Cancer Reform Strategy - NHS Cancer Screening Programmes

CHAPTER 9: STRONGER COMMISSIONING 111framework for planning future cancer servicesand clearly identified priorities, a further 25%were found to be struggling in all these areas.This, therefore, remains an important area fordevelopment.9.6 It is important to recognise thatcommissioning for cancer is particularly complex.There are many different types of cancer, eachwith a different care pathway involving clinicalteams in the community, in acute generalhospitals and in specialist centres. Some aspectsof the diagnosis and treatment of cancer arerare and require highly specialisedcommissioning at a national or Strategic HealthAuthority (SHA) level. Other aspects of cancerare common and overlap with non-cancerservices (such as endoscopy, imaging, pathologyand some surgery) and thus should becommissioned at a more local level.●●As mentioned in chapter 8, an electroniccommissioning toolkit, is beingdeveloped to provide SHAs, SpecialistCommissioning Groups (SCGs), cancernetworks, PCTs and NHS Trusts withcomparative data on incidence, survivaland mortality from cancer and oninformation available from nationalsources such as hospital episodestatistics. The Cancer Action Team willsupport networks in using this toolkitand will commission upgrades as andwhen is necessary; andService specifications for each cancerpathway are being developed, whichwill be linked to the Map of Medicine,a process which offers high qualityclinical information, linked to the NHSIT Programme.9.7 A significant amount of cancer care is bestcommissioned at populations of one to twomillion people because of the critical massrequired to provide effective care. This includesradiotherapy, specialist surgical services forupper gastrointestinal, urological, gynaecologicaland head and neck cancers and aspects ofchemotherapy. For this reason we continue torecommend that cancer commissioning iscoordinated across a network of care, based onpatient care pathways into these services, ratherthan formal organisational boundaries.9.8 The Department of Health has publishedWorld Class Commissioning, which sets out howPCTs should ensure strong commissioning acrossall health services. A support and developmentframework will be available in 2008 to help PCTsgain the capability to become world class. TheCancer Reform Strategy sets out specific supportthat will be available to cancer commissioners.9.9 To strengthen commissioning of cancerservices the following actions are alreadybeing taken:●A guide for cancer commissioners,is currently in development, this willset out the appropriate level for thecommissioning of different cancer services;9.10 Given the cross-organisational way inwhich many cancer services are delivered,collaboration should be an important part ofcancer commissioning:●●●●Patients, local voluntary service providers,alternative providers and other stakeholdersshould be involved in influencing the way inwhich services develop;Commissioners and providers should worktogether to improve service quality andsafety and plan future provision;Clinicians and managers should collectivelydrive forward innovation in the way servicesare delivered; andPCTs should work together to developstrategies and agree priorities.9.11 Cancer networks play an essential role infostering this collaboration. PCTs in somenetworks have been very successful at bringingtogether the relevant commissioningpartnerships to plan and monitor servicedelivery. Other networks have lacked PCTengagement and network teams have largelyworked with providers in isolation ofmainstream health economy systems.