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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

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organising radiotherapy services what are the lessons from england
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 england3
Organising Radiotherapy Services – what are the lessons from England

Tim Cooper

Associate Director – Radiotherapy

National Cancer Action Team

slide4
Vision

Strategy

slide6

Workforce

  • Access
  • Capacity
  • Safety
  • Peer Review
  • Clinical Pathways
  • Clinical Trials and Research
  • New Technology

Governance

Service Delivery

NRIG

(NRAG / Cancer Reform Strategy)

  • Survivorship
  • Communication Skills
  • Leadership
  • Engagement
  • Contracting Framework
  • RTDS/RES
  • Tariff / HRG
  • Commissioning Toolkit

Wider World

Commissioning

www.cancer.nhs.uk/radiotherapy

nrig subgroups
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
headlines
Headlines
  • Relevant Key issues
  • Investment
  • Engagement
  • Leadership
  • Play to your strengths
  • Toolkits
  • Communication
relevant key issues
Relevant Key Issues

What does World Class look like??

  • Access
    • Performance
    • Productivity
  • Workforce
  • Technology
    • IMRT
    • SBRT
    • IGRT
slide10

Workforce

  • Access
  • Capacity
  • Safety
  • Peer Review
  • Clinical Pathways
  • Clinical Trials and Research
  • New Technology

Governance

Service Delivery

NRIG

(NRAG / Cancer Reform Strategy)

  • Survivorship
  • Communication Skills
  • Leadership
  • Engagement
  • Contracting Framework
  • RTDS/RES
  • Tariff / HRG
  • Commissioning Toolkit

Wider World

Commissioning

www.cancer.nhs.uk/radiotherapy

relevant key issues11
Relevant Key Issues

What does World Class look like??

  • Access
    • Performance
    • Productivity
  • Workforce
  • Technology
    • IMRT
    • SBRT
    • IGRT
workforce
Workforce

Reconvened 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

VERT

now 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
Service Delivery

Access

31 days - analysis of early returns

- data completeness !!

Process and pathways

Capacity

Network led planning in many areas

?? 25 satellites

staged plans - ongoing work

RTDS

Missing patients

Radiotherapy Site Visits

National Purchasing Framework

slide14
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
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;

headlines16
Headlines
  • Relevant Key issues
  • Investment
  • Engagement
  • Leadership
  • Play to your strengths
  • Toolkits
  • Communication
slide17

National Cancer Action Team

Department of Health

Payment by Results

UNIT COST COMPARISONS – AVERAGE OF ALL COSTS PER FRACTIONS

Radiotherapy Costing & Tariff Development

leadership engagement
Leadership & Engagement
  • Clinical Leadership
  • Programme Leadership
  • Progress chaser
  • Engagement
    • Profession
    • Public
    • Political
    • Wider
headlines19
Headlines
  • Relevant Key issues
  • Investment
  • Engagement
  • Leadership
  • Play to your strengths
  • Toolkits
  • Communication
build on the strengths
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
headlines21
Headlines
  • Relevant Key issues
  • Investment
  • Engagement
  • Leadership
  • Play to your strengths
  • Toolkits
  • Communication
r port
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
commissioning
Commissioning

Contracting

Contracting Framework Service Specification

Radiotherapy Pathway

www.cancer.nhs.uk/radiotherapy/commissioning

Cancer Commissioning toolkit – radiotherapy section

Radiotherapy Commissioning Pilots x 4

configuration
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
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
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.
headlines29
Headlines
  • Relevant Key issues
  • Investment
  • Engagement
  • Leadership
  • Play to your strengths
  • Toolkits
  • Communication
slide31

Achieving a world class radiotherapy service across the UK

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.