Survivorship: The Commissioning Challenge Kim Fell Cancer Director North Trent Cancer Network

Commissioning in a Cold Climate NHS Confederation produced a discussion paper which highlighted the following: More Self Management – less face to face Effect of recession on health services creates greater demand It is widely believed that there are significant efficiencies to be found in community services

What is Commissioning? Commissioning is the means by which we secure the “Best Value” for patients and taxpayers By best value we mean: The best possible health outcomes, including reduced health inequalities – more local priorities The best possible health care and Within the resources made available by the taxpayer Health Reform in England: update and commissioning framework, DH 2006

PBC Collaborative SCG PCT Levels of Cancer Commissioning Specialist cancer care and specialist paediatric care National priorities More of: Radiotherapy Cancer Drugs Earlier diagnosis Awareness..increased referrals Expected reduction in: Emergency Admissions Length of stay Follow up Leading to increased Productivity and Efficiency at all levels NO ADDITIONAL INVESTMENT

Effectiveness of care pathways - Prevention to End of Life Maximum Health Benefit through Innovation Quality of services Waits Peer Review Clinical Effectiveness Patient Experience and wellbeing Productivity LoS A+E Admissions Follow up rates Outcomes 1/ 5 year Survival Mortality rates Stage at presentation Spend Programme Budgeting Index of deprivation The Challenge in Delivering the Cancer Reform Strategy and QIPP

Future Patient Journey –More of it in the community Prevention/ Referral from GP Local diagnostic clinic Referral to MDT/ Surgery Adjuvant treatment – RT/Chemo (?Some in Primary care) Palliative care Close to home MOStMOSt Choice CNS Follow up Cure- Survivorship Complex cases/ Rare cancers Tertiary Centre RT / CHEMO? Community based teams links to LTC

Critical Points in the cycle

Deprivation within North Trent

5 YEAR PREVALENCE BY CANCER NETWORK DORSET CN has the highest rate of cancer survivors up to 5 years from diagnosis,15% above the UK avg NORTH EAST LONDON CN has the lowest rate of cancer survivors up to 5 years from diagnosis,13% below the UK avg Fig % above UK avg. West Scotland South East Scotland North Scotland Wales Peninsula Dorset Avon, Somerset and Wiltshire Thames Valley Central South coast Yorkshire North of England Anglia Greater Manchester and Cheshire South West London Up to 5% above UK avg. Northern Ireland Humber and Yorkshire Coast Pan Birmingham Up to 5 % below UK avg. North Scotland Lancashire and S.Cumbria Merseyside and Cheshire Mid Trent Leicstershire,Northamptonshire and Rutland Derby Burton 3 Counties Arden Essex S.East London 5-13% below UK avg. North Trent The Greater Midlands Sussex Kent and Medway Surrey,W.Sussex and Hampshire Mount Vernon North East London West London North London Fig 1.1 NOTE: Prevalence data for CN’s in Scotland is Confidential until publication of report Source: NCIN. One, Five and Ten year Cancer Prevalence by Cancer Network, UK, 2006 *Time taken to produce a set of 5 maps per site : 3 days 22 sites: 66 days

Cancer mortality targets are i) to reduce all-cause cancer mortality rates in those defined as: aged under 75 by 20% from a baseline, by ii) for the Spearhead PCTs group to reduce the absolute gap in rates between their group and the England average, in , by 6% by

Cancer Awareness Measure 12 Don’t Know: 25% Male 14% Female BASE N: 1213 Warning Signs of Cancer – Unprompted Awareness General Low Awareness Across all deprivation quintiles

The Engagement Cycle

Recommendations for future action Respondents identified cultural sensitive advocacy services and the availability of interpreters as a particular issue for some organisations. Further exploration in this area may prove useful to fully understand both current service and the challenges surrounding areas that do not have access to such services. Respondents identified the need for information to be available in community languages and accessible from a centrally held place to avoid duplication. “It must surely be possible to translate all existing cancer information into other languages and make available electronically.” “More cancer specific information should be readily available in more languages than at present and cover the entire patient journey. It is very treatment related at the moment and does not cover supportive care.” “ There has been an increase in the variety of different languages spoken, particularly Eastern European languages.” “ The production of audio/written documentation in all different languages is prohibitively expensive Eastern European migrants have recently raised challenges as translated information is not as readily available.” Analysis of the National Black and Minority Ethnic (BME) Baseline Audit Picker Europe Ltd

Breakdown of Ethnic Groups within Picker Survivorship Survey 2009

Picker Survey 2009 NHS Improvement Question 6 Do you feel you need any extra help or advice for any of the following physical, clinical and medical concerns? Question 23 Was the written or printed information you were given easy for you to understand?

BME Profile of Barnsley

BME Healthy Day Event Date: Saturday 3rd July 2010, Time: PM Venue: Barnsley Central Library Shambles Street Town Centre, Barnsley S70 2SB This is a free event and everyone is welcome. Food, refreshments and pampering sessions will be available. Activities for Children, Beautician, Reflexology, Indian Head Massage, Blood Pressure Test, Salsa Dance, Free Make over Tips, Nails Manicure and Paint Design For more information please call: Ask for Roya or any other staff

Sheffield City Council’s community profiling project is now completed. The Council commissioned this to identify key experiences, views and aspirations of Black and Minority Ethnic communities, particularly with regard to community cohesion and provision of, education, housing, health, policing and other services in the city. Community Profiling

Opportunities from the Cancer Reform Strategy Shifting care from inpatients to outpatients Maximising opportunities for prevention and early diagnosis Shifting care from hospital to community Improve clinical outcomes – Implementing the Children and Young People Improving Outcomes Guidance and Supportive and Palliative Care guidance Drive up quality Increase value for money

Workshop Questions In your role: How do you change and influence your service and practice to improve it? What are the barriers you perceive to enhance services? How could you engage across health and social care?