Building on Success Driving improvements in clinical outcomes through a Greater Manchester Cancer Alliance May 2015
Introduction Cancer care in Greater Manchester has seen significant improvements in recent years with one year survival rates, performance against national waiting time targets and patient experience measures all outperforming rates across England. Specialist cancer care is clearly evidenced at being highly effective, even in the context of Greater Manchester s population epidemiology. The challenge facing Greater Manchester in driving improved outcomes for cancer patients lies in the early parts of the patient pathway - ensuring patients are identified, diagnosed and referred promptly for treatment. The Greater Manchester Cancer Alliance is the vehicle through which this could be systematically addressed.
Background (1) Recent publications continue to highlight the relatively poorer clinical outcomes for cancer care in UK compared to other similarly rich European countries. The reasons are believed to be multiple with one of the main reasons being UK patients present with cancer at a more advanced stage Greater Manchester has a very high rate of premature cancer death : This is people dying of cancer under 75y of age [PHE]. This measure is critically important however because of the time-lag with this measure, changes to care now will take many years to feed through The PHE data also shows considerable variation in cancer outcomes within Manchester CCG s Too many patients in GM are being diagnosed as emergencies or at a late stage, significantly affecting their long term clinical outcomes. This table illustrates the rank of GM Local Authorities against the 150 English LAs for premature death from cancer
Background (2) Cancer is a long term condition with significant issues around avoiding premature mortality and survivorship as well as initial treatment. Cancer is becoming more prevalent almost 1 in 2 people can expect to develop cancer in their lifetimes The key determinants in improving outcomes include work in public education and earlier diagnosis; and in the future offering more personalised and effective treatments Cancer care spans many organisations with significant potential for fragmentation and delay. A coordinated integrated system is essential with effective accountable clinical leadership: In GM, over the last 2 years, an integrated cancer system has been set up Progress on key measures is now being seen
Greater Manchester Cancer Alliance GM Cancer Alliance Manchester Cancer MAHSC Cancer Domain GM Cancer Commission ing Board The Greater Manchester Cancer Alliance is a collaboration between healthcare and university partners aligned in a common objective to improve clinical outcomes for Greater Manchester cancer patients.
Guiding Principles Outcome Focussed Clinically Led Patient Centred
Patient Centred Manchester Cancer has successfully bid to Macmillan Cancer Support for funding in excess of 300k over 2 years to form a dedicated user involvement team The team will start work in May 2015 and will ensure that there is genuine supported user involvement at the heart of all Manchester Cancer work Clinically Led Through Manchester Cancer the CEOs of the region s hospital trusts have appointed 20 Clinical Directors Each Director has dedicated time to lead the development of services across the region for a particular cancer type or area Directors lead Pathway Boards, regional multidisciplinary groups that produce clear work plans and annual reports and have named leads for research, education, etc. Outcome Focussed All 20 clinical leaders of cancer specialist areas in GM are focussing predominantly on 3 main outcomes: 1. Survival and reducing cancer and treatment-related harm: Outcome-based scorecards are available at all levels 2. Constantly improving patient experience across the whole pathway 3. Driving innovative practice and research to improve future outcomes
Successes to Date The latest data shows that one year cancer survival is now significantly better than the England average (by 0.6%) and also much better than comparable Cities Patient satisfaction The most recent national data shows that Cancer Care in GM is 1 st or 2 nd of all large conurbations on key patient experience metrics 62 day pathway As a city, the 62d target has been consistently achieved In 2013, GM had 4 non-iog compliant cancer services and in May 2015 this has been reduced to 2 Manchester has an extensive cancer research portfolio of international standing, the MCRC, the CRUK Major Cancer Centre status and also amongst cancer clinical trials, the highest recruiting cancer network in England Trans-agency GM cancer objectives have been recently agreed by all key partners and so for the first time key stakeholders will be bound by the same goals 350k Macmillan funding secured to support Manchester Cancer Pathway Boards in developing innovative ways of caring for the increasing numbers of people living with and beyond cancer
One Year Survival 1996-2012
62 Day Cancer Pathway All providers in GM view the meeting of national targets like 62 days as fundamentally important all breaches are unacceptable. Greater Manchester s performance against the 62-day cancer waiting time target since 2011/12 compared with England as a whole The Christie, as the main specialist cancer service provider, does not accept GP direct referrals unlike other national cancer providers. This means that GPs refer to local hospitals for diagnosis and onward referral. This multistage / multi organisational pathway means there is greater potential for delay. Breach reallocation between providers has been in place for a number of years. Monitor are fully informed and supportive of this mature and collaborative agreement As can be shown in the graph, since 2012/13, GM has consistently out performed the England average for meeting this national target. Audits undertaken in developing GM wide action plan.
Patient Satisfaction Data
Enhancing patient choice and experience through flexible service delivery Patients home Local hospital or primary care centre Mobile Chemotherapy Unit Christie Withington site 80% of GM chemotherapy is delivered close to patients homes. Innovative models of care include local delivery of outpatient follow ups, satellite radiotherapy and other cancer care treatments.
CrUK National Cancer Centres One of Two CRUK Major Centres in the UK The CRUK lung cancer centre of excellence (with UCL) The Movember prostate cancer centre of excellence (with Queens University Belfast) The CRUK centre of excellence for Imaging (with Cambridge)
GM Cancer recruits more patients into clinical trials than any other cancer network in the country. This means GM patients gain access to more innovative and leading edge treatments
Comprehensive Cancer Education Strategy across Greater Manchester Objective Rationale Standardised of the education All staff and the public can access straight forward, prepared, clear and relevant evidence-based content Coordinated educational offering There is understanding across all partners who is responsible and clear ownership of associated process measures and KPI s. Comprehensive All cancer issues are covered, and all stakeholders and service users have a platform for relevant information Multi-modality Continuously improving People digest information in different ways: There should be information in written form as well as podcasts, film, online lectures, face to face group teaching and the creation of an online healthcare professional platform with a facility to certificate and provide evidence of competency. Websites can be the main portal for the information. Constant evolution of the education offer
In summary Through the Greater Manchester Cancer Alliance partners, outstanding progress has already been evidenced in clinical outcomes. This is an innovative coalition of strategic partners aligned in their commitment to drive forward on this improvement agenda. The success of this cancer partnership could act as an exemplar for other service areas. This places Greater Manchester in a unique position as a national leader in holistic cancer care. The GM Cancer Alliance are developing a joint programme of actions around the early part of the cancer pathway to support primary care in the earlier detection, diagnosis and referral of cancer patients. Named GP leaders and Public Health England representatives are integral to this work. It is the aim of the GM Cancer Alliance partners to drive further improvements in cancer outcomes through their continued and sustained integrated action.