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Answering the cancer commissioning questions that really matter

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Can we improve cancer outcomes through the use of robots?

How can we commission services differently to reduce variation in cancer outcomes?

How can we implement a new local model of care for head and neck cancers to improve outcomes?

These are questions set by our partners in NHS England which we have recently answered through expert cancer data, analytical, commissioning and population-healthcare advice.

NHS England’s specialised commissioning services account for £14 billion of NHS spend and relate to a wide range of rarer conditions or services where specialist knowledge is required to commission them effectively.

The cancer component of these services is significant and includes chemotherapy, radiotherapy and the suite of drugs which fall under the Cancer Drugs Fund. Strategic and operational oversight is through the NHS England Cancer Programme of Care Board.

We have a vital role in supporting this through our specialised commissioning public health network, and the varied skills of PHE we make available to NHSE. This includes topic based expertise, systems leadership and, crucially, one of the world’s most complete and robust cancer surveillance and registry data systems.

Our National Cancer Registration Database includes high quality data on diagnosis, treatment and outcomes – all of which are important for specialised commissioning – and we have access to many of the audits run by professional associations.

In addition, the expertise and experience built up by working closely with clinicians allows us to contribute meaningful analysis and interpretation. So, we are well placed to contribute to the support of specialised commissioning. Which brings us back nicely to our questions.

“Can we improve cancer outcomes through the use of robots?”

Well, yes, but only where the evidence and outcomes are well defined. In this example we supported NHS England by working in partnership with their Clinical Reference Group for urological cancer and the British Association of Urological Surgeons (BAUS) to assess the use and impact of robotic surgery for removing the prostate, bladder or kidney in cancer patients.

Robots cost between £1m and £2m so require significant NHS investment and the evidence base continues to develop internationally, across a range of cancer indicators. We were able to investigate differences in length of hospital stay, blood loss, ischaemia time, positive margins (a measure of surgical quality) for various surgical approaches.

We were also able to see if a certain number of operations per hospital was required to give the best patient outcomes. As a direct result of this work, NHS England has implemented a national policy to improve access for patients to have prostatectomies undertaken using robotic approaches. It is one of many examples where PHE’s world class cancer data helps NHS England to support innovations in cancer treatment and care.

But we don’t just use our expertise to focus on cancer innovations and policy, and this brings us to our second question:

“How can we commission services differently to reduce variation in cancer outcomes?”

Variation in cancer outcomes has been subject to continued high profile coverage in England, and a key focus of the recent Cancer Taskforce report is to reduce the variation in outcomes.

Over the past 18 months PHE has been supporting NHS England do just that through its programme in specialised commissioning and production of two ’high spend/high impact’ reports on lung cancer and chemotherapy. These reports described the ‘whole pathway variation’ evident in these two priority areas of cancer care, outlining geographic variation in prevention, early diagnosis, and treatment indicators by CCG in England.

These reports, in parallel with the development of the interactive Strategic Health Asset Planning (SHAPE) atlas for lung cancer and chemotherapy allowed NHS England to interrogate pathway data and understand the impact of commissioning decisions.

The reports and SHAPE tools were used by the NHS England Cancer Programme of Care Board to prioritise lung cancer as a collaborative commissioning priority area, which led to the creation of regional pilots to address variation in lung cancer outcomes in the North and East of England, supported locally through our PHE Centres.

The chemotherapy report, combined with leadership from PHE’s specialised consultants Leonie Prasad and Ayesha Ali, has helped inform NHS England’s Commissioning for Value plans and chemotherapy commissioning products as they continue to develop their work streams on reducing variation.

Of course to tackle variation at local levels, services and new models of care need to transform, which leads us to our final question:

“How can we implement a new local model of care for head and neck cancers to improve outcomes?”

Through our local PHE Centres, our approach impacts directly on improving access, outcomes, and reducing variation. In South Yorkshire, PHE supported commissioners and providers in working together to ensure specialist head and neck cancer services were compliant with national guidelines and NHS service specifications. PHE’s analytical and centre team provided a bespoke epidemiological analysis to support commissioning options.

The data generated were used to support briefings for key local stakeholders, and facilitated implementation of a new model of care. Our data also enables us to evaluate the impact of new models of care and the team continues to support the evaluation and monitoring of the new care model.

This is one of many examples where our nationally collected data, combined with our local expertise, supports the NHS and partners to improve public health and reduce inequalities.

The challenges to deliver the Cancer Taskforce recommendations will require PHE to answer more of these complex cancer intelligence and commissioning questions.

Working together to answer them will continue to have a real, direct, impact on improving outcomes, reducing inequalities, and improving the public’s health.

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