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Means to an end

Means to an end
4 June 2014

Commissioning for service transformation in end of life care is being achieved by one group of CCGs by working closely with a national cancer charity.

Commissioning for service transformation in end of life care is being achieved by one group of CCGs by working closely with a national cancer charity.

Macmillan Cancer Support and four clinical commissioning groups (CCGs) in Staffordshire and Stoke-on-Trent are working together. They are transforming the way people with cancer and those at the end of their lives are cared for and supported; whether that is at the GP surgery, in hospital, at home or in any other setting. 
The programme team has been working in partnership with patients, carers, doctors and other health professionals to make sure that in the future the treatment and care provided in Staffordshire and Stoke-on-Trent is the best in the UK. 
This area and these services were selected for a number of reasons, including: 
 – In Staffordshire and Stoke-on-Trent the number of people with cancer, and deaths rates, are higher than average.
 – Not all patients are on GP end of life care registers. 
 – The number of people living after a cancer diagnosis is predicted to double by 2030. 
 – An increasing ageing population. 
 – Current services are fragmented and need improvement. 
 – There is poor patient experience, with poor outcomes – and there is a national variation in patient experience.
 – Out-of-hours service is poor. 
 – There was a stated wish to improve integrated working in Staffordshire and Stoke-on-Trent, and good links between Macmillan, the NHS and other partners in the area.
A key aspect of the programme is co-production with stakeholders. 
 –  Patients, carers, doctors, and health and social professionals, are all being put at the centre of decision making.
 – Workshops and focus groups have gained insight into what is happening now and what can be done to improve how services are delivered in the future. 
 – The national voices narrative, which articulates the public request for patient focussed, integrated services, was used in clinician engagement activities. 
 – Three members of the public (non-executive board members sitting on the programme board) have overseen the delivery of the work. These three individuals have been leading this work with the community; making sure we gather a range of views representing the public across Staffordshire and Stoke-on-Trent. 
We understood the need to have a sustained community involvement and have also identified a number of locality champions across the whole of the area to help us with our engagement activities.
We are working with Healthwatch and local patient and carer organisations to support this process. This strong engagement strategy with patients and healthcare professionals means that the programme reflects their priorities and builds them into an outcome-based model of services. This engagement infrastructure will be sustainable for the whole contract period. We will actively involve people, carers, families and communities in the design, development, delivery and review of innovative care; and will support arrangements to maximise choice and independence, which will mean that future care and support meets both identified need and people’s aspirations for the future within the available resources. 
Outcomes-based focus 
Macmillan Cancer Support is providing funding for the project management and infrastructure costs that are necessary to radically transform the way that cancer and end of life care services are commissioned. 
The core aim of the programme is to transform the commissioning process, from the current system of commissioning intervention or services, to commissioning the entire patient journey. This will ultimately lead to one sole provider being responsible for the whole cancer and end of life pathway from beginning to end. The programme is defining the outcomes for cancer and end of life services with the public and community. It will continue to do this throughout the process, and once the prime provider is in place. By the end of the programme, the aim is to have appointed two prime providers, one each for cancer and end of life care, who will hold the contracts for a term of between seven and 10 years. These prime providers will then organise the best model of outcome based care across a network of providers, who would be subcontracted to deliver specific services. 
Innovative programme 
Working with patients and carers, health and social care professionals, the outcome of the programme will make the experience as seamless and integrated as possible. At the moment, cancer and end of life care is organised around the needs of care providers such as doctors, nurses and hospitals. This will change so that it is organised around the needs of patients, becoming truly person-centred care. 
In this way, all patients and carers receive the best possible support wherever and whenever it is needed and nobody feels as though they have been lost in the system. The care and support services that patients and carers receive should be personal to them, regardless of where they live. 
This new and innovative project will pioneer a different way of working and will benefit everyone involved in cancer or end of life care. This is a major transformation that is going to mean big changes to the way that providers of health and social care work together. There is a real willingness to change and excitement now that the programme has been identified as one of 14 pioneers of integrated care in England.
Justine Palin is the Macmillan programme director at Cannock CCG.

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