Post on 13-Jan-2016
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www.cancertoolkit.co.ukCancer Commissioning Toolkit (CCT)
Training
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By the end of the training you will:
Have a good understanding of the history of the CCT
Know how to set up and personalise your account
Know how to navigate around the CCT
Be able to read and interpret the dashboards and charts
Know how to export reports
There is a mix of presentation and live working sessions - we have a lot to cover!
Be comfortable and competent with the use of the toolkit
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HISTORY
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The Cancer Commissioning Toolkit (CCT) was developed to realise the aims of the Cancer Reform Strategy (CRS)
“The Cancer Reform Strategy identified better information and stronger commissioning as two of the key drivers to achieve our goal that cancer services in this country should
be amongst the best in the world.
The launch of this Cancer Commissioning Toolkit represents a major step forward in relation to both of these drivers for quality improvement.”
Prof Mike RichardsNational Cancer Director
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Information is key to high quality commissioning
Commissioning of cancer services is complex
Commissioners need to take account of a wide range of factors to make informed decisions
Ready access to high quality information about local services and how they compare with services elsewhere is essential for good commissioning
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NCIS Registries
CCT is a “one stop solution” for access to cancer commissioning information to inform decision making
This toolkit brings together information from all of the sources, in a user friendly format
• Guidance contains suggestions for questions which commissioners can ask service providers
• Advice on how to interpret data
• Analysis of quality and confidence of sources
Smoking cessation
NCASP
Pharmacists
End of life
DH cancer waits
RT – equip survey
CQuINS
HES microsite
Screening
ePACTC-PORT
Pre-CCT Post-CCT
Programme
budgeting
HES
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There are 100s of important metrics that must be taken into account when making commissioning decisions
Breast Lung Colon Skin H&N
Actual incidence
PCT-1
Ag
e-s
tan
da
rdiz
ed
Source: CIS, Date
Ag
e-st
and
ard
ized
/100
,000
Prevalence All Cancers
PCT 1
Male Female
PCT 2 PCT 3
PCT 1
PCT 2
PCT 3
All PCTs
Source: CIS, Date
Ag
e-s
tan
da
rdiz
ed
/10
0,0
00
Prevalence LUNG Cancer
PCT 1
Male Female
PCT 2 PCT 3
PCT 1
PCT 2
PCT 3
All PCTs
Source: CIS, Date
Here commentary about assumptions made in projections
Ag
e-s
tan
da
rdiz
ed
/10
0,0
00
PCT 1LUNG incidence past and projections
Male PCT 1 Female PCT 1
2001 2006 2016
Female UKMale UK
Ag
e-s
tan
da
rdiz
ed
/1
00
,00
0
5-year rolling average mortality All Cancers
1995 2000 2006
Source: CIS, Date
Comments: …
Male PCT 1 Female PCT 1
Female UKMale UK
Ag
e-st
and
ard
ized
/100
,000
5-year rolling average mortality LUNG
1995 2000 2006
Source: CIS, Date
Comments: …
Male PCT 1 Female PCT 1
Female UKMale UK
% c
om
pli
an
ce
% Compliance with # of core Members Present at meetings
All Cancers
LC 1 LC 2 LC 3
All Localities
Source: C-Quiins Date
Core present at meetings
Named Core team
Members
LCT1
LCT2
LCT 3
At ½ of meetings
At 2/3 of meetings %
co
mp
lian
ce
% PCT Collective Measures Met
All Cancers
LC 1 LC 2 LC 3
All Localities
Source: C-Quiins Date
FC
E
Episodes by trust (not normalisied) - LUNG
Trust 1 Trust 2 Trust 3
All TrustsSource: HES, Date
Comments: …
Choose trust 1 2 3
Choose admission type All
Choose procedure All
FC
E
Episodes by PCT (not normalisied) - LUNG
Trust 1 Trust 2 Trust 3
Source: HES, Date
Comments: …
Choose PCT 1
Trust 4
ElectiveNon-elective
Choose procedure All
FC
E /
in
cid
en
ce
Activity trend per PCT - LUNG
1995 2000 2006
Source: HES, Date
Comments: …
PCT 1
England average
Choose PCT 1
Choose procedure All
FC
E /
in
cid
en
ce
Activity trend per PCT - LUNG
1995 2000 2006
Source: HES, Date
Comments: …
PCT 1
England average
Choose PCT 1
Choose procedure All
£
All TrustsSource: HES, Date
Comments: …
Costs of emergency admissions by Trust (not normalised) - LUNG
Choose Trust 1 2 3
Trust 1 Trust 2 Trust 3
£/
FC
E
Costs by FCE
PCT 1 PCT 2 PCT 3
All PCTsSource: HES, Date
Comments: …
100%
% bed-days above trim point
PCT 1 PCT 2 PCT 3
All PCTsSource: HES, Date
Comments: …
100%
% costs due to excess bed-days
PCT 1 PCT 2 PCT 3
All PCTsSource: HES, Date
Comments: …
Planned expenditure of current drugs
Zoom up
Item
1. …2. …3. …4. …
Description
• Here the user could type action items that he/she considers important• …• …• …
Lung Breast Prostate Etc.
1Choose PCT 1Choose PCT
Choose Network
or
NotesStatus NICE guidanceManufacturer
Cost per patient per annum (£)
Etc…
Expected total costs per drug
(£)
Previous year
spend (£)
C
B
A
Number of patients expected in PCT /
network per annum
Incidence per 100,000IndicationDrug NotesStatus NICE
guidanceManufacturerCost per
patient per annum (£)
Etc…
Expected total costs per drug
(£)
Previous year
spend (£)
C
B
A
Number of patients expected in PCT /
network per annum
Incidence per 100,000IndicationDrug
Assumptions: England population = 55 million, Network population = 1m, PCT population = 100,000
Total Costs per PCT / Network £ etc…
Choose Scenario abc Manage scenarios
£ etc…
% s
uc
ces
sfu
lly
qu
it
% Successfully quit at 4 weeks
1995 2000 2006
Source: IC, NHS Date
Comments: …
PCT 1 England
Actual numbers
% success rate
% s
ucc
essf
ull
y q
uit
% Successfully quit after 4 weeks
(self report)
PCT 1 PCT 2 PCT 3
All PCTs
Source: IC, NHS Date
Data
User notes
Add to basket
Rate of quitters by
100,000 pop
% success quitters at 4
weeks
Ra
te p
er
10
00 w
om
en
s
cre
en
ed
Rate of cancer detected
Women aged 50 – 64
2005 - 2006
SHA 1 SHA 2 SHA 3
All SHAs
Source: Screening Date
Coverage Cancer Detected
% o
f w
om
en s
cre
en
ed
Test results 2005 - 2006Women aged 25 – 64
PCt 1 PCT 2 pCT 3
All PCTs
Coverage Test Results
Data
User notes
Add to basket
LCT1
LCT2
LCT 3
View DyskaryosisLevel
Mild
Negative Dyskaryosis
# n
ot
refe
rre
d a
s T
WR
/10
0,0
00
# not referred as TWR
All cancers
PCT 1 PCT 2 PCT 3
All PCTs
Source: CWT, CIS, Date
Jul Aug Sept
Source: CWT, CIS, Date
Comments: …
# not referred as TWR - All cancers
PCT1
PCT England
# n
ot
refe
rre
d a
s T
WR
/10
0,0
00
# T
WR
wit
h c
an
cer
Dia
gn
os
is
/10
0,0
00
# of TWR with cancer diagnosis
All cancers
PCT 1 PCT 2 PCT 3
All PCTs
Source: CWT, CIS, Date
Jul Aug Sept
Source: CWT, CIS, Date
Comments: …
# TWR with cancer diagnosis - All cancers
PCT1
PCT England
# T
WR
wit
h c
an
cer
Dia
gn
os
is
/10
0,0
00
All PCTs
England Average
PCT1
Target (99%)
PCT2
PCT3
Source: CWT, Date
% m
ee
tin
g T
WR
sta
nd
ard
% of TWR meeting Standards
All cancers
Jul Aug Sept
PCT England
% of TWR meeting Standards - All cancers
PCT1
% m
ee
tin
g T
WR
sta
nd
ard
# n
ot
refe
rred
as
TW
R /1
00,0
00
# not referred as TWR
Lung
PCT 1 PCT 2 PCT 3
All PCTs
Source: CWT, CIS, Date
% o
f al
l TW
Rs
% of TWR with cancer diagnosis
All cancers (2006)
PCT 1 PCT 2 PCT 3
All PCTsSource: CWT, CIS, Date
TWR target % NotReferred as
TWR
% TWR with Cancer
Diagnosis
Jul Aug Sept
Source: CWT, CIS, Date
Comments: …
Trend % of TWR with cancer diagnosis
All cancers - PCT1
PCT England
% o
f al
l T
WR
s
Jul Aug Sept
Source: CWT, CIS, Date
Comments: …
PCT England
% of 31 days meeting Standards Vs National Target All cancers - PCT1
% 3
1 d
ays
me
eti
ng
Na
tio
nal
S
tan
da
rds
National Target of TWRs meeting standard (98%)
Jul Aug Sept
PCT England
% of 62 days meeting Standards Vs National Target All cancers - PCT1
% 6
2 d
ays
me
eti
ng
Na
tio
nal
S
tan
da
rds
National Target of TWRs meeting standard (995)
In house treatmentTrust transfer
62 day trend
In trust and transfer
breakdown
% 100%
In Trust treatment
Trust transfer
July Aug Sept
Source: HES Date
62 day cases breakdown – all cancers
PCT1
62 day trend
In trust and transfer
breakdown
Bed
-da
ys /
PC
T in
cid
ence
Excess bed-days by PCT – LUNG (normalised by incidence)
All PCTs
Source: HES, Date
Comments: …
PCT 1 PCT 2 PCT 3
Ex
ce
ss B
ed
-da
ys
1995 2000 2006
Source: HES, Date
Comments: …
Excess Bed-days time trend - LUNG
PCT 1
England average
Ave
rag
e L
oS
Average LoS by PCT – LUNG
All PCTs
Source: HES, Date
Comments: …
PCT 1 PCT 2 PCT 3
%
% admissions without a diagnosis of cancer by PCT – LUNG
PCT 1 PCT 2 PCT 3
All PCTs
Source: HES, Date
Comments: …
% o
f ca
nce
r d
eath
s in
th
e H
osp
ice
% of cancer deaths in the Hospice
All cancers
PCT 1 PCT 2 PCT 3
All PCTs
Source: HES Date
% o
f ca
nce
r d
eath
s in
ho
spit
al % of cancer deaths in hospital
All cancers
PCT 1 PCT 2 PCT 3
All PCTsSource: HES Date
Which Hospital - All cancers
T1 T1 T3T1 T1 T3T1 T1 T3 T1 T1 T3T1 T1 T3T1 T1 T3
T1 T1 T3T1 T1 T3T1 T1 T3
%%
%
%%
%
%
%
%
T1 T1 T3T1 T1 T3T1 T1 T3
PCT1
PCT3 PCT4%
%%
% o
f ca
nce
r h
osp
ital
dea
ths
by
Tru
st
Survival trends per cancer
type and PCT
Activity per admission type
and PCT
Drug budget per indication and
network and PCT
Excess bed-days per cancer type, trust and PCT
# TWR with cancer
diagnosis
Place of death per PCT of
patient and trust
There is a wealth of information in the CCT
The toolkit contains over 100 reports, with more to come
Illustrative
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Careful consideration needs to be given to the way the data are interpreted and used
1. Is a start of a conversation and not an answer in itself
2. Data drives insight and questions, not necessarily answers
3. Need to read the guidance and interpret the data accordingly
4. Not an in-year planning tool
5. Relies on existing data sources
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Welcome screen
Toolkit overvie
w
. .
Quality of service (all
cancers)
. . . . . . .
The Challenge of
cancer
Cancer and Inequalities
Burden of disease (all
cancers)
Demographics
Quality of service (at
cancer type level)
Screening (at cancer type
level)
Referrals (all cancers)
Referrals (at cancer type
level)
Assessment, diagnosis
and staging
Waiting times (summary)
RadiotherapyCancer
MedicinesChemothera
py
Waiting times per cancer
type
Current Drugs
Drug Horizon scanning
EfficiencyPatient
experience (all cancers)
Patient experience (at cancer type level)
Place of death (all cancers)
Place of death (at
cancer type level)
Information
.
Activity and cost
(summary Screen)
Unbundled
Calculator
Programme Budgeting
Activity and Cost per
cancer type
Activity and Cost per
procedure
Case mix activity and
cost
Procedure cost
calculator
Case mix calculator
Case mix benchmarks
Prevention
Outcomes (all cancers)
Burden of disease (at cancer type
level)
Outcomes (at cancer type
level)
Key Cancer Rates
Lifestyle trends
Follow up appointments
Log in screen
Welcome screen
Toolkitoverview
. .
Quality of service (all
cancers)
. . . . . . .
The Challenge of
cancer
Cancer and Inequalities
Burden of disease (all
cancers)
Demographics
Quality of service (at
cancer type level)
Screening (at cancer type
level)
Referrals (all cancers)
Referrals (at cancer type
level)
Assessment, diagnosis
and staging
Waiting times (summary)
RadiotherapyCancer
MedicinesChemothera
py
Waiting times per cancer
type
Current Drugs
Drug Horizon scanning
EfficiencyPatient
experience (all cancers)
Patient experience (at cancer type level)
Place of death (all cancers)
Place of death (at
cancer type level)
Information
.
Activity and cost
(summary Screen)
Unbundled
Calculator
Programme Budgeting
Activity and Cost per
cancer type
Activity and Cost per
procedure
Case mix activity and
cost
Procedure cost
calculator
Case mix calculator
Case mix benchmarks
Prevention
Outcomes (all cancers)
Burden of disease (at cancer type
level)
Outcomes (at cancer type
level)
Key Cancer Rates
Lifestyle trends
Follow up appointments
The CCT broadly follows the chapters and sections of the Cancer Reform Strategy
Cancer “patient journey” in the toolkit
Cancer Landscape
Peer Review Summary
Awareness, Screening and Early detection
Assessment, diagnosis and staging
Treatment
Living with cancer
End of life
Building for the future
InpatientFunding cancer care
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AT Kearney
Partnership working has been critical to the development of this toolkit
To name a few ...
National Cancer Services Analysis Team
National Cancer Screening Programmes
National Cancer Intelligence Network NHS Improvement
National Cancer Action Team
UK Association of Cancer Registries
Pharmaceutical Oncology Initiative
Department of Health
Concentra
Database administrators Usability testers
Your ongoing feedback...
Continuous improvement!=
Section owners National interviews
Feedback from NDP 2008
Pilot sites CCT Steering Group / Team
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Development of the CCT is being supported by member companies of the British Pharmaceutical Industry (ABPI)
Pharmaceutical Oncology Initiative (POI) Group
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The main users of the toolkit will be PCT commissioners, cancer networks and trusts
As of October 2006 there are 152 PCTs in
England
There are 30 Cancer Networks in England
There are 158 trusts in England
Other users of the toolkit:• Cancer charities
• Pharmaceutical companies
• Public, in due course
Users external to the NHS have restricted access to some metrics and small data sets
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The NHS is providing content and data support for CCT users, while Concentra is providing technical support
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TOOLKIT
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The CCT is a web-based tool so you can log on anywhere you have access to the internet
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The dashboard contains the key cancer metrics and allows you to compare your performance to the national average
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Organisations are distributed between the ‘best’ and ‘worst’ score with the top 25% in green and the bottom 25% in red
Top
Qu
art
ile
25%
50%
25%
25%
50%
25%
Top
Qu
art
ile
Top
Qu
art
ile
25%
50%
25%
Some metrics are inverted, i.e. high scores are not at the top if that’s not the ‘best’ result
The size of each section will depend on the
spread of scores, not the number of organisations
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Manage your account and set your default organisations through the User settings menu option and select User Profile
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Each metric can be observed in more detail with information on sources and guidance
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A cancer specific dashboard contains another selection of metrics that can be analysed for each cancer type
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The index contains links to each chapter and section – which lead on from the CRS
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Each issues raised in the sections of the CRS are informed by the charts in the relevant section
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Each chart is fully interactive and contains sources and guidance – filter options on the right hand side change depending on the individual charts
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Timelines allow you to view performance over time, but please note that you can only currently view one organisation at a time
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Peer review data is provided in a slightly different way, with a tick for compliant and a cross for non compliant on given metrics
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Charts can be pre-customised with selected networks, PCTs, trusts or SHAs by selecting ‘Favourites’ in the User setting menu option
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Reports can developed within CCT and exported into a word document, with all relevant source, commentary and comments
Report outputs are fully editable in MS Word
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Add charts and dashboards by setting up the parameters required in the report and using the ‘report basket’ button
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Once named, the charts and dashboards will appear Report Cabinet to run reports from
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The Horizon Scanning section of CCT pulls information from many sources of information for cancer medicine horizon scanning
Journals
Specialist media
Industry
Licensing agencies
Clinical specialists
National “horizon scanning” groups• National Horizon Scanning Centre
• London New Drugs Group
• National Prescribing Centre
Cancer Commissioning Toolkit (CCT)
- Horizon Scanning -
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There are a number of key principles of the CCT Horizon Scanning section
Requests for additions to toolkit will be submitted to a central point and may be submitted by multiple sources
All agents will be considered provided they fall under the definition of "chemotherapy" which has yet to be fully defined
Requests for additions to toolkit must have published supporting evidence. This may be a fully published trial report or an abstract
New drugs/regimens should have an expected EMEA licensing date within 18 months of addition to the database
Drugs/regimens will be removed 18 months after licensing for the listed indication or 3 months after a decision by NICE, whichever occurs first
CNPF will consider requests for new drugs/regimens three times a year as part of NDP
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The Cancer Medicines section contains reports on drug uptake
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The Horizon Scanning reports inform users of upcoming medicines
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Costs are based on patient numbers, medicine costs and number of cycles
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The costs of each treatment can be compared across multiple scenarios
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The cost over time can be seen, based on the expected launch dates of each treatment
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Data from the Horizon Scanning section can be exported into Excel by selecting the ‘Generate XLS’ link
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The Activity Planning reports will inform the user of the uptake and costs of current medicines but is still under development
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The Activity Planner calculates the cost of current regimens based on patient volumes
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C-PORT is an online capacity planning tool that helps with planning resources for hospitals delivering chemotherapy
Chemotherapy Planning Online Resource Tool
C-PORT development and support is being driven by NCAT and Concentra
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C-PORT allows the user to simulate the activity within a unit and therefore understand and plan capacity
This data is centrally hosted and is accessible
through a web-based application
C-PORT models the activity within
chemotherapy units
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The Financial Module in C-PORT allows users to allocate costs and revenue for each regimen
Revenue calculations Cost calculationsActivity calculations
Local regimen list
Human & physical
resources
National standard
regimen listResource cost
Medicine cost
OverheadsTariff income
REVENUE COST
MARGIN / COST RECOVERY
Activity
In the future this information will be automatically imported into CCT
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SCENARIOS
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Scenarios have been developed to demonstrate the capabilities of the toolkit
Scenario 1 – High mortality in specific cancers
Scenario 2 – Inefficient spend
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SCENARIO 1High mortality in specific cancers
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1. the PCT has made less progress than the majority of the country in reducing
mortality levels in the last 10 years
2. there are low one and five year survival rates for colorectal and lung
cancers (in lowest quartile)
A PCT Director of Public Health scans the cancer dashboard to investigate high mortality in colorectal and lung cancers
While she was aware of the high mortality rates, she was less aware that...
Scenario 1 - High mortality in specific cancers (1/6)
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She finds that a high proportion of colorectal and lung cancers are diagnosed through means other than TWR
TWR = Two Week Referral; this is from the time the GP refers
An adjacent PCT has a significantly
lower rate
Scenario 1 - High mortality in specific cancers (2/6)
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Smoking cessation levels are low in the area, which may be a result of poor success rates with quit smoking campaigns
Smoking cessation metrics are poor
Scenario 1 - High mortality in specific cancers (4/6)
% success rate for quit smoking over time is falling
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Another concern is that the PCT’s lung multi-disciplinary teams (MDT) are non-compliant
The peer review report shows that this is due to the lack of a thoracic surgeon and palliative care team member
Scenario 1 - High mortality in specific cancers (5/6)
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A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing
Questions• Why is staging data not being collected? It is already required...
• What are the reasons behind the low 1 and 5 year survival rates?
Strategies• Feed back staging information on all newly diagnosed cases promptly to GPs, to support a locally agreed
audit on recognition of symptoms
• Introduce a strategy for prevention and increased population awareness of signs and symptoms in lung and colorectal cancers, based on a social marketing approach
• Ensure lung MDT compliance to improve curative resection rates and quality of care
Scenario 1 - High mortality in specific cancers (6/6)
These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions
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SCENARIO 2Inefficient spend
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Cancer spend is just above the national average, but ...
this appears to correlate with an above average mortality from cancer for the PCT population
A PCT Director of Finance assumed that spend on cancer looked appropriate but further investigation revealed problems
Scenario 2 - Inefficient spend (1/5)
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This investigation also explained why the cancer network team were suggesting increased investment in certain areas
Screening: coverage is low for both breast and cervical cancer
Radiotherapy: Fractionation rates relatively low
Chemotherapy: Uptake of NICE drugs relatively low
Scenario 2 - Inefficient spend (2/5)
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From the CCT, the team could demonstrate possible causes for a higher than average spend on inpatient care
1. Higher than average level of emergency bed days
Scenario 2 - Inefficient spend (3/5)
2. Higher than average number of deaths in hospital
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They also discovered a high number of cancer emergency bed days above trim point
Scenario 2 - Inefficient spend (4/5)
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A quick look around the toolkit raises a lot of questions and identifies some issues that need addressing
Questions• What is driving the high number of cancer emergency bed days?
• Why are more people dying in hospital in this PCT than most others?
• For each cancer type, what are the reasons for so many excess bed days above the trim point?
Strategies• Develop community based support for end of life care and incorporate this work into existing PCT project
on early discharge with social services
Scenario 2 - Inefficient spend (5/5)
These outputs give a flavour of the type of information available in the toolkit - clearly more analysis is required, and taken as a whole could lead to the following decisions
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THANK YOU