organising radiotherapy services – what are the lessons from england

Delivering World Class RadiotherapyDelivering World Class Radiotherapy

Organising Radiotherapy Services – what are the lessons from

England

Tim Cooper

Associate Director – Radiotherapy

National Cancer Action Team


Organising Radiotherapy Services – what are the lessons from

England

Tim Cooper

Associate Director – Radiotherapy

National Cancer Action Team


Vision

Strategy

Delivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class Radiotherapy

NRIG

(NRAG / Cancer Reform Strategy)

Gover

nanc

e

Wide

r Wor

ld

Service Delivery

Comm

issioning

•Safety

•Peer Review

•Clinical Pathways

•Clinical Trials and Research

•New Technology

•Contracting Framework

•RTDS/RES

•Tariff / HRG

•Commissioning Toolkit

•Workforce

•Access

•Capacity

•Survivorship

•Communication Skills

•Leadership

•Engagement

www.cancer.nhs.uk/radiotherapy


http://www.cancer.nhs.uk/radiotherapy


NRIG Subgroups

NRIG - plus ‘press gang’ members

• Workforce• Technology• Protons• Stereotactic• Radiotherapy Clinical Information Group• Raising the profile of radiotherapy

Plus– Tariff (Costing and Coding groups)– R-PORT– Peer Review

http://images.google.co.uk/imgres?imgurl=http://www.noelkingsley.com/blog/archives/newlin_n2.jpg&imgrefurl=http://www.noelkingsley.com/blog/archives/2006/11/&usg=__3CvNMZeK6r2zMiiv206GIO0RCg8=&h=420&w=326&sz=68&hl=en&start=4&sig2=Kdy7MKoSml3TqIIINjeQBA&tbnid=81oSgyb91PQS0M:&tbnh=125&tbnw=97&prev=/images%3Fq%3Djuggling%2Bballs%2Bin%2Bthe%2Bair%26gbv%3D2%26hl%3Den%26rls%3Dig&ei=N3D0SuihCp_NjAfR8smfDg


Headlines

• Relevant Key issues

• Investment

• Engagement

• Leadership

• Play to your strengths

• Toolkits

• Communication


Relevant Key Issues

What does World Class look like??

• Access– Performance

– Productivity

• Workforce

• Technology– IMRT

– SBRT

– IGRT

http://images.google.co.uk/imgres?imgurl=http://oboerista.files.wordpress.com/2007/11/oreo_cookie.jpg&imgrefurl=http://pixxie214.tumblr.com/&usg=__MiL-q-xquPCVyvkdbVVF78CIh1I=&h=308&w=300&sz=22&hl=en&start=41&itbs=1&tbnid=3JuUg5_6CZffdM:&tbnh=117&tbnw=114&prev=/images%3Fq%3Dbite%2Bat%2Ba%2Btime%26gbv%3D2%26ndsp%3D18%26hl%3Den%26sa%3DN%26start%3D36

Delivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class RadiotherapyDelivering World Class Radiotherapy

NRIG

(NRAG / Cancer Reform Strategy)

Gover

nanc

e

Wide

r Wor

ld

Service Delivery

Comm

issioning

•Safety

•Peer Review

•Clinical Pathways

•Clinical Trials and Research

•New Technology

•Contracting Framework

•RTDS/RES

•Tariff / HRG

•Commissioning Toolkit

•Workforce

•Access

•Capacity

•Survivorship

•Communication Skills

•Leadership

•Engagement

www.cancer.nhs.uk/radiotherapy


http://www.cancer.nhs.uk/radiotherapy


Relevant Key Issues

What does World Class look like??

• Access– Performance

– Productivity

• Workforce

• Technology– IMRT

– SBRT

– IGRT

http://images.google.co.uk/imgres?imgurl=http://oboerista.files.wordpress.com/2007/11/oreo_cookie.jpg&imgrefurl=http://pixxie214.tumblr.com/&usg=__MiL-q-xquPCVyvkdbVVF78CIh1I=&h=308&w=300&sz=22&hl=en&start=41&itbs=1&tbnid=3JuUg5_6CZffdM:&tbnh=117&tbnw=114&prev=/images%3Fq%3Dbite%2Bat%2Ba%2Btime%26gbv%3D2%26ndsp%3D18%26hl%3Den%26sa%3DN%26start%3D36


WorkforceReconvened NRAG workforce subgroup (Jane Barrett chair)

4 tier structure - publishing the learning from the pilot sites

HEI & operational managers – 25th Sept 09 - Developing the radiotherapy workforce– 23rd March 10 - Building on success

VERTnow in 40 clinical centres

Radiotherapy Physics - Modernising Scientific Careers- Meeting 5th March - Developing Solutions

Dosimetrists - secured funding to support national early implementation training

programme. Planned April intake.


Service Delivery

Access31 days - analysis of early returns

- data completeness !!Process and pathways

CapacityNetwork led planning in many areas?? 25 satellitesstaged plans - ongoing work

RTDS

Missing patients

Radiotherapy Site Visits

National Purchasing Framework


IMRT

NRIG Technology Group – Chair Michael Williams.

IMRT at least one centre in each Network by 2012

30% of all fractions should be IMRT

Darzi Innovation Metric

•Commissioner guidance•Generic business case•National Training programme•QA audit programme•Consensus document – publishing the evidence

Awarding training support contracts


Stereotactic

• SBRT• Intracranial already done• Focus on Technique • Define Technology• National Specification to NRIG by end 2010• Indications and body sites

H&N; Lung; Liver; Pancreas; Kidney; Spine; Prostate; Mets and Oligometastases;


Headlines


• Investment

• Engagement

• Leadership


• Toolkits

• Communication

Delivering World Class RadiotherapyDelivering World Class RadiotherapyR

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UNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONSUNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONS

National Cancer Action TeamNational Cancer Action Team Department of HealthDepartment of HealthPayment by ResultsPayment by Results

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Leadership & Engagement

• Clinical Leadership

• Programme Leadership

• Progress chaser

• Engagement– Profession– Public– Political– Wider


Headlines


• Investment

• Engagement

• Leadership


• Toolkits

• Communication


Build on the strengths

• Consensus– 5 centres not 50+

• Commissioning– No Linac fairy – so can push boundaries– Central programme – can move to meet need faster.

• Programmes– NRIG programme already clear, so SRAG can use

this and focus on other areas of importance

• Programme engagement


Headlines


• Investment

• Engagement

• Leadership


• Toolkits

• Communication


R-PORT

• Roll out underway• Complete by Spring 10• Amanda Travis appointed to secure roll out• Demonstrate efficiency• Available to all HEI’s• Ongoing development• User Group


CommissioningContracting

Contracting FrameworkService SpecificationRadiotherapy Pathway

www.cancer.nhs.uk/radiotherapy/commissioning

Cancer Commissioning toolkit – radiotherapy section

Radiotherapy Commissioning Pilots x 4

http://www.cancer.nhs.uk/radiotherapy/commissioning


Configuration:

• Lots of very good work underway

• 4 commissioning pilots– Anglia– Sussex– Merseyside and Cheshire– Lancs and S.Cumbria

• N.Trent, Humber and Yorks

• Greater Midlands


Governance

•Peer Review•New Measures …almost complete …..•Completely different•TSR is a recurring theme in peer review

What does a good evidence folder look like?

What information does the Network Radiotherapy Group need?


Other work

• NRAG FAQ’s– Demystifying NRAG

• Public profile– Engaging with Public; Patients; Health community

and the wider world

• Developing the evidence base– Supporting the argument

• Enhanced Cross UK working– Working together and supporting each other.


Headlines


• Investment

• Engagement

• Leadership


• Toolkits

• Communication


Recommendation 1: Planning for the future

• a rolling ten-year plan, setting out a vision and strategy for future radiotherapy services,

Recommendation 2: Measuring success

• datasets for the reporting of fractionation, waiting times, access, and patient outcomes.

Recommendation 3: Ensuring equity in access

• demand modelling based on differences in cancer incidence on a region-by-region basis.

Recommendation 4: Training the radiotherapy workforce

• A national career promotion strategy should be introduced across the four nations of the UK

Recommendation 5: Integrating new technologies

• NICE should provide national guidance on novel radiotherapy techniques, such as intensity modulated radiotherapy (IMRT) and proton therapy.

Recommendation 6: Communicating with the public

• formulate a strategy and proposal for awareness raising about radiotherapy.

Achieving a world class radiotherapy service across the UK

organising radiotherapy services – what are the lessons from england

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