Cancer Networks: Moving forward

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Cancer Networks Moving forward

• Pat Higgins
• Director of Merseyside and Cheshire Cancer
  Network

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Summary

• The future role of cancer networks
• Driving improvement
• Improving service delivery
• Integrated working
• Planning for Reform in MC and our priorities

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What are the characteristics of networks

• Collaborative
• Partnership
• Patient centred
• Consensus
• Pathways
• Seamless care

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Network Structure

• Taskforce (Board)
• Managers Forum
• Management team
• Cancer Commissioning Group
• Lead Clinicians
• Lead Nurses Forum
• Clinical Network Groups (CNGs)

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NETWORK TASKFORCE
Network Team
Cancer Commissioning Group
Network Managers Forum
Lead Nurses
Lead Clinician
Sefton Sefton PCT, UHA FT, SO and WCNN Trusts
West Cheshire Countess of Chester FT and
Western Cheshire
Liverpool PCT RLBUH LWH FT /Trusts
Eastern Warrington, St Helens Halton and
Knowsley PCTs NCH and St HK Trusts
Wirral Wirral PCT and Wirral Trust and CCO
Urology
ICN
ICN
Breast
ICN
ICN
Colorectal
ICN
OG
HPB
CAYP
Gynae
Lung
Path
Rad
Sarcoma
Neuro
Haem
SPC
Chemo
Primary Care
Chemo
Pharm
Health Inequalities
Paed Palliative
Head Neck
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• Locality Leads
• Sefton Kathy Collins
• Liverpool Linda Devereux
• Wirral West Cheshire Alison Williams
• Eastern Anita Corrigan

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Type of Network

• Governed partnership
• Funded by and accountable to PCTs
• Core roles defined
• PCTs sign off objectives and review 6/12
• Report to PCT Networks Board via Taskforce

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Network challenges

• 2nd highest incidence rates in the country
• Ditto for mortality rates
• Trust configuration - high number of specialist
  trusts
• Cancer centre without surgical oncology
• Lack of academic research leadership
• 5 out of 7 PCTs are Spearhead PCTs

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Cancer Mortality Rates
Best of Europe
European Average
20 Gap
English Average
14 Gap
Merseyside Cheshire Average
126 female lung Ca
North Liverpool
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Excess deaths from cancer
PCT All cancers Lung Cancer   Lung Cancer   Lung Cancer   Deaths1 all Ca 2005 Deaths all all Ca 2006
  Male Female Total Male Female Total
Halton St Helens 66 64 130 23 24 48 883 796
Knowsley 50 45 95 26 33 59 413 449
Liverpool 181 174 355 99 100 199 1398 1330
Sefton 40 29 69 15 27 42 930 834
Warrington 6 -6 0 2 3 5 460 475
West Cheshire 2 9 11 -6 -1 -7 651 693
Wirral 33 49 82 18 24 41 971 1031
Total excess deaths 378 364 742 177 210 387 5706 5612

1 Source NCHOD mortality all ages all cancers
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Key Priorities

• Health Inequalities
• Better Treatment
• Living with and beyond cancer
• Care in appropriate settings
• Ensuring delivery
• Building capability and capacity

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Health Inequalities
Better Treatment

• IOG Delivery
• Supportive Care
• HMDS
• CYP
• Skin
• Sarcoma
• Neuro

Primary Care Strategy
CPORT
CPED Strategy
Map of Medicine
Genetics Fertility access issues?
NCAG
Social marketing
HPB
Pharmacy protocols
PH Analyst Trainee
LD/ACC
Ward dependency project
Follow-ups project
ACC training DVD
CRS screening extension
Satellite Radiotherapy
Development of Lead Clinicians role
BCSP
2WR clinics fit for purpose?
Succession planning / AfC
Workforce planning
Nursing Strategy
Patient information strategy
Adv Comms Skills
AHP Strategy

• Support
• Locality Groups
• CNGs

Living with and Beyond Cancer
Building Capacity and Capability

• Supportive Care
• Key worker
• Holistic assessment
• 24/7 7/7
• Psychology
• Rehabilitation
• Adv Care Planning

website
Pt Involvement Strategy
E-learning
Commissioning toolkit
NDP / NDP Next Steps
ICCP
CRS waiting times
Anatomy oncology
CPIs
SCR Data Warehousing

• Peer Review
• Self Assessment working group
• RAP monitoring

Palliative Care Strategy
MC response to NW Cancer Plan
Inpatient redesign
Research Strategy CRUK Centre
Care in Appropriate Settings
CRS NICE uptake audit
Support ICNs
Ensuring Delivery
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Key Issues facing networks

• Survival!
• Improving Outcomes Guidance
• Peer review
• Influencing the commissioning of cancer services
• Service Improvement and re-design
• Responding to Cancer Reform Strategy

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Oesophago-gastric
Original configuration 8 units all delivering
full range of services
Southport and Ormskirk
Aintree
St Helens and Knowsley
North Cheshire
Cardiothoracic Centre
Royal Liverpool and Broadgreen
Wirral Hospitals
Countess of Chester
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Oesophago-gastric
By 2007 3 centres delivering complex care
Aintree
Cardiothoracic Centre
Partnership with North Wales Network
Wrexham
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Peer review

• Self assessment
• Self Improving
• Validation
• Exception visits
• Performance monitoring
• Using the process to drive up quality and improve
  services

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What the CRS says about Networks

• ..to recommend that cancer
• commissioning is coordinated across a
• network of care, based on patient care
• pathways into these services, rather than
• formal organisational boundaries

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Commissioning

• strengthen the support available to
  commissioners, including publishing a cancer
  commissioning guide and planning toolkit and
• Commissioners should also use existing national
  guidance and standards and the process of peer
  review to assist them in making commissioning
  decisions for cancer.

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World class commissioning

• Providing information and support to promote
  informed choice in treatment and care
• Delivering safe and effective radiotherapy in
  accordance with the recommendations of the
  National Radiotherapy Advisory Group

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What levers do networks have?

• 2.42 PCTs will also need to ensure that
  providers of cancer services collect datasets as
  set out in national contracts.
• 2.65 End of Life Care building on baseline
  reviews improve access to high quality services
  close their homes with rapid response services
  and coordination centres.

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Important quotes

• Networks teams should act as agents for
• commissioners, supporting them to
• coordinate their activities and providing
• shared expertise, maintaining the
• dialogue with clinical teams and users,
• agreeing clinical guidelines and pathways and
  driving forward innovative, high quality care

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What does that look and feel like?
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A bit like this!
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Or if the technology fails - this!

• Herding cats!
• Knitting fog

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Why do we need a North West plan?

• Cancer in the North West - challenges to health
  services and wider community
• Future demand for cancer services
• Improve preventive programmes
• Work with local communities
• An opportunity in to address some of these issues
  collectively individually.

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PREVENTION
To help prevent cancer we will
Pledge 2 We will implement the tobacco control
plan.
Pledge 5 The North West will strive towards
reducing obesity especially in children and
young people.
Pledge 6 The North West will campaign for
greater regulation of sun beds to protect
children and young people.
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SCREENING
To improve and extend breast screening services
Pledge 6 Unacceptable variations in screening
uptake will be investigated and appropriate
action will be taken to target the population
never screened. PCTs leads will examine the
coverage and uptake rates for all screening
programmes to improve and maintain uptake by
their populations.
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TREATMENT
To improve waiting times for cancer treatments
Pledge 10 We will ensure that all patients in
the North West will meet extended standards for
waiting times. For second or subsequent surgery
and chemotherapy this will mean that patients
will wait no longer than 31 days by December 08.
All women referred by their GP with breast
symptoms will be seen within two weeks by
December 2009. All patients with a suspected
cancer detected through screening programmes will
be treated within 62 days by 2009.
To improve the quality of capture of cancer
staging at presentation we will
Action By December 2009 we will have completed
the collection of retrospective staging data for
cancers diagnosed in 2006. During 2008/09 all
data will be collected prospectively through MDTs
to capture this in real time, and be used as a
basis for treatment decisions
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TREATMENT
To improve access to radiotherapy
Pledge 11 Networks, working with their cancer
centres and PCTs will develop radiotherapy
satellite facilities to meet the expectations
within the CRS and NRAG which will guarantee that
patients have a maximum travel time of 45 mins
for the more common cancers and for those
requiring palliative treatment. PCTs will
commission any additional capacity that cannot be
met from better utilisation of existing
equipment..
To deliver local, consistent and safe
chemotherapy
Pledge 16 By 2012 Chemotherapy and other
systemic therapies will be delivered as close to
home as possible where this is safe to do so.
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QUALITY
To reduce cancer inequalities
Pledge 26 By the end of 2008 all networks
will have developed rigorous plans that are
aimed at reducing the health inequalities
experienced by their populations. The
inequalities in cancer mortality rates will then
be rigorously monitored by the SHA.
To commission world class cancer services
Pledge 27 PCTs in the North West commit to
the DH world class commissioning programme
and the use of the cancer commissioning toolkit
when available, through which standardised care
across the North West can be monitored.
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Network Objectives 2008 - 2012

• Early Detection and Prevention
• Ensuring better treatment
• Living with and beyond cancer
• Reducing health inequalities

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Network Objectives 2008 - 2012

• Delivering care in the most appropriate setting
• Ensuring delivery and maintaining progress
• Building capability and capacity