Northern Cancer Alliance Cancer Evolution Collaborate to Innovate - - PowerPoint PPT Presentation

Northern Cancer Alliance

Cancer Evolution – Collaborate to Innovate

Friday 27 September 2019 Ramside Hall Hotel, Durham

@NorthernCancer #CancerEvolution

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• Enter the event code #J575
• Type your question to the panel and press Send. You

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• 55,000 more people each year will survive five years or more following diagnosis.
• Three in four cancers will be diagnosed at an early stage.

NHS Cancer Programme – national

• verview

Dan Cariad, Deputy Director

4 | Over £300 million allocated to Cancer Alliances over three years Rapid Diagnostic Centres planning underway – faster diagnosis and better patient experience More people accessed treatment in 2018 than ever before – including new treatments such as CAR-T A record 2.2 million cancer checks following urgent referral by GP in 2018 – 14% more than in 2017 New bowel cancer screening test (FIT) rolled out – shown to increase uptake by 7% Over 80 radiotherapy machines replaced or upgraded through £130m Radiotherapy Modernisation Programme

HPV vaccination age extension for girls and extended to boys – will protect against certain cancers and reduce incidence

Overall patients rate their cancer care 8.8 out of ten – the best results ever

10,450 more people who were diagnosed in 2016 survived their cancer for at least one year than would have been the case five years before

Cancer survival in England is the highest ever

5 | 5 |

NHS Cancer ProgrammeCancer Alliance achievements

Alliances building their authority and influence in providing clinical, operational and transformational leadership across their geography Appointment to new positions in Alliance leadership teams, bringing increased leadership capacity and seniority Four Cancer Alliances are piloting the Quality of Life metric, working with eight hospital sites across the country. To date, 1,758 cancer patients have completed the questionnaire (response rate 51%) The National Targeted Lung Health Checks Programme will initially run across 10 sites, with results used as the basis for a wider roll out across the country. These sites are in parts of the country with the lowest lung cancer survival rates. Approximately 3,400 cancers will be found over four years, many earlier than would have done otherwise As of February 2019, percentage of Trusts with at least 1 MDT offering LWBC interventions: 99.3% offer HNA – up from 77% in 2017 97.4% offer Care Planning – up from 58% in 2017 Alliances pathway completion:

• 90% of trusts have implemented the

timed diagnostic lung pathway

• 94% of trusts have implemented the

timed diagnostic prostate pathway

• 77% of trusts have implemented the

timed diagnostic colorectal pathway

NHS Cancer Programme

6 | 6 |

NHS Cancer Programme

The Cancer Alliance delivers its objectives by:

• fostering productive partnerships and establishing robust governance

mechanisms to unite these partnerships together;

• setting a strategic transformation plan for cancer;
• deploying transformation funding in a way that is focused on the whole

population;

• harnessing data to analyse and improve operational performance and

longer-term outcomes;

• working closely and collaboratively with the regional NHSE/I offices to

maintain a system-wide overview of cancer services.

Cancer Alliances

NHS Cancer Programme

Cancer Alliances act as the ‘cancer workstream’ of their member STP/ICS(s). Together the Alliance partners lead delivery of improved outcomes and performance for their whole geography.

7 | 7 |

NHS Cancer Programme

The Long Term Plan

NHS Cancer Programme

The Long Term Plan Implementation Framework states “local systems should engage with their Cancer Alliances to set out practically how they will deliver the Long Term Plan commitments for cancer over the next five years including on early diagnosis and survival, while improving operational performance.”

The Long Term Plan Ambitions

• an extra 55,000 people each year will survive for five years or

more following their cancer diagnosis; and

• three in four cancers (75%) will be diagnosed at an early stage.

8 | 8 |

NHS Cancer Programme How we will get there (Long

Term Plan)

Deliver most comprehensive screening programme in the world Ensure equitable and fast access to diagnostic tests and results Provide faster, safer and more precise treatments Offer personalised care for all patients and transform follow-up care Harness the collaboration of academia, the NHS and industry

NHS Cancer Programme

9 | 9 |

NHS Cancer Programme Earlier and faster diagnosis –

progress and next steps

• Rapid Diagnostic Centres
• 19/20 Specification published in July 2018
• Five year framework due for publication in the Autumn
• Faster Diagnosis Standard
• 11 Trusts across England are testing the FDS
• Reporting against the standard to start from April 2020
• Targeted Lung Health Check Programme
• First patients to be seen in October 2019
• Approximately 3,400 cancers will be found over four years
• Primary care
• The Cancer Programme is working with stakeholders to

develop a specification for PCNs on supporting early cancer diagnosis

• This will be subject to GP contract negotiations in winter

2019 ahead of implementation in April 2020

NHS Cancer Programme

10 | 10 |

NHS Cancer Programme Personalised care and support –

progress and next steps

• Quality of life metric
• 2,190 patients completed questionnaires up to August 2019.
• Wider launch of model to be launched in 2020.
• Personalised stratified follow-up
• Handbook to be published
• Audit Support Tool to be shared with Alliances
• Outpatient algorithm to demonstrate total number of outpatient

appointments saved

• Q1 data
• 72% of trusts nationally are already offering personalised care

interventions to people with breast cancer

• 46% of trusts are already ensuring that 2/3 of people who

finish treatment for breast cancer are on a supported self- managed follow up pathway

• 2018 CPES results
• Patients have once again given their overall care an average

rating of 8.8

NHS Cancer Programme

11 | 11 |

NHS Cancer Programme Workforce – progress and next

steps

Delivering the Cancer Workforce Plan

• We invested £8.6m in cancer specific workforce activities last year

(2018/19)

• The size of cancer workforce grew by between 745 and 833 FTE

between 2015 and 2017 across six of the key occupations.

• Specialist roles identified in the Cancer Workforce Plan:
• 200 additional clinical endoscopists by 2021 (in addition to 200

already committed in wave 1)

• 300 reporting radiographers by 2021. 150 started or completed

training by April 2019.

• HEE has supported employers to develop four new apprenticeship

standards.

NHS Cancer Programme

12 | 12 |

NHS Cancer Programme

Materials and resources Cancer Alliance webinars + Share & Learns Cancer Alliances Events Cancer Alliance Workspace Patient and Public Engagement

Support from the national team

NHS Cancer Programme

• 55,000 more people each year will survive five years or more following diagnosis.
• Three in four cancers will be diagnosed at an early stage.

NHS Cancer Programme – Quality of Life Metric

14 | 14 |

NHS Cancer Programme Quality of Life (QoL) outcomes

• NHS England is leading the way in cancer care

by recognising that QoL outcomes are as important to patients as survival.

• Monitoring QoL outcomes will help us

understand the impact of cancer and its treatment.

• The new metric aims to measure quality of life

after a diagnosis of cancer at a scale and depth that is not being matched anywhere else in the world.

Quality of Life metric

15 | 15 |

NHS Cancer Programme The rationale

The LTP Implementation Framework “local systems should engage with their Cancer Alliances to set out practically how they will deliver the Long Term Plan commitments for cancer over the next five years including … roll out of personalised care interventions, including stratified follow up pathways, to improve quality of life.’ The LTP Implementation Framework Support Offer

We will support systems by ‘setting the data collection method and threshold for the national quality of life metric in 2020.’ .

The LTP Ambition

‘From 2019, we will begin to introduce an innovative quality of life metric…to track and respond to the long-term impact of cancer.’ .

Quality of Life metric

16 | 16 |

NHS Cancer Programme The QoL metric(s)

Importance of quality of life

• utcomes

Inform discussions on where to focus effort to improve the quality of services Prompt improvement discussions at a Cancer Alliance, commissioner and provider level Empower patients

Quality of Life metric

17 | 17 |

NHS Cancer Programme Piloting data collection

Alliance Trusts Northern Northumbria Healthcare NHS Foundation Trust Newcastle upon Tyne Hospitals NHS Foundation Trust East of England East Suffolk and North Essex NHS Foundation Trust (Ipswich and Colchester Hospitals) North Central and East London University College London Hospitals NHS Foundation Trust Bart's Health NHS Trust Royal Free London NHS Foundation Trust Wessex University Hospital Southampton NHS Foundation Trust

The QoL pilot project aims to evaluate data collection methods and gather data to develop summary QoL metric(s).

Quality of Life metric

18 | 18 |

NHS Cancer Programme

• EQ-5D (QoL measures)

− Summary scores include Utility/Profile, QALY, 1-100 VAS

• EORTC QLQ-C30 (30

items) − Summary scores include summary domains and the

• verall score

We are using two questionnaires

Both electronic and paper questionnaires are in use.

Quality of Life metric

19 | 19 |

NHS Cancer Programme The end to end process

Eligible patients identified by trusts Patients are invited to take part Administration

• f questionnaire

Receipt of patient response Trust – PHE interaction Data Analysis Patient – Trust interaction

Quality of Life metric

20 | 20 |

NHS Cancer Programme

Testing a format for patient and clinician feedback

Additional activities

A ‘Pilot within a Pilot’ (Wessex Cancer Alliance and Northern Cancer Alliance)

• Graphical displays (Reports) generated for both parties from

participants’ completed questionnaires.

• Using a “scoring” system, validated and tested in research.
• Allows results to be tracked over time
• Evaluating acceptability, ease of completion of scores in the

reports for patients and clinicians and its usefulness

• Potential trigger for intervention and signposting

Quality of Life metric

21 | 21 |

NHS Cancer Programme

Defined criteria for a nationwide data collection (eligibility, tools, time point) Information governance and data sharing systems have been established. A 50% response is achievable. As of August 2019, 4741 patients were invited and 2227 completed questionnaires were recorded. Patients find the survey easy to complete and acceptable. Questionnaire responses have been linked with data held about them in the cancer registry.

Progress so far

Quality of Life metric

22 | 22 |

NHS Cancer Programme

Phase 1: Initial research (May – Dec 16) Phase 2: Analysis and engagement (Dec 16 - Mar 17) Phase 3: Pilot data collection (Apr 17 – Jun 19) Phase 4: Test new criteria and establishing the model for ‘scale up’ (Apr 19 – Mar 20) Phase 5: Launch QoL metric data collection (Apr 20 – Mar 21)

Next steps

Test in ‘rarer’ cancers

Live in all cancers (2022)

Scope children and young people Translate all materials Promote equality of access Test patient level feedback Scope repeated measures

23 | 23 |

NHS Cancer Programme Acknowledgements

• All of the patients who have kindly completed the questionnaires.
• All of the staff at our pilot sites - clinicians, support workers, IT,

information governance and data protection teams.

• Cancer Quality of Life Steering Group and Working Groups.
• York Health Economics Consortium – Dr Andria Hanbury.
• Leeds University – Professor Galina Velikova, Dr Sarah Gelcich.
• Public Health England – Luke Hounsome, Rachael Brannan.

Quality of Life metric

• 55,000 more people each year will survive five years or more following diagnosis.
• Three in four cancers will be diagnosed at an early stage.

Thank you

Dan Cariad – dan.cariad@nhs.net

Early Diagnosis – Where are we now?

Jodie Moffat, Head of Early Diagnosis

Tens of thousands of people are diagnosed with late stage cancer each year

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Proportion of patients diagnosed at stages I&II

Proportion of all staged cancers diagnosed at stage I or II, Northern Cancer Alliance

Current trajectory NHS Long Term Plan ambition for England Staging data completeness

Data source: Stage Breakdown by CCG, England 2017, National Cancer Registration Analysis Service (NCRAS)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Melanoma Breast Uterine Bladder Kidney Prostaste Colorectal Ovarian NHL Lung Oesophageal Stomach Pancreas

Proportion of known stage cancers diagnosed at each stage

Proportion of Cases Diagnosed by Stage, Excluding Unknown Stage, Northern Cancer Alliance, 2016-2017

Stage I Stage II Stage III Stage IV

CRUK Early Diagnosis Waterfall Diagram version 1.1

31

50% 55% 60% 65% 70% 75%

Increase in the proportion of all cancers diagnosed at early stage (I & II)

Bowel screening optimisation Baseline 54% of patients are diagnosed at stage 1&2 Targeted lung screening/ health checks Pathway availability to shorten time frames within secondary care Further optimisation of screening, including risk stratification Supporting timely presentation by public Translational ED research

ED Discovery & Innovation

Cancer referral guideline ‘compliance’ and better pathways for referral

Pre- cancerous indicator Development of cancer Symptom Presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care Specialist visit Diagnosis/ referral to treatment Start of treatment

More screening diagnosis Earlier help-seeking for symptoms Earlier referral for tests Prompt testing and reporting, accurate staging Optimal treatment decisions Greater potential for… … earlier stage/faster diagnosis, better patient experience … prevention/monitoring, early stage diagnosis

Pre- cancerous indicator Development of cancer Symptom Presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care Specialist visit Diagnosis/ referral to treatment Start of treatment

More screening diagnosis Earlier help-seeking for symptoms Earlier referral for tests Prompt testing and reporting, accurate staging Optimal treatment decisions Greater potential for… … earlier stage/faster diagnosis, better patient experience … prevention/monitoring, early stage diagnosis Directing and funding research and collating evidence of what works Influencing for adoption of research into policy and practice Effecting behaviour change (implementation) Acting across the Research to Impact pathway

Directing and funding research and collating evidence

• f what works

Effecting behaviour change Influencing for adoption of research into policy and practice

• Our campaigning led to 174 MPs/Peers

signing our ‘Shoulder to Shoulder’ workforce letter to the PM

• Routes to Diagnosis and staging data/

analysis influence for national policy, cancer waiting times and levers

• Our ACE programme tested innovative MDCs

which has directly led to RDCs being key aspect of NHS LTP

ACE

• Approx. 16,000 conversations about ED with

the public via our cancer roadshow

• Influencing GPs on screening uptake via

evidence-based interventions

• In 18/19 CRUK

Facilitators carried out 2000 practice visits, with 88% leading to action by the GP practice

• Funding research into early diagnosis for 10+ years
• Significant investment in early detection research since

2014

• Building strategic research partnerships at home and

abroad

• Growing and supporting the research community
• Horizon scanning published and grey literature, including

both CRUK- and other-funded research

• Driving data analysis and intelligence

Thank you Jodie.Moffat@cancer.org.uk

Collaborate to Innovate

Mark den Hollander Macmillan Joining the Dots Development Officer

Collaborating to …..

• Support the development of #Cancerwecan in Darlington
• Influence the Macmillan Joining the Dots service.
• Collaboration is a two way process. Learn how these services

influenced the work of the Northern Cancer Alliance.

Local collaboration

Northern Cancer Alliance Living With and Beyond Cancer Project Darlington Citizen Advice ‘Investment in community

• rganisations to improve the
• utcome for everyone affected by

cancer and the best possible patient experience’

The Solomon Grundy Effect!

#Cancerwecan

• Funded on Monday
• Interviewed on Thursday
• Started on Tuesday
• Developed by Friday
• Pathways by Wednesday
• Directory by Thursday
• Commenced in June

Collaboration …..

Provided…..

• Finance
• Localised project meetings
• Individual support
• Established links
• Learn and Share Events

Got back…..

• Positive Evaluation
• Speed of project development
• Timing of HNA’s
• Issues with GDPR
• Using volunteers
• Separating clinical and non-clinical

concerns

Success of #Cancerwecan

Project developed and delivering in five weeks 54 people engaged with the service in a 6 month period Referrals to 26 different local

• rganisations

Regular referrals from Clinical Nurse Specialists, Welfare Rights, GP’s and the Macmillan Information Centre.

A giant by comparison …..

• Macmillan and Durham County Council

partnership run by the Wellbeing For Life service.

• Developed with Coproduction
• Programme Board
• 6.6 facilitators across 3 geographical areas of

County Durham

• Ongoing service development – PAMS, buddying,

mentoring, community clinics…..

Collaboration …..

Provided …….

• Finance
• Evaluation
• Representation

Got back …….

• Experience of a coproduction

approach

• Contribution to evaluation
• Representation on

Programme Board

Success to Date

Engaged with

• ver 400 clients

to date Around one third

• f engagements

with carers, friends or families High number of referrals from clinical sources Significant links to other statutory and voluntary

• rganisations to

ensure a wide range of support

Conclusion

• Significant collaboration to allow support services for cancer

patients

• Investment in third sectors organisations such as Darlington

Citizen Advice

• Investment and representation in Macmillan Joining the Dots
• Pathing the way for future development??

LIFE KITCHEN

RYAN RILEY

Sli.do

Lunch & Networking

Death Café – Located in the Green Room Life Kitchen Demonstration – Main Foyer

Setting the Ambition and Delivering a Whole Systems Approach to Cancer Care

Mr Andrew Welch Chair Northern Cancer Alliance

Northern Cancer Alliance

The Northern Cancer Alliance is a multi-agency collaborative, working together to increase cancer survival across this region, reducing inequalities, improving

• utcomes for everyone

affected by cancer and delivering the best possible patient experience.

ICS Regions and Cancer Alliances

Cancer Alliances

New NHS England regions and ICS areas

Cancer Alliances

From the 2019/20 Alliance Planning Guidance

• Re-affirms the role of Cancer Alliances
• Partners should come together to agree and deliver a system wide plan delivering both

improved operational performance and transformation in outcomes, working with and on behalf of their STPs and ICSs.

• Cancer Alliances will be able to choose how to allocate their overall 2019/20 allocation, within a

number of parameters.

• System wide plan with actions to
• Increase capacity
• Encourage cross organisational working
• Broker agreements across providers to balance supply and demand across the system

Key Challenges

• Despite improvements in one-year survival over recent year, Northern Cancer

Alliance rates continue to be below the national average rate, there remains a higher incidence and there are significant variations in clinical outcomes. We have set the foundations to transform cancer services and outcomes but we continue to have a number of key challenges:

• All cancer incidence is rising – but at a lower rate than seen nationally (2001-

2017 +1.7% compared to 4% in England) so the gap between Alliance and England rates has reduced.

• Mortality rates are falling - at a marginally faster rate than England (-18%

compared to -16% nationally over the same period)

• Despite this both incidence and mortality rates remain significantly higher

than the national average.

• Almost two thirds of cancer diagnoses occur in the over 65s; this cohort is

predicted to increase by almost 40% over the next twenty years (~38% increase for NCA CCGs).

NCA Trends

• Mortality
• Incidence

Northern Cancer Alliance - Trend in Age Standardised Mortality Rates with England Comparison - 2001-2017 (source NCRAS)

England North East and Cumbria

Northern Cancer Alliance - Trend in Age Standardised Incidence Rates with England Comparison - 2001-2017 (source NCRAS)

England North East and Cumbria

Key Challenges

Lung Cancer:

• Incidence and mortality rates from lung cancer are significantly higher than in England as a

whole

• Disproportionately affect the most deprived groups (35% of cases in most deprived group).
• Smoking rates have fallen overall across the Alliance, but remain high in more deprived groups

(chart below to illustrate) Some of our actions

• National Targeted lung Health Checks in Newcastle Gateshead
• Case finding initiatives in South Tyneside, Sunderland, South Tees and Northumbria
• Regional smoking taskforce

Smoking Prevalence

5 10 15 20 25 30 35 40 2011 2012 2013 2014 2015 2016 2017

North East England - Smoking Prevalence in adults (18+) - current smokers (APS)

Source: PHE Fingertips - Tobacco Control Profiles (March 2019)

All Groups Routine and Manual Never worked and long term unemployment Intermediate Managerial and professional

Key Challenges

Screening :

• We have some of the highest screening rates in England
• One year survival is lower than the national average for colorectal cancer despite having better

than average uptake in the bowel screening programmes. Early Diagnosis:

• 1 in 2 patients are diagnosed at a late stage (3 & 4)

Some of our actions

• Rapid Diagnosis Services in Tees and Sunderland
• Vague symptoms pathways in Newcastle and Gateshead
• Regional approach to increasing cervical screening to improve outcomes
• FIT for low risk symptomatic patients - colorectal pathway
• Emphasis on the Faster Diagnosis Standard (28day)

We have a long way to go to achieve the ambition of stage shift. 75% at stages 1 and 2 by

• 2028. We need to take

innovative actions to improve on these trajectories

40.0% 45.0% 50.0% 55.0% 60.0% 65.0% 70.0% 75.0% 80.0%

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028

NCA: Early Stage Diagnosis - All cancers : Trajectory

National Ambition 75% AdjustedTrajectory Current Trajectory AdjustedTrajectory 2

Key Challenges

Performance

• the 62 day cancer waiting time standard is increasingly challenged and not always

meeting the 85% operational threshold due to increased demand and diagnostic pressures, workforce and infrastructure challenges in diagnostics, particularly pathology, imaging and endoscopy services. Some of our actions

• Pathway Boards with clinical leadership to optimise services
• Working together to have an Alliance standard
• Networking of clinical services – radiology and pathology
• Review of services models with workforce vulnerabilities – radiology, oncology

• Our outcomes are not

improving at the rate we would wish.

• The survival gap is widening,

despite achieving the 62day standard or at least being one

• f the best alliances in the

country until recently.

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

NCA : Trend in 1-Year Survival - compared to England

England North East and Cumbria

NCA 1 year survival trend

HSJ INTEGRATED CARE SUMMIT 2019

IMPROVING CANCER OUTCOMES THROUGH ALLIANCES

• Screening/ Early referral
• Prioritise 28 day diagnostic target
• Cancer Alliance rather than individual Trust targets
• Bespoke tumour targets
• Personalised treatment plans and flexible targets

Expert Panel Quiz

Panel Members Dan Cariad – Deputy Director Operations, National Cancer Programme Andrew Welch – Chair, Northern Cancer Alliance Alison Featherstone – Programme Director, Northern Cancer Alliance Annie Dolphin – Lay Representative, Northern Cancer Alliance Pam Lee – Health Inequalities Clinical Lead, Northern Cancer Alliance Dr Jonathan Slade – Deputy Medical Director, NHS England & Improvement Dr Rob Carter – GP, Workforce, Health Education England

Question 1: What are the biggest challenges facing NHS cancer services over the next 5 years? Question 7: What should be the key priorities for cancer workforce planning now and into the future? Question 2: What are the quick wins for improving the cancer waiting time performance across the Alliance? Question 3: Where should we focus our efforts to improve survival rates across the Alliance? Question 4: What are the greatest barriers to addressing variation across the Alliance system?

Panel question choices

'Innovation and its Destructiveness

and the Creative Destruction of the NHS

(seriously?)

Cancer Alliance Conference September 27th, 2019

Dr Bernard Groen, BA (Hons), MA, (PhD)

Outline of the talk

• Theory
• Example 1
• Example 2
• Example 3
• Summary
• I ask you questions (maybe)
• You ask me question (maybe)

Creative destruction (German: schöpferische Zerstörung), sometimes known as Schumpeter's gale, is a concept in economics which since the 1950s has become most readily identified with the Austrian economist Joseph Schumpeter who derived it from the work

• f Karl Marx and popularized it as a theory of economic innovation and

the business cycle.

Healthcare

Digital Health Artificial Intelligence Robotics Genomics BioTech – Regenerative Medicine

Putting it all together. . . There are some really exciting innovations that are shaping our world today, most we are not aware of! Today’s talk is about making you aware of what is possible now, and in the very near future so you can reflect on what that could mean for the way you operate your business and how you better serve the people within your area in the near future. “Action without vision is only passing time. Vision without action is merely day dreaming, but vision with action can change the world!” - Mediba

Closing Remarks