1. Cancer Registration and Health Service Regulation Dr Jenifer A E Smith

2. Outline of presentation Overview of regulation of health care (in England) Cancer information Challenges ahead Opportunities for cancer intelligence units

3. Health Service Regulation Four key organisations: Healthcare Commission Commission for Social Care Inspection Independent Regulator (Foundation Trusts) Audit Commission

4. Statutory Responsibilities of the Healthcare Commission Health and Social Care (Community Health and Standards) Act 2003 Human Rights Act Race Relations (Amendment) Act Mental Health Act

5. Statutory Functions Carrying out reviews and investigations Promoting the co-ordination of reviews and assessments undertaken by other bodies Publishing information about the state of healthcare across the NHS and the independent sector Reviewing data quality Considering unresolved complaints Publishing surveys of the views of patients and staff

6. The Healthcare Commission Inspecting Informing Improving Locally based Healthcare Commission Teams (local presence) Intelligent information (use what we have more effectively) Protect vulnerable groups and reduce inequalities

7. Reviews and inspections Provision of healthcare Arrangements to promote and protect public health Studies aimed at improving economy, efficiency and effectiveness in the NHS Awarding annual ratings to individual organisations

8. Standards for Better Health Seven domains set out in National Standards, Local Action Safety Clinical and cost effectiveness Governance Patient focus Accessible and responsive care Care environment and amenities Public health

9. Methods in Regulation Inspections will be targeted and proportionate Broad spectrum of information used to screen for indicators of poor performance across multiple domains More limited set of indicators continually monitored as part of a surveillance function Further investigation may be themed and involve multiple organisations or concentrated on a single service within an organisation

10. Cancer information Cancer register Disease register for use as a sampling frame, epidemiological base, determining longer term outcome, etc Clinical Audits Assessment of performance against standards Selected disease groups: lung, colorectal, head and neck cancers Comparative information on detailed clinical aspects Peer review Assessment of achievement of National Cancer Standards

11. Cancer Information Contributing to Assessment Quantitative Survival, recurrence rates Qualitative complaints Continual Cancer screening programmes Snapshot Survey data Comprehensive Cancer register Selective Clinical audits

12. Advantages of Cancer Intelligence Record covers NHS and independent providers Patient level data; organisational data Longitudinal data with provision for longer term follow up Linked data on process and outcome Comparative information Ability to examine inequalities by age, sex, geography

13. New Dimensions Equity Access Outcome Performance Provider organisations Commissioners Healthcare communities

14. Challenges for Cancer Intelligence Confidentiality Timeliness Short term outcomes Interpretation of variation with low volumes Relating data to standards Embracing the changes in IT New information centres New data flows Reflecting the patient perspective

15. Cancer Information in Regulation Supporting inspection of providers and commissioners of cancer services Contributing to the information base supporting performance assessment and patient choice Promoting improvement in cancer services and outcomes of treatment New partners, open approach to sharing knowledge and information