3 Applying lessons in the new NHS
16. Improvements in cancer services will need to
be delivered in the face of tighter finances, increases in the
number of new cases each year, and against a background of considerable
change in the NHS. In July 2010, the Secretary of State for Health
asked the National Cancer Director to review the Strategy to determine
if it was the right strategy to deliver improved cancer survival
rates. The NAO found that there was a risk to the successful delivery
of any future strategy unless there was considerable improvement
in the information used to support its implementation. It recommended
that the Department should develop an action plan which identified
the roles, responsibilities and timelines for taking actions.[43]
17. In January 2011, after our hearing, the Department
published its new approach to delivering improvements in cancer
services Improving outcomes: A Strategy for Cancer. It
told us that the new Strategy would be aligned with the direction
set in the July 2010 NHS White Paper, Equity and Excellence:
Liberating the NHS.[44]
The Department told us that the main drivers which would deliver
improved survival rates were: better use of information; more
emphasis on outcome measures rather than processes; effective
commissioning arrangements; and reducing the incidence of cancer
through prevention measures, screening and raising public awareness
of the symptoms of cancer.[45]
18. Within the context of considerable change in
the NHS and the transfer of commissioning responsibility from
PCTs to GPs, the Department assured us that it had the levers
in place to get better data, and set out how it would secure the
improvements (Figure 3).[46]
Figure 3The
Department's approach to data in the new NHS"The
White Paper is very clear that the setting of standards for data
in the health service will sit with the NHS Commissioning Board.
There is an expectation that this single point of accountability
will define the standard and it will be a requirement for providers
in the system to surface data to that standard. This should make
things move faster than they have previously and with some clarity
on who has got to do what, by when, in terms of providing data
to that standard. When a provider surfaces that data, there are
a number of different things it can then be used for. An individual
patient's information could flow back to the patient from an acute
trust to the GP. The White Paper and then the subsequent consultation
on the Information Revolution are clear that we would expect to
collect the data in an aggregate form once through the information
centre. The Information Centre would be expected to publish that
data and allow other third parties to use it and present it to
different groups in ways that may be more meaningful for them.
We would expect to see much more data published and in the public
domain, the source of it coming out of the health service, but
various interpretations that would help people, patients particularly,
to exercise their choice in an informed way and help people to
then ask more questions of the system as a whole. We would also
expect that aggregate data to be used by commissioners to take
a view of their population as a whole to help define and design
services that would make sense for that particular population,
and we would expect cancer services to be part of that."
[47]
19. The numbers of cancer survivors is expected to
increase from 1.7 million in 2010 to 2 million by 2020. Follow-up
care for survivors has typically been through routine outpatient
hospital appointments. The Strategy identified that the increase
in survivors would necessitate improvements in the management
and commissioning of follow-up care, and estimated that up to
£240 million could be saved between 2008 and 2018 if improvements
in follow-up care were made.[48]
The Department told us that it believed meeting the increased
demand should be cost neutral.[49]
It expected to achieve this through commissioning more cost-effective
follow-up care that would meet the needs of patients, including
reducing routine follow-up and providing care in the community.[50]
The Department was, however, unable to measure whether it
was delivering on its commitment of more cost-effective follow-up
care as it did not have information on the reasons for an outpatient
appointment (whether it was during treatment or for monitoring
purposes, or even whether the patient had cancer) as 97% of outpatient
data was not coded.[51]
20. The Department has a National Cancer Survivorship
Initiative which is focussing on the phase after patients have
received primary treatment when the NHS is working with patients
to help them back to as normal and healthy life as possible. The
Department told us that, in the past, it had tended to have a
one-size-fits-all model of follow-up whereby patients would have
outpatient appointments every three months for the first year,
then every four months, then every six months. The Department
believed a lot of that follow-up was not providing the care that
patients either needed or wanted. The Department was working in
partnership, particularly with Macmillan Cancer Support, to look
at what patients wanted in terms of follow-up care and to give
patients the best chance of survival.[52]
43 Q 75; C&AG's report, para 24 Back
44 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 Back
45
Q 75 Back
46
Q 77 Back
47
Q 77 Back
48
Q 39; C&AG's report, para 20 and 3.13 Back
49
Q 99 Back
50
Qq 92, 99 Back
51
Qq 39, 81; C&AG's report, para 3.14 Back
52
Qq 92, 99 Back
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