The Changing Nature of Cancer Services

1
The Changing Nature of Cancer Services

• Pat Higgins
• Director
• Merseyside and Cheshire Cancer Network

2

• 12 Hospital Trusts
• 14 PCTs
• plus Isle of Man and parts of North Wales
• 2.3 m population
• Established in 2000

3

• Taskforce
• Policy
• Strategy

• Network Managers Forum
• Co-ordination
• Implementation

• Clinical Network Groups
• Clinical reference
• Local standards
• Benchmarking /audit
• Patient / carer input

• Redesign
• Service Improvement facilitators
• Cancer Services Collaborative

4
Clinical Network Groups

• Breast
• Gynaecology
• Colorectal
• Palliative Care
• Haematology
• Skin
• Urology
• Upper GI (OG HPB)
• Head Neck

• Lung
• Radiology
• Pathology
• Primary Care
• Supportive Care
• Childrens Palliative Care
• Neuro-Oncolgy
• Health Inequalities
• 3 Patient / Carer Groups

5
Key Drivers
National Targets and Standards
Local Patient and Carers Views
Cancer Services
Local Assessment of Health Needs
6
Cancer Mortality

• National Standards, Local Action,
• Health Social Care Standards and Planning
  Framework 2005 - 2008
• Substantially reduce mortality rates by 2010
  from cancer by at least 20 in people under 75,
  with a reduction in the inequalities gap of at
  least 6 between the fifth of areas with the
  worst health and deprivation indicators and the
  population as a whole.
• MCCN Baseline (1996) 162 per 100,000 Target
  (2010) 121 per 100,000

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Best of Europe
8
Best of Europe
European Average
9
Best of Europe
European Average
England Average
10
Best of Europe
European Average
England Average
Merseyside Cheshire Average
11
Best of Europe
European Average
England Average
Merseyside Cheshire Average
North Liverpool
12
Best of Europe
European Average
20
England Average
Merseyside Cheshire Average
North Liverpool
13
Best of Europe
European Average
20
England Average
14
Merseyside Cheshire Average
North Liverpool
14
Best of Europe
European Average
20
England Average
14
Merseyside Cheshire Average
126
North Liverpool
15
Improve Prevention

• Spearhead PCTs (9 out of 14)
• Health Inequalities CNG - Paula Grey
• Closer links to Public Health, Cardiac Network
  and Local Authority

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Improve Prevention

• Spearhead PCTs (9 out of 14)
• Health Inequalities CNG - Paula Grey
• Closer links to Public Health, Cardiac Network
  and Local Authority

But weve still got a long way to go.
17
Improve Detection

• Breast screening age extension
• Liquid-based cytology for cervical screening
• April 2006 - Bowel screening programme

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Improve Detection

• Breast screening age extension
• Liquid-based cytology for cervical screening
• April 2006 - Bowel screening programme

But weve still got a long way to go.
19
Improve Diagnosis

• 9 new static MRI / CT scanners
• PET scanning
• National Endoscopy Training Centre
• Radiology Protocols
• Sentinel Node Biopsy HER2
• Video Conferencing / Telemedicine

20
Improve Diagnosis

• 9 new static MRI / CT scanners
• PET scanning
• National Endoscopy Training Centre
• Richard Sturgess - Nat Clinical Lead
• Radiology Protocols
• Sentinel Node Biopsy HER2
• Video Conferencing / Telemedicine

But weve still got a long way to go.
21
Improve Treatment

• No post-code lottery for chemotherapy
• 17 day waiting time for radiotherapy
• 2 add/4 replacement linacs
• 6.8 million local investment last year
• Pathways / protocols / service redesign

22
Improve Treatment
But More and more referrals from outside
area Working Times Directive Modernising Medical
Careers Payment by Results Choice

• No post-code lottery for chemotherapy
• 17 day waiting time for radiotherapy
• 6.8 million local investment last year
• Pathways / protocols / service redesign

23
Improve Treatment
But More and more referrals from outside
area Working Times Directive Modernising Medical
Careers Payment by Results Choice
And NICE Improving Outcomes Guidance Cancer
Waiting Times targets Peer Review

• No post-code lottery for chemotherapy
• 17 day waiting time for radiotherapy
• 6.8 million local investment last year
• Pathways / protocols / service redesign

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Supportive Palliative Care

• 1.7m investment identified
• Over 155 practices have adopted the GSF (36 of
  the practices)
• LCP coverage 12 Hospital Trusts and a growing
  number of PCTs
• LCP adapted for the care of the dying child
• Strategies for adult and childrens palliative
  care updated
• End of Life Care extended beyond cancer to other
  conditions such as CHD

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NICE Improving Outcomes Guidance

• Breast 1996 / 2004
• Colorectal 1997 / 2004
• Lung 1998
• Gynaecology 1999
• Upper GI 2001
• Urology 2002
• Haematology 2004
• Supportive Palliative Care 2004
• Head Neck 2004
• Childrens, Sarcoma, Skin, Brain ?2005

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NICE Improving Outcomes Guidance

• Gynae From 6 units to 1 centre
• OG From 8 units to 2 centres
• Urology From 7 units to 2 centres

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Northern SMDT Liverpool Womens
Hospital/ Aintree/Southport
Nominated leads from CCO and Specialist Surgical
Centre to attend each MDT
Eastern SMDT Whiston/Warrington
Southern SMDT Wirral/Chester
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Emerging Teams
WHT
CoCH
Wales (Wrexham)
RLBUH
CTC
NCH
SO
SHK
AHT
SMDT 1
SMDT 3
SMDT 2
OG Surgical Treatment Centre 1 (CTC)
OG Surgical Treatment Centre 2 (to be designated)
OG Surgical Treatment Centre 3 (to be designated)
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Local MDT
Local MDT
Local MDT
Local MDT
Local MDT
Local MDT
Local MDT
Prostate SMDT
Kidney SMDT
Bladder SMDT
Phil Cornford
Lee Robinson
Richard Stephenson
Urology Surgical Treatment Centre (RLBUH )
Urology Surgical Treatment Centre (Wirral)
Testis SMDT Mark Fordham, RLBUH Penis SMDT
Nigel Parr, WHT Noel Clark, Greater Manchester
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Cancer Waiting Times

• Two Week Rule (now)
• Urgent GP/GDP referral to first OPA lt14 days
• 31 Day Rule (Dec 2005)
• Decision to treat to first treatment lt 31 days
• 62 Day Rule (Dec 2005)
• Urgent GP/GDP referral to first treatment lt 62
  days
• NB Breast, Testicular, Acute Leukaemia and
  Children's Cancers

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Cancer Waiting Times

• Two Week Rule (now)
• Urgent GP/GDP referral to first OPA lt14 days
• 31 Day Rule (Dec 2005)
• Decision to treat to first treatment lt 31 days
• 62 Day Rule (Dec 2005)
• Urgent GP/GDP referral to first treatment lt 62
  days
• NB Breast, Testicular, Acute Leukaemia and
  Children's Cancers

SHA Mar 05 99 93 76
32
Same Cancer, Different Pathway
Trust A
10 days
97 days
4
1
3
2
4
1 - GP referral 2 - First Appointment 3 -
Decision to treat 4 - First treatment
8 days
36 days
12 days
Trust B
33
Focus Energy Matrix
High
Purposeful (10)
Disengaged (20)

• exhausted and no inner resources to regenerate
  self
• denial behaviours
• defensive avoidance
• Turn up to everything but no actions
• No initiative
• Very busy but no outputs

• Focus on critical LT goals
• Self-aware and clear about direction
• Strong will-power and highly selective
• Very positive and lots of energy
• Well intentioned and willing
• Frenetic motion gt constructive action

Focus
Procrastinators (30)
Distracted (40)
Low
Low
High
Energy
Summary prepared from Harvard Business Review
Article Beware the Busy Manager Reprint RO
202 D