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Guidance on tracking investment and developments in cancer services

  • Last modified date:
    8 February 2007

The NHS Cancer Plan set out the Government's commitment to increasing investment in cancer services, rising to an extra £570m per annum by 2003-04.

To: Strategic Health Authority Chief Executives

Ministers, Nigel Crisp and Mike Richards, the National Cancer Director, have agreed that we need to address the ongoing concern about how much is being invested in practice. They have asked for an exceptional tracking exercise, to pull together the information currently held within the NHS on the additional investment in cancer services in 2001/02 and 2002/03, and the service developments funded as a result of that investment. The attached template (Excel spreadsheet) sets out the information that is required; this collection has been approved by the Review of Central Returns Steering Committee (ROCR/03/003). A checklist to this guidance is listed below.

The context

It has become clear that the data on cancer investment requested within the routine Service and Financial Framework commissioner returns contains too many omissions and inaccuracies to be used to answer the questions that are being posed. Without a specific exercise to compile information on cancer investment, we are unable to demonstrate where we stand on the Cancer Plan commitment.

Ministers and Mike Richards have acknowledged when challenged that in some cases hypothecated funds (£255m hypothecated nationally in 2001/02) and earmarked funds (£76m earmarked at HA level in 2002/03) will not have been used entirely on cancer services. They have gone on to point out that progress is nonetheless being made in implementing the Cancer Plan in all areas. But continuing speculation about spending levels risks undermining stakeholder and public confidence in the progress that is being made. We need accurate information both on the sums spent and - importantly - on the developments these are funding, so that we can be clear at both national and local levels about the true position, both for public accountability and to inform planning for 2003/04 and beyond.

We hope this exercise will also help you build a shared understanding with local stakeholders about investments to date: the starting point for the cancer component of local delivery plans. LDPs need to include forecast outturn on the increased cancer spend for 2002/03 and investment plans for 2003/04 to 2005/06, against the national capacity assumption of £570m additional spending for cancer services in 2003/04 compared to 2000/01.

The information required

We have consulted colleagues from StHAs and cancer networks to identify the best approach to this exercise, aiming to build a clear picture while minimising the additional burden of work this will pose.

The attached template sets out what is required. This should be completed so far as possible, although if it is not possible to follow the breakdown at Section Two of the template from the information available locally, an alternative breakdown may be supplied at Section Three. A checklist is listed below on the potential sources of information.

Many cancer networks have already gathered much of this information and - given organisational changes over this period - offer the best basis on which to assemble this information. So the information should be provided, and will be published, on a cancer network basis, with an StHA agreeing each network return. Three star Trusts are required to complete the data collection exercise along with other organisations.

Where a Trust is part of more than one network, there will need to be local agreement about which network return will include it. Information will be collated and analysed nationally.

The intention will be to make public the headline national and network level figures. Information will be shared with you ahead of publication.

Please return the information to your DHSC contact by 28 February 2003.

Further advice is available from the contacts, who are shown here:

DHSC:  North
Contact: Pat Blain
Details: Pblain@doh.gsi.gov.uk
0191 301 1313 / 07860 717 429

DHSC: Midlands and the East
Contact: Linda Hastings
Details: Linda.hastings@essexsha.nhs.uk
01376 302 308 

DHSC: South
Contact: Sue Dodd
Details: Sue.S.Dodd@doh.gsi.gov.uk
020 7725 2688 

DHSC: London
Contact: Joe Kearney
Details: Joe.kearney@nelondon.nhs.uk
020 7655 6718

DHSC: National 
Contact: Simone Bayes
Details: Simone.bayes@doh.gov.uk
020 7972 4944

Alan Doran
Director of Operations Cancer 

Heather Gwynn
CHD Programme Manager 

Template Checklist

General

We suggest information is initially collected on a provider basis although some elements may need to be added when it is collated on a network basis: for example, funding provided by health authorities or PCTs to the voluntary sector. Please do not include:

  • Inflationary cost pressures for existing services
  • Initiatives funded by the voluntary sector (eg Macmillan or local hospices) - but do include pick up costs where they have occurred
  • Centrally-funded projects - the costs of which will be added in at national level (see list at end)

i. Cancer Drugs

Baseline data on expenditure on cancer drugs in 2000/01 will be needed in order to calculate the additional expenditure in 2001/02. Most Trusts should (via pharmacy) be able to identify expenditure on cancer drugs for both 2000/01 and for 2001/2. They should also be able to give expenditure for at least the first 6 months of 2002/3 (April - September) and this should be used to project the full 2002/3 expenditure.

A list of NICE cancer drugs is listed below. If possible, please also include drugs given as supportive treatment for cancer patients (e.g. bisphosphonates, antiemetics for chemotherapy, colony stimulating factors). Where Trusts can be sure that these were used for cancer patients they should be included.

Some hormonal drugs for cancer are prescribed by Trusts and should be included. In addition hormonal treatments prescribed in primary care (e.g. for breast cancer and prostate cancer) should be considered. This information is available to GPs through Prescribing Analyses and Cost (PACT) from the Prescription and Pricing Authority.

ii. Expansion of consultant numbers

These should be relatively easy to track at a Trust/network level. Some consultants will work across sites - to avoid double-counting, the site holding the substantive contract should be deemed to be the employing organisation.

The six specialties designated as 'cancer' consultants are:

  • Radiologists
  • Histopathologists
  • Haematologists
  • Clinical Oncologists
  • Medical Oncologists
  • Palliative Medicine Consultants

Others where cancer forms a major component of their work (which should be mentioned in the job description), are likely to include:

  • Breast Surgeons
  • Colorectal Surgeons
  • Upper GI Surgeons
  • Thoracic Surgeons
  • Urologists - some
  • ENT/Oral - some
  • Physicians - lung/gastroenterologists/breast - some

iii. New Services

New services may have been introduced to deliver waiting times targets, implement Improving Outcomes guidance and to follow up on CHI or peer review assessment. Examples may include:

  • Rapid Access Clinics - with dedicated staff (e.g. nurse practitioners, secretarial staff, clinical assistants)

  • Specialist teams (e.g. nurse specialists, team coordinators)

  • Additional imaging services (e.g. radiographers)

  • Additional endoscopy services (e.g. nurses, technicians)

  • Additional theatre sessions

  • Increased inpatient beds for cancer

  • Expanded radiotherapy services (e.g. therapy radiographers, medical physicists, technicians)

  • Expanded chemotherapy services (e.g. chemotherapy nurses, oncology pharmacists/technicians)
  • Expanded hospital-based information/support services
  • Expanded hospital-based palliative care teams

iv. Reconfiguration of services

Service reconfiguration is necessary in many areas to ensure patients, particularly those requiring less common interventions, are treated by specialist multi-disciplinary teams who see sufficient numbers of patients to maintain expertise. Examples include action to comply with Improving Outcomes guidance for gynaecology, upper gastro-intestinal and urological cancers where services in a cancer centre may need to be expanded but matching resources are unable to be released from a local hospital.

v. Additional funding for voluntary hospices

HAs/PCTs should be able to track the funding made available to voluntary hospices for 2000/01, 2001/2 and what has been committed for 2002/3.

vi. Other

Any other developments or expenditure that do not fit the above headings: the service developments should be described.

CHEMOTHERAPY: 'NICE CANCER DRUGS'

Published appraisals

The NHS should now be implementing the following NICE chemotherapy appraisals:

  • topotecan for ovarian cancer
  • docetaxel, paclitaxel, gemcitabine and vinorelbine for lung cancer
  • temozolamide for brain cancer
  • gemcitabine for pancreatic cancer
  • taxanes for breast and ovarian cancer
  • fludarabine for lymphocytic leukaemia
  • irinotecan, oxaliplatin and ralitrexel for bowel cancer
  • trastuzumab (Herceptin) for breast cancer
  • rituximab for follicular lymphoma
  • doxorubicin (Caelyx) for advanced ovarian cancer
  • imatinib (Glivec, Novartis) for chronic myeloid leukaemia

CENTRALLY-FUNDED SCHEMES

Please exclude any central funding received specifically for the following initiatives

  • Breast screening extension to women aged 65-70
  • Breast screening quality assurance
  • Cancer network management support (ie £40k per network)
  • Cancer registry additional funding
  • Cancer Services Collaborative teams
  • Capital costs of linear accelerators, CT and MRI scanners
  • Cancer commissioning pilots
  • District nurse training scheme
  • Endoscopy training initiative
  • Histopathology training school
  • National Cancer Research Network
  • Palliative care in-year central funding (£10m in 2002/03)
  • PCT cancer leads
  • Peer review
  • Smoking cessation services

If you are aware that central funds have been supplemented for any of these initiatives (eg network management or breast screening extension) this additional funding should be included.

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