Brain tumours and NHS England
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1 Brain tumours and NHS England Andrew Brodbelt Consultant Neurosurgeon and Division Clinical Director The Walton Centre NHS Foundation Trust, Liverpool NCRAS CNS tumours workshop April 12 th 2016.
2 National programmes of care and clinical reference groups Stereotactic radiosurgery NICE guidance consultation People with brain tumours Overview
3 What is a specialized service? Specialized services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialized hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.
4 National Programmes of Care and Clinical Reference Groups NHS England commissions specialized services 14% of total budget = 13,800,000,000 Clinical strategies Commissioning based on: Clear evidence Cost effective Patient focused
5 Five (Six) Programmes of Care Internal medicine Cancer and blood Mental health Trauma Women and children Within Cancer there were 16 Clinical reference groups including CNS tumours Radiotherapy Chemotherapy
6 Clinical Reference Groups (CRGs) The primary source of clinical advice on the development and assurance of specialized services contract products (such as specifications and commissioning policies)
7 CNS tumours - Membership Chair (Paul Grundy) 14 regional representatives Merseyside and Cheshire Patient representatives (up to 4) Professional organizations (up to 4) Accountable commissioner
8 Work programme highlights Service specifications revision 5ALA clinical commissioning policy Molecular markers Co dependencies PICO research topics for NIHR SRS/T revision of service specifications
9 Service Specifications evidence base Department of Health Improving Outcomes; a Strategy for Cancer Department of Health (2011) Cancer Commissioning Guidance - Department of Health (2011) NICE Improving supportive and palliative care for adults with cancer - NICE(2004) Improving outcomes for people with brain and other CNS tumours (2006) NICE clinical guidelines: Diagnosis and management of patients with metastatic spinal cord compression (November 2008) NICE clinical guidelines: Improving outcomes in children and young people with cancer (August 2005) Quality standard for end of life care for adults NICE (2011) Quality standard for patient experience in adult NHS services NICE (2012)
10 Service specifications continued National Cancer Peer Review National Cancer Peer Review (NCPR) handbook National Cancer Action Team (2011) Manual for cancer services: brain and CNS measures (2011) Manual for cancer services: acute oncology measures (April 2011) Manual for cancer services: chemotherapy measures (June 2011) Other Chemotherapy services in England. National Chemotherapy Advisory Group (2009)
11 5 ALA Commissioning policy Written by Stephen Price Accepted But cost within tariff
12 Molecular markers Commissioning policy Written by Sebastian Brandner 1p19q, MGMT, IDH 1, and many others? To be incorporated into genetic and molecular markers for all tumours
13 NIHR research priorities and codependancies Taken from the James Lynd Alliance The value of molecular markers The role of interval scanning The role of early palliative care + (CW) Early reoperation
14 Originally 6 national SRS units Expert reference group formed (PG chair) Compromise Local SRS for mets / acoustics / meningiomas National providers for AVM s, TGN Any platform 100 / year / unit SRS / T
15 SRS / T Consultation ERG review of comments made National procurement Scoring of applications Contracting (May 2016) Response to challenges Quality assurance Outcomes
16 SRS for rare tumours Haemangioblastoma Pilocytic astrocytomas Ependymoma Trigemminal schwannomas Principles for SRS Surgery is 1 st choice SRS if surgery not possible Residual disease Inoperable Recurrence (after surgery considered) Patient choice not considered!
17 CRG - What we didn t do Numbers for peer review NF1 / NF2 service specifications revision Volume MRI s
18 CNS tumours group ended 2016 New Clinical Reference Groups in Cancer Cancer Surgery, Radiotherapy, Chemotherapy, Diagnostitics, TYA New Membership 4 regional representatives Patient and professional representatives Expert Reference Groups continuing Skull base provision (NCIN, NNAP) SRS Quality Assurance
19
20 Update on NICE guidance
21
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