Commissioning Specialised Cancer Services 2013-14

1. Commissioning Specialised Cancer Services 2013-14 Pam Evans Cancer Commissioning ManagerMidlands & East Specialised Commissioning Group (East of England) Richard McDonald

2. From April 2013, specialised services will become the core responsibility of the NHS Commissioning Board (NHS CB) • Set national priorities, strategic direction, standards and policies • Assurance of Clinical Commissioning Groups (CCGs) for non-direct services • Directly commission services: • Primary Care, Offender Health, Military Health, Specialised ‘Prescribed’ Services • Specialised services will account for over £11.8bn - or 10% - of the entire NHS budget from 2013-14

3. Ambition of the NHS CB is to help achieve equity and excellence in the provision of specialised care and treatment through ensuring excellent commissioning which will:- • Achievenational consistency in delivery of commissioning functions and minimise duplication • Improve and build on the quality and equity of access to services • Deliver improved outcomes for patients

4. A single national operating model - consistent, • transparent and equitable, operating within resource • limits and continuing to improve patient • outcomes and ensure robust clinical engagement • through: • Clinical Reference Groups (CRG’s) • Strategic Clinical Networks (SCN’s) • Senates.

5. Clinical Commissioning Groups Needs full engagement so as to understand each others intentions. Community Care Developing Integrated Pathways Joined up approach to commissioning even if contracts are led by a different authority Primary Care NHS Commissioning Board 10 LATs with a lead for specialised services Secondary Care Tertiary Care Quaternary Care

6. The East Anglia Local Area Team (LAT) will be the specialist commissioning hub for specialist providers within the: • East Anglia LAT • Essex LAT • Hertfordshire and South Midlands LAT (Bedfordshire and Hertfordshire)

7. Now 2012/13 Provider contracts for specialised services held by host PCT and managed by SCG Services commissioned on a local/regional patient population basis Associate arrangements in place Different SCG portfolios Separate contracts for highly specialised services Financial allocations based on PCT agreements Commissioners (wider role) Future 2013/14 Provider contracts legally held by the NHSCB and managed by the LAT (IS still to be finalised) Services commissioned on a provider basis – one national contract per provider Integrated single contracts Consistent ‘Manual’ of prescribed specialised services Highly specialised services integrated within single contract Budget setting methodology to be agreed Supplier Managers and Local Service Specialists

8. Manual for prescribed specialised services 143 services are listed and described. Specialist cancer services include: • Blood and marrow transplantation services (all ages) • PET CT Services (all ages) • Proton beam therapy service (adults and children) • Radiotherapy Service (all ages) • Specialist Cancer Services (adults) • Specialist Cancer Services (children and young people) The full manual can be found at http://www.commissioningboard.nhs.uk/resources/spec-comm-resources/

9. Five Programmes of Care (POC’s) • Area A – Internal medicine (digestion,renal,hepatobiliary, and circulatory system) • Area B – Cancer and blood (infection, cancer, immunity and haematology) • Area C – Mental health • Area D – Trauma (traumatic injury, orthopaedics, head and neck, and rehabilitation) • Area E – Women and children (women and children, and congenital and inherited diseases)

10. Clinical Reference Groups (CRG’s) Each CRG has developed a core set of products • Policies • Service specifications • Quality measures and dashboards • CQUINs • QIPP • Innovation Portfolio The service specifications and policies have been out for consultation since Dec 2012 Full details of the consultation can be found at http://www.commissioningboard.nhs.uk/ourwork/d-com/spec-serv/consult/

11. B1a Clinical commissioning policy Stereotactic Body Radiotherapy/ Stereotactic Ablative Radiotherapy • B1a Radiotherapy • B2 Clinical commissioning statement Positron Emission Tomography – Computerized Tomography (PET-CT) • B2 Positron Emission Tomography – Computerized Tomography (PET-CT) • B3a Cancer: Skin • B3b Cancer: Gynaecological • B3d Cancer: Brain & Central Nervous System • B3e Cancer: Pancreatic • B3f Cancer: Oesophogeal • B3g Cancer: Soft Tissue Sarcoma

12. B3h Cancer: Anal • B3i Cancer: Mesothelioma • B3j Cancer: Head & Neck • B3k Cancer: Urological • B3k2 Cancer: Penile • B3k3 Cancer: Testicular • B3l Chemotherapy: Adult • B3m Chemotherapy: Paediatric • B3n Cancer: Teenagers and young people • B4a Blood & Marrow Transplantation: Adult • E4 Paediatric Oncology • E3h Paediatric Medicine: Palliative Care

13. On rare occasions, providers commissioned to provide specialised services may be unable to achieve key national requirements in full. • In these circumstances, providers may apply for a derogation of service. • Derogation means the temporary delay in meeting key service requirements in full, as described in the service specification, or other mandatory commission requirements. • An agreed derogation supports full implementation over a time limited period according to provider capacity and capability. • If patient safety is considered to be at risk due to phased service implementation then derogation will not be agreed and the continuing commissioning of a specific service within the provider will be reviewed.

14. The NHS Commissioning Board recognises that there will be applications made by provider trusts and/or clinical teams to the NHS Commissioning Board to commission services which are not in the NHS Commissioning Board’s Annual Commissioning Plan. Such applications will be referred to as “proposed service developments”. • No decision will be made to commission NHS services as part of any proposed service development which is outside the NHS Commissioning Board’s Annual Commissioning Plan until a proposed service development has been assessed, prioritised and a policy decision has been taken as to whether the NHS Commissioning Board’s existing Annual Commissioning Plan should be amended to include the proposed service development. • Any application to amend the NHS Commissioning Board Annual Commissioning Plan to include an in-year service development must be set out in a detailed business plan which describes the proposed policy change, the evidence base to support the policy and sets out the costs of both making the policy change and not making the policy change. The NHS Commissioning Board will require considerable and compelling evidence of both the clinical and cost effectiveness of the proposed service development before agreeing to a change within a financial year