The London Cancer New Drugs Group Meeting 2008

A commissioner’s response

Provided by Mr Dominic Conlin, Director of Strategic Commissioning, Croydon PCT

I am the Director of Strategic Commissioning for Croydon PCT. I welcome the scope and ambition of the Cancer Reform Strategy and, acknowledging my bias, am particularly pleased to see the focus on strengthening commissioning. The goals of commissioners are to maximise the overall health of the population, to provide the best available care driven by the evidence base, to reduce inequalities and to ensure best use of public money through informed investment decisions. I would like to explore some personal perspectives on a number of the themes in the Cancer Reform Strategy to demonstrate how commissioners’ overarching objectives are supported—and can be realised—through the Strategy.

The Tsar and his team are to be commended on the coherence of their plan with the other significant development and current policy launch from the department on World Class Commissioning. The emerging themes from this latter workstream continue to be developed, but an illustration from the pilot work within South East Coast SHA sets out the key building blocks of the commissioning cycle. It is interesting to note that many of the commissioning requirements to support and deliver on the Cancer Reform Strategy are reflected in it.

 

I particularly like the dual nature of the illustration in Figure 1 as it provides an insight into both the strategic and technical steps that underpin commissioning. Both imply the iterative and cyclical nature of commissioning and, while I have started with the needs-led, public- and patient- centred approach, that must be seen alongside the other more functional and institutional framework to reflect the multidimensional nature of health services.

There are four themes in the Cancer Reform Strategy, which I believe are of particular resonance for PCTs:

• Prevention and earlier diagnosis have clear overlaps with PCT priorities on health improvement and reducing inequalities. It is consistent with much of the service redesign work that has gone on in other specialties. The Strategy reminds us that smoking, alcohol and obesity all rate as the highest risks for incidence of cancer and, similarly, they are all key indicators of health inequalities. There will be a range of benefits if PCTs can successfully address these proposals

For example, screening rates in London are typically lower than the rest of the country. Drill into this analysis further and, as the Strategy’s ‘Inequalities Impact Assessment’ demonstrates, there is a stark symmetry to the lowest rates and areas of known deprivation. Similarly, while data recording on ethnic origin has been patchy, it is known that uptake on screening has been lowest in BME groups. My perspective on this is that ‘more of the same’ may address the volume issue, but, depending on the demography of your registered population, it will simply widen the inequalities gap on access and outcomes. Some strategic thought on different approaches to navigating and supporting patients to screening services would bear fruit and I see a key role for advocacy and information services alongside primary care practitioners. The end result, of course, as with a range of other conditions, is that we know that by identifying and better managing patients at risk, better outcomes are achieved and patient experience is improved.

• It follows that I am delighted to see ‘Improving the Patient Experience’ as a key chapter. The World Class Commissioning policy that I referenced earlier puts at its heart a challenge to “add years to life and life to years”. On the one hand, an obvious measurable patient benefit and, on the other, a more qualitative aspect.

The underpinning ten pledges for patients in the chapter frame the areas of focus, although I was most drawn to the commitments around:

• Improved access to services
• Improved quality of services
• Improved information about services

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