transforming cancer care: the bigger picture and what's next€¦ · care in the long term...
TRANSCRIPT
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Transforming cancer care: the bigger picture and what's next
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Session planIntroduction and progress of
the National Cancer
Programme
Cally Palmer – National Director for Cancer at NHS
England
The future of NHS cancer
care in the long term plan for
cancer
Cally Palmer with Professor Richard Gilbertson
University of Cambridge, Li Ka Shing Chair of
Oncology, Head of Dept of Oncology
Discussion with panel
Leading change on the
ground
Dr Fiona McKinna – Vice Chair of Surrey and
Sussex Cancer Alliance
Dr Afsana Safa – Clinical Cancer Lead, North
West London STP
Discussion with panel
What’s your priority for
closing the survival gap?
Q&A with audience and panel
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Firm foundations – key achievements so far
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• Ten multi-disciplinary diagnostic “one stop shops” for rapid assessment and diagnosis
• Faster diagnosis pathways published for prostate, colorectal and lung cancers – early implementers show promising signs – more people getting treated faster
• £130 million radiotherapy upgrade programme
• Establishing pilots of lung cancer case finding to diagnose patients more quickly
• World leading quality of life metric
• Fast track funding for the most promising new cancer drugs
• £600 million programme to transform care by 2020/21
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All-cancer survival, 2000 -2015, ONS
1-year survival 5-year survival
10-year survival
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50,000
100,000
150,000
200,000
250,000
300,000
350,000
Total cancers and cancer deaths, ONS
Total number of cancer cases
Total number of deaths from cancer
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But there’s more to do….
We need to close the gap on the rest of the world
Cancer UK survival relative to European comparators
Acute Leukaemia (child) Among the highest
Melanoma Just below the highest
Oesophagus, Brain (child), Lymph.
Leukaemia, Myeloid LeukaemiaUpper half
Breast, Prostate, Lymphoma (child), Liver,
Colon, RectumMid-field
Cervix Lower half
Pancreas, Lung, Ovary, Stomach, Brain Among the lowest
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How to get involved
Use the sli.do feature tell us
What’s your priority for closing the survival gap?
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The future of cancer careProf Richard Gilbertson
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Discussion
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Cancer AlliancesLeading change and making a difference on the ground
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Dr Fiona McKinnaClinical Co-Chair, Surrey and Sussex Cancer Alliance
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Overview of the Cancer Alliance
• Three STPs – Frimley Healthcare (ICS), Surrey Heartlands (Devo), East Surrey & Sussex
• Two counties – Surrey & Sussex
• Individual provider and CCG financial challenges
• Multiple iterations of delivery plan, and funding arrived in August 2018
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• Current performance and outcomes vary across the region – with the best and worst in England
• Balance is to help and support poor performance, but still recognise and reward areas of excellence that want to do more
• Our ambition is to demonstrate measurable change (Day 28 Group)
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Overview of the Cancer Alliance
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• Current performance and outcomes vary across the region – with the best and worst in England
• Balance is to help and support poor performance, but still recognise and reward areas of excellence that want to do more
• Our ambition is to demonstrate measurable change (Day 28 Group)
The agreed Alliance Work Programmes are:
The 2018/19 High Priority Pathway Groups are:
PreventionEarlier
DiagnosisTreatment &
CareLiving With &
Beyond Cancer
Breast LungUpper
GIColo-rectal
Urology
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Example SSCA Projects
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• To address variation in current CWT
• Embed 104d, 62d, Day 28 standards in parity with RTT and A&E standards
• Delivery of Timed Pathways (Lung, Colorectal, Prostate)
• Transition to Diagnosis by Day 28
• Clinically led
• Co-design with NHS Improvement
• Underpinned by analytics (demand and capacity modelling)
• FIT for symptomatic patients and programme for earlier diagnosis and collaboration with local clinical teams
• Collaboration with NHS Bowel Cancer Screening (South) Director
• Links with Bowel Cancer Screening bring academic challenge and ‘big data’
• Recognised need for different strategy for vague symptoms pilot, supporting local teams to further develop clinical pilots/service evaluation
• MoU between the 2 cancer centres
(Brighton, Guildford)
• Radiotherapy capacity and demand
modelling completed, shared with
HASC Regional Chairs and patient
group representatives
• Variations in linac efficiencies
highlighted
• Analytics showcased for AHSN award
via Surrey Heartlands STP
• Capacity and access for our
population – linking to FYFY and
Taskforce
Day 28 Group FIT Symptomatic Radiotherapy
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Early Successes
• Ensuring Alliance is data-driven, with all decisions founded on quality evidence and consultation
• Early governance and assurance checks via the Institute of Healthcare Improvement
• Opportunities in development with our devolution STP partners (Surrey Healthcare)
• Alliance confirmed as the delivery arm on cancer by our 3 STP partners
• Excellent engagement with local HASCs (Health and Adult Social Care boards)
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• Excellent early adoption of methodologies in
Lung to implement Timed Pathway –
spearheaded by 2 Joint Clinical Leads for
Lung
• Alliance Self-Assessment - ‘positive’
feedback and scoring
• AHP Lead for Living With & Beyond Cancer
recruited
• Macmillan funded Co-Production Lead in
recruitment (patient and public engagement)
• Strong links forged with PHE colleagues in
support of our Prevention work programme
• Working with the University of Surrey
regarding academic evaluation of Alliance
initiatives and assessment of patient
experience regarding Shared Decision
Making
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Dr Afsana SafaNWL London STP Clinical Cancer Lead
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There is a wide range of Cancer Alliance work
Safety netting in
primary care
Cutting edge
prostate cancer
diagnosis
Working across
organisations
with STP
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Safety netting
• Primary Care diagnostic strategy – patients are monitored throughout the process until their symptoms are explained
• This approach promotes earlier diagnosis and reduced emergency diagnoses of cancers (poorer mortality)
• Takes administrative tasks away from GPs – more time with patients
• Aims to: • improve early diagnosis,
• reduce variation
• improve patient satisfaction
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RAPID pathway for prostate cancer
• Pathway improvement:• Identify cancer earlier,
• Better patient safety and experience
• - ‘First in the world” fusion technology for a revolutionary biopsy procedure
• - mp-MRI first, reduced complications
• - Faster and more accurate diagnosis enabling earlier treatment
All in
one
day
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Working with the STP
• Over 2 million people
• Over £4bn annual health and care spend
• 8 local boroughs
• 8 CCGs and Local Authorities
• Over 400 GP practices
• 10 acute and specialist hospitals
• 2 mental health trusts
• 2 community health trusts
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Psychological support
• New design and implementation of a pathway for adults affected by cancer in NWL
• Psychological distress is common around the diagnosis, treatment and living with cancer.
• 58% of patients emotional needs are still not addressed adequately.
• We have identified gaps in our whole pathway as well an a new approach to join up services from primary through to specialised care in an STP approach
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Psychological support
“..we wouldn’t give people chemotherapy without anti-
sickness drugs, so why would we treat someone with a
disease which clearly has significant psychological
impact, without offering psychological support.”
Dr Matthew Williams, Consultant Clinical Oncologist, Imperial College Healthcare
Trust.
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Discussion
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Q&A
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Key question……..What’s your priority for closing the survival gap?