Memorandum submitted by Avon, Somerset
and Wiltshire NHS Cancer Services
ASWCS' RESPONSE TO
THE NAO REPORT:
THE NHS CANCER
PLAN
1. Cancer Networks have helped drive forward
improvements in cancer services, but there is more to do if they
are all to become fully effective.
1.1 Sufficient resources are not always available
to enable networks to operate effectively.
In a survey carried out recently across the
34 networks with 28 responses it was found that the funding is
inconsistent bearing no relation to network size or complexity,
with very different staffing structures in place to achieve the
targets of the Cancer Plan. Arguably it should be a fairer process
for resourcing each of the networks' across England. Most of the
networks survive because of charitable funding; earlier networks
have reached the end of the three years charitable funding and
are faced with negotiating further income from the Pre-owned Assets
Tax's (POT). The Primary Care Trust (PCT) and Strategic Health
Authority) (SHA) support is very variable across the country and
many of the network managers are finding it hard to keep going,
relying on staff vacancies and subsequent slippage to manage their
incomes. Multi Disciplinary Teams (MDT) also need to be fully
resourced to work adequately and key staff such as specialist
nurses are often inappropriately administrating. There is also
evidence in some networks when the core team leaves and time is
taken to replace them no progress is made on targets.
POT income to networks across England ranges
from an average per POT of £11,000 per annum to £111,000,
21 of the 28 networks have an income shortfall in 2005.
Question: Whilst SHA's support networks, basis
for funding networks is inconsistent. There may be a link to those
receiving less funding support being less effective. Should there
be a consistent approach?
1.2 Making the cross-boundary approach work has
not been straightforward.
Across England network Boards are non statutory
and made up of membership across many organisations (26 in ASWCS).
The membership of the Boards changed significantly following "Shifting
the Balance of Power" and it is very hard to get Chief Executives
engaged from the Strategic Health Authorities the PCT's and Trusts.
Where they are engaged the networks' report much clearer decision-making
and support.
Decision-making across a network is made more
difficult because of the difficulty of the cross boundary approach,
as each of the statutory organisations feel they want to keep
the freedom to deploy resources in the way they see fit. The network
being an overarching non-statutory organisation challenges that
position by arguing for a population approach.
Question: We found that most networks still
have service changes to be made to meet the requirements of the
NICE Improving Outcomes Guidance. Do networks in their present
format have the ability to bring about these most difficult of
service changes?
1.3 Not all Cancer Networks plan Effectively.
Many of the networks surveyed by the NAO did
not have service delivery plans and other key strategies in place.
Some networks do not have the capacity, or resources and skills,
to plan effectively, though this is a priority. Most of the networks
would have moved forward since the NAO survey and have these structures
in place or are working to do so. The ongoing peer review process
will ensure that the networks are compliant and will require that
the appropriate planning be in place.
Question: Given the inconsistent staffing
structures in networks, how could they improve their planning
to adequately address the strategic direction of their varied
constituent organisations?
1.4 There is scope to improve the commissioning
of cancer services in some networks.
The support of PCT's varies from network to
network, with the development of the commissioning groups as outlined
in the Cancer Measures improving the situation, but the evolving
NHS creates more challenges to the overarching role of Cancer
networks and the influence, which they can bring to bear.
Question: Given the autonomy of PCT's to make
their own financial decisions, should the SHA's underpin Networks'
specific knowledge of a disease group and require PCT's to consult
prior to submission and sign off, of Local Delivery Plans?
1.5 There are concerns regarding the duty of
partnership expected from cancer network organisations in the
context of the evolving NHS.
The networks operate by facilitating changes
and improvements throughout their constituent organisations. The
cancer network has a specific role in planning and implementing
elements of the Cancer Plan, which because they affect wider populations
are beyond the control, expertise and resources of individual
Trusts, POT's or local health communities. An example of this
is in managing the service based NICE Improving Outcomes Guidance.
For many cancers patient numbers across the network are small
and a critical mass of cases need to be managed in centres to
meet quality measures, clinical governance demands and outcome
targets. The resulting reconfiguration of services goes beyond
the scope and discretion of an individual PCT or Trust to decide
the best outcomes across a whole network population (ASWCS 2.2
million).
Central policy is being pursued through networks:
Funding allocations are passed, in some cases through SHA's for
distribution and monitoring by networks. Responsibility for implementing
national guidance on cancer care (NICE) and for devising Action
Plans, many of which have major implications for the configuration
of hospital services, is also with the networks.
The advent of Foundation Trusts is also contrary
to population planning and management.
Question: How can a network balance the goals
of the Department of Health with the considerable constraints
in the local health communities, especially around lack of funding
to deliver the targets?
Mary Barnes
Director of ASWCS
21 March 2005
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