Specialised Urology CRG Update David Hrouda

Transcription

1 Specialised Urology CRG Update David Hrouda September 2014

2 The Role of the Clinical Reference Group: Specialised Urology formed May

3 How commissioning is structured NHS England responsible for commissioning prescribed specialised services through provider based commissioning for all eligible England patients. Clinical commissioning groups (CCGs) supported by commissioning support units - responsible commissioning community and acute care for local populations Local authorities responsible for prevention services for local populations NHS England responsible for commissioning primary care (including dental etc.), health in the justice system, military health, screening programmes 3

4 What is Specialised? All care provided by Specialist Cancer Centres for specified rare cancers (Penile, Testicular) Complex surgery for specified common cancers provided by Specialist Cancer Centres (defined specialist surgery only for Bladder, Kidney and Prostate cancers) Certain specified interventions provided by specified Specialist Cancer Centres (cryotherapy for renal cancer) All Chemotherapy All Radiotherapy New additions from PSSAG 4

5 Aim of national commissioning commissioned? Convergence to consistent standards Contracting for equity (but not one size fits all) Improve outcomes Decisions influenced by clinical advice National commissioning products implemented locally 5 year strategy to transform inputs and outcomes 5

6 Clinical Reference Groups (CRGs) Specialised Services Directly Commissioned by NHS England Lead development of the products or tools required for the effective commissioning of specialised services. 75 Clinical Reference Groups Clinical Advice & Leadership in Specialised Commissioning Patient & Stakeholder Views 6

7 Chair Commissioner SPECIALISED UROLOGY CRG MEMBERSHIP Vijay Sangar Programme Director Highly Specialised Cancer & Blood Services, NHS England Senate Cheshire & Mersey Nigel Parr North East, North Cumbria Nicola McCulloch Aftab Bhatti Greater Manchester Yorkshire and The Humber West Midlands East Midlands East of England London NW London NE London S South West Thames Valley Wessex South East Coast Helen Johnson Matthew Simms Rupesh Bhatt Santhanam Sundar Anthony Riddick David Hrouda Asif Muneer David Nicol Mark Stott Vacant Rowland Rees Seshadri Sriprasad Affiliated Orgs BAUN Jane Booker BAUS Jo Cresswell PPE PPE PPE PPE BUG RCR Simon Chowdhury John Graham Hugh Butcher Fiona Carey Colin Sloan Gordon Cairns

8 Policy Development Process CRG Agreement Formal Consultation (if required) Implementation Stakeholder Views CPAG Sign Off Programme Board Sign Off Finance Review 8

9 Commissioning Specialised Services The specialised commissioning function of NHS England takes place at 3 levels: National - National Clinical Director for Specialised Services within Medical Directorate with National coordinating team. Regional Regional Programme of Care Managers working as part of National Programme of Care maintain balance between national consistency and local delivery. Area Teams 10 Area Teams have responsibility across England to contract and deliver national frameworks with local providers 9

10 bns The Financial Challenge If we continue with the current model of care it is likely we will face a funding gap between projected health spending requirements and NHS England resource of around 30bn between 2013/14 and 2020/21. This estimate is before taking into account any productivity improvements and assumes the NHS England resource remains protected at flat real. Projected Resource vs. Projected Spending Requirements bn gap 90.0 FY 13/14 FY 14/15 FY 15/16 FY 16/17 FY 17/18 FY 18/19 FY 19/20 FY 20/21 Total Projected Costs Projected Resource 10

11 Strategic Direction 1. Ensuring consistent access to effective treatments in line with evidence based clinical policies, underpinned by audit 2. Clinical sustainability programme with providers, focused on quality and value 3. Financial sustainability programme with providers, focused on better value 4. Systematic market review of capacity, consolidating services to address clinical/financial issues 5. New commissioning approaches that promote integrated care 6. Systematic rules-based approach to in-year management of contractual service delivery

12 12 Our Work Programme

13 Domains NHS Outcomes Framework Prevent Premature Death Enhance QoL in survivors Help recovery from ill health Ensure people have a positive experience Safe environment, protect from harm Planning Guidance Equity Efficiency

14 Products Service Specifications Disease specific commissioning Policy Statements CQUINS Quality Dashboards

15 Current Work Plan Service Specifications Penile Cancer Testis Cancer Bladder, Prostate and Renal Cancer Quality Dashboards Penile Cancer Testis Cancer

16 Current Work Plan Policy/Specification RAS Penile Implant Urethroplasty SNS SSR Renal Cryo/RFA Prostate HIFU/Cryo

17 Specifications Current review of Kidney Bladder & Prostate Cancer Specifications Align NE London Volume Outcome Relationship Improve Outcomes Options for different configurations depending on population 17 NHS Presentation to [XXXX Company] [Type Date]

18 Data In order to Commission effectively Quality measures Quality data Quality collection

19 Quality Dashboard Example Percentage of patients with penile cancer in whom data is collected and registered within 40 days of discharge Description KPI Numerator Denominator Period BAUS Data Completeness BAUS data: Minimum dataset completed for patients undergoing penile cancer surgery (%) Number of patients that have a complete BAUS dataset within 40 days of discharge All patients undergoing penile cancer surgery quarterly

20 Example:Quality Dashboard for Penile Cancer Preventing People from Dying Prematurely: Time from primary surgery to nodal surgery (high priority) 1 Year Survival rate (high) any penile SCC 5 Year Survival rate (high) - any penile SCC Enhancing Quality of Life in Survivors Proportion of men with primary disease undergoing penile preserving surgery Helping People Recover from Ill Health Emergency readmission rates at 30 days for ILND

21 Quality Dashboard for Penile Cancer Treating people in a safe environment: General: Proportion of patients undergoing partial or total penectomy or ILND on extended VTE prophylaxis. Proportion of patients for whom COSD (clinical outcomes & services database) data registry is complete

22 Output Percentage of patients undergoing penile cancer surgery in whom BAUS audit data is collected and registered with 40 days of discharge Period Numerator Denominator Trust Average National Average Q % 80%

23 Output Bullet Chart

24 Data Collection Using available resources HES SACT NCIN - COSD BAUS Other registries 24 NHS Presentation to [XXXX Company] [Type Date]

25 Problems with data Collection Unable to catch all data that matches QD Data may be missing in some areas Varied routes of collection Who should collect 25 NHS Presentation to [XXXX Company] [Type Date]

26 Solving the problems One measure for Commissioning: The number of patients with condition X that have a full Z data set collected within 40 days of discharge Z can be BAUS, COSD??? 26 NHS Presentation to [XXXX Company] [Type Date]

27 Where can we work together? Align Quality Measures (NICE QS) Quality Dashboards Requires Collaboration NHSE, NCIN, NICE, BAUS 27 NHS Presentation to [XXXX Company] [Type Date]

28 Conclusions The Specialised Urology CRG in NHSE is young and evolving rapidly Its work plan varies depending on priorities Service Specs & Policy will also evolve Commissioning will require excellent data We need to work together to make data collection happen