- A new focus on outcomes
- A renewed focus on patient empowerment and
- Changes to the commissioning structures.
Despite all the hullabaloo about GP commissioning, as Chairman of the All Party Parliamentary Group on Cancer, the most important aspect of these reforms for me has always been the new focus on outcomes. This focus above all else will encourage and force the NHS to raise its game. And luckily for patients, the plans to implement this new focus have escaped the skirmishes and remain intact.
The concept of GP commissioning was always going to attract criticism and scorn. Too many questions remain unanswered. Cancer is a set of 200+ diseases with often complex care pathways, so how were GPs going to commission specialised cancer services and ensure they remain integrated? How were services that spanned consortia boundaries – such as radiotherapy – going to be commissioned? Why was the guaranteed funding for cancer networks – a tremendous source of expertise for GPs – going to end well before the transition period for GP commissioning was complete?
There were too many targets for the opponents of reform to hit. In speeches in the House last year and at the Britain Against Cancer conference in December, I and many others advocated changes to GP commissioning. After pressure both inside and outside Parliament, I believe the Government was wise to conduct its listening exercise.
However, for many of us interested in cancer, the twists and turns over GP commissioning was always a red herring. Provided the distinction between commissioner and provider does not get blurred, how one precisely defines the commissioning structure is less important than measures to ensure the quality of the treatment itself improves.
Partly because of political preference, for too long the NHS has been focused on process based targets and less focused on the actual quality of care. The emphasis has been on throughput at the expense of just how well patients are being treated. No wonder productivity has fallen. To now focus the NHS on outcomes is the major innovation of these reforms. This new focus will do more than any other single measure to improve the quality of care received by patients.
The All Party Parliamentary Group on Cancer’s [APPGC’s] 2009 report ‘Tackling Cancer Inequalities’ recognised as its starting point that cancer survival rates in this country lag far behind the best in Europe. One should always be careful when comparing – for example, France’s data originates out of its five centres of excellence. But there can be little doubt this country flounders in the lower divisions of the international cancer league tables.
The report found that patients who reached the one year survival point stood as much chance of getting to the five year point as patients in other countries; but we fell down compared to others in getting patients to the one year point. This suggests that we are as good as any other country at treating cancer once it is detected, but poor at detecting it in the first place. Other evidence confirms this. A recent report highlighted that over a quarter of cancer patients are only diagnosed when they turn up at A & E Departments.
The challenge is to detect cancer earlier. The key recommendation from the APPGC’s report was therefore the introduction of a one year survival outcome measure. Poor one year figures suggested late diagnosis. So getting the NHS to focus on one year survival figures will encourage earlier diagnosis. With the help of others, the Coalition Government listened and one and five year cancer survival measures are now in the Outcomes Framework.
We all know prevention is better than cure; that clinically proven screening saves lives and cost; and that enormous benefits accrue from GPs having greater access to diagnostics. But the local NHS is more likely to drive these initiatives forward if we focus much more aggressively on the outcome measures – in other words, how many patients have survived cancer and how well have they been treated?
This new focus on outcomes is crucially important. For the first time in the history of the NHS we are elevating the importance of the quality of care. Every clinical outcome is about an individual patient – assessing outcomes will have real meaning to patients, rather than merely measuring compliance with targets set by a central management which sometimes have no clinical relevance.
Luckily this most important idea is the one on which both Tories and Liberals can agree. Good fortune too that the NHS Future Forum made no suggested changes to the Outcomes Framework, having found enthusiasm across the NHS for the idea. It is just a pity that, in the tribal politics which can sometimes dominate Parliamentary business, the Labour Party has so far not recognised this fact as well.