Pharmaceutical Oncology Initiative Partnership

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Cancer Commissioning Toolkit (CCT)
Background
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Agenda

• Background and context of the Cancer
  Commissioning Toolkit
• Cancer Reform Strategy and World Class
  Commissioning
• Content of the toolkit
• Navigation
• Outputs and functionality
• Case studies
• National roll-out and support

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Introduction
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The Cancer Commissioning Toolkit (CCT) was
developed to realise the aims of the Cancer
Reform Strategy (CRS)
The Cancer Reform Strategy identified better
information and stronger commissioning as two of
the key drivers to achieve our goal that cancer
services in this country should be amongst the
best in the world. The launch of this Cancer
Commissioning Toolkit represents a major step
forward in relation to both of these drivers for
quality improvement.
Prof Mike Richards, National Cancer Director
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What is the CCT
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Information is key to high quality commissioning

• Commissioning of cancer services is complex -
  there are many different types of cancer and many
  potential diagnostic and therapeutic
  interventions for each cancer type
• Commissioners need to take account of a wide
  range of factors to make informed decisions -
  these include
• national guidance and priorities
• local needs
• access to services
• service quality and outcomes

Ready access to high quality information about
local services and how they compare with services
elsewhere is essential for good commissioning
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CCT is a one stop solution for access to cancer
commissioning information to inform decision
making
Pre-CCT
Post-CCT
NCIS Registries
DH cancer waits
End of life
CCT
CCT
ePACT
C-PORT
HES

• This toolkit brings together information from all
  of the sources, in a user friendly format
• Guidance contains suggestions for questions which
  commissioners can ask service providers
• Advice on how to interpret data
• Analysis of quality and confidence of sources

HES microsite
NCASP
Screening
RT equip survey
Programme budgeting
CQuINS
Smoking cessation
Pharmacists
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There are 100s of important metrics that must be
taken into account when making commissioning
decisions
Illustrative List of metrics not exhaustive
Place of death per PCT of patient and trust
Survival trends per cancer type and PCT
TWR with cancer diagnosis
There is a wealth of information
Activity per admission type and PCT
Excess bed-days per cancer type, trust and PCT
Drug budget per indication and network and PCT

• The toolkit will contain 109 reports
• 85 reports (78) are now complete - the remaining
  24 completed by the end of June

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Benefits
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However, careful consideration needs to be given
to the way the data are interpreted and used

• Is a start of a conversation and not an answer in
  itself
• Data drives insight and questions, not
  necessarily answers
• Need to read the guidance and interpret the data
  accordingly
• Not an in-year planning tool
• Relies on existing data sources

Not all data has been fully validated this
process will be ongoing particularly over the
next few weeks
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Partnership working has been critical to the
development of this toolkit
National Cancer Action Team
National Cancer Intelligence Network
UK Association of Cancer Registries
National Cancer Services Analysis Team
CCT
Pharmaceutical Oncology Initiative
National Cancer Screening Programmes
Department of Health
Concentra
AT Kearney
To name a few ...
Launch
The launch of the first release of the toolkit
was at the NDP in June
Refine
The plan is to refine and improve it over time,
taking account of feedback from users
Maintain
There is a commitment to keeping the information
in the toolkit up to date - as new information on
cancer becomes available this will be added to
the toolkit
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The CCT broadly follows the chapters and sections
of the Cancer Reform Strategy
Cancer patient journey in the toolkit
Awareness, Screening and Early detection
Peer Review Summary
Assessment, diagnosis and staging
Living with cancer
Building for the future
Funding cancer care
Cancer Landscape
End of life
Treatment
Inpatient
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The CCT is also integral to the World Class
Commissioning (WCC) programme

• Strong Cancer Commissioning will be vital to
  delivering World Class Cancer Services (CRS,
  2007)

• Close working with the World Class Commissioning
  (WCC) Programme nationally and locally
• WCC Assurance System has 3 elements

Health Outcomes
Competencies
Governance
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There is a suite of products that support the
challenges of WCC
Health Outcomes
Competencies
Governance
Health Outcomes
Challenges
Cancer commissioning support
Know the key interventions that will make a
difference across the pathway from prevention to
post treatment care

• Network pathways on Map of Medicine
• Commissioning Guidance

• Cancer Commissioning Toolkit
• National Cancer Intelligence Network

Know your baseline position and how this relates
and compares to England (Europe/World next)

• Key performance indicators
• Clinical quality
• Patient experience
• Financial efficiency

• NICE guidance
• Peer Review Measures
• National Priorities and Standards

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The toolkit supports the competencies required
for WCC
Health Outcomes
Competencies
Governance
Competencies
CCT Support

• Self-assess against the competencies
• Ensure leadership and partnerships in place
• Ensure skills within the commissioning / network
  team, or access to skills

• Prioritisation
• Financial analysis

http//www.dh.gov.uk/en/Managingyourorganisation/C
ommissioning/Worldclasscommissioning/index.htm
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The toolkit also supports the governance of WCC
Health Outcomes
Competencies
Governance
Governance
CCT input
CCT input
Cancer Commissioning must be integrated with
mainstream PCT health economy processes - e.g.
needs assessment, prioritisation, contracting,
monitoring
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The CCT is a web-based tool with interactive
outputs
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The dashboard contains the key cancer metrics
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Each metric can be observed in more detail with
information on sources and guidance
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A cancer specific dashboard contains another
selection of metrics that can be analysed for
each cancer type
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The index contains links to each chapter and
section which lead on from the CRS
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Each issues raised in the sections of the CRS are
informed by the reports in the relevant section
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Each report is fully interactive and contains
sources and guidance
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Reports can be pre-customised with selected
networks, PCTs, trusts or SHAs
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Reports can be selected, aggregated and exported
into a word document
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The CCT in action
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Scenarios have been developed to demonstrate the
capabilities of the toolkit

• Scenario 1 High mortality in specific cancers
• Scenario 2 Inefficient spend
• After lunch further examples peer review,
  cancer drugs

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Scenario 1 High mortality in specific cancers
(1/6)

• A PCT Director of Public Health scans the PCT
  Cancer Dashboard. She is of course aware of the
  PCTs relatively high rate of mortality from
  cancer (particularly colorectal and lung
  cancers). Reducing cancer mortality is an
  important element of the Local Area Agreement.
• The DPH has been less aware that

The PCT has made less progress than the majority
of the country in reducing mortality levels since
1997
There are low one and five year survival rates
for colorectal and lung (in the lowest quartile)
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Scenario 1 High mortality in specific cancers
(2/6)

• A high proportion of colorectal and other cancers
  are diagnosed through non urgent routes (DPH asks
  the PCT-X PEC cancer lead and cancer network team
  to undertake more analysis of the reasons for
  variation across the network, as an adjacent
  PCT-Y has a lower rate)

PCT-X
PCT-Y
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Scenario 1 High mortality in specific cancers
(3/6)
Emergency admissions due to obstruction of the
bowel are high
Staging of colorectal cancers by the hospital
Trust has been low
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Scenario 1 High mortality in specific cancers
(4/6)

• Smoking cessation metrics are poor and success
  rate for quit smoking over time is falling

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80
60
40
20
0
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Scenario 1 High mortality in specific cancers
(5/6)

• The lung MDT is non compliant. The peer review
  report shows this is due to the lack of a
  thoracic surgeon and palliative care team member

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Scenario 1 High mortality in specific cancers
(6/6)

• The outputs give a flavour of the type of
  information available in the toolkit
• Clearly more analysis is required and taken as a
  whole could lead to the following decisions

• The information suggests that the PCT population
  is presenting late with cancer
• It identifies important treatment issues to
  rectify. The CCT provides the DPH with more
  information to target recommendations for action,
  which she takes to the cancer locality group
• All MDTs/Trusts to collect staging and co
  morbidity data (already required)
• Staging information on all newly diagnosed cases
  to be fed back promptly to GPs, to support a
  locally agreed audit on recognition of symptoms
• A strategy for prevention and increased
  population awareness of signs and symptoms in
  lung and colorectal cancers, based on a social
  marketing approach
• Ensure lung MDT compliance to improve curative
  resection rates and quality of care

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Scenario 2 - Inefficient spend (1/5)

• The PCT Director of Finance concludes that PCT
  share of spend on cancer looks broadly
  appropriate
• It is just above average but this appears to
  correlate with an above average incidence and
  mortality from cancer for the PCT population

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Scenario 2 - Inefficient spend (2/5)
During the development of the strategy for
implementing the Cancer Reform Strategy he is
concerned that the cancer network team are
recommending increased investment in
radiotherapy, chemotherapy and screening
Radiotherapy fractionation rates are low
relative to other areas of the country
Chemotherapy uptake in NICE drugs is low
relative to other areas of the country

• In addition, screening coverage is low for both
  breast and cervical cancer

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Scenario 2 - Inefficient spend (3/5)

• He asks the cancer network team to help him
  develop a more detailed analysis of spend to
  explain the higher spend, using the template on
  the toolkit to compare local with national
  average spend
• From the cancer commissioning toolkit they
  demonstrate possible causes for a higher than
  average spend on inpatient care

A higher than average number of cancer deaths in
hospital rather than at home
A higher than average level of hospital cancer
emergency admissions
PCT-Z
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Scenario 2 - Inefficient spend (4/5)
A high number of cancer emergency bed days above
trim point
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Scenario 2 - Inefficient spend (5/5)

• The PCT asks the cancer network team to support
  them to identify and address the reasons for the
  high emergency bed use and high
  oncology/haematology elective admissions as well
  as to develop community based support for end of
  life care
• This work is incorporated into an existing PCT
  project on early discharge with social services

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Scenario 2 - Inefficient spend (5/5)

• The outputs give a flavour of the type of
  information available in the toolkit
• Clearly more analysis is required and taken as a
  whole could lead to the following decisions

• The PCT asks the cancer network team to support
  them to identify and address the reasons for the
  high number of cancer emergency bed days above
  trim point as well as to develop community based
  support for end of life care
• This work is incorporated into an existing PCT
  project on early discharge with social services

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The main users of the toolkit will be PCT
commissioners, cancer networks and trusts
As of October 2006 there are 152 PCTs in England
There are 158 trusts in England
Other users of the toolkit
There are 30 Cancer Networks in England

• Cancer charities
• Pharmaceutical companies
• Public in due course

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How will different groups use it
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Roll-out of the toolkit is key to ensuring its
success
Roll-out
Training

• 5 x CCT Train the Trainers Courses for NHS (9th
  June 18th June) 2 x London, 1 x Bham, 2 x
  Manchester
• Content
• Origins of CCT
• Structure and navigation
• Case studies
• Working session
• Target audience 10 x CCT Section Owners plus 30
  x Network Directors (or nominees)

• NDP Launch (5-6th June 2008)
• Conferences
• NCIN (18th June 2008) ,
• NHS Confederation (18-20th June 2008)
• Regional Launches (June -July 2008)
• Cancer Commissioning Masterclasses (tbc -
  Autumn 2008)

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CCT registration

• Network Directors have a role to play in
  coordinating initial and ongoing registration of
  users for the CCT
• Initially, Networks have been asked to provide a
  list of people they would wish to have access to
  the CCT on its launch, so that registration can
  be completed in preparation for CCT training and
  roll-out
• Subsequently, registration can be made by
  potential users through the CCT website, but
  registration will again require authorisation
  from the relevant Network Director

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CCT user support process from the NHS and
Concentra
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Details of support process from the NHS and
Concentra
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CCT section owner sign-off

• CCT Section Owner sign off is required for each
  completed chapter prior to release (by 20th June
  2008)

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The toolkit was developed through a lengthy
consultation process

• A great number of people have contributed to the
  development of the CCT
• Workshop attendees (including CAT and those at
  previous NDPs)
• Section Owners (responsible for CCT Chapters)
• Data Owners (responsible for providing the data
  behind the charts)
• Database administrators (supporting the
  translation of data into chart format)
• Use of prototype
• Three pilot sites (NE London CN, Sussex CN, N
  Trent CN)
• Interviews nationally
• User Acceptance Testers
• UAT1 (8 -10th April 2008)
• UAT2 (24th April to 1st May 2008)
• UAT3 (16th - 19th May 2008)
• UAT4 (21st-22nd May 2008)
• Usability Testers (participants on 14th April and
  6th May 2008)
• CCT Project Steering Group and Project Team
• Feedback from NDP, June 2008

THANK YOU TO ALL!
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Role of industry
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We hope that you now have a good idea of what the
CCT can do for you and wed like to thank
everyone who has been involved ...
UK Association of Cancer Registries
National Cancer Intelligence Network
Database administrators
National Cancer Action Team
National Cancer Services Analysis Team
Pharmaceutical Oncology Initiative
National Cancer Screening Programmes
Pilot sites
Department of Health
AT Kearney
Concentra
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Thanks to our sponsors for the Southeast Coast
Launch

• Sue Sutton - Pfizer
• Mike Ringe - Roche

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CCT Website address www.cancertoolkit.co
.uk