Survivorship:The Commissioning Challenge

Kim Fell

Cancer Director

North Trent Cancer Network

Commissioning in a Cold Climate

NHS Confederation produced a discussion paper which highlighted the following:

More Self Management – less face to face Effect of recession on health services creates

greater demand It is widely believed that there are significant

efficiencies to be found in community services

What is Commissioning?

Commissioning is the means by which wesecure the “Best Value” for patients andtaxpayers

By best value we mean:

The best possible health outcomes, including reduced health inequalities – more local priorities

The best possible health care and Within the resources made available by the taxpayer

Health Reform in England: update and commissioning framework, DH 2006

PBC

Collaborative

SCG

PCT

Levels of Cancer Commissioning

Specialist cancer care and specialist paediatric care

National priorities

More of:

Radiotherapy

Cancer Drugs

Earlier diagnosis

Awareness ..increased referrals

Expected reduction in:

Emergency Admissions

Length of stay

Follow up

Leading to increased Productivity and Efficiency at all levels

NO ADDITIONAL INVESTMENT

Effectiveness of care pathways - Prevention to End of Life

Maximum Health Benefit through Innovation

Quality of servicesWaits

Peer ReviewClinical Effectiveness

Patient Experience and wellbeing

ProductivityLoS

A+E AdmissionsFollow up rates

Outcomes1/ 5 year Survival

Mortality ratesStage at presentation

Spend Programme Budgeting

Index of deprivation

The Challenge in Delivering the Cancer Reform Strategy and QIPP

Future Patient Journey –More of it in the community

Prevention/Referral from GP

Local diagnostic clinic

Referral to MDT/Surgery

Adjuvant treatment – RT/Chemo

(?Some in Primary care)

Palliative careClose to home

MOSt

Choice

CNSFollow up

Cure-Survivorship

Complex cases/Rare cancers

Tertiary CentreRT / CHEMO?

Community based teams links to LTC

Critical Points in the cycle

Deprivation within North Trent

5 YEAR PREVALENCE BY CANCER NETWORK

DORSET CN has the highest rate of cancer survivors up to 5 years from diagnosis,15% above the UK avgNORTH EAST LONDON CN has the lowest rate of cancer survivors up to 5 years from diagnosis,13% below the UK avg

Fig 14 5-15% above UK avg.West ScotlandSouth East ScotlandNorth ScotlandWalesPeninsulaDorsetAvon, Somerset and WiltshireThames ValleyCentral South coastYorkshireNorth of EnglandAngliaGreater Manchester and CheshireSouth West London

Up to 5% above UK avg.Northern IrelandHumber and Yorkshire CoastPan Birmingham

Up to 5 % below UK avg.North ScotlandLancashire and S.CumbriaMerseyside and CheshireMid TrentLeicstershire,Northamptonshire and RutlandDerby Burton3 CountiesArdenEssexS.East London

5-13% below UK avg.North TrentThe Greater MidlandsSussexKent and MedwaySurrey,W.Sussex and HampshireMount VernonNorth East LondonWest LondonNorth London

Fig 1.1

NOTE: Prevalence data for CN’s in Scotland is Confidential until publication of report

Source: NCIN. One, Five and Ten year Cancer Prevalence by Cancer Network, UK, 2006

*Time taken to produce a set of 5 maps per site :3 days 22 sites: 66 days

0 20 40 60 80 100 120 140 160 180 200

England

Ryedale

Richmondshire

Barnsley

Calderdale

Wakefield

Scarborough

Harrogate

Kingston upon Hull

Rotherham

Leeds

Kirklees

North Lincolnshire

Hambleton

York

Doncaster

East Riding of Yorkshire

Bradford

Sheffield

North East Lincolnshire

Craven

Selby

Lo

cal an

d U

nitary A

uth

orities

Cancer mortality targets are i) to reduce all-cause cancer mortality rates in those  

defined as:   aged under 75 by 20% from a 1995-97 baseline,

      by 2009-11      

      ii) for the Spearhead PCTs group to reduce the

      absolute gap in rates between their group and

      the England average, in 1995-97, by 6% by  

      2009-11        

Cancer Awareness MeasureCancer Awareness Measure

12

Don’t Know:25% Male

14% FemaleBASE N: 1213

Warning Signs of Cancer – Unprompted Awareness

• General Low Awareness

• Across all deprivation quintiles

The Engagement Cycle

Recommendations for future action

Respondents identified cultural sensitive advocacy services and the availability of interpretersas a particular issue for some organisations. Further exploration in this area may prove useful

to fully understand both current service and the challenges surrounding areas that do nothave access to such services.

Respondents identified the need for information to be available in community languages andaccessible from a centrally held place to avoid duplication.

“It must surely be possible to translate all existing cancer information into other languagesand make available electronically.”

“More cancer specific information should be readily available in more languages than atpresent and cover the entire patient journey. It is very treatment related at the moment and

does not cover supportive care.”

“There has been an increase in the variety of different languages spoken, particularly EasternEuropean languages.”

“The production of audio/written documentation in all different languages is prohibitivelyexpensive Eastern European migrants have recently raised challenges as translated

information is not as readily available.”

Analysis of the National Black andMinority Ethnic (BME) Baseline Audit

Picker Europe Ltd

Breakdown of Ethnic Groups within Picker Survivorship Survey 2009

1%

1%

1%

4%

93%

White British

Any other Whitebackground

Any other Mixedbackground

Indian

Missing

Ethnic Group(78 service users)

Picker Survey 2009 NHS Improvement

Experience of care Baseline 2009 : Sheffield v National

0.0%10.0%

20.0%30.0%40.0%50.0%

60.0%70.0%80.0%

90.0%100.0%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Question Number

Mea

n % Local

National

Question 6

Do you feel you need any extra help or advice for any of the following physical, clinical and medical concerns?

Question 23

Was the written or printed information you were given easy for you to understand?

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

0-15

16-64

65+

BME (non-white)White (Non-UK)White UK

BME Profile of Barnsley

BME Healthy Day EventDate: Saturday 3rd July 2010,Time: 11.00-2.00 PMVenue:Barnsley Central Library Shambles StreetTown Centre,BarnsleyS70 2SBThis is a free event and everyone is welcome. Food, refreshments and pampering sessions will be available.Activities for Children, Beautician, Reflexology, Indian Head Massage,Blood Pressure Test, Salsa Dance, Free Make over Tips, Nails Manicure and Paint DesignFor more information please call: 01226 320131. Ask for Roya or any other staff

Sheffield City Council’s community profiling project is now completed. 

The Council commissioned this to identify key experiences, views and aspirations of Black and

Minority Ethnic communities, particularly with regard to community cohesion and provision of, education,

housing, health, policing and other services in the city.

Community Profiling

Opportunities from the Cancer Reform Strategy

Shifting care from inpatients to outpatients Maximising opportunities for prevention and early diagnosis

Shifting care from hospital to community

Improve clinical outcomes – Implementing the Children and Young People Improving Outcomes Guidance and Supportive and Palliative Care guidance

Drive up quality Increase value for money

Workshop Questions

In your role:

How do you change and influence your service and practice to improve it?

What are the barriers you perceive to enhance services?

How could you engage across health and social care?