The story of Greater Manchester Cancer An Integrated Cancer System 2013-19 Dave Shackley

Landscape of cancer in GM in 2012/3 ‘Healthier lives’ report 2010-12 Premature cancer deaths: 6/10 LA’s in GM bottom 20% (cancer) City of Manchester 150/150 Dissolution of regional cancer networks (HSCA 2012) “A need to develop a GM strategy” Good research offering but too much variation in care & poor outcomes across GM ‘Safe & Sustainable – the Cancer Case for Change’ July 2012 (GM) “An integrated approach is needed”, emphasising benefits of a GM perspective Many surgical services not meeting national standards Greater Manchester Cancer Summit 24-25th Sept 2012

National Cancer Vanguard 2015-18 ‘Manchester Cancer’ 2013-2016 Funded by all 10 GM hospitals Independent Chair/ Med Dir GM objectives with an MoU 20 ‘pathway boards’ PaBC integral Annual reports: SYSTEM perspective National Cancer Vanguard 2015-18 Multiple projects with London partners ‘Greater Manchester Cancer’ 2016- The Cancer programme for GM Starting just before GM devolution Funded by whole system Co-produced GM cancer plan Research & education incl. Public health to hospice care

‘GM’ Ethos: The experts are clinically-active colleagues and patients who work closely with managers Clinically active colleagues NHS Managers Patients Balanced, shared leadership/ engagement from all

‘GM’ Ethos: The experts are clinically-active colleagues and patients who work closely with managers Clinically active NHS Managers Understand what its like to be in the cancer system Provide balance/ perspective to professional discussions Intimate knowledge of frontline services Awareness of latest research/ new ideas Special relationship with patients/ public More likely to be listened to by other frontline staff Patients

Some GM cancer achievements since 2013 Patient survival gap to England closed Compared to 2013, we now have an additional 750 patients who live more 12 months after diagnosis On track to ensure >75% of patients survive at least a year after diagnosis by 2021 Av survival: 1980 – 1y now – 10y

Some GM cancer achievements since 2013 Patient survival gap to England closed Over last 5 years best 62d performance vs. other alliance areas

Some GM cancer achievements since 2013 Patient survival gap to England closed Over last 5 years best 62d performance vs. other alliance areas Huge progress in detecting cancer earlier Moving ahead of England on diagnosing patients with early stage (curable) disease: GM 49% 2013 54% vs. 53% (previously 1-2% behind) % presenting as emergency: 2013 - 25% 2018 - 19%

Some GM cancer achievements since 2013 Patient survival gap to England closed Over last 5 years best 62d performance vs. other alliance areas Huge progress in detecting cancer earlier Significant steps in prevention 3 fold increase in people stopping smoking

Some GM cancer achievements since 2013 Patient survival gap to England closed Over last 5 years best 62d performance vs. other alliance areas Huge progress in detecting cancer earlier Significant steps in prevention Brought a shared community & structure to cancer across GM; Connected experts in GM

Working as a system has provided added impetus to improve… National cancer vanguard GM Cancer plan Cancer Champions Gateway C – primary care education Accelerated pathways Lung Health Checks/ CURE programme

Working as a system has provided added impetus to improve… National cancer vanguard None envisaged in 2013 GM Cancer plan Cancer Champions Gateway C – primary care education Accelerated pathways Lung Health Checks/ CURE programme

Working as a system provides a shared identity/ resources GM Cancer Research GM Cancer Conference “Share innovations, create new ideas and network”

       1 in 7 Late presentation System challenges Variation

       £ + workforce 1 in 7 System challenges Late presentation Variation

Summary – Progress report Both patients and clinically-active colleagues act as experts. This works. A GM-level plan & GM-level collaboration are both essential in coordinating improvement Bringing people together yields unexpected benefits We are confident we are positioned well to tackle future issues

Some NCV Outputs Citizen-led social movement : ‘Cancer Champions’ Can-guide: New SDM tool to aid decision making in advancing disease ‘Gateway C’ – online primary care cancer education platform Cancer Intelligence Service Digital pathology feasibility pilot Behavioural nudges in screening: Changes to screening letter Rapid Cancer diagnostic units Optimising medicines: Pharma Challenge New system level governance models Best practice timed pathways 7d face to face palliative care: Pilot work Personalised follow up pilots using technology

Why are best practice pathways needed? Marked unwarranted variation between hospitals/ alliances Standardised pathway is easier to benchmark, audit & improve Shorter time to treatment better for patients Less appointments mean more convenience and saved resource Evidence based clinical guidance to help deliver the FDS and 62d

Degree of variation between Cancer Alliances Colorectal Cancer Lung Cancer Stage 1 + 2 (‘Early stage’) 36 to 46% 21-33% 5 year survival 57 to 64% 12 to 18% Variation in last years 62d performance Median 73% (range 62-82) Median 71% (range 64-83)

Faster Diagnostic Pathways Principles Clinically led Patients involved Broad stakeholder engagement sMDT by day 21 Patient aware Cancer YES/ NO by day 28 latest Recognised Enablers Daily senior triage of referrals Straight to test/ one stop clinics Reporting scans (‘hot’ or <24h) Diagnostic ‘bundles’ Pathway navigators Clear agreed protocols Avoid repeated MDT’s

‘Disruptive technologies’: MP Mri scanning pre-biopsy Increased perineal biopsy options (incl LA) Sector approaches to facilitate MR guided biopsies & more robust workforce Alliance level prostate MDT’s