Analysis

Vanguard sites move forward in improving cancer services

A year ago NHS England called for applications from organisations across the country to become vanguard sites for a new programme of care models.

Picture credit: Alamy

A year ago NHS England called for applications from organisations across the country to become vanguard sites for a new programme of care models.

The vanguards are being developed as part of the NHS Five Year Forward View published in 2014, which set out the future of the health service based on new models of care, with cancer care being described as a clinical priority.

To date, 50 vanguards have been set up, of which 13 are part of an acute care collaboration. According to NHS England, their aim is to spread excellence in hospital services and management, driving efficiency and improvement across the country.

Specialty partnerships

The acute care collaboration includes specialty partnerships covering areas such as cancer and mental health. Leading cancer hospitals University College London Hospitals (UCLH) NHS Foundation Trust, the Royal Marsden NHS Foundation Trust and

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Picture credit: Alamy

 

A year ago NHS England called for applications from organisations across the country to become vanguard sites for a new programme of care models.

The vanguards are being developed as part of the NHS Five Year Forward View published in 2014, which set out the future of the health service based on new models of care, with cancer care being described as a clinical priority.

To date, 50 vanguards have been set up, of which 13 are part of an acute care collaboration. According to NHS England, their aim is to spread excellence in hospital services and management, driving efficiency and improvement across the country.

Specialty partnerships

The acute care collaboration includes specialty partnerships covering areas such as cancer and mental health. Leading cancer hospitals University College London Hospitals (UCLH) NHS Foundation Trust, the Royal Marsden NHS Foundation Trust and the Christie NHS Foundation Trust have joined forces as a clinical network. Its aim is to innovate, expand existing cancer networks to improve early diagnosis and reduce variations in the quality and cost of care.

The Independent Cancer Taskforce strategy published last year highlights significant variations in survival among patients in England. It recommends that processes for commissioning, accountability and provision should be overhauled, and that critical workforce deficits should be addressed.

The Five Year Forward View predicts that the cost of cancer services will grow by 9% a year, which means it could rise to £13 billion per annum by 2020/21.

Reduce variation

UCLH cancer programme director Jonathan Gardner says: ‘We have an opportunity to influence positive outcomes and experience and reduce variation.’

Mr Gardner adds that UCLH is keen to work with its partners on areas such as early diagnosis, implementation of best practice and new models of care.

‘Across the UK we are not doing as well in our one to five-year survival rates compared with Europe or the rest of the world,’ he says.

Diagnosis in emergency departments

Mr Gardner explains that patients with lung, colorectal and upper gastrointestinal cancers are being diagnosed through emergency department routes, when their disease is at an advanced stage, rather than through GP referral.

UCLH is working with North Middlesex University Hospital NHS Trust on new ways to co-ordinate radiotherapy services and to implement a chemotherapy programme in the community.

Mr Gardner says: ‘In the future, cancer nurse specialists may be employed by one organisation but work across a number of organisations, and in primary and secondary care,’ he says. ‘We need to break down barriers between organisations. There may be some initial costs, but in the long term, diagnosing people with cancer in the early stages will save lives, which is the most important thing, and save money.’

Royal Marsden NHS Foundation Trust chief executive Cally Palmer, who has been seconded to NHS England as national cancer director, will lead implementation of the Independent Cancer Taskforce’s strategy.

Patient consultation

Trust chief nurse Shelley Dolan believes that, to attain the goals of the vanguard, patients must be consulted on ideas for designing a better system. ‘We have consulted various people, including those in primary and secondary care, hospices and patient groups, in developing a general model,’ she says.

Ms Dolan adds that distances between cancer vanguard organisations has not been a problem because they have weekly teleconferences to update on progress.

‘Nurses are playing important leadership roles across the vanguards,’ she says. ‘They are involved in patient journeys and can work across systems, including across primary and secondary care. As someone with a cancer nursing background, I can see this is an opportunity for nurses to make a difference.’

Collaboration

In Greater Manchester, the Christie NHS Foundation Trust is taking the lead with collaboration from Trafford Clinical Commissioning Group (CCG) and Manchester Cancer.

Manchester Cancer medical director David Shackley highlights the need to tackle fragmentation in healthcare services. He says: ‘In Manchester alone there are 12 CCGs and ten acute providers. No single organisation holds overall accountability for the patient’s pathway, and this can lead to fragmentation and lack of standardisation.

‘Standardisation would help nurses and other clinicians immeasurably. The vanguard will try to resolve all this by getting commissioners to take a common approach, and providers to adopt the same clinical and operational standards.’

Transformation fund

All 50 NHS England vanguards can access a transformation fund of £340 million in 2016/17 to develop new care models.

Dr Shackley says the three lead organisations in the cancer vanguard, which cover a catchment area of ten million patients, are developing a business proposal to acquire more funds.

‘We hope for substantial funding due to the breadth of the cancer vanguard, which covers prevention, early detection, new diagnostic models and more work streams across the entire pathway,’ he says.

Vanguards should find out how much funding they will receive in spring 2016.

Role of nurses

Former nurse and director of the new care models programme at NHS England Samantha Jones says that nurses have an important role to play in the vanguards, and that clinicians should help shape the emerging models of care at a local level.

‘The vanguards are challenging our current approach to workforce,’ she says. ‘We must ensure, for example, that we are making the best use of nurses, whether in hospitals, the community or primary care. This may include senior and specialist nurses working between different organisations to maximise their skills and experience.’

 

 

 

 

 

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