

At 2/3 of meetings %

co

mp

lian

ce

% PCT Collective Measures Met

All Cancers

LC 1 LC 2 LC 3

All Localities

Source: C-Quiins Date

FC

E

Episodes by trust (not normalisied) - LUNG

Trust 1 Trust 2 Trust 3

All TrustsSource: HES, Date

Comments: …

Choose trust 1 2 3

Choose admission type All

Choose procedure All

FC

E

Episodes by PCT (not normalisied) - LUNG


Source: HES, Date

Comments: …

Choose PCT 1

Trust 4

ElectiveNon-elective


FC

E /

in

cid

en

ce

Activity trend per PCT - LUNG

1995 2000 2006

Source: HES, Date

Comments: …

PCT 1

England average

Choose PCT 1


FC

E /

in

cid

en

ce

Activity trend per PCT - LUNG

1995 2000 2006

Source: HES, Date

Comments: …

PCT 1

England average

Choose PCT 1


£

All TrustsSource: HES, Date

Comments: …

Costs of emergency admissions by Trust (not normalised) - LUNG

Choose Trust 1 2 3


£/

FC

E

Costs by FCE

PCT 1 PCT 2 PCT 3

All PCTsSource: HES, Date

Comments: …

100%

% bed-days above trim point

PCT 1 PCT 2 PCT 3


Comments: …

100%

% costs due to excess bed-days

PCT 1 PCT 2 PCT 3


Comments: …

Planned expenditure of current drugs

Zoom up

Item

1. …2. …3. …4. …

Description

• Here the user could type action items that he/she considers important• …• …• …

Lung Breast Prostate Etc.

1Choose PCT 1Choose PCT

Choose Network

or

NotesStatus NICE guidanceManufacturer

Cost per patient per annum (£)

Etc…

Expected total costs per drug

(£)

Previous year

spend (£)

C

B

A

Number of patients expected in PCT /

network per annum

Incidence per 100,000IndicationDrug NotesStatus NICE

guidanceManufacturerCost per

patient per annum (£)

Etc…

Expected total costs per drug

(£)

Previous year

spend (£)

C

B

A

Number of patients expected in PCT /

network per annum

Incidence per 100,000IndicationDrug

Assumptions: England population = 55 million, Network population = 1m, PCT population = 100,000

Total Costs per PCT / Network £ etc…

Choose Scenario abc Manage scenarios

£ etc…

% s

uc

ces

sfu

lly

qu

it

% Successfully quit at 4 weeks

1995 2000 2006

Source: IC, NHS Date

Comments: …

PCT 1 England

Actual numbers

% success rate

% s

ucc

essf

ull

y q

uit

% Successfully quit after 4 weeks

(self report)

PCT 1 PCT 2 PCT 3

All PCTs

Source: IC, NHS Date

Data

User notes

Add to basket

Rate of quitters by

100,000 pop

% success quitters at 4

weeks

Ra

te p

er

10

00 w

om

en

s

cre

en

ed

Rate of cancer detected

Women aged 50 – 64

2005 - 2006

SHA 1 SHA 2 SHA 3

All SHAs

Source: Screening Date

Coverage Cancer Detected

% o

f w

om

en s

cre

en

ed

Test results 2005 - 2006Women aged 25 – 64

PCt 1 PCT 2 pCT 3

All PCTs

Coverage Test Results

Data

User notes

Add to basket

LCT1

LCT2

LCT 3

View DyskaryosisLevel

Mild

Negative Dyskaryosis

# n

ot

refe

rre

d a

s T

WR

/10

0,0

00

# not referred as TWR

All cancers

PCT 1 PCT 2 PCT 3

All PCTs

Source: CWT, CIS, Date

Jul Aug Sept


Comments: …

# not referred as TWR - All cancers

PCT1

PCT England

# n

ot

refe

rre

d a

s T

WR

/10

0,0

00

# T

WR

wit

h c

an

cer

Dia

gn

os

is

/10

0,0

00

# of TWR with cancer diagnosis

All cancers

PCT 1 PCT 2 PCT 3

All PCTs


Jul Aug Sept


Comments: …

# TWR with cancer diagnosis - All cancers

PCT1

PCT England

# T

WR

wit

h c

an

cer

Dia

gn

os

is

/10

0,0

00

All PCTs

England Average

PCT1

Target (99%)

PCT2

PCT3

Source: CWT, Date

% m

ee

tin

g T

WR

sta

nd

ard

% of TWR meeting Standards

All cancers

Jul Aug Sept

PCT England

% of TWR meeting Standards - All cancers

PCT1

% m

ee

tin

g T

WR

sta

nd

ard

# n

ot

refe

rred

as

TW

R /1

00,0

00

# not referred as TWR

Lung

PCT 1 PCT 2 PCT 3

All PCTs


% o

f al

l TW

Rs

% of TWR with cancer diagnosis

All cancers (2006)

PCT 1 PCT 2 PCT 3

All PCTsSource: CWT, CIS, Date

TWR target % NotReferred as

TWR

% TWR with Cancer

Diagnosis

Jul Aug Sept


Comments: …

Trend % of TWR with cancer diagnosis

All cancers - PCT1

PCT England

% o

f al

l T

WR

s

Jul Aug Sept


Comments: …

PCT England

% of 31 days meeting Standards Vs National Target All cancers - PCT1

% 3

1 d

ays

me

eti

ng

Na

tio

nal

S

tan

da

rds

National Target of TWRs meeting standard (98%)

Jul Aug Sept

PCT England

% of 62 days meeting Standards Vs National Target All cancers - PCT1

% 6

2 d

ays

me

eti

ng

Na

tio

nal

S

tan

da

rds

National Target of TWRs meeting standard (995)

In house treatmentTrust transfer

62 day trend

In trust and transfer

breakdown

% 100%

In Trust treatment

Trust transfer

July Aug Sept

Source: HES Date

62 day cases breakdown – all cancers

PCT1

62 day trend

In trust and transfer

breakdown

Bed

-da

ys /

PC

T in

cid

ence

Excess bed-days by PCT – LUNG (normalised by incidence)

All PCTs

Source: HES, Date

Comments: …

PCT 1 PCT 2 PCT 3

Ex

ce

ss B

ed

-da

ys

1995 2000 2006

Source: HES, Date

Comments: …

Excess Bed-days time trend - LUNG

PCT 1

England average

Ave

rag

e L

oS

Average LoS by PCT – LUNG

All PCTs

Source: HES, Date

Comments: …

PCT 1 PCT 2 PCT 3

%

% admissions without a diagnosis of cancer by PCT – LUNG

PCT 1 PCT 2 PCT 3

All PCTs

Source: HES, Date

Comments: …

% o

f ca

nce

r d

eath

s in

th

e H

osp

ice

% of cancer deaths in the Hospice

All cancers

PCT 1 PCT 2 PCT 3

All PCTs

Source: HES Date

% o

f ca

nce

r d

eath

s in

ho

spit

al % of cancer deaths in hospital

All cancers

PCT 1 PCT 2 PCT 3

All PCTsSource: HES Date

Which Hospital - All cancers

T1 T1 T3T1 T1 T3T1 T1 T3 T1 T1 T3T1 T1 T3T1 T1 T3

T1 T1 T3T1 T1 T3T1 T1 T3

%%

%

%%

%

%

%

%

T1 T1 T3T1 T1 T3T1 T1 T3

PCT1

PCT3 PCT4%

%%

% o

f ca

nce

r h

osp

ital

dea

ths

by

Tru

st

Survival trends per cancer

type and PCT

Activity per admission type

and PCT

Drug budget per indication and

network and PCT

Excess bed-days per cancer type, trust and PCT

# TWR with cancer

diagnosis

Place of death per PCT of

patient and trust

There is a wealth of information in the CCT

The toolkit contains over 100 reports, with more to come

Illustrative

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Careful consideration needs to be given to the way the data are interpreted and used

1. Is a start of a conversation and not an answer in itself

2. Data drives insight and questions, not necessarily answers

3. Need to read the guidance and interpret the data accordingly

4. Not an in-year planning tool

5. Relies on existing data sources

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Welcome screen

Toolkit overvie

w

. .

Quality of service (all

cancers)

. . . . . . .

The Challenge of

cancer

Cancer and Inequalities

Burden of disease (all

cancers)

Demographics

Quality of service (at

cancer type level)

Screening (at cancer type

level)

Referrals (all cancers)

Referrals (at cancer type

level)

Assessment, diagnosis

and staging

Waiting times (summary)

RadiotherapyCancer

MedicinesChemothera

py

Waiting times per cancer

type

Current Drugs

Drug Horizon scanning

EfficiencyPatient

experience (all cancers)

Patient experience (at cancer type level)

Place of death (all cancers)

Place of death (at

cancer type level)

Information

.

Activity and cost

(summary Screen)

Unbundled

Calculator

Programme Budgeting

Activity and Cost per

cancer type


procedure

Case mix activity and

cost

Procedure cost

calculator

Case mix calculator

Case mix benchmarks

Prevention

Outcomes (all cancers)

Burden of disease (at cancer type

level)

Outcomes (at cancer type

level)

Key Cancer Rates

Lifestyle trends

Follow up appointments

Log in screen

Welcome screen

Toolkitoverview

. .

Quality of service (all

cancers)

. . . . . . .

The Challenge of

cancer

Cancer and Inequalities

Burden of disease (all

cancers)

Demographics

Quality of service (at

cancer type level)

Screening (at cancer type

level)

Referrals (all cancers)

Referrals (at cancer type

level)

Assessment, diagnosis

and staging

Waiting times (summary)

RadiotherapyCancer

MedicinesChemothera

py

Waiting times per cancer

type

Current Drugs

Drug Horizon scanning

EfficiencyPatient

experience (all cancers)

Patient experience (at cancer type level)

Place of death (all cancers)

Place of death (at

cancer type level)

Information

.

Activity and cost

(summary Screen)

Unbundled

Calculator

Programme Budgeting


cancer type


procedure

Case mix activity and

cost

Procedure cost

calculator

Case mix calculator

Case mix benchmarks

Prevention

Outcomes (all cancers)

Burden of disease (at cancer type

level)

Outcomes (at cancer type

level)

Key Cancer Rates

Lifestyle trends

Follow up appointments

The CCT broadly follows the chapters and sections of the Cancer Reform Strategy

Cancer “patient journey” in the toolkit

Cancer Landscape

Peer Review Summary

Awareness, Screening and Early detection

Assessment, diagnosis and staging

Treatment

Living with cancer

End of life

Building for the future

InpatientFunding cancer care

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AT Kearney

Partnership working has been critical to the development of this toolkit

To name a few ...

National Cancer Services Analysis Team

National Cancer Screening Programmes

National Cancer Intelligence Network NHS Improvement

National Cancer Action Team

UK Association of Cancer Registries

Pharmaceutical Oncology Initiative

Department of Health

Concentra

Database administrators Usability testers

Your ongoing feedback...

Continuous improvement!=

Section owners National interviews

Feedback from NDP 2008

Pilot sites CCT Steering Group / Team

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Development of the CCT is being supported by member companies of the British Pharmaceutical Industry (ABPI)

Pharmaceutical Oncology Initiative (POI) Group

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The main users of the toolkit will be PCT commissioners, cancer networks and trusts

As of October 2006 there are 152 PCTs in

England

There are 30 Cancer Networks in England

There are 158 trusts in England

Other users of the toolkit:• Cancer charities

• Pharmaceutical companies

• Public, in due course

Users external to the NHS have restricted access to some metrics and small data sets

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The NHS is providing content and data support for CCT users, while Concentra is providing technical support

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TOOLKIT

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The CCT is a web-based tool so you can log on anywhere you have access to the internet

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The dashboard contains the key cancer metrics and allows you to compare your performance to the national average

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Organisations are distributed between the ‘best’ and ‘worst’ score with the top 25% in green and the bottom 25% in red

Top

Qu

art

ile

25%

50%

25%

25%

50%

25%

Top

Qu

art

ile

Top

Qu

art

ile

25%

50%

25%

Some metrics are inverted, i.e. high scores are not at the top if that’s not the ‘best’ result

The size of each section will depend on the

spread of scores, not the number of organisations

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Manage your account and set your default organisations through the User settings menu option and select User Profile

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Each metric can be observed in more detail with information on sources and guidance

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A cancer specific dashboard contains another selection of metrics that can be analysed for each cancer type

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The index contains links to each chapter and section – which lead on from the CRS

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Each issues raised in the sections of the CRS are informed by the charts in the relevant section

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Each chart is fully interactive and contains sources and guidance – filter options on the right hand side change depending on the individual charts

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Timelines allow you to view performance over time, but please note that you can only currently view one organisation at a time

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Peer review data is provided in a slightly different way, with a tick for compliant and a cross for non compliant on given metrics

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Charts can be pre-customised with selected networks, PCTs, trusts or SHAs by selecting ‘Favourites’ in the User setting menu option

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Reports can developed within CCT and exported into a word document, with all relevant source, commentary and comments

Report outputs are fully editable in MS Word

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Add charts and dashboards by setting up the parameters required in the report and using the ‘report basket’ button

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Once named, the charts and dashboards will appear Report Cabinet to run reports from

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The Horizon Scanning section of CCT pulls information from many sources of information for cancer medicine horizon scanning

Journals

Specialist media

Industry

Licensing agencies

Clinical specialists

National “horizon scanning” groups• National Horizon Scanning Centre

• London New Drugs Group

• National Prescribing Centre

Cancer Commissioning Toolkit (CCT)

- Horizon Scanning -

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There are a number of key principles of the CCT Horizon Scanning section

Requests for additions to toolkit will be submitted to a central point and may be submitted by multiple sources

All agents will be considered provided they fall under the definition of "chemotherapy" which has yet to be fully defined

Requests for additions to toolkit must have published supporting evidence. This may be a fully published trial report or an abstract

New drugs/regimens should have an expected EMEA licensing date within 18 months of addition to the database

Drugs/regimens will be removed 18 months after licensing for the listed indication or 3 months after a decision by NICE, whichever occurs first

CNPF will consider requests for new drugs/regimens three times a year as part of NDP

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The Cancer Medicines section contains reports on drug uptake

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The Horizon Scanning reports inform users of upcoming medicines

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Costs are based on patient numbers, medicine costs and number of cycles

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The costs of each treatment can be compared across multiple scenarios

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The cost over time can be seen, based on the expected launch dates of each treatment

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Data from the Horizon Scanning section can be exported into Excel by selecting the ‘Generate XLS’ link

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The Activity Planning reports will inform the user of the uptake and costs of current medicines but is still under development

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The Activity Planner calculates the cost of current regimens based on patient volumes

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C-PORT is an online capacity planning tool that helps with planning resources for hospitals delivering chemotherapy

Chemotherapy Planning Online Resource Tool

C-PORT development and support is being driven by NCAT and Concentra

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C-PORT allows the user to simulate the activity within a unit and therefore understand and plan capacity

This data is centrally hosted and is accessible

through a web-based application

C-PORT models the activity within

chemotherapy units

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The Financial Module in C-PORT allows users to allocate costs and revenue for each regimen

Revenue calculations Cost calculationsActivity calculations

Local regimen list

Human & physical

resources

National standard

regimen listResource cost

Medicine cost

OverheadsTariff income

REVENUE COST

MARGIN / COST RECOVERY

Activity

In the future this information will be automatically imported into CCT

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SCENARIOS

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Scenarios have been developed to demonstrate the capabilities of the toolkit

Scenario 1 – High mortality in specific cancers

Scenario 2 – Inefficient spend

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SCENARIO 1High mortality in specific cancers

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1. the PCT has made less progress than the majority of the country in reducing

mortality levels in the last 10 years

2. there are low one and five year survival rates for colorectal and lung

cancers (in lowest quartile)

A PCT Director of Public Health scans the cancer dashboard to investigate high mortality in colorectal and lung cancers

While she was aware of the high mortality rates, she was less aware that...

Scenario 1 - High mortality in specific cancers (1/6)

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She finds that a high proportion of colorectal and lung cancers are diagnosed through means other than TWR

TWR = Two Week Referral; this is from the time the GP refers

An adjacent PCT has a significantly

lower rate


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Smoking cessation levels are low in the area, which may be a result of poor success rates with quit smoking campaigns

Smoking cessation metrics are poor


% success rate for quit smoking over time is falling

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Another concern is that the PCT’s lung multi-disciplinary teams (MDT) are non-compliant

The peer review report shows that this is due to the lack of a thoracic surgeon and palliative care team member


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A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing

Questions• Why is staging data not being collected? It is already required...

• What are the reasons behind the low 1 and 5 year survival rates?

Strategies• Feed back staging information on all newly diagnosed cases promptly to GPs, to support a locally agreed

audit on recognition of symptoms

• Introduce a strategy for prevention and increased population awareness of signs and symptoms in lung and colorectal cancers, based on a social marketing approach

• Ensure lung MDT compliance to improve curative resection rates and quality of care


These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions

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SCENARIO 2Inefficient spend

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Cancer spend is just above the national average, but ...

this appears to correlate with an above average mortality from cancer for the PCT population

A PCT Director of Finance assumed that spend on cancer looked appropriate but further investigation revealed problems

Scenario 2 - Inefficient spend (1/5)

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This investigation also explained why the cancer network team were suggesting increased investment in certain areas

Screening: coverage is low for both breast and cervical cancer

Radiotherapy: Fractionation rates relatively low

Chemotherapy: Uptake of NICE drugs relatively low


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From the CCT, the team could demonstrate possible causes for a higher than average spend on inpatient care

1. Higher than average level of emergency bed days


2. Higher than average number of deaths in hospital

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They also discovered a high number of cancer emergency bed days above trim point


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A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing

Questions• What is driving the high number of cancer emergency bed days?

• Why are more people dying in hospital in this PCT than most others?

• For each cancer type, what are the reasons for so many excess bed days above the trim point?

Strategies• Develop community based support for end of life care and incorporate this work into existing PCT project

on early discharge with social services


These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions

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THANK YOU

1 cancer commissioning toolkit (cct) training

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