Transcript Improving the Quality of Cancer Care Experience in England

Cancer: The story in England
Professor Mike Richards
National Cancer Director for England
International Workshop
London, UK, June 2007
Progress on Cancer in England: Overview
Where have we come from?
Where are we now?
What has brought about change?
Where next?
The Problem of Cancer in England in the 1990s
 High incidence/mortality
 Poor survival rates compared with Western Europe
(EUROCARE)
 Inequalities (geographical and by social class)
 Underfunding (staff and facilities)
 Long waits
 Fragmentation of services
All-cancers five-year survival index (%)
Patients diagnosed 1990-94, followed up to 1999
0
20
40
60
80
0
100
AUSTRIA
FRANCE
FRANCE
AUSTRIA
GERMANY
SWEDEN
SPAIN
SPAIN
SWITZERLAND
SWITZERLAND
NETHERLANDS
FINLAND
SWEDEN
NETHERLANDS
FINLAND
GERMANY
ITALY
ITALY
NO RWAY
NO RWAY
ENGLAND
DENMARK
SCO TLAND
ENGLAND
WALES
SCO TLAND
DENMARK
WALES
CZECH REP.
SLO VENIA
SLO VENIA
CZECH REP.
ESTO NIA
SLO VAKIA
SLO VAKIA
ESTO NIA
PO LAND
EURO PE
MEN
20
PO LAND
EURO PE
Nordic countries
South and West Europe
UK (England, Scotland, Wales)
Eastern Europe
Data covering less than 100% of country
40
60
80
100
WOMEN
Cancer in England: The Late 1990s
1995:
Calman–Hine Report
(Chief Medical Officers for England & Wales)
1996
1999:
: Improving Outcomes Guidance
Reports (breast, colorectal …)
Pace of change not fast enough.
Downing Street Summit
Cancer a ‘top priority’
NHS Cancer Plan 2000
First ever comprehensive strategy to
tackle cancer in England
(prevention palliative care)
Key targets and milestones
Commitments on investment, workforce,
facilities
Delivery mechanisms
Monitoring Progress on Cancer in England
The National Audit Office (which is
independent of government) conducted 3
reviews into progress on cancer in 2004/5
These reviews show that substantial
progress has been made, but more needs to
be done
Cancer : Progress on Outcomes
 Cancer mortality falling
(15.7% in 8 years in people under 75)
 Survival rates improving across a wide range of
cancers
 Experience of care has improved between 2000
and 2004 (surveys conducted by the Department
of Health and the National Audit Office)
Progress on Cancer Service Organisation
Services have changed radically
 Around 1500 multidisciplinary teams in
England
Cancer networks are bringing primary,
secondary and tertiary sectors together
Services for complex surgery are being
reconfigured
Peer review appraisal of services against
national standards is underway
Progress on NHS Cancer Plan Commitments (1)
 Smoking prevalence is falling
 Breast screening has been extended
 Bowel screening has started
 Waiting time targets have been achieved
 Use of new anticancer treatments is
increasing rapidly
 Accrual of patients into clinical research
trials has tripled
Progress on NHS Cancer Plan Commitments (2)
Additional investment has been
made in cancer and palliative care
The cancer workforce has expanded
New facilities have been installed
What has brought about change?
Multiple factors:
1. Consistent political priority and profile
2. Having a clear direction of travel (Cancer Plan and
NICE guidance)
3. Investment: funding, staff, equipment, drugs
4. National oversight of implementation
 Cancer Programme Board
 National Cancer Team
5. Local cancer networks
6. Internal and external monitoring of progress (e.g.
National Audit Office)
National oversight of implementation
 Cancer Programme Board
 National Cancer Team
 Cancer screening coordination
 Support for providers: service redesign (QI)
 Peer review appraisal programme (QA)
 Network development
 Support for commissioners (e.g. guidance on
PET/CT; brachytherapy etc.)
 NICE guidance implementation
 Cancer registry coordination
Local Cancer Networks
Typically serve populations of 1.5-2.0 million
Partnership organisations
Service planning
Clinical engagement
Action Plans with milestones
Delivering change: The example of
cancer waiting times
2 Key targets set in 2000 to be achieved by 2005
31 day: Diagnosis (decision to treat)
to first treatment:
(98% operational standard)
62 day: Urgent referral to first treatment:
(95% operational standard)
Progress on Cancer Waits: 2000 - 2004
Development of infrastructure
 Cancer Services Collaborative
 Cancer waiting times database
 Workforce expansion
But: Little or no progress on delivery
e.g. only 70% achievement of 62 day target
for tumours other than breast cancer
Progress on Cancer Waits 2005-2006 (1)
 National Cancer Waits Project established
 Problems identified
 Lack of profile
 Lack of local ownership
 Lack of clinical engagement
 Poor measurement
 Lack of proactive pathway management
 Specific blockages (e.g. endoscopy;
radiotherapy)
 Poor communication between Trusts
Progress on 62 day target
Monthly 62 Day Performance
(Monthly CWT-Db provider based statistics)
100.0%
95.0%
85.0%
80.0%
75.0%
Month
Performance-All Providers
Threshold
Jul-06
Jun-06
May-06
Apr-06
Mar-06
Feb-06
Jan-06
Dec-05
Nov-05
Oct-05
Sep-05
Aug-05
Jul-05
Jun-05
70.0%
May-05
% Performance
90.0%
Progress on Cancer Waiting Times 2005-2006
How has this been achieved?
 High national profile
 Local leadership: focus and grip
 Improved data collection: weekly PTL
 Service redesign: Cancer Services Collaborative
 Navigators / coordinators within Trusts
 Intensive Support Team working with
“challenged” Trusts
 Rigorous Performance Management
Cancer in England: where next?
 New challenges
 Rising incidence of cancer (ageing population)
 Obesity epidemic
 Rising expectations in society
 Limited finances
 Manifesto commitments
 Changing NHS
 New opportunities
 New technologies
 New treatments
 Cancer Reform Strategy, 2007
Cancer in England: Summary
We have undoubtedly made progress over
the past 5-10 years
We still have more to do to achieve our
stated aim of being amongst the best in
Europe
There are multiple new challenges to be
faced