Transcript The NCSI: Current activity

National Cancer Survivorship Initiative
2010 Update
The NCSI: Current activity
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The Cancer Reform Strategy established the National Cancer
Survivorship Initiative (NCSI) which is working to ensure that those living
with and beyond cancer get the care and support they need to lead as
healthy and active a life as possible, for as long as possible.
The NCSI is working to demonstrate that through investment in new
models of cancer aftercare there are opportunities to improve quality and
efficiency of services. Adopting new cancer ‘aftercare’ models can free
up ‘empty’ outpatient appointments and enable investment in specialist
services for those who need them.
The next key activity is ‘prototyping’ of risk-stratified pathways of care,
which can demonstrate: increased numbers of patients with a care plan,
reduction in outpatient visits and reductions in avoidable A&E
attendances and admissions
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NCSI Economic Evaluation Summary
During 2010 the NCSI completed an economic evaluation exercise to understand the
costs to the NHS and to cancer survivors of current follow up arrangements. The work
suggests that:
• The average personal cost of patients of a single attendance a single out-patient
clinic ranges from £21 to £54 for adult survivors. For children and young people
and their families the costs ranged from £65 to £160. The costs are higher for CYP
clinics mostly due to more time taken off work by parents attending clinics with their
children. Over 5 years of follow up these costs range from £227 to £857 for adults
and from £385 to £953 for attendances at CYP follow up clinics.
• 22% of adult respondents and 19% of CYP respondents said that they had noticed
new symptoms that they had not yet discussed with a health care
professional that they planned to raise at their appointment.
• 59% of both adult and CYP respondents said they had seen their GP at least once
since their previous appointment at the follow up clinic.
• 36% of adult respondents and 41% of CYP respondents report being seen by
another healthcare practitioner since their previous clinic appointment
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Key points from Case Note Review
During 2010 the NCSI undertook a case note review of 600 records to
establish the cost to the NHS of current follow-up care over 5 years.
The case note review suggests that:
• Over 5 years of follow up on average 29% of adult patients' contact
with NHS is unplanned (by cost)
• On average, these unplanned events cost £317 [£1,094 x 0.29] per
patient over 5 years
• The average overall costs per adult patient for each tumour type are:
Breast:
£916
Lung:
£546
Colorectal:
£1,130
Prostate:
£1,051
Figures in progress and subject to change. Data range is across 11 different hospital sites - the case note review covered
Breast, Colorectal, Head & Neck, Lung, Prostate cancer, and Myeloma.
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Emerging principles to support implementation
of the five shifts
The NCSI’s emerging principles suggest
commissioners should ensure that
people living with and beyond cancer:
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have risk stratified pathways of care
rather than a one size fits all approach
have a dynamic personal care plan
which arises from an assessment of the
disease, the treatment, and the
individual’s personal circumstances
following diagnosis
receive information provision that meets
individual needs, is timely, accessible
and promotes confidence, choice, and
control
are encouraged to self manage with
support, with rapid access to appropriate
professional care when problems arise
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Transformed Pathways of Care: Overview
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Self-management with support and
appropriate surveillance
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Care Management
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Complex Care
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Key questions to consider
 What are the principles and challenges to redesigning
how services are delivered for those living with and
beyond cancer?
 What is unique to cancer? What is general to other
conditions that have been managed, or to long term
conditions?
 What do commissioners need to do differently?
 How do you measure the quality, effectiveness and
safety of services for people who are living with and
beyond cancer?
 What are the implications for the workforce to deliver
redesigned pathways of care and support?
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Summary
Exciting opportunity to pro-actively influence the delivery of care to a
rapidly increasing percentage of the population
Challenge to develop practical, sustainable evidence based pathways
offering enhanced quality and productivity
National Cancer Survivorship Initiative