This award goes to a team who can demonstrate how they have improved an aspect of cancer commissioning.
Herceptin at Home – a shared care model delivering patient choice and efficiency
Pan Birmingham Cancer Network
In February 2010 a QIPP initiative to deliver Herceptin at home, saving £700k recurrently, was at risk of failing. Despite local CQUIN incentive for Trusts, there were barriers, (organisational, financial, emotional and safety) to working with a private sector organisation; Health Care at Home through a strategic partnership began working with the West Midlands Specialised Commissioning Group.
The Cancer Network and its Service Improvement Team were asked to support this work stream as a key priority. By focusing on improving the patient’s experience of care, the Service Improvement Facilitator was able to bring together local teams to agree the appropriate care pathway, supported by IT and effective communication in accordance with Information Governance requirements.
After six months, 61 per cent of eligible Herceptin patients from five chemotherapy units in three Foundation Trusts were opting to receive their treatment at home.
This pilot demonstrated the feasibility of delivering home chemotherapy through effective partnership working between NHS and private sector providers.
Improving cancer outcomes through value-based commissioning
NHS National Programmes, Roche Products Ltd and North East London Cancer Network
This project was designed to simplify the considerable task of costing cancer into an achievable process by focusing on costing two high-volume cancer pathways – breast and lung. The key objective was to facilitate the delivery of high-quality cancer care by understanding the costs of the clinically effective pathways in order to inform future commissioning, ensuring services are appropriately funded. This would give a good guide to commissioners on their total funding requirements for cancer and allow them to have an informed discussion with their providers on how they could improve quality and value-for-money cancer care.
The project will give commissioners greater clarity on which HRGs align with the national pathways for lung and breast cancer, and enable consistent coding of activity across London. Commissioners will have a better understanding of current patient pathway flows across London Trusts, and the impact that has on costs. In turn this should inform commissioning of Secondary Care activity related to best practice care. Roche has benefited from costed pathways being developed to include NICE approved treatments and cancer care being appropriately funded across London.
The project has brought providers and commissioners closer together to help them better understand the true cost of delivering cancer care. A population-based predictive cost model has been developed to cost out the best practice breast cancer care pathway. This has enabled greater clarity on current service specification against the best practice pathway and informed negotiations between commissioners and providers on quality improvements.
The output from the costed pathways project is also being used as part of a pilot to develop best practice tariffs for selected tumours in shadow form from 2012/13 across London.
Cancer chemotherapy commissioning doesn’t have to be a black hole
East Midlands Cancer Network, Royal Derby Hospitals NHS Foundation Trust
The East Midlands Cancer Network (EMCN) demonstrates best practice in commissioning chemotherapy drugs in the interest of patients by driving quality, productivity and equity of care through improved understanding of chemotherapy expenditure in the absence of network-wide electronic prescribing systems.
The EMCN programme used detailed expenditure data to facilitate a clinically led commissioner review of prescribing practices. This approach has reduced the rate of increase in spending on chemotherapy over the past three years, which was achieved in parallel with enhanced patient care through the development of agreed funded care pathways and treatment algorithms. In turn this has enabled more equitable and evidence-based management of patients, which is resulting in improved patient outcomes across the region.
It also serves to emphasise the benefits of a single lead commissioner working with a single cancer network on behalf of the commissioning stakeholders in a defined area. It also provides a way in which a simple expenditure review process can result in benefits in quality and cost until the new mandatory chemotherapy dataset is established.