Filed Under (Clinical Commissioning Groups, National Commissioning Board) by Paul on 16-07-2012
Readers will not be surprised to know that I am very mistrustful of the ability of internal NHS culture to reform itself with sufficient speed and depth to enable it to survive, let alone thrive. Nor that it is my belief that many of the appointments to the leadership of the NCB have been from within the most conservative wing of that most conservative culture. Given how much power the NCB has been given by the Secretary of State over the future of the NHS, this is a big worry.
But blog readers will also remember how pleased I was at the appointment of the non-executive directors of the NCB – all of which come from outside of that culture and with the potential ability to lead the changes that will be necessary. As I said Board meetings look to be a treat.
This is the first of an occasional series highlighting some of the public ideas of the new non-execs pointing to ways in which commissioners could develop new models of care.
Ciarán Devane is the Chief Executive of Macmillan Cancer Support, an organisation which in order to survive has to combine the ability to provide care and love to people at times of their greatest vulnerability, with a very tough and capable approach to the business of fund raising. Too many in the NHS see these two attributes as being in some way in opposition. Macmillan demonstrates that this is just not necessarily true – and the NHS needs every institution to do both.
Ciarán wrote an important article in the HSJ on 05/07/2012 (page 20) which highlights the efficacy of this approach and gives us some hope for the ability of the NHS to make the changes that are needed.
The article concerned the model of consultant follow-ups every 6 months during the five years following a diagnosis of cancer. The article takes us back 40 years to begin costing this practice. If you had carried out a 6 monthly follow up for bowel cancer patients in 1972 for the five years after their cancer was diagnosed, the horrid truth would have been that virtually none survived that period. With 1000 bowel cancer patients a year, and such a low survival rate, this may have cost around £150,000.
Now survival rates have been transformed – and many will now reach five years survival – when they need a full scan, and the cost has risen to £620,000. Prevalence of bowel cancer has also risen by 50% meaning that the cost is £910,000.
OK, so it’s 6 times more expensive but if it needs doing, it needs doing. But one leading surgeon has reviewed 800 cases and found that only one cancer has been uncovered by this intervention.
So the cost has gone up 6 times and the efficacy of the intervention is very poor. Why do we do it? The main answer is because we always have.
But let’s just step back from this for a moment. This is the leader of a major cancer charity saying that one of the main ways in which aftercare is offered should stop.
He also has a suggestion for delivering a much better set of outcomes from a different intervention. The National Cancer Survivorship Initiative for England which will soon be published will show how to educate patients to self-manage and how to provide exercise programmes that promote recovery and well being.
This offers commissioners an opportunity to commission very different outcomes for cancer aftercare – providing much better value.
As he says in the article “I hope that clinical commissioning groups will grasp the nettle and work with revamped clinical networks to get key players around the table”
Just to remind CCGs that as CE of Macmillan Ciarán’s is an important voice from a patient group and as a non- exec of the NCB CCGs should pay close attention to one of the most important people in NHS Commissioning.