National Specialised Commissioning for Radiotherapy

Dr Peter KirkbrideMedical DirectorThe Clatterbridge Cancer Centre

Purpose

CRGs established to be primary source of clinical advice to NHS England in support of the direct commissioning of prescribed specialised services.

‘Through their work programmes, and by working in partnership with key stakeholders, CRGs drive improvements in the quality, equity, experience, efficiency and outcomes of commissioned specialised services.’

Membership• Full (voting) members:• Clinical chair.• National Clinical Director(s) pertinent to the CRG's role, who will

act as co-chair(s).• 14 clinical representatives (3 from the London senate area, 1

from each of the other 11 senate areas in England).• Up to 4 patient and carer representatives.• Up to 4 members representing organisations with a significant

role in the assurance and coordination of clinical training.• Accountable commissioner (acting as national lead

commissioner)• Collaborating commissioner (usually a commissioner who has

previously acted as lead commissioner to the group or from an area team with specialised commissioning responsibility).

Membership• N1 North East Chris Walker • N2 Greater Manchester, Lancashire & S

Cumbria Carl Rowbottom • N3 Cheshire and Mersey Peter Kirkbride • N4 Yorkshire and Humber Ann Henry • M1 West Midlands Daniel Ford• M2 East Midlands Russell Hart • M3 East of England Christopher Scrase• L1 London NW Danielle Power • L2 London NE vacant• L3 London S Imogen Locke • S1 South West Carol Scott • S2 Wessex Kim Sanderson • S3 Thames Valley Ralph Roberts • S4 South East Coast David Bloomfield

• Patient and Carer Members• Lesley Smith • Tony Murphy • Linda Samuels • Ron Clayton • Institute of Physics and Engineering Derek

D’Souza• Society and College of Radiographers

Charlotte Beardmore • Royal College of Radiologists Diana Tait• Co-chairs (interim) Peter Kirkbride and

Adrian Crellin• Accountable commissioner Kim Fell

Resources

The role of the CRG is to:• Act as a source of expert, and where possible consensus,

advice to NHS England on specialised services.• Actively engage with a range of stakeholders to inform and

develop improvement priorities, shape key products developed by the CRG and inform CRG recommendations.

• Develop a range of commissioning 'products' (including service specifications and commissioning policies) which describe the national requirements of commissioned providers of specialised services and promote high quality, equitable care.

• Drive quality improvement, through the identification of best practice and development of key outcome measures for inclusion in quality dashboards to promote and benchmark quality

The role of the CRG is to:• Act as a source of expert, and where possible consensus,

advice to NHS England on specialised services.• Actively engage with a range of stakeholders to inform and

develop improvement priorities, shape key products developed by the CRG and inform CRG recommendations.

• Develop a range of commissioning 'products' (including service specifications and commissioning policies) which describe the national requirements of commissioned providers of specialised services and promote high quality, equitable care.

• Drive quality improvement, through the identification of best practice and development of key outcome measures for inclusion in quality dashboards to promote and benchmark quality

The role of the CRG is to:• Act as a source of expert, and where possible consensus,

advice to NHS England on specialised services.• Actively engage with a range of stakeholders to inform and

develop improvement priorities, shape key products developed by the CRG and inform CRG recommendations.

• Develop a range of commissioning 'products' (including service specifications and commissioning policies) which describe the national requirements of commissioned providers of specialised services and promote high quality, equitable care.

• Drive quality improvement, through the identification of best practice and development of key outcome measures for inclusion in quality dashboards to promote and benchmark quality

The role of the CRG is to:• Act as a source of expert, and where possible consensus,

advice to NHS England on specialised services.• Actively engage with a range of stakeholders to inform and

develop improvement priorities, shape key products developed by the CRG and inform CRG recommendations.

• Develop a range of commissioning 'products' (including service specifications and commissioning policies) which describe the national requirements of commissioned providers of specialised services and promote high quality, equitable care.

• Drive quality improvement, through the identification of best practice and development of key outcome measures for inclusion in quality dashboards to promote and benchmark quality

Scope of RT Service specificationAims and objectives of service• Using the Quality Dashboard approach it is expected that radiotherapy services

will be developed over time to ensure that: • Safety: Radiotherapy is delivered according to national standards • Uptake: 52% of all cancer patients should be offered radiotherapy at some point in

their pathway. • Access: Local calculations based on Malthus predictions should be used to increase

the number of attendances per million population by 2016. Up to 47,000 attendances per million population. Earlier access to radiotherapy should be demonstrated by greater use of radical (rather than palliative) radiotherapy

• Capacity: An additional 13% capacity is identified as available to meet fluctuations in demand and technical development requirements. This is essential to be able to meet waiting times targets.

• Wait for First Treatment: Radiotherapy: 62 day from urgent referral to treatment and 31-Day Wait from decision to treat to treatment for all cancers and second or subsequent treatment: It is also expected that departments meet the Joint Collegiate Council for Oncology (JCCO) standards for radiotherapy treatment which should be regularly monitored by each service

Quality dashboard

• Quality Dashboard pilot programme to provide additional ‘real-time’ information on outcomes for specialised services and assurance on the quality of that care.

• The information can be used by:– Provider Boards to provide an overview of the service quality they

provide; and– NHS England specialised services commissioners to understand the

quality and outcomes of services and reasons for excellent performance or alternatively, any variation.

• Pilot started in July 2012/13; teams from 20 CRG’s (including Radiotherapy) agreed key measures for each service area

The role of the CRG is to:• Inform work on data and pricing, enabling the transparent

identification and funding of specialised services activity, and support the development over time of appropriate coding, currencies and tariffs that capture and support best practice commissioned pathways.

• Develop an innovation portfolio, sharing good practice and identifying initiatives for potential national roll out.

The role of the CRG is to:• Inform work on data and pricing, enabling the transparent

identification and funding of specialised services activity, and support the development over time of appropriate coding, currencies and tariffs that capture and support best practice commissioned pathways.

• Develop an innovation portfolio, sharing good practice and identifying initiatives for potential national roll out.

Commissioning through Evaluation (CtE)

• Launched in September 2013• Selective Internal Radiotherapy first service to benefit: SABR

now under consideration• Aimed at improving access to services not currently routinely

funded by NHS as existing evidence does not demonstrate sufficient clinical and cost-effectiveness for routine use.

• Treatments/technologies chosen for CtE will have shown promise in terms of improving patient outcomes

• Once provider centres selected, CtE treatments offered to patients deemed clinically suitable within defined parameters of explicit evaluation programme.

The role of the CRG is to:• Lead initiatives to improve the value for money of

commissioned specialised services, recommending decommissioning in areas of potential inefficiency or waste, identifying areas where clinical collaboration may generate savings and enabling the reinvestment of resources in identified priorities.

• Identify areas of improvement that may be support through the use of CQUIN funding, developing schemes and associated reporting requirements for inclusion in provider contracts.

• Inform the consideration by the Clinical Advisory Group (and subsequently, Ministers) of services for inclusion / exclusion in the list of those specialised services prescribed for direct commissioning by NHS England.

The role of the CRG is to:• Lead initiatives to improve the value for money of

commissioned specialised services, recommending decommissioning in areas of potential inefficiency or waste, identifying areas where clinical collaboration may generate savings and enabling the reinvestment of resources in identified priorities. (Radiotherapy QIPP – fractionation)

• Identify areas of improvement that may be support through the use of CQUIN funding, developing schemes and associated reporting requirements for inclusion in provider contracts.

• Inform the consideration by the Clinical Advisory Group (and subsequently, Ministers) of services for inclusion / exclusion in the list of those specialised services prescribed for direct commissioning by NHS England.

Resources

Resources

The role of the CRG is to:• Lead initiatives to improve the value for money of

commissioned specialised services, recommending decommissioning in areas of potential inefficiency or waste, identifying areas where clinical collaboration may generate savings and enabling the reinvestment of resources in identified priorities.

• Identify areas of improvement that may be support through the use of CQUIN funding, developing schemes and associated reporting requirements for inclusion in provider contracts.

• Inform the consideration by the Clinical Advisory Group (and subsequently, Ministers) of services for inclusion / exclusion in the list of those specialised services prescribed for direct commissioning by NHS England.

The role of the CRG is to:• Lead initiatives to improve the value for money of

commissioned specialised services, recommending decommissioning in areas of potential inefficiency or waste, identifying areas where clinical collaboration may generate savings and enabling the reinvestment of resources in identified priorities.

• Identify areas of improvement that may be support through the use of CQUIN funding, developing schemes and associated reporting requirements for inclusion in provider contracts.

• Inform the consideration by the Clinical Advisory Group (and subsequently, Ministers) of services for inclusion / exclusion in the list of those specialised services prescribed for direct commissioning by NHS England.

Resources

Latest Developments• Briefing to stakeholders: ‘it is clear that we need to

make some immediate improvements to the way in which we commission these services in order to put specialised commissioning on a stronger footing for the future’.

• 7 distinct workstreams with focus on financial control in 2014-15 and planning for the 2015-16 commissioning round.

• Working to a 3-month timetable; weekly reviews

Latest Developments• Workstream 1 – Strategic Projects• Workstream 2 – Strategy• Workstream 3 - Clinically Driven Change• Workstream 4 - Operational Leadership• Workstream 5 - Commercial and Technical Delivery• Workstream 6 - Strong Financial Control• Workstream 7 – Analytics

Summary• RT-CRG grappling with large agenda• RT-CRG operating in time of uncertainty• Cost saving a priority for NHS England• No central support available, reliant on goodwill of

members and their Trusts• Need to keep professional bodies ‘in the loop’• RCR, SCoR and IPEM all represented on RT-CRG• Also need communication with, and support from,

‘coal-face’

Questions?

Where I have come from