Supplementary memorandum submitted by
the Department of Health
Question 22 (Mr Field):
Earlier diagnosis improves the likelihood of
survival. An international workshop of cancer epidemiologists
and other experts examined evidence during the preparation of
the NHS Cancer Plan on differences in cancer survival rates—this
was reported in the National Audit Office (NAO) Report "Tackling
Cancer in England: Saving More Lives" published in March
2004. The workshop concluded that patients in England tend to
have more advanced cancer at the time of diagnosis than in some
other countries, at least for breast and bowel cancer.
A study commissioned by the Department of Health
from Una Macleod et al on "Factors influencing
patient and primary care delay in the diagnosis of cancer: a database
of existing research and its implications for future practice"
looked at studies which had considered patient delay and practitioner
delay separately, rather than comparing the relative delay. However,
the study did identify that the patient phase of delay was generally
greater than the practitioner phase, and that patient delay varied
for different cancers. (A hardcopy of this study has been sent
separately to the Committee.)
It should be noted that the term "delay"
may not be appropriate to use in relation to patients in primary
care as it includes both a conscious decision by a patient not
to consult about symptoms but possibly also a lack of awareness
of symptoms. In addition, we are aware that some patient groups
dislike the term "delay" because it is judgmental.
Question 93 (Mr Williams):
We are committed to giving patients more choice
and control over their healthcare and services and we are already
increasing choice of hospital for patients needing planned hospital
care. Since last August, patients who will wait more than six
months for their elective care are being offered the choice of
faster treatment at an alternative provider, meaning that those
waiting longest are benefiting first from choice.
By the end of this year, patients needing a
referral for surgery will be offered a choice of four to five
providers at the time they are referred for treatment by their
GP. Most patients referred for elective care will be offered this
choice from December. However, following extensive discussions
with the NHS, we have recognised that choice of hospital would
not be appropriate for all services. We included cancer services
within this category. We are committed to ensuring that patients
with suspected cancer are seen within two weeks of referral and
ensuring this rapid access to services was considered more important.
However, choice is important in cancer services. Patients should
be offered more choice about the treatment they receive, including
choice of provider wherever possible.
Giving patients the opportunity to choose their
provider is one of the first areas in which we are extending choice.
We are continuing to work to ensure that patients have an informed
choice of treatment options and treatment providers, choice about
their ongoing care and choice at the end of life. There is more
work to be done in developing our thinking on how choice should
be available within primary care and emergency and specialist
networks.
We are currently developing the detailed policy
for the extension of choice of hospital to give patients needing
planned hospital care the right to choose any healthcare provider
which meets the Healthcare Commission's standards and which can
provide the care within the price that the NHS will pay by 2008.
As part of this, we will consider how best to ensure these choices
are available to cancer patients.
Creating a Patient-led NHS: Delivering the NHS
Improvement Plan
The above report (available at www.dh.gov.uk/publications),
published in March 2005, addressed specialist networks (of which
cancer networks are an example):
— Chapter 2 sets out what services
will look like and confirmed that the NHS will offer "integrated
networks for . . . specialist care to ensure that everyone throughout
the country has access to safe high quality care."—see
paragraphs 2.22-2.28 in particular.
— Chapter 3 sets out how the
NHS will develop the way it secures services for its patients
including that it will: "Strengthen existing networks for
. . . specialist services, with PCTs and Strategic Health Authorities
(SHAs) having explicit responsibility to review and develop them"
and confirms that "There is more work to do to develop thinking
on how choice should be available within . . . specialist networks,
how far providers should offer choices in treatment and ongoing
care and how choice at the end of life will work."
— Chapter 5 talks about making
the changes and notes that: "a strong network of care providers
is required who can respond quickly to what patients want, who
can introduce new clinical practices at pace and who can flex
their services to fit new pathways of care."
COLLECTIVE COMMISSIONING
During the Committee hearing, Sheffield was
given as an example of an area that had established successful
collective commissioning—NORCOM, the North Derbyshire, South
Yorkshire & Bassetlaw Commissioning Consortium. The Committee
requested a note on NORCOM, which follows below:
North Derbyshire, South Yorkshire & Bassetlaw
Commissioning Consortium (NORCOM)
|
| Constituents PCTS | Weighted Population
|
|
| Barnsley | 258,256 |
| Doncaster Central | 108,712
|
| Doncaster East | 92,263
|
| Doncaster West | 119,496
|
Doncaster Total | 320,471
|
Rotherham | 255,278
|
| North Sheffield | 142,837
|
| South East Sheffield | 174,626
|
| Sheffield South West | 106,987
|
| Sheffield West | 119,144
|
Sheffield Total | 543,594
|
South Yorkshire Strategic Health Authority Total
| 1,377,599 |
|
| |
Updated November 2003
WHAT IS
NORCOM?
The North Derbyshire, South Yorkshire and Bassetlaw Commissioning
Consortium (NORCOM) came into effect from 1 April 2002 and covers
the 13 PCTs operating in this geographical area.
NORCOM is a joint sub-committee of the 13 PCT Boards and
all the Boards have signed up to a formal Establishment Agreement
which defines the membership, the lines of accountability and
the working arrangements.
The focus of the NORCOM process is a monthly meeting of the
PCT Chief Executives and the Acute Trust Chief Executives to receive
reports, recommendations etc and make collective decisions.
The minutes of the NORCOM meetings go to the public session
of all the PCT Board meetings.
THE NORCOM TEAM
There is a central specialist team of 16 staff, hosted by
Barnsley PCT to support the NORCOM activities. There are also
two lead nurses and eight lead clinicians relating to the clinical
networks. The current central budget is £1.93 million.
The member PCTs fund the work of the NORCOM team through
a capitation-based levy, reviewed on an annual basis.
WHAT DOES
NORCOM DO?
The Consortium is responsible for two main areas of work:
— commissioning specialised services,
— supporting the development and maintenance
of clinical networks.
More recently the NORCOM team has also been approached to
take on specific project work relating to "Booking and Choice".
SPECIALISED SERVICES
The main focus of the specialised services work is the planning
and review of services and agreeing a common commissioning framework.
The central team co-ordinates a limited pooled budget for selected
high cost procedures, to reduce financial risk. All the other
service budgets continue to be held by the individual PCTs.
There are seven commissioning groups covering the following
services:
Renal;
Cardiac;
Specialist Cancer;
Neurosciences;
Specialist Childrens;
Genetics; and
Dental Services.
There are NORCOM representatives on the various groups involved
in the commissioning of high and medium secure services.
There is a formal collaborative working arrangement with
TrentCOM and the LNR Specialist Commissioning Group, who are similar
specialist commissioning consortia covering Leicester, Northampton,
Rutland, Nottinghamshire and Derbyshire. This joint work will
focus on co-ordinating the commissioning of specialist services
for populations greater than 3-6 million.
There are also regular meetings with the West Yorkshire and
North & East Yorkshire and North Lincolnshire Consortia to
co-ordinate commissioning priorities.
There is regular attendance at the DoH/Specialist Commissioning
Group representatives meetings.
There are NORCOM officers participating in national work
eg Burns, Pulmonary Hypertension.
As the host commissioner, NORCOM recently led on behalf of
all commissioners, nationally, the assessment of the Sheffield
stereotactic radiosurgery service.
CLINICAL NETWORKS
There are seven clinical networks in existence:
Cardiac;
Cancer;
Critical Care;
Neonatology;
OMFS/ENT;
Pathology; and
Vascular.
All the clinical networks have network co-ordinator support
from the NORCOM specialist team, together with a lead clinician.
The existing networks are at various stages of development.
The Cardiac and Cancer networks are both in a stage involving
some re-organisation and modernisation of their working arrangements.
The Pathology network is taking forward a number collaborative
projects, including joint purchasing and workforce planning.
The Critical Care network is currently focusing on clinical
service improvement and consolidation of service changes implemented.
The OMFS/ENT, Neonatology and Vascular networks were formed
last year and are still in a development phase.
The potential added value of other clinical networks is being
investigated.
OTHER/MISCELLANEOUS
NORCOM is co-ordinating the North Trent Priorities process
for the development of common commissioning policies across the
patch.
The NORCOM specialist team is also participating fully in
the LDP process, and the implementation of the Financial Flow
Reforms.
The team negotiates and performance manages service level
agreements with specialist hospitals elsewhere in the country.
This work is shared with TrentCom.
| 
