Cancer Networks:
Moving forward
Pat Higgins
Director of Merseyside and
Cheshire Cancer Network
Summary
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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
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Collaborative
Partnership
Patient centred
Consensus
Pathways
Seamless care
Network Structure
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Taskforce (Board)
Managers Forum
Management team
Cancer Commissioning Group
Lead Clinicians
Lead Nurses Forum
Clinical Network Groups (CNGs)
NETWORK TASKFORCE
Network Team
Lead
Clinician
Sefton
Sefton PCT, UHA FT,
S&O and WCNN
Trusts
Cancer
Commissioning
Group
Lead Nurses
Network Managers
Forum
Liverpool
Eastern
Wirral
PCT RLBUH & LWH
FT /Trusts
Warrington, St
Helens & Halton and
Knowsley PCTs
NCH and St H&K
Trusts
Wirral PCT and
Wirral Trust and
CCO
Urology
West Cheshire
Countess of
Chester FT and
Western Cheshire
ICN
ICN
Breast
Colorectal
ICN
ICN
ICN
OG
HPB
CAYP
Gynae
Chemo
Lung
Pharm
Chemo
Path
Health
Inequalities
Rad
Paed
Palliative
Sarcoma
Neuro
Head &
Neck
SPC
Primary
Care
Haem
Kathy Doran
Network Chair
Pat Higgins
Network Director
Jackie Sanders
Business Support Manager
Jon Hayes
Deputy Network Director
Ged Corcoran
Medical Director
Kathy Collins
Network Manager
Linda Devereux
Network Manager
Sarah Griffiths
Business Support Manager
Carol Cottrell
Business Support Co-ordinator
Alison Williams
Network Manager
Pauline Webster
Business Support Co-ordinator
Pat Sneddon
Nurse Director
Anita Corrigan
Network Manager
Penny Robinson
Business Support Coordinator
Eleri Philps
Patient Dependency Manager
Anne Hines
Lead Pharmacist
Vacancy
ICCP Lead Nurse
Debbie Moores
Business Support Co-ordinator
Adrienne Brownrigg
Clinical Lead, End of Life Programme
Ian Connolly
Performance Improvement Manager
Claire MacLean
Public Health Analyst
Simon Pearce
Information Analyst
Locality Leads
1
Katherine Webb
Trainee Public Health Analyst
2
Marie Coughlin
Bowel Cancer Screening Manager
Mandy Snee
Network Manager
Cheshire and Merseyside
Bowel Cancer Screening Programme
(11 members of staff)
3
Tracie Keats
ICCP/LD Project Manager
4
1.
Sefton:
Kathy Collins
2.
Liverpool:
Linda Devereux
3.
Wirral & West Cheshire:
Alison Williams
4.
Eastern:
Anita Corrigan
Paul Mackenzie
Health Inequalities Manager
Key
Sandra Rowlands
Patient Information Manager
Chris Barker
Web Manager
Lead Team
Gloria Payne
Patient & Carer Facilitator
Dan Seddon
Public Health Consultant
Prevention and Early Detection Strategy
Outline indicates externally
funded or temporary post
Senior Management
Team
Improvement Team
Information Team
Business Support
Team
Type of Network
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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
• 2nd 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
20% Gap
English Average
14% Gap
Merseyside & Cheshire
Average
North Liverpool
126% female lung Ca
Excess deaths from cancer
PCT
All
canc
ers
Deaths[1
Lung
Cancer
all Ca
2005
Death
s all
all Ca
2006
]
Male
Female
Total
Male
Female
Total
Halton & St Helens
66
64
130
23
24
48
883
796
Knowsley
50
45
95
26
33
59
413
449
Liverpool
181
174
355
99
100
199
1398
1330
Sefton
40
29
69
15
27
42
930
834
Warrington
6
-6
0
2
3
5
460
475
West Cheshire
2
9
11
-6
-1
-7
651
693
Wirral
33
49
82
18
24
41
971
1031
Total excess deaths
378
364
742
177
210
387
5706
5612
[1]
Source NCHOD mortality all ages all cancers
Key Priorities
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Health Inequalities
Better Treatment
Living with and beyond cancer
Care in appropriate settings
Ensuring delivery
Building capability and capacity
Health Inequalities
Primary Care Strategy
CPED Strategy
Genetics &
Fertility – access
issues?
Social marketing
PH Analyst Trainee
LD/ACC
ACC training DVD
CRS screening extension
Development of Lead Clinicians’ role
Succession planning / AfC
Workforce planning
Adv Comms Skills
BCSP
2WR clinics fit
for purpose?
Nursing Strategy
AHP Strategy
Building Capacity and
Capability
Pt Involvement Strategy
E-learning
NDP / NDP Next Steps
Anatomy & oncology
Peer Review
• Self Assessment –
working group
•RAP monitoring
CRS NICE uptake audit
Ensuring Delivery
IOG Delivery
Better Treatment
•Supportive Care
CPORT
•HMDS
Map of Medicine
•CYP
NCAG
HPB
•Skin
Pharmacy protocols
•Sarcoma
Ward dependency
•Neuro
project
Follow-ups
project
Satellite Radiotherapy
Support
•Locality Groups
•CNGs
website
Patient information strategy
Commissioning toolkit
CRS waiting times
CPIs
SCR & Data Warehousing
ICCP
Supportive Care
•Key worker
•Holistic assessment
•24/7 7/7
•Psychology
•Rehabilitation
•Adv Care Planning
Living with and
Beyond Cancer
Palliative Care Strategy
M&C response to NW
Cancer Plan
Inpatient redesign
Research Strategy &
CRUK Centre
Support ICNs
Care in Appropriate
Settings
Key Issues facing networks
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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
Cardiothoracic Centre
Royal Liverpool and Broadgreen
Wirral Hospitals
Countess of Chester
Oesophago-gastric
By 2007
3 centres delivering complex care
Aintree
Cardiothoracic Centre
Partnership with North Wales Network
Wrexham
Peer review
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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.
2.65 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
To help prevent cancer we will:
Pledge 2: We will implement the tobacco control plan.
Pledge 5 : The North West will strive towards reducing
obesity especially in children and young people.
Pledge 6: The North West will campaign for greater
regulation of sun beds to protect children and young
people.
SCREENING
To improve and extend breast screening services:
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
To improve waiting times for cancer treatments:
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 2009. All patients with a suspected cancer detected
through screening programmes will be treated within 62 days by
2009.
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 2006. 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 2008 - 2012
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Early Detection and Prevention
Ensuring better treatment
Living with and beyond cancer
Reducing health inequalities
Network Objectives 2008 - 2012
• Delivering care in the most
appropriate setting
• Ensuring delivery and maintaining
progress
• Building capability and capacity