Transcript Plymouth Hospitals NHS Trust

PLYMOUTH HOSPITALS NHS TRUST
Cancer Summit 12th February 2015
Shaping a
blueprint
for cancer
Plymouth Cancer
Summit
Sean Duffy
February 2015
www.england.nhs.uk
Four big challenges and opportunities
Tackling late
diagnosis
Enabling access
to the best
treatments
Supporting
people living
with and beyond
cancer
Better outcomes
for older people
www.england.nhs.uk
Older people are more likely to be diagnosed
following an emergency presentation
www.england.nhs.uk
Enablers
Ambition and
clarity of focus
Cancer strategy
Greater
transparency on
quality and
outcomes
Expert and
passionate
cancer
community
www.england.nhs.uk
Cancer Summit
Plymouth Hospitals NHS Trust
12th February 2015
Ruth Bridgeman - Programme Director,
National Peer Review Programme
Plymouth over the years
Plymouth Tumour MDTs across 2011/12, 2012/13, 2013/14 and 2014
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2011/12
2012/13
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2013/14
2014
Plymouth over the years
Plymouth Cross Cutting across 2011/12, 2012/13, 2013/14 and 2014
100%
90%
80%
70%
60%
50%
2011/12
40%
2012/13
2013/14
30%
20%
10%
0%
2014
Improving the Patients Experience:
Planning in the Context of Service Change
View National and Trust Reports at www.quality-health.co.uk
Plymouth Cancer Summit
February 2015
Dr Reg Race
Quality Health
 Big improvements in services 2010-2014 seen by patients in most Trusts – and continuing
improvement in 41% of Trusts 2013-14, building on earlier improvements
 Significant improvements on 46 questions, 2010-14
 Major differences between Trusts – huge variations from top to bottom performing
 Some kinds of patients less likely to be positive than others:
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Patients in some tumour groups e.g. brain/cns, other cancers
Patients entering through the ED rather than a recognised cancer pathway
Those without a CNS, concentrated in specific tumour groups and age groups
Those in London
Those in the most deprived areas
Patients from ethnic minorities
Patients who are not heterosexual
Younger patients under 25 and in some cases the over 75s
Women (on most questions but not all)
Patients with a mental health or LT condition
Patients initially diagnosed more than 5 years ago
Patients with a recurrence of cancer or where it hasn’t responded to treatment
This pattern of response much the same in every CPES
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Organisation of services affects patients: confusion, crowding, complexity creates
poorer experience of care
Activity will rise as survivorship extends, so plan for that
Complex pathways need clarity on CNS control and navigation for patients
Patients presenting initially through ED are different in each tumour group: some
of the rarest cancers have the highest proportions entering through ED
Evidence that non specialist cancer wards do not support the patient in the way
you would want
Front end access and referral by primary care – and liaison with them after acute
phase of treatment is crucial, from the patients point of view
CNS cover and access to them is critical
Information giving is key: strong evidence that good information improves
outcomes in other areas
Patients with rarer cancers have a consistently poorer experience
Present services at Plymouth: comparative weakness in front end referral and
access, some CNS scores, ward nursing care, conflicting information, transition
point information to GPs post discharge, giving of assessment and care plans,
personal treatment
Beyond Primary Treatment
Professor Jane Maher
Joint Chief Medical Officer
Macmillan Cancer Support
The number of people living with
cancer will double by 2030
•Breast 70-80%
•Colorectal 50%
•Prostate 40-50 %
http://www.evidence.
nhs.uk/qipp
Cancer day
J Robert Sneyd
Plymouth University
Peninsula Schools of Medicine & Dentistry
[email protected]
Feb 2015
How did we do?
UoA1
• Overall 13/31
• Joint 13th with Exeter
• National leaders in
research output quality
Life beyond the Cancer Drug Fund: an
update on the CDF and a view on the
sustainable commissioning of cancer
drugs in England
• Professor Peter Clark
• Medical Oncologist
• Chair of the NHS England Chemotherapy
Reference Group and of the Cancer Drug Fund
17 Presentation 15 January 2015
Commissioning of new drug/indication in proposed CDF-CtE:
cancer drug referred to NICE & positive CDF prioritisation
Positive
prioritisation by
Cancer Drugs
Fund & NICE
If mature outcome data will not change NICE re-appraisal: removed from the CDF
Cancer Drugs
Fund
funding
If mature outcome data might
change NICE re-appraisal, drug into
CDF Commissioning through
Evaluation
If no
NICE technology appraisal
Continu
ed
funding
by CDF
Removed from the
CDF
If no
NICE TA
review
Timeline
Clinical
trial results
on 1o end
points
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If yes
If yes
Baseline
commissioning
Baseline
commissioning
Drug licensing
The Cancer Drug Fund and
Commissioning through Evaluation
• The process: the opportunity for the more highly valued cancer drugs
assessed by the CDF (whether in NICE appraisal process or not to be
appraised) to be audited for key outcomes and then be re-assessed:
outcomes could be as predicted from clinical trials, better or worse (NB
survival, utilities, resource use, effect on the patient pathway)
• Then options: return to NICE with mature data and the opportunity for a new
Patient Access Scheme if necessary and then continued funding depends on
NICE approval or not; for non-NICE drugs, assess outcomes and either into
baseline commissioning or out of the CDF
• The consequence: NHS England has to fund the baseline commissioning of
those effective drugs which do not to go to NICE ie those for rare cancers
• The NHS gains key outcome information to guide assessment of value for
consideration of baseline commissioning but which also feeds back into NICE
appraisals and guidelines: a huge contribution to England and the world
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‘The
Future of Radiotherapy’
The NHS and Future Plans for Radiotherapy
Plymouth Cancer Summit 2015
Dr Adrian Crellin
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What can currently cure cancer?
Surgery 49%
Radiotherapy
40%
Radiotherapy
Chemotherapy
11%
Chemotherapy
Surgery
5%
22%
Professor Sir Mike Richards, NCRI 2011
18%
Surgery
Chemotherapy
Radiotherapy
RT = £335M
DH Cancer Reform Strategy 2007 – Aim - ‘World Class Radiotherapy’
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No new market entrants – Clinical Trials and ETC – CtE roll out
INNOVATIONS IN RESEARCH
Simon Rule
Professor of Clinical Haematology
University of Plymouth, Schools of Medicine and
Dentistry
Derriford Hospital, Plymouth Hospitals NHS trust
ENRICH – NCRI multicentre Randomised open
label phase II/III trial of Rituximab & Ibrutinib vs
Rituximab & CHemotherapy in Elderly mantle cell
lymphoma
R-CHEMO/R
Standard care
R-CHEMO
(every 21/28
days) for 6-8
cycles
Rituximab
(every 56 days)
for 2 years
Follow-up
until disease
progression
R
IR/R
Intervention
Ibrutinib daily
+ Rituximab
(every 21/28
days) for 8
cycles
Ibrutinib daily
+ Rituximab
(every 56 days)
for 2 years
Ibrutinib to
continue until
disease
progression
Indian Ocean Sea Hare
Using the power of light to project a
brighter future for cancer diagnostics
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Prof of Biomedical Imaging and Biosensing
Consultant Clinical Scientist – GHs / RD&E
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Prof Nick Stone
The Concept:
“an intelligent optical
biopsy at the tip of a
needle”
>13,500 lymphomas
diagnosed per annum
UK
Interpretation
software
Needle probe
Spectrometer
Laser
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A Carer Perspective
Bosom Pals
Academic Developments - Professor R Sneyd, Dean and Professor of
Anaesthesia, Plymouth University, Peninsula Schools of Medicine and
Dentistry
Chemotherapy and CDF - Professor Peter Clark MA MD FRCP, Chair Cancer
Drug Fund, Chair, NHS England
The Future of Radiotherapy - Dr Crellin Consultant Clinical Oncologist and
DoH National Clinical Lead in Proton Beam Therapy
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