organising radiotherapy services – what are the lessons from england
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Organising Radiotherapy Services – what are the lessons from England. Tim Cooper Associate Director – Radiotherapy National Cancer Action Team. Organising Radiotherapy Services – what are the lessons from England. Tim Cooper Associate Director – Radiotherapy National Cancer Action Team. - PowerPoint PPT PresentationTRANSCRIPT
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Organising Radiotherapy Services – what are the lessons from
England
Tim Cooper
Associate Director – Radiotherapy
National Cancer Action Team
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Organising Radiotherapy Services – what are the lessons from
England
Tim Cooper
Associate Director – Radiotherapy
National Cancer Action Team
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Vision
Strategy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class Radiotherapy
NRIG
(NRAG / Cancer Reform Strategy)
Gover
nanc
e
Wide
r Wor
ld
Service Delivery
Comm
issioning
•Safety
•Peer Review
•Clinical Pathways
•Clinical Trials and Research
•New Technology
•Contracting Framework
•RTDS/RES
•Tariff / HRG
•Commissioning Toolkit
•Workforce
•Access
•Capacity
•Survivorship
•Communication Skills
•Leadership
•Engagement
www.cancer.nhs.uk/radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
NRIG Subgroups
NRIG - plus ‘press gang’ members
• Workforce• Technology• Protons• Stereotactic• Radiotherapy Clinical Information Group• Raising the profile of radiotherapy
Plus– Tariff (Costing and Coding groups)– R-PORT– Peer Review
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Headlines
• Relevant Key issues
• Investment
• Engagement
• Leadership
• Play to your strengths
• Toolkits
• Communication
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Relevant Key Issues
What does World Class look like??
• Access– Performance
– Productivity
• Workforce
• Technology– IMRT
– SBRT
– IGRT
Delivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class Radiotherapy
NRIG
(NRAG / Cancer Reform Strategy)
Gover
nanc
e
Wide
r Wor
ld
Service Delivery
Comm
issioning
•Safety
•Peer Review
•Clinical Pathways
•Clinical Trials and Research
•New Technology
•Contracting Framework
•RTDS/RES
•Tariff / HRG
•Commissioning Toolkit
•Workforce
•Access
•Capacity
•Survivorship
•Communication Skills
•Leadership
•Engagement
www.cancer.nhs.uk/radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Relevant Key Issues
What does World Class look like??
• Access– Performance
– Productivity
• Workforce
• Technology– IMRT
– SBRT
– IGRT
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
WorkforceReconvened NRAG workforce subgroup (Jane Barrett chair)
4 tier structure - publishing the learning from the pilot sites
HEI & operational managers – 25th Sept 09 - Developing the radiotherapy workforce– 23rd March 10 - Building on success
VERTnow in 40 clinical centres
Radiotherapy Physics - Modernising Scientific Careers- Meeting 5th March - Developing Solutions
Dosimetrists - secured funding to support national early implementation training
programme. Planned April intake.
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Service Delivery
Access31 days - analysis of early returns
- data completeness !!Process and pathways
CapacityNetwork led planning in many areas?? 25 satellitesstaged plans - ongoing work
RTDS
Missing patients
Radiotherapy Site Visits
National Purchasing Framework
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
IMRT
NRIG Technology Group – Chair Michael Williams.
IMRT at least one centre in each Network by 2012
30% of all fractions should be IMRT
Darzi Innovation Metric
•Commissioner guidance•Generic business case•National Training programme•QA audit programme•Consensus document – publishing the evidence
Awarding training support contracts
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Stereotactic
• SBRT• Intracranial already done• Focus on Technique • Define Technology• National Specification to NRIG by end 2010• Indications and body sites
H&N; Lung; Liver; Pancreas; Kidney; Spine; Prostate; Mets and Oligometastases;
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Headlines
• Relevant Key issues
• Investment
• Engagement
• Leadership
• Play to your strengths
• Toolkits
• Communication
Delivering World Class RadiotherapyDelivering World Class RadiotherapyR
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ther
apy
Co
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g &
Tar
iff
Dev
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ent
Rad
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UNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONSUNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONS
National Cancer Action TeamNational Cancer Action Team Department of HealthDepartment of HealthPayment by ResultsPayment by Results
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Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Leadership & Engagement
• Clinical Leadership
• Programme Leadership
• Progress chaser
• Engagement– Profession– Public– Political– Wider
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Headlines
• Relevant Key issues
• Investment
• Engagement
• Leadership
• Play to your strengths
• Toolkits
• Communication
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Build on the strengths
• Consensus– 5 centres not 50+
• Commissioning– No Linac fairy – so can push boundaries– Central programme – can move to meet need faster.
• Programmes– NRIG programme already clear, so SRAG can use
this and focus on other areas of importance
• Programme engagement
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Headlines
• Relevant Key issues
• Investment
• Engagement
• Leadership
• Play to your strengths
• Toolkits
• Communication
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
R-PORT
• Roll out underway• Complete by Spring 10• Amanda Travis appointed to secure roll out• Demonstrate efficiency• Available to all HEI’s• Ongoing development• User Group
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
CommissioningContracting
Contracting FrameworkService SpecificationRadiotherapy Pathway
www.cancer.nhs.uk/radiotherapy/commissioning
Cancer Commissioning toolkit – radiotherapy section
Radiotherapy Commissioning Pilots x 4
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Configuration:
• Lots of very good work underway
• 4 commissioning pilots– Anglia– Sussex– Merseyside and Cheshire– Lancs and S.Cumbria
• N.Trent, Humber and Yorks
• Greater Midlands
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Governance
•Peer Review•New Measures …almost complete …..•Completely different•TSR is a recurring theme in peer review
What does a good evidence folder look like?
What information does the Network Radiotherapy Group need?
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Other work
• NRAG FAQ’s– Demystifying NRAG
• Public profile– Engaging with Public; Patients; Health community
and the wider world
• Developing the evidence base– Supporting the argument
• Enhanced Cross UK working– Working together and supporting each other.
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Headlines
• Relevant Key issues
• Investment
• Engagement
• Leadership
• Play to your strengths
• Toolkits
• Communication
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Delivering World Class RadiotherapyDelivering World Class Radiotherapy
Recommendation 1: Planning for the future
• a rolling ten-year plan, setting out a vision and strategy for future radiotherapy services,
Recommendation 2: Measuring success
• datasets for the reporting of fractionation, waiting times, access, and patient outcomes.
Recommendation 3: Ensuring equity in access
• demand modelling based on differences in cancer incidence on a region-by-region basis.
Recommendation 4: Training the radiotherapy workforce
• A national career promotion strategy should be introduced across the four nations of the UK
Recommendation 5: Integrating new technologies
• NICE should provide national guidance on novel radiotherapy techniques, such as intensity modulated radiotherapy (IMRT) and proton therapy.
Recommendation 6: Communicating with the public
• formulate a strategy and proposal for awareness raising about radiotherapy.
Achieving a world class radiotherapy service across the UK
Delivering World Class RadiotherapyDelivering World Class Radiotherapy