Survivorship: Building the Evidence for Commissioners by September –

1. Survivorship: Building the Evidence for Commissioners by September – Ursula Peaple Lead for Rare Cancers London and South East Coast Specialised Commissioning Groups 31st March 2011

2. What Commissioners want • Meets Policy Imperatives • Greater Integration of Pathways • Better Quality Service & Patient Experience • Financial & Activity Modelling • Value for Money: Cost Effectiveness/ Cost Savings • Clear Benefits • Clear Outputs

3. Building the Evidence for Commissioners • Dialogue within Trust (Foundation & other Trusts) – service development processes may vary • Dialogue with commissioners – not just children but Cancer Networks, Promote to wider audience Public Health, Local Authorities • Provide the Context for Cancer and Children & Young People survivorship & Demand – don’t assume it’s understood • Need to respond to the difficult Contracting environment e.g. No growth other than inflation - use QIPP and CQUINs • Prioritisation & Focus • Patient Perspective • Involve Stakeholder Groups if possible • What has been Commissioner response so far? • LISTEN to what Commissioners say

4. Strategic Context Cancer: • Children & Young People IOG Peer Review • Improving Outcomes Strategy for Cancer applies to all cancers • Rarer Cancers Equity Agenda • “Disability” Agenda Liberating the NHS: • Commissioning Changes • Patient Self-care, Choice & Experience • Local Accountability

5. Improving outcomes: A Strategy for cancer • Needs of People living with and beyond cancer include information about treatment and care options, psychological support, advice on financial assistance and support in self-managing their condition. • Carers have their needs for information, advice and support. • National Cancer Survivorship Initiative (NCSI), - more survivors need to have the care and support to live as healthy a life as possible, for as long as possible. • We want to see improvements in the outcomes which are particularly relevant for people living with and beyond cancer, such as: • reducing ill health associated with cancer treatment; • reducing risks of recurrent cancer; • reducing the proportion of people who report unmet physical or psychological support needs following cancer treatment; • increasing the proportion of cancer survivors of working age who are able to work who are in work; • increasing the proportion of children or young people survivors who are in education or employment; • increasing the proportion of cancer survivors who are able to live independently.

6. NHS Commissioning Context • Commissioning Changes NCB / GP Consortia • Commissioners Changing – knowledge gap? • Patient Experience This Year 11/12: • • Basecase: -1% • • Downside: -1% + -2.5% • • CQUIN remains at 1% Next 5 Years • 15 to 20 billion from NHS budget to reinvest to meet rising growth in demand

7. Making the case • A clear Model / Case Management • Clear thresholds on levels • Think Pathways – not Organisations • Statement of Need & Population served • What resources are already in place, yours and others • Why this approach is better than another approach • Clear about the outputs: • What difference will it make?

8. Making The Case • Is it a Trust priority? • Where is the income coming from? • Stages of Implementation? • If we can’t afford all of it what are the priorities? • Say what patients want most? • Share draft with commissioners for comment

9. QIPP: Invest to Save: Check Trust Approach Of Use? • Quality and productivity gains at interface between organisations: e.g. between health and social care, or primary and secondary care. • Integration of services may be appropriate. • Reduced tariffs for emergency admissions to encourage hospitals to work with primary / community care to improve out-of-hospital care. • Organisations need to work together, put patients’ first and manage risk across the system. • NHS-wide focus: • To make step changes in pathways • • Q: improving quality of health care • • I: promoting and adopting innovation • • P: productivity savings • • P: disease prevention, health and wellbeing promotion

10. CQUINS • Structure of a CQUIN scheme: • • National / Regional / Local • A CQUIN scheme: locally agreed package of quality improvement goals and indicators, which if achieved, enables the provider to earn its full CQUIN payment. • A CQUIN scheme should address the three domains of quality: safety, effectiveness and patient experience; and reflect innovation. •  A CQUIN goal describes a quality improvement objective which is being incentivised through the CQUIN scheme, e.g. “to improve the health of babies and mothers in the 14 days after birth”.

11. CQUINS CQUIN: non recurring – but could help as a stepping stone To collect more evidence of • impact on pathways • Possible cost benefits • Benefits to patients • Thresholds between levels

12. CQUIN: Example 1 To support patients to self manage their XXX condition • Patient experience Domain 1a • Patients involved in decisions about their care and supported to self manage  • 80% of London patients responding to Pan London questions in XXX specific patient survey that ‘Yes’ or ‘Yes to some extent’ they were • Involved in decisions about their care and treatment • Given ready access to information about their condition • Supported to manage their XXX condition • Survey: (In the last 12 months.. • Were you involved as much as you wanted to be in decisions about your care and treatment? – Yes definitely, Yes to some extent, no • Were you able to get information about your medication and condition when you needed to? – Yes definitely, Yes to some extent, no • Helped to manage your condition and stay well? (For example, in taking your medication, accessing community support, maintaining a healthy lifestyle) – Yes definitely, Yes to some extent, no) • 50% response rate of surveyed patients required. Survey approach to be determined by trusts and can include electronic methods.

13. Conclusions: Don’t trust to Luck! • Clear Message Backed by evidence of • Need • Rationale for the model • Cost benefits • Patient benefits Talk with Trust / Commissioners ASAP.