The London Cancer New Drugs Group Meeting 2008

I would urge colleagues to tap into the reservoir of expertise within user groups. There is a significant body of evidence that user design and involvement facilitates the commissioning process. To my mind, as set out in Figure 1, there is an iterative process that begins with co-design of services, including elements around culture and tone of service, and—following provision—moves through the audit of patients’ experience to identify areas for improvement and then on again through the cycle.

Commissioners will need to be creative as well as performance focused to deliver this and I wonder if the Strategy could have gone a step further in recommending the use of incentives (and penalties) to drive improvements.

• The Cancer Reform Strategy also emphasises the need for more effective use of data by commissioners in the chapter on ‘Using Information to Improve Quality and Choice’. The proposed toolkit to support analysis, enable benchmarking and evaluate services will be welcomed by PCTs. In the same way that PCTs use ‘best practice indicators’ to assess provider performance, we should also self assess against such commissioning frameworks. For example the Strategy indicates that this toolkit would provide a means to assess trends in survival rates and other indicators of effectiveness, which PCTs could use to support investment decisions.

• I have already welcomed the call for stronger commissioning and noted the coherence between the Cancer Reform Strategy and World Class Commissioning, and I passionately believe that there is a linear relationship between strong (world class) commissioning and world-class services. I articulated the goals of commissioners in my introduction and, in my view, success is measured by evidence of the PCT’s duties to its registered population as a health benefits organisation. Stronger commissioning will support both Clinical and Corporate Governance and the delivery of our four key duties:

• Duty of Care
• Duty of Quality 
• Duty of Partnership
• Duty of Financial Responsibility

Finally I would like to offer a perspective on the role that Cancer Networks might bring in supporting the effective implementation of the Strategy. As the role of commissioners broadens and, as I have reflected earlier, we subject ourselves to the same benchmarks on performance and effectiveness as we do our providers, both the outputs and the means by which we commission become important. I referred to the proposed toolkit as a means of self assessment and, similarly, PCTs use a number of national or other systems to test assurance. NICE or the Healthcare Commission would probably be the two highest profile examples.

Cancer Networks are well placed to act as the agents for commissioners. We know that this would build on the credibility and expertise developed in the successful implementation of the first Cancer Plan. Their modus operandi fits with PCT models on needs assessment, service improvement, redesign and peer review. We know that many cancer services should be planned to best effect across a larger population than that of most PCTs and it follows, therefore, that a degree of collaboration between commissioners is required.

Finally, of course, Cancer Networks should be funded by PCTs. Again it follows that PCTs would wish to use this resource as effectively and widely as possible. I would also see a role for Cancer Networks in specification, procurement and performance management, which, in my view, are the critical new competencies for commissioners.

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