Cancer Alliances Workshop (South Region) Thursday 9 June 2016 - - PowerPoint PPT Presentation

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Cancer Alliances Workshop (South Region)

Thursday 9 June 2016 11:00 – 15:00

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Welcome

Nigel Acheson, Regional Medical Director (South), NHS England

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Context and background

Cally Palmer, National Cancer Director, NHS England

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Why a focus on cancer?

“The disparity between incidence and awareness of bowel cancer in the UK is greater than that of any other cancer. This results in poor awareness of symptoms, late detection, high mortality and greater treatment expense than would be the case if awareness were higher.” “The first mention of the word 'cancer' was used by a doctor in the middle of a sentence. It seems that he may have believed that I had already been informed.” “….. Some doctors are rather keen to give information as quickly as possible without recognising where the patient is coming from. Medical information needs to match patient need.” “We over diagnose, over treat, and treat for marginal benefit.”

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Implementation Plan

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National Cancer Programme

National Cancer Advisory Group Five Year Forward View Board Early Diagnosis workstream Patient experience workstream Living With and Beyond Cancer workstream National Cancer Senior Management Team National Cancer Transformation Board High Quality Modern Services workstream Prevention workstream Commissioning, Provision and Accountability workstream

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 £15m to test the faster diagnosis standard in 5 areas and  Launch a National Diagnostic Capacity Fund and  Roll out the ACE wave 2 pilots:

• London Cancer
• Greater Manchester
• Leeds
• Bristol
• Oxfordshire
• Airedale, Wharfedale & Craven

 Cancer Alliances

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Key priorities for 2016/17

Multi-disciplinary diagnostic centres in the community

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What are Cancer Alliances?

Work across and with STPs to provide the detail

• n cancer

For the first time an integrated dashboard A shared focus on cancer across the pathway National priorities delivered locally

Bring together providers and commissioners

Knowing where the gaps are and working together to address

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Phase 1 Cancer Dashboard

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Alliances to Accountable Networks?

Accountable Cancer networks

Shared learning and testing

Est. alliances

Est. Cancer vanguard

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Alliance footprints – how many?

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Timeframes

May – June 2016 Local design workshops Start July 2016 Draft Alliance footprints and local structures proposed End July 2016 Oversight Group agrees Alliance footprints and local structures From September NHS England business plan commitment on starting to roll out Cancer Alliances End October 2016 Draft Cancer Alliance action plans proposed Mid November 2016 Oversight Group agrees action plans

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Questions

How should Alliances engage with the prevention agenda? Who are the key stakeholders that would make up Alliances? How do we give the Alliances levers? How do we encourage a collaborative approach from the start? What is the relationship with the Cancer Vanguard?

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Purpose of the workshop

Jo Cottam, National Cancer Policy Lead, NHS England

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Recap…

• Cancer Alliances are the local stakeholders.
• They are not employing organisations.
• On the basis of shared data and metrics, Alliances will agree action

plans which set out at a system-wide level the activity required to deliver the Taskforce strategy locally. This means:

• Delivering improvements against 2020 ambitions
• Delivering particular initiatives.
• In practice this will involve adding the next layer of detail on cancer to

STPs.

• Alliances will take decisions required to lead the cross-organisation,

whole system approach to improving outcomes.

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Therefore…

• This is not completely separate to the STP process – we are looking to

ensure that STP leads are driving the establishment of Alliances.

• Alliances will need support – this will be determined locally, but we

expect this will be provided in part by Clinical Networks.

• The establishment of Alliances does not change the statutory

responsibilities of individual members.

• The progress made by Cancer Alliances in leading improvements in

cancer outcomes will be highlighted by performance against:

• the integrated cancer dashboard
• metrics associated with Alliance action plans.

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Purpose of the workshop

• To develop proposals, informed by engagement with key regional

stakeholders, on:

• The geographic footprints of Cancer Alliances
• The structure of each Cancer Alliance/how each Cancer Alliance will

function locally to ensure that each can lead the improvement of cancer outcomes for its population

• The ‘gateway’ points for the development of Cancer Alliances over

the coming years.

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Discussion: proposed geographies

Pat Haye, Deputy Director Clinical Networks and Clinical Senates (South), NHS England

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Principles for determining Cancer Alliance geographies

• Ideally, Cancer Alliance geographies will both:
• 1. Be aligned with patient flows
• 2. Be aligned with STP footprints.

Where it is not possible to meet both of these criteria, the first criterion will take precedence.

• Cancer Alliances will bring together stakeholders from across the whole

cancer pathway, therefore Alliance geographies must include one or more tertiary centres.

• We expect that Cancer Alliances will cover populations of between 2-3

million.

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Specialised Commissioning Strategic approach

Vaughan Lewis Clinical Director Specialised Commissioning (South)

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STP spend by top service areas - 14/15

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5 year strategic view

• Population focus
• 2 to 3 Million population base for most specialised

services

• Consolidation into fewer centres
• Clustering of inter-related and co-dependent services
• Horizon scanning re emerging technologies
• Emphasis on quality
• Networked provision of lower acuity elements of care
• Transformation through STP alliance

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National Recommendations

23 CRG ref CRG Service Line RECOMMENDATION B01 Radiotherapy Radiotherapy (All Ages) Sub Region (Hub) B01 Radiotherapy Brachytherapy and Molecular Radiotherapy (All Ages) Sub Region (Hub) B01 Radiotherapy Breast Radiotherapy Injury Rehabilitation National B01 Radiotherapy Proton Beam Therapy National B02 PET-CT Positron Emission Tomography Computed Tomography Scanning (All Ages) Health Economy B10 Thoracic Surgery Cancer: Malignant Mesothelioma (Adult) Health Economy B11 Upper GI Surgery Cancer: Oesophageal and Gastric (Adult) Health Economy B12 Sarcoma Cancer: Soft Tissue Sarcoma (Adult) Sub Region (Hub) B12 Sarcoma Primary Malignant Bone Tumours Service (Adults and Adolescents) National B13 CNS Tumours Cancer: Brain and Central Nervous System (Adult) Health Economy B13 CNS Tumours Complex Neurofibromatosis Type 1 Service (All Ages) National B13 CNS Tumours Neurofibromatosis Type 2 Service (All Ages) National B14 Urology Cancer: Specialised Kidney, Bladder and Prostate (Adult) Health Economy B14 Urology Cancer: Penile (Adult) Sub Region (Hub) B14 Urology Cancer: Testicular (Adult) Sub Region (Hub) B14 Urology Ex-vivo Partial Nephrectomy National B15 Chemotherapy Cancer: Chemotherapy (Adult) Health Economy B15 Chemotherapy Cancer: Chemotherapy (Children, Teenagers and Young Adults) Sub Region (Hub) B16 Head and Neck Cancers Cancer: Head and Neck (Adult) Health Economy B17 Teenage & young peoples Cancers Cancer: Teenagers and Young People Health Economy

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NHS South STP population sizes

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0.92M 0.89M 0.84M 0.55M 1.16M 0.76M 1.82M 0.52M 0.61M 1.98M 1.78M 1.66M 0.54M

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0.92M 0.89M 0.84M 0.55M 1.16M 0.76M 1.82M 0.52M 0.61M 1.98M 1.78M 1.66M 0.54M

2.5

4.4

Combined populations of STP ‘clusters’

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Discussion: local structures

Chris Harrison, National Clinical Director for Cancer, NHS England

• To examine shared outcomes data to identify

areas across whole pathways where improvement is required

• To agree an action plan which:
• Adds the next layer of detail on cancer

to STPs

• Addresses areas where improvement is

required

• Delivers the Taskforce strategy locally

(by both seeking to meet the Taskforce’s 2020 ambitions and focusing on some specific recommendations/initiatives)

• To lead the delivery of the action plan by:
• Driving the activity required within their
• wn organisations
• Working together to lead the joint

activity

• Charities
• Patients
• Other local

stakeholders Meets quarterly

SUPPORT

• Clinical Network staff (TBC: boosted by national funding)
• NHS England and NHS I regional staff (TBC: boosted by national funding)
• TBC: central support (e.g. on analytics)
• Chair: Alliance

lead*

• STP

lead(s)/rep(s)

• Senior rep from

each provider trust

• GP/GP

federation lead(s)

• Director of

Public Health

• Specialised

commissioner lead

• CCG lead
• Voluntary sector

provider(s) Meets every two months

CANCER ALLIANCE PARTNERSHIP

• To provide challenge

and advice on the development and delivery of Alliance action plans

CANCER ALLIANCE ADVISORY GROUP

Cancer Alliance Model - STRAW MAN FOR DISCUSSION

*A senior clinician or manager who has credibility to provide cross-organisational leadership within the NHS and with stakeholders

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Discussion questions

• Does the straw man include the right members of the Cancer Alliance

Partnership and the Cancer Alliance Advisory Group? Is anyone missing?

• What support will Alliance members need? How can we make use of existing

local capacity in supporting Alliances?

• Ultimately the Commissioning, Provision and Accountability Oversight Group will
• versee Cancer Alliances, although Regional Executive Teams will also play a

key role. What other local governance arrangements - particularly in relation to STPs - need to be taken into account?

• Does the straw man represent a meaningful approach to clinical leadership and

patient engagement? If not, how can this be improved?

• How often and in what way should the Cancer Alliance Partnership and the

Cancer Alliance Advisory Group meet?

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Discussion: 'gateway points' for Alliance development

Jo Cottam, National Cancer Policy Lead, NHS England

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Discussion: scenario

Scenario: the members of the Cancer Alliance Partnership in a particular area have been given formal accountability for the outcomes for their cancer population. The members of the Partnership will all be held to account for delivering improvements against these outcomes, and will share both the risks and benefits of meeting these outcomes. Discussion question: What steps will the Cancer Alliance need to have taken before being given this formal accountability?

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Wrap up and close

Nigel Acheson, Regional Medical Director (South), NHS England