The Sheffield Transformational survivorship project

NCSI - drivers Cancer Reform Strategy 2007

Breast Colorectal Prostate

Old New Revised pathway (NTCN 2011)  ‘One size fits all approach’  CEA 3/12 (2yrs) 6/12 (3yrs) CT 9 and 24 months Colonoscopy  OPA 3/12 (2yrs) 6/12 (3 yrs.)  5 years secondary care led  Clinical components same  OPA frequency reduced  Transfer of care to PC

Diagnosis & Treatment Recovery Early monitoring End of life care Progressive illness Later monitoring What happens here?

Cancer survivorWider population Use of the NHS past 12 months:  Primary Care  Specialist doctor  A+E 90% 45% 20% 68% 15% 11% Impact on work and relationships  Prevented by health from working in preferred occupation  Health interferes in relationship with partner 25% 29% 9% Difficulty/ inability in undertaking different activities:  Vigorous activities (running/ sports)  Housework, shopping, cooking  Going out  Social activities  Personal care 59% 16% 18% 16% 13% 27% 2% 4% 2% Macmillan Health and Well Being Survey 2008

Where we think people are…. Is not necessarily the case…

New Colorectal Pathway 2011 HNA + Care Plan Colonoscopy 6/52 OPA + CEA 9m OPA CT result CEA CT 12m CEA 15m OPA + CEA 18m CEA 21m CEA 24m OPA CT result CEA HNA colon CT 6m OPA for 1 yr. CEA HNA rectal Risk Stratification Level 1 CEA 6 m HNA review 3 m OPA + CEA 6 m CEA Cancer Care Review Level 2 CEA 6 m + Review Treatment Summary Colonoscopy Colonoscopy 5 yrly Health and well-being event

NCSI ‘immediate benefit to patient experience and quality of care along the pathway’

HNA and Care Planning Treatment Summaries Health and Well-being programme Cancer Care Review support pilot Risk stratified pathways Remote Monitoring Workforce Education and development Rehabilitation > Working through cancer > Let’s get moving pathway Project work-streams

A complete picture Revised follow up pathway The Recovery Package Locally commissioned scheme Self-management Clinical effectiveness

Forecast No. of potential eligible patients per year = 450 Old pathway (visit) > 2 x OPA per £72 each = £64,800 70% Level 1 = 315 > 2 x CEA per £18 each = £11,340 25% Level 2 =112.5 > 2 x CEA per £18 each = £4, x review per 41 each = £4,612 Total under scheme = £20,002 Saving per year = £44,798 Cost benefit analysis - colorectal