1 Cancer Commissioning Toolkit (CCT) Training

2 By the end of the training you will: Have a good understanding of the history of the CCT Know how to set up and personalise your account Know how to navigate around the CCT Be able to read and interpret the dashboards and charts Know how to export reports There is a mix of presentation and live working sessions - we have a lot to cover! Be comfortable and competent with the use of the toolkit

3 HISTORY

4 The Cancer Commissioning Toolkit (CCT) was developed to realise the aims of the Cancer Reform Strategy (CRS) “The Cancer Reform Strategy identified better information and stronger commissioning as two of the key drivers to achieve our goal that cancer services in this country should be amongst the best in the world. The launch of this Cancer Commissioning Toolkit represents a major step forward in relation to both of these drivers for quality improvement.” Prof Mike Richards National Cancer Director

5 Information is key to high quality commissioning Commissioning of cancer services is complex Commissioners need to take account of a wide range of factors to make informed decisions Ready access to high quality information about local services and how they compare with services elsewhere is essential for good commissioning

6 NCIS Registries CCT is a “one stop solution” for access to cancer commissioning information to inform decision making This toolkit brings together information from all of the sources, in a user friendly format Guidance contains suggestions for questions which commissioners can ask service providers Advice on how to interpret data Analysis of quality and confidence of sources This toolkit brings together information from all of the sources, in a user friendly format Guidance contains suggestions for questions which commissioners can ask service providers Advice on how to interpret data Analysis of quality and confidence of sources Smoking cessation NCASP Pharmac ists End of life DH cancer waits RT – equip survey CQuINS HES microsite Screening ePACT C-PORT Pre-CCT Post-CCT Programme budgeting HES

7 There are 100s of important metrics that must be taken into account when making commissioning decisions Survival trends per cancer type and PCT Activity per admission type and PCT Drug budget per indication and network and PCT Excess bed-days per cancer type, trust and PCT # TWR with cancer diagnosis Place of death per PCT of patient and trust There is a wealth of information in the CCT The toolkit contains over 100 reports, with more to come Illustrative

8 Careful consideration needs to be given to the way the data are interpreted and used 1.Is a start of a conversation and not an answer in itself 2.Data drives insight and questions, not necessarily answers 3.Need to read the guidance and interpret the data accordingly 4.Not an in-year planning tool 5.Relies on existing data sources

9 The CCT broadly follows the chapters and sections of the Cancer Reform Strategy Cancer “patient journey” in the toolkit Cancer Landscape Peer Review Summary Awareness, Screening and Early detection Assessment, diagnosis and staging Treatment Living with cancer End of life Building for the future Inpatient Funding cancer care

10 AT Kearney Partnership working has been critical to the development of this toolkit To name a few... National Cancer Services Analysis Team National Cancer Screening Programmes National Cancer Intelligence Network NHS Improvement National Cancer Action Team UK Association of Cancer Registries Pharmaceutical Oncology Initiative Department of Health Concentra Database administrators Usability testers Your ongoing feedback... Continuous improvement! = Section owners National interviews Feedback from NDP 2008 Pilot sites CCT Steering Group / Team

11 Development of the CCT is being supported by member companies of the British Pharmaceutical Industry (ABPI) Pharmaceutical Oncology Initiative (POI) Group

12 The main users of the toolkit will be PCT commissioners, cancer networks and trusts As of October 2006 there are 152 PCTs in England There are 30 Cancer Networks in England There are 158 trusts in England Other users of the toolkit: Cancer charities Pharmaceutical companies Public, in due course Users external to the NHS have restricted access to some metrics and small data sets

13 The NHS is providing content and data support for CCT users, while Concentra is providing technical support

14 TOOLKIT

15 The CCT is a web-based tool so you can log on anywhere you have access to the internet

16 The dashboard contains the key cancer metrics and allows you to compare your performance to the national average

17 Organisations are distributed between the ‘best’ and ‘worst’ score with the top 25% in green and the bottom 25% in red Top Quartile 25% 50% 25% 50% 25% Top Quartile 25% 50% 25% Some metrics are inverted, i.e. high scores are not at the top if that’s not the ‘best’ result The size of each section will depend on the spread of scores, not the number of organisations

18 Manage your account and set your default organisations through the User settings menu option and select User Profile

19 Each metric can be observed in more detail with information on sources and guidance

20 A cancer specific dashboard contains another selection of metrics that can be analysed for each cancer type

21 The index contains links to each chapter and section – which lead on from the CRS

22 Each issues raised in the sections of the CRS are informed by the charts in the relevant section

23 Each chart is fully interactive and contains sources and guidance – filter options on the right hand side change depending on the individual charts

24 Timelines allow you to view performance over time, but please note that you can only currently view one organisation at a time

25 Peer review data is provided in a slightly different way, with a tick for compliant and a cross for non compliant on given metrics

26 Charts can be pre-customised with selected networks, PCTs, trusts or SHAs by selecting ‘Favourites’ in the User setting menu option

27 Reports can developed within CCT and exported into a word document, with all relevant source, commentary and comments Report outputs are fully editable in MS Word

28 Add charts and dashboards by setting up the parameters required in the report and using the ‘report basket’ button

29 Once named, the charts and dashboards will appear Report Cabinet to run reports from

30 The Horizon Scanning section of CCT pulls information from many sources of information for cancer medicine horizon scanning Journals Specialist media Industry Licensing agencies Clinical specialists National “horizon scanning” groups National Horizon Scanning Centre London New Drugs Group National Prescribing Centre Cancer Commissioning Toolkit (CCT) - Horizon Scanning - Cancer Commissioning Toolkit (CCT) - Horizon Scanning -

31 There are a number of key principles of the CCT Horizon Scanning section Requests for additions to toolkit will be submitted to a central point and may be submitted by multiple sources All agents will be considered provided they fall under the definition of "chemotherapy" which has yet to be fully defined Requests for additions to toolkit must have published supporting evidence. This may be a fully published trial report or an abstract New drugs/regimens should have an expected EMEA licensing date within 18 months of addition to the database Drugs/regimens will be removed 18 months after licensing for the listed indication or 3 months after a decision by NICE, whichever occurs first CNPF will consider requests for new drugs/regimens three times a year as part of NDP

32 The Cancer Medicines section contains reports on drug uptake

33 The Horizon Scanning reports inform users of upcoming medicines

34 Costs are based on patient numbers, medicine costs and number of cycles

35 The costs of each treatment can be compared across multiple scenarios

36 The cost over time can be seen, based on the expected launch dates of each treatment

37 Data from the Horizon Scanning section can be exported into Excel by selecting the ‘Generate XLS’ link

38 The Activity Planning reports will inform the user of the uptake and costs of current medicines but is still under development

39 The Activity Planner calculates the cost of current regimens based on patient volumes

40 C-PORT is an online capacity planning tool that helps with planning resources for hospitals delivering chemotherapy C hemotherapy P lanning O nline R esource T ool C-PORT development and support is being driven by NCAT and Concentra

41 C-PORT allows the user to simulate the activity within a unit and therefore understand and plan capacity This data is centrally hosted and is accessible through a web-based application C-PORT models the activity within chemotherapy units

42 The Financial Module in C-PORT allows users to allocate costs and revenue for each regimen Revenue calculations Cost calculations Activity calculations Local regimen list Human & physical resources National standard regimen list Resource cost Medicine cost Overheads Tariff income REVENUE COST MARGIN / COST RECOVERY Activity In the future this information will be automatically imported into CCT

43 SCENARIOS

44 Scenarios have been developed to demonstrate the capabilities of the toolkit Scenario 1 – High mortality in specific cancers Scenario 2 – Inefficient spend

45 SCENARIO 1 High mortality in specific cancers

the PCT has made less progress than the majority of the country in reducing mortality levels in the last 10 years 2. there are low one and five year survival rates for colorectal and lung cancers (in lowest quartile) A PCT Director of Public Health scans the cancer dashboard to investigate high mortality in colorectal and lung cancers While she was aware of the high mortality rates, she was less aware that... Scenario 1 - High mortality in specific cancers (1/6)

47 She finds that a high proportion of colorectal and lung cancers are diagnosed through means other than TWR PCT-Y PCT-X TWR = Two Week Referral; this is from the time the GP refers An adjacent PCT has a significantly lower rate Scenario 1 - High mortality in specific cancers (2/6)

48 Smoking cessation levels are low in the area, which may be a result of poor success rates with quit smoking campaigns Smoking cessation metrics are poor Scenario 1 - High mortality in specific cancers (4/6) % success rate for quit smoking over time is falling

49 Another concern is that the PCT’s lung multi-disciplinary teams (MDT) are non-compliant The peer review report shows that this is due to the lack of a thoracic surgeon and palliative care team member Scenario 1 - High mortality in specific cancers (5/6)

50 A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing Questions Why is staging data not being collected? It is already required... What are the reasons behind the low 1 and 5 year survival rates? Strategies Feed back staging information on all newly diagnosed cases promptly to GPs, to support a locally agreed audit on recognition of symptoms Introduce a strategy for prevention and increased population awareness of signs and symptoms in lung and colorectal cancers, based on a social marketing approach Ensure lung MDT compliance to improve curative resection rates and quality of care Scenario 1 - High mortality in specific cancers (6/6) These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions

51 SCENARIO 2 Inefficient spend

52 Cancer spend is just above the national average, but... this appears to correlate with an above average mortality from cancer for the PCT population A PCT Director of Finance assumed that spend on cancer looked appropriate but further investigation revealed problems Scenario 2 - Inefficient spend (1/5)

53 This investigation also explained why the cancer network team were suggesting increased investment in certain areas Screening: coverage is low for both breast and cervical cancer Radiotherapy: Fractionation rates relatively low Radiotherapy: Fractionation rates relatively low Chemotherapy: Uptake of NICE drugs relatively low Chemotherapy: Uptake of NICE drugs relatively low Scenario 2 - Inefficient spend (2/5)

54 From the CCT, the team could demonstrate possible causes for a higher than average spend on inpatient care 1. Higher than average level of emergency bed days Scenario 2 - Inefficient spend (3/5) 2. Higher than average number of deaths in hospital PCT-Z

55 They also discovered a high number of cancer emergency bed days above trim point Scenario 2 - Inefficient spend (4/5)

56 A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing Questions What is driving the high number of cancer emergency bed days? Why are more people dying in hospital in this PCT than most others? For each cancer type, what are the reasons for so many excess bed days above the trim point? Strategies Develop community based support for end of life care and incorporate this work into existing PCT project on early discharge with social services Scenario 2 - Inefficient spend (5/5) These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions

57 THANK YOU