>>Cally Palmer: Good morning everyone. I'm Cally Palmer, Chief Executive at the Royal
Marsden. It's a specialist cancer centre in London. And I'd just like to introduce Dr.
Shelley Dolan, who's a cancer nurse and happens to be Chief Nurse at the Royal Marsden. Dr.
Tony Brzezicki, who is a GP and Chairman of one of the larger CCGs in London and also
cancer lead for a London programmed transform cancer and Miles Scott, who is my colleague,
and Chief Executive at St George's Health Care NHS Foundation Trust.
I'm just going to do a very brief introduction if I may and then hand to Shelley to talk
about the detail of our proposal. And a bit like the Christie, I'd like to start with
the problem we're trying to address or the issue we're trying to address for patients.
We know, in London and elsewhere in the country, that cancer care is variable, fragmented,
patients find it slow to get to the stage of definitive diagnosis and treatment. And
we want to put a model in place that allows us to get patients the right treatment in
the right place, first time not the second, third or fourth time.
Our proposal is an accountable, clinical network for cancer, in West London initially. It covers
a population of 3.2 million, covers about 2,000 cancer clinicians already working extremely
closely together on pathways, again like the Christie's model. It covers 10 trusts, 13
clinical commissioning groups, hospices and cure organisations.
What's different? I think there are three things about what's different. It's a collaborative
model so it is working across the whole system, completely different levers and incentives.
We want this to be a proper accountable network with a funding mechanism behind it so it's
bold. And it does cover the whole pathway from primary community care through acute
care to end of life care. So, it's very different and the reason we need the vanguard is to
give us [Inaudible] it's a bold initiative requiring this kind of political and technical
support. So, over to Shelley now on the detail.
>>Shelley Dolan: Thank you. So, the accountable, clinical network for cancer is bold and ambitious
but we have good plans, fantastic collaboration and I'm just going to talk through very briefly
six key things. At the centre is the patient and family voice. We have worked for some
time with Neil Bacon, the Chief Executive of iWantGreatCare. And right at the centre
of our model, patients and families in real time using SMART Technology will be evaluating
our ACMC and setting key performance metrics right from the word go. So, patients truly
are at the heart of the model.
It will also reduce variation and fragmentation because for the first time all of the partners
in cancer looking at the whole patient journey from prevention, early diagnosis, survivorship
and end of life care are bound up in one organisation, accountable together with the lead provider
which is the Royal Marsden. We are working with public health and primary care on exciting
research that early detection of cancer and of course prevention. We've already written,
over the last two years, evidence based exemplar, timed pathways for cancer care. Over 3,000
clinicians have contributed to those across London and we will use those to drive better
care. And also to get people into greater numbers of people into international clinical
trusts, very important to change survival.
So, first [Inaudible] to KPI's is around patient experience, second is around survival and
better care. This is not a vanguard about making 1 or 2% difference. This is about 10
to 15% difference in survival. We work with the National Data Registry so we know the
figures. So, we have about 20,000 new cases of cancer treated in this area of London and
we hope to see survival change in 350 to 400 cases.
The other big difference Cally eluded to was the funding. All the partners in this model
have agreed if we get this, and there's the political will to allow it to happen, to put
all of the cancer funding in this model. Money is an important lever, we've done a lot in
improvement architecture as the question I just said but now we really need to make it
happen for patients and families. And there's good evidence from the United States that
the money is important. But what we're not asking for is more money for cancer care in
London, not for the ACNC, not for the Royal Marsden. The U.S. has shown that with these
models the utility goes up and the costs come down. So, we will save money and be more productive
and efficient.
There'll also be improved clinical safety. We will, right from the get go, share all
SIs [Inaudible] or complaints across the whole system. So, that we can use the system effectively
and learn in real time. Also, we will ensure that this is 24/7 so this will mean that patients
and families at two o'clock in the morning at the weekend will not be ringing 999 as
the services are not linked up.
Right from the beginning and this is my last point. We will be modelling this model with
the experts in the Cumberland initiative who have worked internationally to model new health
care settings.
And this will ensure that our system is robustly and objectively monitored and evaluated and
can be used by the vanguards across the NHS to our colleagues in Manchester and our colleagues
at UCLH in London.
We have already established benchmarks with our colleagues internationally and our colleagues
in the U.S. who have done a lot around these models have never done anything on patient
experience. So, they're very keen to learn from England on that. And we're keen to learn
with others, with the Christie and UCLH who you'll hear from at the moment. Above all,
everything will be transparent to patients and families, to commissioners, and the NHS.
So, in conclusion, yes, the accountable, clinical network for cancer in West London is a very
bold initiative but actually people really deserve a step change in their cancer services.
The Royal Marsden has an international track record for delivering excellence in cancer
care research and education. And with our fantastic partners across the system in West
London, as one of our CCG Chairs said to me last week, this will be a game changer for
cancer and the NHS. Thank you.
>>Host Speaker: Thank you very much. That was perfect timing, seven minutes on the dot.
Thank you, any questions for the team from the Royal Marsden Hospital? Colleague over
here.
>>Steve Sharples: My name's Steve Sharples. Can you tell me please... you talked about
SMART Systems? Can you explain those more?
>>Shelley Dolan: Yes, for the patient experience. Yes, so we've been working with Neil Bacon
and iWantGreatCare and we will have the same system throughout hospices, GP surgeries,
the community providers and hospitals to measure real time patient feedback. The work we've
been doing is using Smartphones. We did a pilot with some colleagues in Glasgow looking
at the older person and measuring their C-SAS scale, chemotherapy scale, and virtually we
found that all parts of the community are very well used to using SMART technology.
So, it doesn't extend everywhere but we can use different technology for different people.
But actually, the international work led in Scotland showed that actually there was great
use of technology by all parts of the community. I hope that's helpful.
>>Host Speaker: Ian, please.
>>Ian Dodge: Ian Dodge, NHS England. Great presentation, two questions. In February,
the team presented a slightly different proposal around rolling out your speciality franchise
model building on the chemo and radio that you've been successfully delivering in Kingston
and other places. Could you just explain how what you're now proposing builds on and goes
further than that? That's the first question, second question, is particularly to Miles.
You said in the presentation that this is, kind of, hard edged real accountable clinical
network. So what will this mean for surgery at St. Georges?
>>Cally Palmer: Well I'll start if I may on the franchise model and then it's more appropriate
for Miles to talk about his institution. So, our early concept was a franchise model RMH
[Inaudible]
We looked at that very carefully and the problem is we need something that's nationally reproducible
and that's fast and collaborative and RMH [Inaudible] is something we can do anyway
but it's slow because it often requires capital investment and it's the Marsden doing too.
What it isn't, is a collaborative partnership where we're all taking risks together to make
it better for patients. So, I think the concept behind this culturally is really important
because we're all going to be taking a risk with our cancer business. Miles is, I am,
we all are. So, the ten trusts, the 13 CCGs to get to a completely new model and it'll
be nerve racking but then that's what vanguard's supposed to be about. So, Miles on surgery
at Georges.
>>Miles Scott: Yes, sure. So, I think it's a really important question and I think this
is exactly where this vanguard proposal will do stuff that we can't do at the moment. So,
we have lots of established alliance working but it's based on the principle of a coalition
of the willing if you like. And we've achieved a great deal, particularly in areas of patient
experience, but it's all been done based on everybody on consensus essentially.
What this model will enable us to do is by establishing a joint delivery vehicle with
a clear structure and clear governance and rules of engagement. The organisations who
have, frankly, a large commercial risk, a large service delivery risk are saying we
are prepared to put our cancer services together into a joint delivery vehicle. Because we
understand how we will be able to reshape the services that we provide without either
disadvantaging the rest of our organisation, undermining the rest of our organisation,
or undermining services that are outside of cancer. And that's the big distinction between
I think this and the RMH [Inaudible] franchising model that we can go beyond chemotherapy and
radiotherapy.
We can get into what are probably the more difficult areas actually of joint working
around surgery, around gastroenterology and so on. Because we've worked out, we believe,
how to retain people's interest both clinical and frankly financial and yet deliver the
standards that we aspire to at the same time and make real change in that.
>>Host Speaker: Thank you very much we've got time for one very quick question, the
woman in the back in the red please.
>>Participant: Really good proposal. Obviously a very big project that you're proposing.
Just wondered, what's the thing that keeps you awake at night about it? What's going
to be the biggest challenge in moving this forward?
>>Cally Palmer: Thanks very much. Tony, do you want to address that as a key council
leading commissioner?
>>Dr Tony Brzezicki: So, there are two tickets in town bearing where we are in cancer. One
is early diagnosis and working across the secondary and tertiary care system alone does
nothing at all to alleviate that. So, working with primary care, the community, public health
England around early diagnosis is absolutely crucial.
So, you can improve early diagnosis and there's a lot in the commissioning intentions. But
we have 13 CCGs, so you do the same piece of work with 10 providers, 13 CCGs in a matrix
model. You do it all together and implement it quickly and effectively and that's where
the survival benefits Shelley spoke about comes from. And the second is the variability
and care which in the short term at least can have approximately the same benefit for
patients.
So, North West and South West London already have established protocols. They already have
the data understanding where the variability is but it happened to governance model to
push through and enforce changes to improve care and level it up across the organisation
to international best standards. So that is the fundamental difference to what's been
going on before and that's why for us in West London this is a critical vanguard.
>>Host Speaker: Thank you very much. Thank you very much to the Royal Marsden team and
partners. Give them a big round of applause.