Oli Hudson, of Wilmington Healthcare, writes about the effect that reforms and initiatives surrounding cancer care during this calendar year have had on oncology suppliers.
The reform of cancer services has long been a priority for the NHS; but it is fair to say that in 2019, several initiatives, previously talked about, or piloted locally, have taken centre stage under NHS England’s long-term plan.
This was released at the beginning of the year, had a profile boost via an implementation framework in July, and is now setting the agenda for cancer across England.
The whole NHS has been given some ambitious targets to improve both early diagnosis and survival. These words sound simple to utter but bely a whole raft of challenges, in patient access, in variation in service quality, and in outcomes. There are also different pathways, practices and financial constraints that industry will recognise.
One of the signs that CCGs and providers will need to collaborate more closely on tackling cancer over the next decade can be seen in the NHS oversight framework (OF).
Now the main regulating framework of the local NHS, the OF brings together what was the CCG IAF – the system of KPIs for commissioners - and the Single Provider Framework into one set of joint targets with different areas assigned different responsibilities.
The cancer landscape
Specialised commissioning is still done at national level via NHS England and its specialist commissioning groups, assisted by the clinical reference groups for cancer. However, at a more local level, integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) have a cancer agenda too, and over time, some of these commissioning responsibilities could pass to them. Especially as data for survival is now being collected at STP/Cancer alliance level, they now have some accountability for this.
Other elements of the landscape are in a state of flux – particularly that of stakeholders, with cancer alliances, established in 2016 off the back of the successful vanguards set up in London and Manchester, now expected to all but lead in cancer at STP/ICS level, providing strategic responses to the long term plan, and driving pathway change in individual tumour types via site-specific tumour groups.
The alliances are also expected to set up the rapid diagnostic centres nationwide – yet another new group of stakeholders – which currently only exist in 10 pilot areas. These will be crucial in finding the right patients at the right time and stage in order for the next generation of cancer treatments to work most effectively.
There are also roles for primary care, especially in screening and rehabilitation services, which could well come under the aegis of primary care networks (PCNs). And there is the establishment of multidisciplinary teams, to help, particularly, with community-based cancer care and care closer to home services.
Cancer alliances
Cancer alliances - partnerships of clinicians, patients and transformation managers - spread across STP boundaries.
For example, East of England Cancer Alliance covers the Mid and South Essex STP, the Suffolk and North Essex STP (set to become and ICS), Norfolk and Waveney STP, Cambridgeshire and Peterborough STP, Hertfordshire and West Essex STP and Bedfordshire, Luton and Milton Keynes STP.
As integration kicks in and both STPs and CCGs begin to merge, we can expect this cancer alliance to lead the direction of cancer services – which depend on collaboration, data sharing and pooling of specialist services regardless of administrative boundaries in this area.
Cancer alliance board members include representation from hospital trusts, clinical commissioning groups, specialised commissioning, public health and national cancer charities.
Each alliance has a plan they must deliver on, and a new round, responding to the main NHS long-term plan, is expected soon.
Next-gen treatments
Medtech must also be available to assist the NHS in its attempt to make the new generation of cancer treatments effective. These target genetic mutations that accelerate the growth of many types of tumours, have particular benefits for children, and are set to come on to the market within months.
NHS England chief executive Simon Stevens has said that the health service must be ready to fast-track tumour agnostic drugs, and this will depend very much on a network of pathology laboratories able to perform the right companion diagnostics.
NHS England will now work with the industry to step up preparations and embed the tests for these genomic mutations within existing cancer pathways.
Industry impact
At first sight it may seem that the medtech industry, with its range of new radiological and surgical treatments, should focus on helping the NHS reach the survival target; however, the long-term plan’s success depends very much on the overall improvement of cancer services. Industry can align on screening (are the right patients for our therapy being accessed and do we know how many there are)? And diagnosis (are we finding the right patients at the right time and stage, such a time where out therapies will make survival more likely)?
There is a picture emerging that key stakeholder groups will comprise networks, of various kinds; cancer alliances being the most high profile, but also subsets of clinical engagement groups and cancer networks, such as tumour site specific groups, childrens’ cancer networks and radiology networks. Decision making units are forming at the moment and it is crucial to target the right stakeholders with the right message.
