London cancer workshop 9 th March 2011

1. London cancer workshop9th March 2011

2. Agenda

3. Objectives • To inform providers of the implementation programme • To engage providers in the development of the provider network model and specification • To outline to providers the timeframe for specification development and provider network bids • To prompt providers to begin provider network discussions and bid development

4. The model of care Chris Harrison

5. Developing the proposals • 45 clinicians working over 12 months • Three work areas: early diagnosis; common cancers and general care; rarer cancers and specialist care • Case for change: December 2009 • Model of care: August 2010 • Extensive 3-month engagement on proposals – over 85 per cent of survey respondents supportive

6. The case for change • Later diagnosis has been a major factor in causing poorer relative survival rates • There are areas of excellence in London but inequalities in access and outcomes exist • Treatment and care should be standardised • Specialist surgery should be centralised: common treatments should be localised where possible • Comprehensive pathways should be commissioned; organisational boundaries should not be a barrier

7. The model of care • Improve early diagnosis by addressing public awareness, GP access to diagnostics, screening uptake rates and health inequalities • Extended local provision of common cancer services, such as chemotherapy, non-complex surgery and acute oncology • Further consolidation of surgical services for rarer cancers into specialist centres • A small number of networks of providers delivering standardised pathways

8. Provider networks • Model of care recommends the split of commissioning and provider networks • Provider networks to deliver comprehensive pathways in response to fragmentation of services • Concept right but language of networks clouds issue • Integrated cancer systems containing all NHS organisations delivering cancer services from diagnosis to end of acute care

9. Workstream Phase one Phase two Phase three Dec 10 – Mar 11 Apr 11 – Mar 12 Apr 12 – Mar 13 1. Public health and primary care 2. Best practice 3. Radiotherapy commissioning 4. Integrated system designation 5. Integrated system development Implementation workstreams

10. Integrated system developmentRachel Tyndall

11. Integrated system designation • Providers will be asked to respond collaboratively to a integrated system specification • There will be more than one and fewer than five • Which system they are in will be the provider’s choice • Only providers in a system will provide cancer services • Legal status required for contracting

12. Services • Integrated systems will be required to demonstrate how they will contribute to the delivery of the model of care: • Early diagnosis • General care • Common cancer • Rarer cancers and specialist care

13. Specification • In addition to services, the integrated system specification will cover 6 areas: • Scope • Governance • Information • Incentives • Culture • Research and education

14. Standards • Commissioners will set measures and thresholds to assure quality and drive excellence

15. Incentives • Money • Commissioning incentives • Within integrated system • E.g. stroke tariff • Workforce • Cross boundary working • Clinical leadership • Reputation • Of system versus of organisation • Performance info across pathway

16. The givens • We will change the way we commission to commissioning by pathways • Only those part of an integrated system will provide cancer services • Will contain as a minimum all secondary and tertiary care providers • Some pathways will cross systems • Will demonstrate commitment to implementing model of care for common and rarer cancer services • Clinically led with an overarching governance board will manage system as single entity

17. Timeline

18. WorkshopIncentives, strategy and practicalities Rachel Tyndall

19. The givens • We will change the way we commission to commissioning by pathways • Only those part of an integrated system will provide cancer services • Will contain as a minimum all secondary and tertiary care providers • Some pathways will cross systems • Will demonstrate commitment to implementing model of care for common and rarer cancer services • Clinically led with an overarching governance board will manage system as single entity

20. Group session - incentives Tables 1 and 4 • How should tariffs for the whole pathway be set? • How should prices for the interventions within the pathway be set? • Should commissioners be involved in setting these prices? • What are the future capital funding arrangements to ensure that the required investment takes place?

21. Group session - strategy Table 2 • How would financial accountability work across the integrated system? • How would being part of an integrated system with pathway pricing affect an organisation’s financial strategy? • Will the impact on business models be significant enough to prompt Monitor’s involvement, particularly for FT applications?

22. Group session - practicalities Table 3 • What are the information requirements to make the system work? • What form of contracting will be required for intra-system activity and flows? • What influence will MFF have on the distribution of work within the system? • How can it be ensured that the creation of integrated systems does not add costs to service delivery?

23. Feedback session

24. Next steps • Further workshops with your colleagues • Ongoing work in March on commissioning an integrated system • Outline specification published in April • Ongoing development of the model beyond April • Bidding stage from April to June • Tailored support available during bid development • For further information on the case for change and model of care visit www.csl.nhs.uk/publications