The Sheffield Transformational survivorship project

NCSI - drivers

National Cancer Survivorship Initiative 2008

Finite resources

Increasing survivors

Unmet needs

Cancer Reform Strategy2007

• Breast

•Colorectal• Prostate

Old NewRevised pathway (NTCN 2011)

‘One size fits all approach’

CEA 3/12 (2yrs) 6/12 (3yrs) CT 9 and 24 months Colonoscopy

OPA 3/12 (2yrs) 6/12 (3 yrs.)

5 years secondary care led

Clinical components same

OPA frequency reduced

Transfer of care to PC

Diagnosis & Treatment Recovery

Early monitoring

End of life care

Progressive illness

Later monitoring

What happens here?

Cancer survivor Wider population

Use of the NHS past 12 months:

Primary Care Specialist doctor A+E

90%45%20%

68%15%11%

Impact on work and relationships Prevented by health from

working in preferred occupation

Health interferes in relationship with partner

25%

29%

9%

9%

Difficulty/ inability in undertaking different activities: Vigorous activities (running/

sports) Housework, shopping,

cooking Going out Social activities Personal care

59%

16%18%16%13%

27%

2%4%4%2%

Macmillan Health and Well Being Survey 2008

Where we think people are….

Is not necessarily the case…

New Colorectal Pathway 2011H

NA

+ Ca

re P

lan

Colo

nosc

opy

6/52 OPA

+CEA

9m OPA

CT resultCEA

CT

12mCEA

15m OPA

+CEA

18mCEA

21mCEA

24m OPA

CT resultCEA

HNAcolon

CT

6m OPA

for 1 yr.CEA

HNArectal

Risk

Str

atific

ation

Level 1CEA 6 m

HNAreview

3 mOPA

+CEA

6 mCEA

CancerCare

Review

Level 2CEA 6 m

+Review

TreatmentSummary

Colo

nosc

opy

Colo

nosc

opy

5 yr

ly

Health and well-being event

NCSI

‘immediate benefit to

patient experience

and quality of care along the

pathway’

HNA and Care Planning

Treatment Summaries

Health and Well-being programme

Cancer Care Review

1-2-1 support pilot

Risk stratified pathways

Remote Monitoring

Workforce Education and development

Rehabilitation

> Working through cancer

> Let’s get moving pathway

Project work-streams

A complete pictureRevised follow up

pathwayThe Recovery Package

Locally commissionedscheme Self-management

Clinical effectiveness

• Forecast No. of potential eligible patients per year = 450

• Old pathway (visit) > 2 x OPA per yr. @ £72 each = £64,800

• 70% Level 1 = 315 > 2 x CEA per yr. @ £18 each = £11,340• 25% Level 2 =112.5 > 2 x CEA per yr. @ £18 each = £4,050 + 1 x review per yr. @ 41 each = £4,612 Total under scheme = £20,002

Saving per year = £44,798

Cost benefit analysis - colorectal