1. Cancer Mortality Target Measuring and Monitoring at a National Level Jennifer Benjamin, Department of Health Kathy Elliott, National Cancer Action Team N&YCRIS, Cancer Mortality Reduction Rates Workshop 27 July 2009

2. Presentation Overview Policy Commitments How the targets were set Progress to date Ongoing performance management & assessment Observations Conclusions and Q&A

3. Policy Commitments

4. Cancer Targets Cancer mortality target < 75 –Reduce mortality rates for England by at least 20% Inequality gap < 75 –Reduce the absolute gap in mortality rates between England and the Spearhead Groups by at least 6%

5. Interventions to achieve the target

6. Setting the target National trends Looked at comparable countries Modelling based on possible interventions Conclusion: “Challenging but achievable”

7. Cancer Mortality Target 20% reduction Target Measure* (Year) Baseline141.2 (1995/6/7) Latest actual115.5 (2004/5/6) Target113.0 (2009/10/11) Final day of the target period will be 31 Dec 2011. The mid-point target period is 2010. * 3 year average mortality rate per 100,000

8. Cancer Mortality Target Inequality Gap 6% reduction Target Measure (Year) Baseline20.7 (1995/6/7) Latest actual18.0 (2005/6/7) Target19.5 (2009/10/11) Final day of the target period will be 31 Dec 2011. The mid-point target period is 2010. * 3 year average mortality rate per 100,000

9. Progress on cancer mortality target Mortality rate from cancer for people aged under 75 has reduced since baseline from 18.2% to 115.5 (2005- 07), Nearly 9,000 lives were saved in 2007 compared with 1996. There were 61,921 deaths (2007) Lowest recorded rate

10. Progress on cancer mortality target

11. Progress on inequality gap Three year average mortality rates for cancer under 75 for the Spearhead Group have fallen for each period since baseline. Gap has reduced by 13.2% since the baseline compared to the target of at least 6% in 2009-11.

12. Progress on inequality gap

13. Ongoing Performance, Management and Assessment National target and Inequalities Gap published annually Care Quality Commission Periodic Review 09/10 –Reduction in <75 mortality rate –All age all cause mortality PCT Operating Plan (Vital Signs) Local Area Agreements

14. Observations DH also interested in local variations Important that local targets are managed by local health communities Support current efforts to look at outliers and the potential underlying causes May need to focus on specific cancers e.g. breast and colorectal New interventions may have an impact e.g. public awareness and early diagnosis

15. Conclusions National trend – right direction and will continue to be monitored at a national level Interested in local variations and the impact locally as well as nationally Targets helps to focus effort

16. The National Awareness and Early Diagnosis Initiative (NAEDI) Mortality rates in baseline assessments, 2012 and other local targets Kathy Elliott - National Cancer Action Team Jennifer Benjamin - Department of Health Cancer Mortality Reduction Rates – Workshop to look at the 2010 Targets NYCRIS - July 2009

17. Presentation Overview Local variation by Cancer Network Local ambition or targets Awareness and early diagnosis (NAEDI) Baseline assessments Local progress and focus Beyond 2010 – local ambition and value for money

18. Relative change in cancer mortality by cancer network since 1997 "Good" Relative change in mortality rates and the level of change in mortality rates since 1997 (compared to England level) by cancer network. 5 year rolling age-standardised mortality rates (2001-2005) for all cancers for 0-74 years age group; % change in mortality rates since 1997 National Cancer Action Team

19. Cancer Reform Strategy...the Department of Health will work through the National Cancer Equalities Initiative with SHAs and PCTs to agree challenging goals for reducing cancer mortality in every cancer network area by 2012. These goals will pay particular attention to tackling the different forms of inequality... as a means to reducing overall mortality. The progress made by each PCT, cooperating through the cancer network, in meeting these goals will form an important part of our ongoing action to reduce cancer inequalities. (p 86 CRS) National Cancer Action Team

20. Local Ambition Vital Signs Local Area Agreements World Class Commissioning Cancer Reform Strategy Definitions –Same as 2010 target –Inequalities/ Gaps –Within another – eg life expectancy –Site specific

21. Awareness and Early Diagnosis The Core Hypothesis 1.Low public awareness and/or negative beliefs about cancer 2.Late presentation to GPs 3.Delays in primary care (awareness/ attitudes/access to diagnostics) 4.Late referral to hospital 5.Delays in secondary care 6.More advanced disease at diagnosis 7.Poor survival rates 8.Avoidable deaths

22. Baseline assessments To help identify variation at Cancer Network, PCT and General Practice level To inform local awareness and early diagnosis strategy Core indicators –One year and five year survival rates –One year survival rates against international benchmarks –Screening uptake and coverage –Referral rates and emergency admission –Mortality New information –CAM; Primary Care Audit; Staging Data Production of a guide to aid Cancer Networks and PCTs

23. Key Actions – in parallel Local needs and priorities Leadership – including clinical leadership Local strategy, plans and ambition New services and service change Sharing learning and demonstrating impact

24. Awareness and early diagnosis – services and interventions Public understanding and the reduction of barriers to take action Primary care – or other entry points for patients to services The importance of information to monitor or evaluate as we introduce new services or initiatives

25. Local Cancer Ambition Local needs assessment –Joint Strategic Needs Assessment Aligning, setting and refreshing ‘ambition’ –Trajectories and monitoring Evidence based plans –PCT Commissioning plans Investment Delivery and monitoring

26. Conclusions Local variation - understood and acted on Clarity about how local cancer mortality ‘ambition’ will be agreed and monitored, including inequalities Increased confidence that interventions and new services are effective, and the time frames they will have an impact on mortality Fast and effective ways to share emerging and best practice

27. Any Questions?

28. Kathy Elliott National Lead for Prevention, Early Diagnosis and Inequalities National Cancer Action Team Blackberry and Mobile 07799095779 kathy.elliott@gstt.nhs.uk Office 0207 972 4816 kathy.elliott@dh.gsi.gov.uk Note – please use both email addresses