Advice to Support commissioners to achieve improvements in cancer services Version 6 Please note this toolkit is a draft version and any comments / recommendations should be emailed to england.operations-south@nhs.net

A commissioning toolkit for cancer This toolkit aims to support CCGs and NHS England with securing improvements in cancer services – ensuring that patients are seen as quickly as possible (compliance with cancer performance standards) and with achieving the best possible outcomes for cancer patients. It brings together key pieces of work by members of the cancer task and finish group that was set up by NHS England (South region) during July, August and September 2014. A full list of contributors is set out at the end of the document. This toolkit remains a draft document and is subject to revision.

Contents Commissioning responsibilities Who is responsible for commissioning cancer and what resources are available to help commission cancer services? How to access performance information What performance data is available and where can it be found? Managing cancer waits What governance arrangements should be in place and what questions should commissioners ask providers? Stakeholder map Which stakeholders should commissioners develop and maintain their relationships with?

Commissioning responsibilities Who is responsible for commissioning cancer and what resources are available to help commission cancer services? The attached guide, kindly reproduced with permission from South East Coast Cancer Strategic Clinical Network, clearly sets out where cancer commissioning responsibilities lie across Clinical Commissioning Groups and NHS England and will be helpful with ensuring good collaborative arrangements are in place. The national cancer commissioning toolkit, located at www.cancertoolkit.co.uk, includes links to national cancer commissioning guidance that covers the whole commissioning cycle from assessing health needs and developing contract service specifications to monitoring performance. In addition, NICE Improving Outcomes Guidance (IOG) is available for a range of cancers and can be found at http://www.nice.org.uk/GuidanceMenu/Conditions-and-diseases/Cancer

How to access performance information What performance data is available and where can it be found? A range of performance information is available to help commissioners monitor the delivery of cancer services. The attached spreadsheet lists a series of data resources for consideration when commissioning for cancer. The most useful resource available is the National Cancer Intelligence Network Cancer Commissioning Toolkit which contains data ranging from Cancer Prevalence and Mortality to Referral rates and Referrals resulting in a diagnosis of cancer. The NHS England KIS dashboards also provide the latest available public and non-public data around provider & CCG performance against the cancer performance standards (including tumour site specific information): https://kis.southcentral.nhs.uk/sites/KIS/Dashboards

Managing cancer waits What governance arrangements should be in place and what questions should commissioners ask providers? The following questions have been developed so that commissioners can check that appropriate arrangements are in place for managing cancer waits: Where there are collaborative commissioning arrangements in place can you clearly describe the process for ensuring that cancer waits are addressed for all commissioners with the relevant providers? What mechanisms are you using to ensure that specialised cancer pathways and their local commissioning outputs are aligned? What is your role in assuring 62 day targets and how is this role discharged? What are your governance processes for reviewing the performance of your providers and how do you act upon the reports you receive on consistently poor performance? Do you access http://www.cquins.nhs.uk/ and review provider uploads to identify risks with the quality of services and cancer performance standards? How do you manage cancer wait breaches and do you use the financial penalties/incentives accorded within the Acute Services contract: http://www.england.nhs.uk/wp-content/uploads/2013/12/sec-a-part-1415.pdf (page 41,42 outline the relevant penalties for breaches)? Do you have access to information on reasons for breaches; recovery plans, performance trajectories etc. How have these been developed and tested? How has data been assured for completeness and accuracy? Do you have sight on the numbers of patients who remain on trackers past their breach date? - this will help with understanding the reasons for breaches as well as identifying at an early stage the breaches that will be recorded. Are you familiar with the provider’s policy for managing breaches / escalation of potential breaches? Have you developed capacity plans for cancer as part of your 2 and 5 year plans and how does the availability of direct access diagnostics feature in these plans? How have you assured plans and trajectories? Contact your Strategic Clinical Network for advise regarding care pathways, best practice and methods for supporting the delivery of the cancer standards.

Managing cancer waits: resources The NHS IMAS Elective Intensive Support Team have developed a good practice guide ‘Delivering Cancer Waiting Times’, which is available on the NHS IMAS website: http://www.nhsimas.nhs.uk/what-we-can-offer/intensive-support-team/delivering-cancer-wait-times/ The guide focuses on the following key areas: Good practice governance principles in relation to reporting and performance management;  Tools and techniques for modelling and planning cancer demand and capacity; Examples of core cancer infrastructures, including individual and team roles, systems and processes;  Robust approaches to the administrative aspects of waiting times management, including referral and booking management, patient tracking, etc.; and Management of integrated functions and services across diagnostics, outpatients, and inpatients. Further demand and capacity tools are also available through the NHS IMAS website: http://www.nhsimas.nhs.uk/intensive-support-team/ The DH Cancer Waiting Times guide (included to the right) aims to provide answers to common questions about cancer waiting times requirements and seeks to ensure that staff from both information and clinical teams understand the cases they need to be reporting on.

Stakeholder map

Feedback We would like to ask for feedback on the content of this toolkit and how we could further share experiences and good practice across Area Teams and CCGs to ensure the delivery of high standards across the south.  Please send any feedback or contributions you have to england.operations-south@nhs.net

Produced by This toolkit was developed by the Cancer Task and Finish Group. Thanks are given to all members of the group and in particular contributions from: Nigel Acheson, Medical Directorate, South Lawrence Tyler, Operations and Delivery, South Sunita Berry, South West Strategic Clinical Networks and Senate Stephen Duckworth, South East Coastal Strategic Clinical Networks James Beyer, Improvement and Support Team, South Jonathan Miller, South West Cancer Network Ben Andrew, Analytical Services, South Carmel Gulliver-Clarke, Nursing Directorate, South Gurmit Sandhu, Kent and Medway AT Nathan Hall, Operations Directorate, South Siobhan Kelly, BGSW Area Team