Transformation of cancer care in London
A groundbreaking new way to organise the treatment of NHS cancer patients in London has been launched, with experts predicting it could help to save up to a thousand lives in the capital every year.
In future, London’s cancer services will be run by two new bodies – known as Integrated Cancer Systems – based on a similar model in the US, recognised as an international gold standard for cancer care*.
The first and only ones of their kind in the UK, the new systems bring together all the cancer care providers across the capital and beyond, using their joint resources and expertise to provide the best possible outcome for every patient.
Key to their success will be the ICSs’ push to get anyone with cancer symptoms to visit their GP immediately and for them to be referred for further investigation without delay.
As well as improving survival rates by up to a thousand lives a year, the new ICSs have pledged to drive up patient satisfaction in the capital, which lags behind other parts of the country.
Professor Kathy Pritchard-Jones, the chief medical officer of the first ICS to launch, London Cancer, said: “London is a world-class city and every single Londoner with cancer deserves world-class care.
“But too many Londoners are being diagnosed with cancer at an advanced stage of the disease, when it is difficult, if not impossible, to cure. That’s why we need the radical change that these new integrated cancer systems can provide.”
“Being part of London Cancer means planning, operating and behaving as a whole system,” said Rob Hurd, Chief Executive of the Royal National Orthopaedic Hospital.
“Our staff will collaborate with colleagues across the system, providing us with a fantastic opportunity to improve the way we care for local patients."
“London Cancer will create research-based best practice models of treatment and care across NHS organisations that will lead to improved outcomes, high levels of patient satisfaction and better value from every pound we spend in our cancer services.”
London Cancer serves 3.5 million people in north central and north east London and west Essex. It brings together community, primary, secondary and tertiary care providers in a formal governance structure, which also harnesses the expertise of leading cancer academics and charities.
London Cancer is one of two Integrated Cancer Systems (ICS), working alongside London Cancer Alliance, which serves the remaining parts of the capital.
Professor Pritchard-Jones explained: “The new London Cancer partnership will focus cancer care on the needs of the patient in a way that has not been possible under the current model of care, which too often delivers a disjointed and fragmented experience for Londoners.
“Instead of thinking about care at an individual hospital level, London Cancer clinicians at local hospitals will work in partnership with GPs and colleagues from across the system to map out a comprehensive, seamless clinical pathway for every patient.
“Patients will be diagnosed efficiently and have access to the best care and treatment the system can offer for treating their particular cancer, no matter where they live or first access care”
Patients with rarer cancers**, or requiring specialist surgery, will benefit from the full range of innovative treatment options co-ordinated by the specialist cancer centres.
And local care for common cancers will be delivered to consistently high standards closer to home.
As well as driving up survival rates, London Cancer will:
- Ensure that by 2015 a third of cancer patients – compared to just 18% currently – are participating in potentially beneficial clinical trials and research ***
- Deliver patient satisfaction ratings of more than 90% on key issues for patients
Critical to London Cancer’s success will be promoting early diagnosis of the disease to the public and in primary care.
Professor Pritchard-Jones said: “Members of the public need to be aware of the early warning signs of cancer and the importance of going to the doctor without delay. We will also support GPs, who see an average of just eight new cancer cases a year, to get better at identifying elevated cancer risk among patients with general symptoms that wouldn’t normally cause alarm”.
For further details and photographs of case-studies, please email: email@example.com
Case study 1
Taxi-driver Mark Fitzpatrick, from Leyton, east London, was diagnosed with lymphoma in February this year and is nearing the end of successful treatment.
Some of it, such as diagnostic tests, was carried out Barts Cancer Centre, but he was able to have all his chemotherapy five minutes from home at Whipps Cross Hospital.
He explained: “To get to Barts, which was an option, would have taken an hour each way. I rent my black cab and had to give it back as I was ill and I couldn’t get public transport as you have to avoid catching germs.
“So I would have been paying £70 a round trip which is a huge amount when you’re not working. Being able to be treated in my local hospital has made things so much easier for me.”
He added: “Equally important, is that it’s comforting to be in a familiar environment with familiar faces and know that you can be home in five minutes, once the treatment is over.
“Its reassuring to know that I’ve benefited from the best possible care from diagnostic tests at Barts through to treatment at my local hospital by a small dedicated outpatients unit.
“Being able to receive chemotherapy close to home, particularly when feeling very ill, made the whole process as smooth and pleasant as it could be.
“Everybody should be entitled to this excellent service at every stage of their care – from their initial diagnosis through to treatment close to home.”
Case study 2
Patricia Jupp, of Woodford Green, Essex, has been treated three times for different cancers over the last 15 years, and was closely involved in making sure patients’ views were integral in the creation of London Cancer.
She said: “Every cancer patient has the right to the best possible treatment and I believe this new system will help to ensure equity across our area and a seamless care pathway for every patient. This will guarantee top quality care every step of the way, without delay or problems.
“When I was diagnosed with my first cancer – ovarian – in the mid-nineties, they didn’t have a system where everyone had a chance to go to a specialist centre. I firmly believe I would have suffered fewer complications had I been treated from the very start at a specialist centre and that my second cancer – endometrial – would have been diagnosed earlier.
“When I found I had breast cancer in 2008, things had moved forward in terms of treatment and, as my cancer was detected through a routine screening, I was treated straightaway at Barts – a specialist cancer centre.
“This new system will hopefully mean even better treatment in the future, as well as more patients being able to get some of their treatment – such as chemotherapy – at their local hospital, delivered to the standards of specialist centres.
She added: “What London Cancer also aims to do is to empower patients by giving them real knowledge about what is available so they can make a choice, alongside access to the highest possible standards of treatment.
“A good example is being able to choose laparoscopic surgery. Not everyone offers this at the moment and not every patient will ask for it. This will change with London Cancer, so everyone has the full choice of treatments regardless of where they live.”
Notes for editors
* The highly successful model of care practiced in Boston, New England, is a clear point of reference for London Cancer. In Boston, world-leading cancer centres and research institutes such as Dana–Farber, provide care and undertake research and training within a network of hospitals working in partnership across the area.
** Many hospitals do not treat enough cases to build the expertise necessary to treat them to the highest standards. To save more lives in London, specialist cancer care will be provided by the leading experts in the system, either at a cancer centre, or working in outreach settings in local hospitals. Specialist stroke, trauma and heart attack centres operating across London are already demonstrating the life saving potential of this model of care.
*** London Cancer is committed to as many of its patients as possible benefiting from taking part in research. If a patient’s cancer is suitable, they will be invited onto a clinical trial or to donate tissue samples for future research. Taking part in clinical trials helps researchers discover whether a new treatment is better than the current standard treatment and it has other benefits, including even closer medical supervision.
For more details about London Cancer, please visit the website at www.londoncancer.org
Tackling London’s poorer cancer outcomes
The radical new way to organise cancer care was recommended in a review by the NHS in London to establish why, despite having many excellent cancer clinicians and centres, the capital has some of the worst clinical outcomes in the country, primarily because of late diagnosis. The review recommended raising awareness of the early warning signs of cancer and the importance of early presentation as crucial to eliminating 1000 avoidable deaths from cancer in London each year.
Median one year cancer survival rates for all cancers: London Cancer area – 63.8%; national – 66.5%.
London Cancer objectives
- Being patient-focused through listening, communication, involvement, information, education, choice, and personalisation. Patient need and the patient journey will be the organising framework for care
- Optimising care along a co-ordinated pathway through earlier diagnosis, excellent treatment for all, local treatment where appropriate, compassionate aftercare and empowering/supporting patient self-management.
- Embedding research for personalised care, equitable access to trials, the discovery of new treatments and evaluating new ways of working together with patients
- Increasing value through superior outcomes for patients per pound invested; continual improvement over time against our previous performance.
Hospital Trusts making up London Cancer
Barnet and Chase Farm Hospitals NHS Trust • Barts Health NHS Trust (including Whipps Cross and Newham Hospitals) • Barking, Havering and Redbridge University Hospitals NHS Trust • Great Ormond Street Hospital for Children NHS Foundation Trust • Homerton University Hospital NHS Foundation Trust • Moorfields Eye Hospital NHS Foundation Trust • North Middlesex University Hospital NHS Trust • Princess Alexandra Hospital NHS Trust • The Royal Free Hampstead NHS Foundation Trust• The Royal National Orthopaedic Hospital • University College Hospitals, including their Macmillan Cancer Centre• Whittington Health
London Cancer board
The governance of London Cancer will be led by the London Cancer board, chaired by Pelham Allen. It is constituted as an independent, patient-led board that will consider recommendations for improvement from the cancer pathway boards that are led by expert clinicians and include patients and representatives from primary care. Specific improvements to cancer services and pathways will be agreed with commissioners to make the necessary changes. The London Cancer Board, including chief medical officer, Professor Kathy Pritchard-Jones, will hold providers of cancer care to account on an ongoing basis for their behaviours and commitment to the delivery of London Cancer’s goals.
With all of its partners also members of London Cancer, UCLPartners is a natural host for the new organisation. It will provide corporate support to London Cancer, and, through its close connections with trust and academic partners, help to promote coherence across the integrated cancer system.
World-class standards for every patient, every time
A senior clinical director for each of the cancer pathways (brain, breast, colorectal, gynaecological, head and neck, haematological, hepato-pancreatic- biliary, lung, skin, stomach and oesophagus and urology) will support providers to improve access to screening and diagnostics so that treatment can begin as soon as possible. The pathway directors will also drive the system towards international best practice so that all patients have access to the full range of care of a world-class system.
As part of UCLPartners, the largest Academic Health Science System in the UK, London Cancer will also ensure that its patients are first to benefit from some of the most advanced cancer treatments in the world, including the latest drugs, gene therapies and radiotherapy and radiosurgery technologies, no matter where they live. By 2015, London Cancer is committed to at least a third of its patients benefiting from participation in clinical trials and service innovation.
Transforming patient satisfaction in London
As well as the poorer relative survival rates in London, the integrated cancer systems will address the lower levels of patient satisfaction in the capital, highlighted by the National Cancer Patient Survey. London had the lowest scores for 9 out of 10 questions where there were significant regional differences. The capital’s biggest weaknesses were perceived to be the general organisation of NHS services, especially those connecting primary and hospital care, and the difficulties patients reported in contacting a clinical nurse specialist.
As well as addressing these specific issues, London Cancer is committed to giving patients a more powerful voice and active involvement in decisions about their treatment and care, and in setting priorities for service improvement.
Community, primary, secondary and tertiary care providers working together as one
Community, primary and secondary care providers will join forces with the system’s world-leading specialist hospitals and cancer centres to ensure that all London Cancer patients have access to the full spectrum of treatment and therapy options of a world class cancer system.
London Cancer works with academic partners, including University College London, Queen Mary, University of London, and City University, charity sector partners, such as Macmillan, who are supporting the system-level change programme within London Cancer, and hospices. London Cancer’s ambition is to include a wider membership over time.