1. S URVIVORSHIP : B UILDING THE E VIDENCE FOR C OMMISSIONERS BY S EPTEMBER – Ursula Peaple Lead for Rare Cancers London and South East Coast Specialised Commissioning Groups 31 st March 2011 1

2. W HAT C OMMISSIONERS WANT Meets Policy Imperatives Greater Integration of Pathways Better Quality Service & Patient Experience Financial & Activity Modelling Value for Money: Cost Effectiveness/ Cost Savings Clear Benefits Clear Outputs 2

3. B UILDING THE E VIDENCE FOR C OMMISSIONERS Dialogue within Trust (Foundation & other Trusts) – service development processes may vary Dialogue with commissioners – not just children but Cancer Networks, Promote to wider audience Public Health, Local Authorities Provide the Context for Cancer and Children & Young People survivorship & Demand – don’t assume it’s understood Need to respond to the difficult Contracting environment e.g. No growth other than inflation - use QIPP and CQUINs Prioritisation & Focus Patient Perspective Involve Stakeholder Groups if possible What has been Commissioner response so far? LISTEN to what Commissioners say 3

4. S TRATEGIC C ONTEXT Cancer: Children & Young People IOG Peer Review Improving Outcomes Strategy for Cancer applies to all cancers Rarer Cancers Equity Agenda “Disability” Agenda Liberating the NHS: Commissioning Changes Patient Self-care, Choice & Experience Local Accountability 4

5. I MPROVING OUTCOMES : A S TRATEGY FOR CANCER Needs of People living with and beyond cancer include information about treatment and care options, psychological support, advice on financial assistance and support in self- managing their condition. Carers have their needs for information, advice and support. National Cancer Survivorship Initiative (NCSI), - more survivors need to have the care and support to live as healthy a life as possible, for as long as possible. We want to see improvements in the outcomes which are particularly relevant for people living with and beyond cancer, such as: reducing ill health associated with cancer treatment; reducing risks of recurrent cancer; reducing the proportion of people who report unmet physical or psychological support needs following cancer treatment; increasing the proportion of cancer survivors of working age who are able to work who are in work; increasing the proportion of children or young people survivors who are in education or employment; increasing the proportion of cancer survivors who are able to live independently. 5

6. NHS C OMMISSIONING C ONTEXT Commissioning Changes NCB / GP Consortia Commissioners Changing – knowledge gap? Patient Experience This Year 11/12: Basecase: -1% Downside: -1% + -2.5% CQUIN remains at 1% Next 5 Years - 15 to 20 billion from NHS budget to reinvest to meet rising growth in demand 6

7. M AKING THE CASE A clear Model / Case Management Clear thresholds on levels Think Pathways – not Organisations Statement of Need & Population served What resources are already in place, yours and others Why this approach is better than another approach Clear about the outputs: What difference will it make? 7

8. M AKING T HE C ASE Is it a Trust priority? Where is the income coming from? Stages of Implementation? If we can’t afford all of it what are the priorities? Say what patients want most? Share draft with commissioners for comment 8

9. QIPP: I NVEST TO S AVE : 9 Quality and productivity gains at interface between organisations: e.g. between health and social care, or primary and secondary care. Integration of services may be appropriate. Reduced tariffs for emergency admissions to encourage hospitals to work with primary / community care to improve out-of-hospital care. Organisations need to work together, put patients’ first and manage risk across the system. NHS-wide focus: To make step changes in pathways Q: improving quality of health care I: promoting and adopting innovation P: productivity savings P: disease prevention, health and wellbeing promotion Check Trust ApproachOf Use?

10. CQUINS Structure of a CQUIN scheme: National / Regional / Local A CQUIN scheme: locally agreed package of quality improvement goals and indicators, which if achieved, enables the provider to earn its full CQUIN payment. A CQUIN scheme should address the three domains of quality: safety, effectiveness and patient experience; and reflect innovation. A CQUIN goal describes a quality improvement objective which is being incentivised through the CQUIN scheme, e.g. “to improve the health of babies and mothers in the 14 days after birth”. 10

11. CQUINS CQUIN: non recurring – but could help as a stepping stone To collect more evidence of impact on pathways Possible cost benefits Benefits to patients Thresholds between levels 11

12. CQUIN: E XAMPLE 1 To support patients to self manage their XXX condition Patient experience Domain 1a Patients involved in decisions about their care and supported to self manage 80% of London patients responding to Pan London questions in XXX specific patient survey that ‘Yes’ or ‘Yes to some extent’ they were Involved in decisions about their care and treatment Given ready access to information about their condition Supported to manage their XXX condition Survey: (In the last 12 months.. Were you involved as much as you wanted to be in decisions about your care and treatment? – Yes definitely, Yes to some extent, no Were you able to get information about your medication and condition when you needed to? – Yes definitely, Yes to some extent, no Helped to manage your condition and stay well? (For example, in taking your medication, accessing community support, maintaining a healthy lifestyle) – Yes definitely, Yes to some extent, no) 50% response rate of surveyed patients required. Survey approach to be determined by trusts and can include electronic methods. 12

13. C ONCLUSIONS : D ON ’ T TRUST TO L UCK ! Clear Message Backed by evidence of Need Rationale for the model Cost benefits Patient benefits Talk with Trust / Commissioners ASAP. 13