The Cancer Reform Strategy sets out a programme of action to improve cancer services in England rather than the whole of Britain.
As the strategy is implemented, we will track our progress in relation to other countries on issues such as survival and mortality, awareness, early detection, access to different forms of treatment, clinical outcomes, patient experience and costs.
However, these comparisons are not simple and the National Cancer Intelligence Network will be asked to develop a framework to allow for accurate comparisons with other countries.
The Cancer Reform Strategy was developed in the context of changes in the relationship between the centre and those working at a local level in the national health service, and the understanding that decisions are increasingly made locally whenever possible. The strategy contains a range of advice, guidance and expectation and implementation will be monitored in a number of ways.
As part of their performance management role, strategic health authorities will be expected to monitor the performance of primary care trusts and specialist commissioning group in relation to cancer commissioning, against the key criteria set out in the strategy and in the forthcoming commissioning guide.
The Healthcare Commission, and the future Care Quality Commission, will continue to play an important role in assessing whether cancer services are delivered in accordance with national guidance and standards. Improved data on clinical outcomes will also enable us to monitor the implementation of existing guidelines and these results will be shared with the regulator.
It was acknowledged in the Cancer Reform Strategy that obesity is now the most preventable risk factor for cancer and accounts for 10 per cent. of all cancer deaths among non-smokers.
‘Healthy Weight, Healthy Lives’ committed to annual reviews on progress towards meeting the New Ambition on Healthy Weight. In addition to indicators of body mass index, the Government are seeking to develop further indicators of success in achieving the New Ambition.
The national awareness and early diagnosis initiative will be composed of several separate but related components, including the development of key messages about cancer risks and symptoms, development of an awareness assessment tool, a survey of public awareness, pilots of different approaches to raise awareness, and an audit of general practitioner referrals. Each component has its own timescale and will be evaluated separately.
The specific details of the initiative are currently being developed but it is anticipated that work will be beginning imminently.
The Department is currently in discussion with the Royal College of General Practitioners and the National Patient Safety Agency about setting up and running the national audit in primary care of newly diagnosed cancers. The audit tool will be developed and tested in 2008.
(2) when he expects all patients with suspected cancer detected through national screening programmes to enter the 62 day pathway; how often he plans to measure performance against this standard; and what sanctions there will be for NHS organisations which do not meet the standard;
(3) what the timetable is for ensuring that hospital specialists are able to ensure that patients who were not referred urgently by their GP, but who have symptoms indicating a high suspicion of cancer, are managed on the 62 day pathway; how often he plans to measure performance against this standard; by what means; and what sanctions will be imposed on NHS organisations which do not meet the standard;
(4) what the timetable is for ensuring that all patients referred to a specialist with breast symptoms, even if cancer is not suspected, will be seen within two weeks of referral; how often he plans to measure the achievement of this standard; and what sanctions will be imposed on NHS organisations which do not meet the standard.
The Cancer Reform Strategy (December 2007) proposed an extension to the current cancer waiting times standards that were introduced by the National Health Service Cancer Plan (September 2000). The proposed implementation timescales for these extended standards are:
Standard Implemented from Patients referred to a specialist with breast symptoms (where cancer is not initially suspected) should be seen within two weeks of referral December 2009 All patients with suspected cancer detected through national screening programmes should be seen within 62 days December 2008 All patients who receive radiotherapy as a second or subsequent treatment should begin within 31 days December 2010 All patients who receive radiotherapy as a second or subsequent treatment should begin within 31 days December 2008 All patients who receive chemotherapy or surgery as a second or subsequent treatment (including treatments for recurrent conditions) should begin treatment within 31 days December 2008 Hospital specialists will have the right to ensure that patients who were not referred urgently by their GP, but who have symptoms or signs indicating a high suspicion of cancer, are managed on the 62 day pathway Implementation date to be confirmed, but guidance on monitoring will be circulated in 2008
Patients referred to a specialist with breast symptoms (where cancer is not initially suspected) should be seen within two weeks of referral
All patients with suspected cancer detected through national screening programmes should be seen within 62 days
All patients who receive radiotherapy as a second or subsequent treatment should begin within 31 days
All patients who receive chemotherapy or surgery as a second or subsequent treatment (including treatments for recurrent conditions) should begin treatment within 31 days
Hospital specialists will have the right to ensure that patients who were not referred urgently by their GP, but who have symptoms or signs indicating a high suspicion of cancer, are managed on the 62 day pathway
Implementation date to be confirmed, but guidance on monitoring will be circulated in 2008
The Department will monitor NHS progress towards delivery, and achievement of these extended standards by NHS organisations on a quarterly basis. The mechanism to be used for monitoring progress and achievement is currently under consideration by a joint departmental and NHS expert group.
The sanctions imposed will depend on the performance of the healthcare organisations concerned. Primary care trusts (PCTs) are funded to meet the healthcare needs of their populations, which will include the provision of cancer services. PCTs are expected to plan for and commission services, and monitor delivery of those services against local agreements. Commissioners of cancer services will be subject to the wider assurance system being developed under the ‘world class commissioning’ programme, and managed by strategic health authorities. The Healthcare Commission also provides an independent assessment of both providing and commissioning healthcare organisations to ensure that they are providing a high standard of care.
The Cancer Reform Strategy said that to improve information for cancer patients, our immediate next step is for cancer networks to adopt and implement the tumour specific national information pathways which will be launched by the National Cancer Director on 21 July 2008. This will make nationally agreed information available to frontline cancer health professionals to offer to patients at key points in their cancer journey.
We are also introducing information prescriptions, personalised prescriptions which will draw on local as well as national knowledge and information and will guide people to relevant websites, telephone numbers and support groups for their condition, as well as providing information directly to patients at appropriate times during their care pathway. The evaluation of the pilot programme, of which four sites are focusing on cancer, will take place during 2008. The evaluation will inform national implementation of information prescriptions for all people with long-term conditions, including cancer.
To support the introduction of information prescriptions, the national cancer action team is working in partnership with cancer charities to develop a system to enable health professionals to generate tailored information prescriptions at any point in the cancer pathway. The system will draw on high quality national content, while making sure local details can be added. The project will be developed in 2008 for roll out in 2009.
Providers will wish to consider how they can best audit information delivered to individual patients and whether this is meeting patients’ needs. Commissioners should specify to providers through robust service specifications their requirements around patient information, which should be measurable and monitored through the quality monitoring of contracts at primary care trust level.
The Cancer Reform Strategy said that commissioners will want to work with providers to ensure they have robust systems in place to ensure that cancer patients experience good continuity of care. Commissioners should specify to providers through robust service specifications their requirements around continuity of care for cancer patients, which should be measurable and monitored through the quality monitoring of contracts at primary care trust level.
The Cancer Reform Strategy is a five year plan. The precise timetable for the introduction of the national cancer survivorship initiative has not yet been finalised. The new National Health Service Cancer Patient Experience Survey Programme will help to inform the evaluation of the initiative but full plans for evaluation have yet to be developed.
In recognition of the challenge to reduce inequalities in cancer, the national cancer director will begin a National Cancer Equality Initiative, bringing together key stakeholders from the professions, voluntary sector, academia and equality groups to develop research proposals on cancer inequalities, test interventions and advise on the development of wider policy. The national cancer director is currently scoping the initiative, and a representative advisory group is currently being established. The advisory group will meet for the first time in spring 2008, and will report directly to the Department’s Cancer Programme Board.
This is a new initiative, and details of monitoring performance of the initiative and by what means will be decided as the work progresses.
Cancer Research UK is developing a modular assessment tool to assess levels of awareness of cancer risk factors and symptoms. The tool is expected to be validated in the autumn 2008.
The Department will use the tool to conduct national surveys of cancer symptom awareness across a random section of the population. The first survey of cancer symptom awareness is likely to be in late 2008 or 2009. It will then be repeated at least every two years.
The national surveys on cancer symptom awareness are only intended to assess the public’s knowledge levels and are entirely separate from any surveys looking at patient experiences.
A small coordinating team is already in place, based initially at the National Cancer Research Institute (NCRI). An initial meeting of the coordinating team and the major funding stakeholders took place in January 2008. A formal steering group, to oversee the development of the National Cancer Intelligence Network (NCIN), will be set up in the first half of 2008. Once established the NCIN will be accountable, via its steering group, to the board of the NCRI.
As the funders of research and analytical services in the United Kingdom, the partner organisations within the NCRI board will determine priorities for routine analyses at a national level and for research.
Good quality information and data enhance patient choice, drive up service quality and underpin stronger commissioning. The performance of the NCIN will be measured by changes to clinical outcomes and patient experience, detailed in annual reports from the NCIN.
Primary care trusts (PCTs) will want to evaluate the quality of support they receive from cancer network teams as well as review the effectiveness of the cancer network and the contribution from its participants as a whole.
The team in the cancer network is usually accountable to a nominated lead PCT chief executive for the cancer network who has responsibility for assessing individual and team performance against objectives set collectively by the PCTs in the network. The Cancer Reform Strategy makes clear that strategic health authorities will be expected to monitor the performance of their PCTs. PCTs in cancer networks will therefore be assessed at a national level against their performance on a range of national requirements and on-going existing commitments, for example cancer improving outcomes guidance.
The cancer action team will also support cancer networks and their constituent PCTs to assess their individual and collective performance against a range of indicators that will be of local interest through the presentation of benchmarked information for England on the cancer commissioning toolkit which will be available in June 2008.
Working with the national cancer action team, we plan to publish guidance for cancer commissioners later this year.
Commissioners of cancer services will be subject to the wider assurance system being developed under the “world class commissioning” programme and managed by the strategic health authorities. The Healthcare Commission will also provide an independent assessment of provider and commissioner health care organisations to ensure that they are providing a high standard of care.
The review is not yet complete, and has yet to produce final recommendations. The initial findings of the review were incorporated into the Cancer Reform Strategy, and are reflected in paragraphs 9.32-9.34. Work on a timetable for changes to payment by results for cancer services will be undertaken once the final recommendations of the review have been received and considered. We expect the recommendations to be received shortly.