Cancer Networks: Moving forward Pat Higgins Director of Merseyside and Cheshire Cancer Network

Summary The future role of cancer networks Driving improvement Improving service delivery Integrated working Planning for Reform in M&C and our priorities

What are the characteristics of networks Collaborative Partnership Patient centred Consensus Pathways Seamless care

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

NETWORK TASKFORCE Network Team Lead Clinician Network Managers Forum Liverpool PCT RLBUH & LWH FT /Trusts Sefton Sefton PCT, UHA FT, S&O and WCNN Trusts Eastern Warrington, St Helens & Halton and Knowsley PCTs NCH and St H&K Trusts Wirral Wirral PCT and Wirral Trust and CCO ICN Cancer Commissioning Group West Cheshire Countess of Chester FT and Western Cheshire Urology Breast Colorectal OG HPB CAYPGynaeLungPathRad Sarcoma Neuro Primary Care Haem ChemoPharmHealth Inequalities Paed Palliative Head & Neck SPCChemo Lead Nurses

Senior Management Team Improvement TeamInformation Team Business Support Team Outline indicates externally funded or temporary post Key Lead Team Locality Leads 1.Sefton: Kathy Collins 2.Liverpool: Linda Devereux 3.Wirral & West Cheshire: Alison Williams 4.Eastern: Anita Corrigan

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

Network challenges 2 nd 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

Cancer Mortality Rates Best of Europe European Average English Average Merseyside & Cheshire Average North Liverpool 20% Gap 14% Gap 126% female lung Ca

Excess deaths from cancer PCTAll canc ers Lung Cancer Deaths [1 ] [1 ] all Ca 2005 Death s all all Ca 2006 MaleFemaleTotalMaleFemaleTotal Halton & St Helens Knowsley Liverpool Sefton Warrington West Cheshire Wirral Total excess deaths [1] [1] Source NCHOD mortality all ages all cancers

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

Health InequalitiesBetter Treatment Living with and Beyond Cancer Care in Appropriate Settings Building Capacity and Capability Ensuring Delivery Social marketing CPED Strategy Primary Care Strategy Commissioning toolkit LD/ACC ICCP CRS screening extension BCSP 2WR clinics fit for purpose? Peer Review Self Assessment – working group RAP monitoring Support Locality Groups CNGs Workforce planning E-learning NDP / NDP Next Steps Anatomy & oncology PH Analyst Trainee CRS waiting times SCR & Data Warehousing Research Strategy & CRUK Centre Satellite Radiotherapy M&C response to NW Cancer Plan Support ICNs Inpatient redesign Palliative Care Strategy Follow-ups project Patient information strategy website Ward dependency project IOG Delivery Supportive Care HMDS CYP Skin Sarcoma Neuro CPORT NCAG HPB Supportive Care Key worker Holistic assessment 24/7 7/7 Psychology Rehabilitation Adv Care Planning Adv Comms Skills Succession planning / AfC AHP Strategy Nursing Strategy Pt Involvement Strategy CRS NICE uptake audit Map of Medicine Pharmacy protocols Development of Lead Clinicians’ role Genetics & Fertility – access issues? CPIs ACC training DVD

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

Oesophago-gastric Original configuration: 8 units all delivering full range of services Southport and Ormskirk Aintree St Helens and Knowsley North Cheshire Royal Liverpool and Broadgreen Wirral Hospitals Countess of Chester Cardiothoracic Centre

Oesophago-gastric By centres delivering complex care Aintree Cardiothoracic Centre Wrexham Partnership with North Wales Network

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

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

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.

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;

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 End of Life Care – building on baseline reviews improve access to high quality services close their homes with rapid response services and coordination centres.

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;

What does that look and feel like?

A bit like this!

Or if the technology fails - this! Herding cats! Knitting fog

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.

PREVENTION Pledge 2: We will implement the tobacco control plan. To help prevent cancer we will: Pledge 6: The North West will campaign for greater regulation of sun beds to protect children and young people. Pledge 5 : The North West will strive towards reducing obesity especially in children and young people.

To improve and extend breast screening services: SCREENING 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.

TREATMENT 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 All patients with a suspected cancer detected through screening programmes will be treated within 62 days by To improve waiting times for cancer treatments: 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 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

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.

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.

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

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