Manchester City Council

Health and Wellbeing Board

Item 8
19 March 2014

Manchester Health and Wellbeing Board

Report for Resolution
Report to:

Health and Wellbeing Board 19 March 2014

Subject:

Development of the Manchester Cancer Commissioning Board

and update from the Manchester Cancer Improvement
Partnership Programme

Report of:

Clinical Commissioning Group Chairs

Summary
The purpose of this report is to inform the Health and Wellbeing Board of the
development of the Manchester Cancer Commissioning Board, to provide an update
about the Manchester Cancer Improvement Partnership (MCIP) Programme and
outline of a proposed launch for consideration.
Recommendations
The Board is asked to:
To endorse the aims and objectives of the Manchester Cancer Commissioning
Board
To endorse the aims and objectives of the Manchester Cancer Improvement
Partnership Programme
To approve the MCIP programme launch as described

Board Priority(s) Addressed:

2,3,4 and 8

Contact Officers:
Name:
Position:
Telephone:
E-mail:

Janet Tongue
Manchester Cancer Improvement Partnership
0161 765 4051
janet.tongue@manchester.nhs.uk

Name:
Position:
Telephone:
E-mail:

Coral Higgins
City Wide Commissioning Team
0161 765 4051
coral.higgins@manchester.nhs.uk

Background documents (available for public inspection):

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The following documents disclose important facts on which the report is based and
have been relied upon in preparing the report. Copies of the background documents
are available up to 4 years after the date of the meeting. If you would like a copy
please contact one of the contact officers above.
Macmillan Cancer Improvement Partnership in Manchester: DRAFT baseline report
2013

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1.

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Background

1.1 The Greater Manchester and Cheshire Cancer Summit in 2012 agreed a
vision for world class cancer care which included:

Commissioning services that emphasise treatment of patients and people with

cancer and not just the cancer itself;
Developing the commissioning of complete cancer pathways from primary
prevention, through early detection and diagnosis, screening, treatment,
survivorship and end of life care;
Implementing commissioning priorities that bring greater focus to the early
(primary prevention, detection and earlier diagnosis) and latter parts of cancer
pathways (aftercare/survivorship and end of life care);

1.2 To achieve this vision a Manchester Cancer Commissioning Board (MCCB)

has been established to oversee the commissioning of the services for patients with
suspected or diagnosed cancer, at the request of the three Manchester CCGs.
1.3

Information recently published by Public Health Manchester has shown that:

Manchester is 150th out of 150 for premature mortality from cancer(June 2013
data from the Longer Live website)

Cancer incidence in Manchester is approximately 420 (per 100,000

population) compared to 410 for the North West and 407 for England.

Cancer mortality in Manchester is approximately 202 (per 100,000 population)

compared to 179 for the North West and 164 for England. (NWCIS figs for
North, Central, South Manchester CCGs, North West and England 20092011).
We need to improve this position and prevent a widening of the gap.
1.4 The MCCB aims to adopt an approach to the commissioning of cancer
services which considers total pathways of care:

from health promotion / disease prevention, access to primary care service,

diagnostics, treatment options, follow up / survivorship, specialist palliative
care and includes end of life care

that are based on population needs as well as clinical evidence for best
practice

that offer value for money, that can be re-invested to further improve the
experience and outcomes for our patients.
1.5

The formation of MCCB will ensure that:

Cancer is kept high on the local commissioning agenda

Pathways for patients for suspected or diagnosed cancer are complex and
patients will often cross organisational boundaries.
Pathways are monitored through performance of providers and patient
experience
Representatives on the MCCB agree priorities and areas of focus are relevant
and will contribute to improving outcomes and patient experience

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1.6

The MCCB objectives are:

Strategic leadership of cancer commissioning on behalf of North, Central and

South Manchester CCGs and the Citywide Commissioning and Quality Team
Co-ordinate the commissioning of high quality cancer services, and to share
good practice
Lead the development of a Manchester city wide commissioning strategy for
cancer / cancer plan for 2014-17 that will support the delivery of citywide
cancer commissioning plans which deliver efficient, effective packages of care
for cancer patients that offer best outcomes and value for money, and the
implementation of local and national strategies / policies
Scope current provision of cancer services for Manchester patients and to
compare against agreed citywide plan / strategy and to understand the cancer
budget and costs of current cancer pathways
Develop tumour specific service specifications, in collaboration with providers
and specialist commissioners as appropriate, incorporating known national
and agreed local standards and key performance indicators
Endorse effective and efficient clinical pathways developed by commissioners
and health care professionals
Monitor the overview of current performance of providers of cancer services
against national and agreed local standards and key performance indicators.
Agree recommendations to address service deficiencies
Support service redesign by providers to ensure high quality services, and
monitor implementation of local action plans
Horizon scanning - Plan for future services and to influence the development
of future services, based on national developments and local priorities

1.7

The Governance structure is set out below:

North Manchester
CCG

NW Specialist
Commissioning / NHS
England GM / Strategic
Clinical Network

Central Manchester
CCG

South Manchester
CCG

Joint Commissioning &

Management Board

Manchester Cancer
Commissioning Board

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Greater Manchester
Cancer Commissioning
Strategy Board

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Health and Wellbeing Board

Item 8
19 March 2014

1.8 The Macmillan Cancer Improvement Programme (MCIP) forms part of the
work of the new Commissioning Board, further information is given below.
2.

The Manchester Cancer Improvement Programme

2.1 The MCIP Programme aims to deliver changes to help achieve the vision
agreed at the Manchester Cancer Summit along with the Macmillan 9 outcomes.
MCIP is funded by Macmillan Cancer Support and has been designed in 2 Phases.
Phase 1 invests 2.35m in primary, palliative, community and end of life care. It
includes enhanced training for the health and social care workforce and the
development of new palliative care services. This is expressed diagrammatically
below and further information is given in Appendix 1.
Figure to show Work stream outputs
From p.41 ICF GHKEvaluation of Phase 1 of the Macmillan Cancer Improvement
Partnership in Manchester: DRAFT baseline report

2.2 Phase 2 invests a further 1.1m into local redesign work and is focused on
reviewing and improving breast and lung pathways. The funding agreement for the
second phase of the MCIP programme was signed by the Chief Officer of South

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Manchester CCG on behalf of the Partnership in December 2013. This followed a

series of workshops that led to the development of logic models. Phase 2 builds on
Phase 1and aims to improve cancer outcomes for breast and lung patients through
development of seamless pathways for the full patient journey - prevention and
promotion, through early diagnosis and treatment, to survivorship or end of life care:

The rationale to redesign the lung pathways is based on: pathway complexity,
higher lung cancer incidence and mortality levels in Manchester than
elsewhere.
The rational to redesign breast cancer pathways is based on unsustainability
of current follow up models and need to respond more to issues related to
survivorship.

2.3 The commencement in post of the MCIP Programme Lead and agreed shape
of a Programme Team marks a shift towards implementation for the MCIP
Programme. The Phase 1 staff structure has now been agreed and is being recruited
to (posts are fixed term until December 2015).To create some delivery capacity in
advance of filling the fixed term posts, a skeleton Programme Team has been
created.
2.4 A number of key deliverables in Phase 1 have been identified and work is
progressing to implement these:

Development of model for North Manchester Palliative Care based on

Midhurst principles
A Locally Commissioned service to encompass Primary Care Cancer
Champions and a Quality Mark for General Practice
Joint work between the PPE group and EPACCS to develop a proposal to
improve the quality and update of palliative care resisters and GSF.
Scoping of the learning and development requirements of the health and
social care workforce through a contracted piece of work

While, further work is required to create fully developed plans, good progress is
anticipated for all of the key deliverables identified.
2.5 Work has also started to consider how best to implement Phase 2. An
initiation meeting will be held involving key stakeholders to ensure agreement to the
way forward and clear linkages to other initiatives. The Phase 2 team leader post
(called Deputy Programme Lead) has been agreed and is also out to recruitment.
3.

Manchester CIP Launch

3.1

A Programme launch has been proposed to:

Raise awareness about the programme amongst stakeholders not directly

involved on a day to day level
Create an opportunity to recruit people affected by cancer and carers to
become part of the programme
Engage with members of the public

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3.2 The MCIP Board has considered a launch format to include a morning focused
on more strategic areas and afternoon geared towards an event. It is proposed that
this takes place on 26 June 2014, 10am-2.30pm. Key features of the launch are
proposed as:

A prominent city centre venue Town Hall combined with outside space
(Albert Square) for street teams; publicising cancer screening, information
stalls.

3.3

The morning sessions would include:

Introductory words by celebrity/relevant name in health care (individuals TBC)

Why are we here? Explanation of the main elements of the programme and
why it is needed in Manchester.
Interactive panel discussion addressing pre-submitted questions from
patients/clinicians.

3.4 Invitees will include: People affected by cancer; community groups; voluntary
sector, Information stalls key services to provide information on their role in cancer
care; clinicians / healthcare managers, Public Health; local MPs, Local councillors,
NHS England and the media.
3.5

It is anticipated that given the focus on user involvement at this event that:

A series of mini-launches could take place in each of the hospitals (North,

Central and South Manchester) throughout the summer. A PABC has
proposed that these take place on clinic days to take full advantage of the
presence of the relevant individuals on those days.

Educational events Clinicians can be invited to city-wide educational

evening events where the MCIP Programme Office and individual
workstreams can present their work to date, inviting discussion and
comments from clinicians.

3.6 Communications to clinicians and key partners will be in place ahead and after
the launch to provide tailored information.

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Appendix 1 - Item 8
19 March 2014

Appendix 1
MCIP Outcomes and additional information
Primary care work stream
Background
Patient experience surveys show that there is a wide variation in the levels and
standards of support received in general practice in terms of early recognition of
signs/symptoms of cancer, early referral and subsequent support offered during and
post diagnosis. The proportion of patients with a cancer diagnosis within a practice is
relatively low in comparison with other disease specific groups. It is also accepted
that where patients are diagnosed at a late stage via primary care or diagnosed via a
medical emergency route their relative survival rates are compromised.
It is acknowledged that the use of cancer registers is sporadic and are frequently out
of date so they are of limited use to the practice to support patients.
Cancer care reviews are not undertaken consistently across the 102 general
practices and nor do they assist in helping practices support the holistic needs of
patients. This is compounded by GPs and practice staff often feeling ill prepared in
supporting and talking to patients affected by cancer. This situation is exacerbated
by the lack of information and support surrounding cancer in general practice
available to patients, carers and primary care staff.
Activities
Activities and service delivery targets have been selected as a result of Macmillans
extensive experience of cancer care best practice and their endorsement of a
number of national health initiatives.
Outcomes

All practices have up to date cancer registers.

Standard cancer care reviews are adopted by all practices.

Increased use of risk stratification.

A Macmillan Quality Standard Mark for General Practice.is developed and GP

Practices are encouraged to apply.

Cancer champions identified for every practice.

GPs have increased knowledge to enable early referral and regularly use
national cancer decision tools.

Effective sharing of best practice and learning across Manchester

Patients holistic and psychological needs are fully addressed

People affected by cancer are more informed about their condition, how to
manage it and where/when to seek support.
Community Care Work stream
Background
There is a growing recognition that cancer after care is not as effective as it could be
due to fragmentation between the various providers. This can cause patients to feel
disempowered to manage their own condition and often feel isolated.
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People living with cancer have on-going unmet needs from their cancer and
treatment, for example late side effects of treatment, greater risk of other long term
conditions and risk/fear of cancer recurrence.
There is also a drive to deliver care in the community and closer to home, to improve
patient experience and meet needs after treatment.
Outcomes

Increased awareness, knowledge and skills among community health and

social care staff around cancer to support people affected by cancer.

Improved communication and more coordinated pathways between acute,

primary care and community care.

Improved quality of care and patient experience. People with cancer feel that
their individual needs are thoroughly assessed and understood.

People are more informed about their condition, how to manage it and
where/when to seek support.

Increased confidence and ability to self-manage among people with cancer

Carers of people affected by cancer feel better supported and more

empowered

People lead healthier lifestyles through changed attitudes and behaviours

Improved health and well-being and quality of life for people affected by
cancer.
Supported, Palliative and End of Life Care Work stream
Background
The evidence shows that the system in Manchester needs improving and that there
is inequity in end of life care where 63% of patients die in hospital. From the 2012
patient experience survey only 38% of patients felt they were given enough support
by health and social care services following hospital discharge.
Outcomes

Increased compliance with Gold Standards Framework.

All GP practices establish a robust palliative care register and have monthly
palliative care practice meetings.

Increase the number of patients who have a recorded preferred place of care.

Increase the number of patients who have an advanced care plan.

Increase user involvement in the development of supported palliative and end

of life care services.

People affected by cancer have an increased confidence and ability to

manage cancer and the knowledge of how to seek support.

Increased confidence and reduced anxiety and isolation among carers.

Reduced inpatient hospice admissions.

Reduced emergency admissions due to cancer and/or complications

Reduce the number of hospital follow up appointments (before and after)

inpatient admissions.
Impact of all three work streams

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Improved experiences and outcomes for people affected by cancer.

Contributes to Macmillan nine outcomes and local partner priorities.
People affected by cancer know they have had a Macmillan experience
Well trained and skilled workforce in Manchester who are better able to
support people affected by cancer at any point of their journey.
Earlier diagnosis and detection of recurrence leading to improved survival
rates.
A fully integrated and joined up care pathway that is more efficient, cost
effective and meets the needs of people affected by cancer.
Improved long term health and well-being of people with cancer and of their
wider network of families/friends/carers through transfer of knowledge and
behaviours.
Enhanced patient experience across the system and particularly at the end of
life, so people have increased dignity, respect and choice at end of life.
Widespread attitudinal behavioural changes among people affected by cancer
and professionals, particularly around the changing cancer story and the shift
towards greater self-management.

MCIP Phase 2
Expected outcomes
The agreement is for 1.1m of Macmillan Cancer Care support funding to be used to
improve outcomes for breast and lung cancer patients as set out below.
Intended outcomes following Lung Pathway redesign:

Increase in the number of patients diagnosed through the 2 week referral

route

Development of a complete seamless pathway of care from pre diagnosis to

post treatment programmes to palliative and EOL care

Care delivered closer to patients home or place of choice

Redesign of the diagnostic pathway which will improve efficiency and improve
patient experience and out comes

Lung cancer patients will be well informed and have the right information and
support that is right for them. When new problems emerge patients will be
supported through anticipatory planning

Post treatment programmes established to increase patient and carer

confidence in coping, problem solving and accessing services

Key patient problems such as breathlessness, fatigue, anxiety and nutritional

support are addressed through established referral pathways

Patients and their carers will feel supported in both palliative and end of life
care

Service users at the forefront of co creation

Intended outcomes following Breast Pathway redesign:

Improved cancer outcomes through seamlessly delivered pathways from

diagnosis to end of life care

Reduced variation in access to and experience of care through consistent

application of best practice

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Appendix 1 - Item 8
19 March 2014

Patients are offered information about their cancer, and their support and
treatment options, including the short and longer term consequences of
treatment
Patients are given support through treatment itself, including support for life
style changes
Carers support needs are addressed
People living with and beyond cancer are empowered to self-manage their
condition based on their needs and preferences and are informed to do so
There is a greater focus on recovery and health and wellbeing after cancer
treatment
Movement away from a single model of follow up to tailored support that
enables early recognition of the consequences of treatment and the signs and
symptoms of further disease
Patients are offered tailored follow up to meet their needs which will ensure
that their needs will be better met and resources used more effectively
Patients know how to maintain a healthy lifestyle including the benefits of
physical activity
User groups for people affected by cancer understand what should be
available and can participate with confidence in local discussions with
commissioners and providers
Patient who are concerned about a recurrence know how to re-access
specialist care
Patients who are at EOL have choice in their preferred place of care and
access to the right professionals and support at the right time.

Phase 2 Delivery Stages

Stage 1: Strategic review and planning, designing optimal services
Information gathering on current and best practice for breast and lung pathways
including palliative and end of life care. Assessment of need, review of current
services and prioritisation of key areas. Design of optimal pathways using national
guidance and established best practice.
Stage 2: Revision and development of a commissioning service specification
and implementation of that service specification
Review of current service specifications and development of outcome based
specifications for all interventions linked to each provider involved in the cancer
pathways for breast and lung including end of life services and which support the
delivery of Macmillans Nine Outcomes. Development of key tumour specific metrics
based on national quality standards and local objectives including key performance
indicators.
Implementation of service solutions as detailed in the logic models and with which
enable the outcomes for the project to be realised.
Stage 3: Monitoring and evaluation
Development of a performance monitoring and management systems to monitor
outcomes, quality standards and patient experience.

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