Presentation on theme: "Commissioning Patient Centered Care & Improving Outcomes for People with Cancer Di Riley Associate Director, Clinical Outcomes NCIN."— Presentation transcript:
Commissioning Patient Centered Care & Improving Outcomes for People with Cancer Di Riley Associate Director, Clinical Outcomes NCIN
To cover: Improving Outcomes Long Term Conditions in Cancer Commissioning Patient Centred Services
What are Outcomes Clinical v Patient Survival Quality of Life Stage of disease Return to normality Co-morbidity Treatment Toxicity & side effects Role of National Cancer Intelligence Network?
NCIN Goal Goal for NCIN: To develop the best cancer information service of any large country in the world Why? To provide feedback on performance to clinical teams To promote stronger commissioning To provide informed choice for patients To provide a unique opportunity for health services research i.e. To improve outcomes
NCIS Example: Trends in one year cancer survival, breast cancer, females, England, 1985-2004 (five-year moving average) NCIN Publications Cancer Incidence by Ethnicity Cancer Incidence by Ethnicity **June 2009** Cancer Incidence by Deprivation, England, 95-2004Cancer Incidence by Deprivation, England, 95-2004 **NEW** Cancer PrevalenceCancer Prevalence (undertaken by Thames Cancer Registry) Cancer Incidence and Mortality by Cancer Network, UK, 2005 1 Year Survival Trends (incl. 1 year Survival by Cancer Network), Eng, 1985-2004
Improving Outcomes Public awareness Stage at diagnosis Co-morbidities –at & after diagnosis Children and Young Peole ‘Outcomes Measures’ –clinical –patient reported International Benchmarking
Long Term Conditions:....... A condition that cannot at present be cured, but can be controlled by medication and other therapies e.g.Diabetes Heart Disease Chronic obstructive pulmonary disease Over 15.4 million people in England with a LTC (~30%)
UK Population Between 1983 & 2008 % >65 and over, inc. from 15% to16%, an increase of 1.5 m people. Population by age, UK, 1983, 2008 and 2033, ONS By 2033, 23% of population will be >65 years of age By 2033, only 18% will be <16 years In 2008, median ages Women 40 years Men 38 years
Population aged 65+ years
Cancer Incidence Since 1977, incidence rate for cancer has increased in Great Britain, by 25% 14% increase in men 32% increase in women
Lung Cancer Incidence
Prostate Cancer Survival 5 year relative survival rates Increased by an average of 12% every 5 years between 1986 & 1999 42% to 65%
Breast Cancer Survival CR-UK For women diagnosed with breast cancer in 2001-2006 (England) 5-year relative survival rates - 82% compared with only 52% thirty years earlier in 1971-75
Incidence and Mortality
UK Cancer Prevalence UK 2008 estimates (based on diagnoses 1971-2004 applied to 2008 population; Thames Cancer Registry, 2008) Breast (female)550,000 Large bowel250,000 Prostate215,000 Lung65,000 Other920,000 All cancers2,000,000
So.....the implications! Ageing population Increasing presence of long term conditions Increasing risk of cancer Increasing cancer incidence Increased survival Reductions in mortality More living with cancer So, more people with LTC will also have cancer What about treatment effects?
Treatment Effects Treatment Long-term side effects Late side effects Chemotherapy Fatigue Menopausal symptoms Neuropathy Heart failure Kidney failure Infertility Liver problems Cataracts Infertility Liver problems Lung disease Osteoporosis Reduced lung capacity Second primary cancers Radiotherapy Fatigue Skin sensitivity Cataracts Cavities and tooth decay Heart problems Hypothyroidism Infertility Lung disease Intestinal problems Memory problems Second primary cancers Surgery Scars / Chronic pain Lymphoedema
Commissioning considerations Long term conditions (Ageing population) Inc. cancer incidence Increasing survival Increasing prevalence Late effects Long term effects/conditions What drives Commissioning – cancer or condition?
Patient Centred Commissioning Strong cancer commissioning is vital to ensure: high quality services are delivered reflect needs of local populations reflect national priorities cost effective
Commissioning is Complex? Many types of cancer Many different care pathways Clinical teams in the community, DGHs and specialist centres. Some aspects require highly specialised commissioning at a national or SHA level. Other aspects overlap with non-cancer services (diagnostics & ?LTC) and commissioned at a more local level.
An example? A known cancer patient visits GP with breathlessness –Refer back to oncology team? –Refer to a cardiologist? –Refer to a respiratory physician? Commissioners view: –Commission patient pathways –Underlying cause identified and treated –Establish a ‘MDT breathlessness clinic’ –Cancer MDT involved
The Cancer Commissioning Toolkit (CCT)
25 Cancer Commissioning Guidance was launched in January 2009 as a ‘sister’ product to the CCT Sets out the key issues and questions for commissioners for: Assessing health needs Reviewing services Monitoring performance Service specifications Sets out the key issues and questions for commissioners for: Assessing health needs Reviewing services Monitoring performance Service specifications Easy to use format Interactive Quick links Easy to use format Interactive Quick links
Each section of the Cancer Commissioning Guidance contains Key Questions for commissioners – and where to find the answers
Long Term Conditions Late Effects Long Term Effects Rehabilitation Services Holistic Needs Survivorship Patient Centred Care Pat. Reported Outcomes
Commissioning considerations Long term conditions (Ageing population) Inc. cancer incidence Increasing survival Increasing prevalence Late effects Long term effects/conditions What drives Commissioning – Patient Pathways?