PHE Cancer Board Plan 2017 - 2021 A plan for PHE staff - Gov.uk
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PHE Cancer Board Plan 2017 - 2021 A plan for PHE staff
PHE Cancer Board Plan
i
PHE Cancer Board Plan
Foreword
Cancer is a leading PHE has over four
public health challenge hundred people working
– a condition that in on cancer in a diverse
all its forms is likely to and complex range
affect one in two of us of programmes that
during our lifetime. However, over 40% of form one of the ten cross-cutting PHE
cancers are thought to be preventable so Programmes and co-ordinated through the
our work can have a profound effect on PHE Cancer Board. Our plan provides the
those burdened with this disease by tackling framework for our work programmes across
inequalities and reducing the impact of the the organisation and highlights how we will
major risk factors such as smoking, obesity work in partnership with external bodies that
and alcohol. PHE is a significant contributor is key to making the delivery a success.
in the system-wide approach cancer across We have highlighted the extensive range of
England and we recognise that success activities of our system-wide data collection
will come from strong partnership-working and analysis for all cancer.
across the health and care sector, with the
voluntary and charitable sector and most of Dr Jem Rashbass, National Director
all with the public themselves. Disease Registration/ PHE Strategic Lead
for Cancer
This strategy outlines our contribution to
the cancer system and how our activities
integrate with the work of others. We have
made cancer a cross-cutting programme
to bring together the extensive skills and
expertise we have in PHE. This embraces
the design and implementation of national
prevention programmes based on the
best evidence, population screening for
breast, bowel and cervical cancer, cancer
vaccination programmes, public awareness
campaigns, all the national cancer data
collection and analysis, and our support for
the long-term quality of life of those living
with or who have had cancer.
Duncan Selbie, Chief Executive
ii
PHE Cancer Board Plan
Contents
About Public Health England ............................................................................................... i
Foreword ..............................................................................................................................ii
Glossary ..............................................................................................................................iv
Introduction ......................................................................................................................... 1
PHE activities: ................................................................................................................... 1
External activities:.............................................................................................................. 1
Cancer work in PHE ............................................................................................................ 3
Governance and accountability .......................................................................................... 5
Section 1: Delivering on the Taskforce
Recommendations .............................................................................................................. 7
Workstream 1. Lead the national work-stream on cancer prevention and public health......... 7
Workstream 2. Drive a national ambition to achieve earlier diagnosis ................................... 9
Workstream 3. Make patient experience as important as safety and clinical effectiveness .. 11
Workstream 4. Transform our approach to support people living with and beyond cancer .. 13
Workstream 5. Make the necessary investments required to deliver a modern,
high-quality service ......................................................................................................... 15
Workstream 6. Overhaul processes of commissioning, accountability and provision .......... 17
Section 2. Consolidating and accelerating our cancer intelligence function .................... 19
Section 3. Working in collaboration................................................................................... 21
Section 4. Communications and Awareness..................................................................... 23
Section 5. Investing in cancer activity ............................................................................... 25
Appendices ....................................................................................................................... 27
Appendix 1: PHE Cancer Board Terms of Reference and Membership .............................. 27
Appendix 2: Related resources ...................................................................................... 29
iii
PHE Cancer Board Plan
Glossary
ACE Accelerate, Coordinate and Evaluate NCRAS National Cancer Registration and
ALB(s) Arm’s Length Body (Bodies) Analysis Service
BCOC Be Clear On Cancer NCRI National Cancer Research Institute
CAS Cancer Analysis Service NEoLCIN National End of Life Care Intelligence
CCG Clinical Commissioning Group Network
CDF Cancer Drugs Fund NHSE NHS England
CNS Clinical Nurse Specialist NHSI NHS Improvement
COMARE Committee on Medical Aspects of NICE The National Institute for Health and
Radiation in the Environment Care Excellence
COSD Cancer Outcomes and Services NIHR National Institute for Health Research
Dataset ODR (PHE) Office for Data Release
CPES Cancer Patient Experience Survey ONS Office for National Statistics
CPRD Clinical Practice Research Datalink PHE Public Health England
CQC Care Quality Commission PHOF Public Health Outcomes Framework
CRCE Centre for Radiation and Chemical and PMO Programme Management Office
Environmental Hazards PROMS Patient Reported Outcome Measures
CRUK Cancer Research UK QA Quality Assurance
CSQM Clinical Service Quality Measures RTD Routes to Diagnosis
DH Department of Health RTDS Radiotherapy Dataset
DIDs Diagnostic Imaging Datasets SACT Systemic Anti-Cancer Treatment
DPH Directors of Public Health STPs Sustainability and Transformation Plans
EAG Expert Advisory Group UK NSC UK National Screening Committee
FIT Faecal Immunochemical Testing UV Ultra-Violet
FYFV Five Year Forward View
HEE Health Education England
HPV Human Papillomavirus Infection
HTA Health Technology Assessment
ICBP International Cancer Benchmarking
Partnership
ICTR Independent Cancer Taskforce Report
IR(ME)R Ionising Radiation (Medication Expo-
sure) Regulations
JCVI Joint Committee of Vaccinations and
Immunisation
KPIs Key Performance Indicators
LAs Local Authorities
LINAC Linear Accelerator
MDT Multi- Disciplinary Team
MRC Medical Research Council
NCIN National Cancer Intelligence Network
iv
PHE Cancer Board Plan
Introduction
Public Health England (PHE) is a major contributor to the system-wide approach to cancer
in England outlined in the Independent Cancer Taskforce Report ‘Achieving World Class
Cancer Outcomes: a strategy for England 2015-2020’ (published in July 2015). We bring
leadership in prevention, screening, health marketing and cancer data collection, liaison and
analysis and support many other cancer-related areas. We deliver through our national role
in Public Health and our partnership with health and social care in Local Government as well
as our collaborations with NHS England, other Arm’s Length Bodies (ALBs), Third Sector
partners and Academia. We are committed to improving the public’s health and reducing
variation and inequalities across society.
This, our internal plan, outlines our approach to co-ordinating Public Health England’s
cancer work for the next 5 years, set in the national context of the whole cancer system. It
is aligned with the Five Year Forward View (FYFV) and the Independent Cancer Taskforce
Report (ICTR) and is the manifesto that coordinates the work across PHE to deliver on these
cross-organisational strategies as well as our own core work and innovation. It describes
our ambitions and what we will do to maximise our effectiveness while working in
partnership with others to deliver on the recommendations made in Independent Cancer
Taskforce and enhance PHE’s own role in the fight against cancer.
1
PHE Cancer Board Plan
A schematic diagram showing the relationship
between the internal cancer-related activities in
PHE and those in the wider service
Key:
Health Protection Health Improvement NHS Service-led
PHE activities:
Prevention of infection Behavioural Factors; smoking; Systemic Anticancer
Hazards Screening Data for National Statistics
related morbidity obesity; alcohol, UV exposure Therapy (SACT) Data
Ionising Radiation (Medical Immunisation and Survivorship and
Exposures) Regulations prevention of infection Health marketing Cancer screening QA Cancer Drugs Fund Audit
Quality of Life
related cancers
Radiation worker follow-up Surveillance of radiation
Be Clear on Cancer Interval cancer surveillance Supporting End of Life Care
workers
Data collection, quality assurance, analysis and intelligence
Local delivery through centres and regions; healthcare public health, health and wellbeing, health protection and specialised commissioning
External activities:
National Data and Policy: National Data and Policy: 3rd Sector: CRUK; Mac- Research: basic; applied; Commissioners: CDF; Patients and Public
ONS and DH ONS and DH millan; other charities service; epidemiology RTDS provision
Cancer Screening QA Data for National Statistics Routes to Diagnosis NHS CancerStats Cancer as a Rare Disease PROMS
Cancer Outcomes and Radiation Exposure Phenotypic Data for 100K Systemic Anticancer
ACE Programme Patient Portal
Services Dataset COMARE & IR(ME)R Genome Project Therapy Data
MDT performance Data to inform National CRUK CancerStats Outcome monitoring and National Cancer Patient
Clinical trial follow-up
monitoring Cancer Policy and Policy relapse Experience Survey
National Lung and Prostate International Cancer Macmillan Local Cancer Surveillance for Genetic RT provision and use; Online prognostic
cancer audits Benchmarking Partnership Intelligence tool Cancer Syndromes Proton Beam Therapy tools (e.g. PREDICT)
Service KPIs and Cancer
Access to Diagnostic tests Tissue bank linkage Cancer Drugs Fund Audit Radiation worker follow-up
Peer Review
Standardised pathology
Screening Be Clear on Cancer
reporting
2
PHE Cancer Board Plan
Cancer work in PHE
Public Health England has a wealth of • Be Clear on Cancer Evaluation with Health
expertise and knowledge in cancer, and is Marketing and NCRAS
well-recognised for its unique position in • Communicating complex messages about
many areas. We spend over £22 million a screening to patients, professionals,
year directly on cancer and employ over 400 the media and the public, supported by
people who work directly on cancer-related Screening, NCRAS, Communications,
work, with many more working in areas that Specialised Commissioning and our
significantly contribute to our cancer activity. Regions and Centres
• Radiation worker follow-up involving Health
PHE cancer-related activity spans the entire Protection Centre for Radiation, Chemical
patient pathway. From cancer prevention and Environmental Hazards (CRCE) and
(which includes our work on obesity, alcohol NCRAS
& tobacco, UV radiation and radon exposure, • NCRAS data to support others such as
screening and HPV vaccination), to earlier specialised commissioning, Public Health
diagnosis (including cancer screening and Outcomes Framework, health economics,
health marketing), guiding and supporting the Knowledge & Intelligence and Health
NHS to commission treatment and services Marketing
(specialised commissioning, screening, data • Local networks for national initiatives and
intelligence and health economics) through support for Local Authority Public Health
to supporting those living with and beyond teams through our Centres & Regions, for
cancer and end-of-life care, encompassing example tobacco control, alcohol harm
and responding to user needs and patient reduction and tackling indoor radon
experience.
How the plan will be used
In early 2016 cancer was established as
one of the ten PHE Corporate Programmes.
In doing so, we have begun to harness the Our plan will be used by all areas of PHE
benefits from cross-organisational working and working on cancer related activities, to set the
identify further opportunity to exploit our com- direction of travel for a coordinated approach,
bined skills and knowledge. This allows us to ensuring join up both internally and externally
work synergistically, sharing expertise, creating over the next 5 years. Each year the PHE
efficiencies and cost savings. To external Cancer Board will approve a delivery plan
collaborators and partners it shows how we using the strategy as its guide, adapting
link our diverse cancer work and provides us where needed to new initiatives, intelligence
with a single voice and common front door. and policy as this arises. The delivery plan will
indicate the year on year deliverables and will
Examples of existing internal collaborations link with other PHE plans and priorities. It will
include: be the responsibility of the PHE Cancer Board
to ensure the strategy is reflected in business
• The monitoring of cancer screening involving
planning processes and to decide on the
National Cancer Registration, Analysis
annual priorities for each year.
Service (NCRAS), and Cancer Screening
3
PHE Cancer Board Plan
Breadth of cancer-related activity in PHE, through all steps
of the patient pathway:
Behavioural
PR
factors
EVE
Environmental
N
risks and hazards
TIO
Physical activity Smoking
N
Diet and obesity Alcohol
Immunisations
and prevention of infection-related cancers
Health
marketing
SIS
GN O
D IA
Data and
intelligence
Cancer
T
EN
TM
EA
TR
OR
IP
SH E
AR
screening
R VIV E C
S U L IF
PREVENTION F
DIAGNOSIS DO
EN
TREATMENT
P
SURVIVORSHI
LI FE C ARE
END OF
Patient experience
Mental health Health economics
4
PHE Cancer Board Plan
Governance and accountability
To deliver our ambitions on cancer success- chaired by our Chief Executive, is responsible
fully we need to coordinate our approach both for the co-ordination and delivery of our work
internally across PHE departments and Direc- on the cancer taskforce recommendations
torates and externally, aligning with the National and reports to the PHE Delivery Board. The
Cancer Transformation Board Implementation Delivery Board requires the PHE Cancer Board
Plan, as well as delivering in collaboration with to report monthly on its progress against the
stakeholders and the public. strategy and delivery plans. The PHE Cancer
Board Terms of Reference and Membership
Internally, Cancer is one of PHE’s Corporate can be found in Appendix 1.
Programmes and the PHE Cancer Board,
PHE Cancer Board: Governance, Functions and Membership
National Cancer PHE Cancer Board PHE Delivery Board
Transformation Board
Chaired by PHE CEO and Oversight of Cancer as one of
Oversight of Cancer Taskforce includes leads for all PHE cancer ten corporate programmes
Recommendations related functions
Stakeholders
All PHE Directorates/ functions
NHSE, CRUK, CQC, HEE, responsible for cancer-related
activity report to the Cancer
Macmillan, NICE, NHS Digital
Board and align activity with
PHE’s Cancer Internal Strategy
Health & Data & Screening & Specialised Health Health Health
Research
Wellbeing Intelligence Immunisation Commissioning Economics Marketing Protection
Behaviour Data Leadership, Supporting Commis- Assessing Prevention, Working with
change registration, commis- NHS sioning of cost-effective earlier partners to
and policy analysis sioning commissioning research; interventions diagnosis reduce the
- tobacco, and release. and quality of services and collabora- to prevent, and raising hazardous
alcohol harm Clinical assurance care. Cancer tions with diagnose and awareness effects of
reduction, Epidemiolo- of cancer Programme of academia, treat with multiple environmen-
childhood gy, support screening Care Board. NIHR, NCRI campaigns tal factors
obesity, for research services charities & and radiation
physical others
activity
TF 1, 27, 28,
64, 90, 91, TF 5, 10, 11, TF 37, 51,
TF 2, 3, 4, 48 92, 94 12 13 76, 82 TF 14 TF 95, 96 TF 2, 15
Local Delivery: Regions & Centres ensure link up to national strategy, lead and enable local delivery and feedback from local level
Patient engagement & experience
Communications
5PHE Cancer Board Plan
Externally, the PHE Cancer Board will work Additionally, we will develop our partnership
with the National Cancer Transformation working at national, regional and local levels,
Board, which provides the focal point for building on successful collaborations to
system-wide leadership on the implementation develop more formal arrangements with the
of the Independent Cancer Taskforce Cancer Third Sector including CRUK, Macmillan, Teen-
Strategy for England 2015 - 2020, enabling age Cancer Trust, National Cancer Research
a joined up and coherent approach. PHE Institute (NCRI) and many others as well as
leads the prevention work-stream of the strengthening our activities with academia.
National Cancer Transformation Programme. More detail about our partnership working can
be found in section 3.
External Governance
Five Year
Forward View
CEOs Board
National Cancer National Cancer Clinical
Advisory Group Transformation Steering
Board Group
Cancer Data
Regional NHS Cancer PHE HEE
and Analytics
Cancer Boards Performance Cancer Cancer
Advisory Group
(sub-groups of and Delivery Board Board
STP boards) Group (PDG)
STP Cancer
footprints Alliances Individual project groups
The next section will outline the three key • Develop our internal data and intelligence
areas of our strategy and describe the work functions to be responsive to user need
we will deliver over the next 4 years. and to develop links across PHE
cancer-related activities
Our plan will: • Strengthen our partnerships, acknowl-
edging the expertise and challenge that
• Align our work with the Independent Cancer
partners bring and to scope further
Taskforce recommendations, showing
opportunity to work with combined
where we have a lead or support role and
strength
what we are committed to delivering
6PHE Cancer Board Plan
Section 1: Delivering on the Taskforce
Recommendations
Workstream 1. Lead the national commissioning, service provision and decision
work-stream on cancer prevention making. PHE leads the prevention work-stream
and public health of the National Cancer Transformation Board to
better exploit the system resources and
expertise to reduce the incidence of
We can prevent cancer by changing behav- preventable cancers.
iours, influencing policy, by the elimination or
reduction of harm and improving protection. Our ambitions:
PHE’s ‘From Evidence Into Action: Opportuni-
ties to Protect and Improve the Nations’ Health’ • To significantly reduce the 40% of
sets out our ambitions to tackle many of the preventable cancers caused by lifestyle,
root causes of preventable cancers. By provid- behavioural, and environmental and
ing the evidence base we can change policy, chemical exposure through increased
and through our national and regional teams public awareness and by providing the
and local centres we support a whole system evidence to influence policy and support
approach, engaging clinicians, commissioners local decision making
and local authority providers to inform
A diagram demonstrating Department Chil
PHE’s key areas of work of Health dho
Tob od
and partnerships acc ob
Local Lifestyle advic o co
es
it
Authorities e& nt
pre ro
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PHE
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su
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Third
re
Joint Committee on
Vaccinations and Immunisation
nc
Sector
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ev
ie
CRUK
w
N H7S
providersPHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
Address obesity as part of a whole systems approach, working with Gov-
ernment, Directors of Public Health and the voluntary sector to increase the NHSE, Local Authorities,
proportion of children leaving primary schools at a healthy weight (2) Department of Health (DH)
Work with Government and NHSE to develop and publish a new tobacco
control plan and will lead on the implementation of the plan with partners NHSE, DH
including NHSE and CRUK to reduce the number of adults smoking to 13%
by 2020 (3)
Following the publication of the Alcohol Evidence Review in December 2016,
PHE will work at a national and local level to promote the findings and support NHSE, DH, Academia
the implementation of appropriate evidence based policies (4)
Work with the Joint Committee on Vaccination and Immunisation (JCVI) to Joint Committee on Vaccina-
re-evaluate the effectiveness of the HPV vaccination in boys (5) tions and Immunisation (JCVI)
Work with the JCVI and NHSE to take forward the HPV vaccination pilot for
men who have sex with men (5) JCVI and NHSE
Support the work to monitor the use of cancer-preventative medication
across the population and work with partners to ensure maximal use of these NHSE
interventions (6,7)
Work with other ALBs, charities and other stakeholders to ensure that lifestyle NHSE, Care Quality Com-
advice is provided to cancer patients to prevent secondary cancers, increase mission (CQC), NICE, Third
sustained health lifestyles and reduce recurrence (8) Sector
In line with the PHE Liver Disease Framework we will examine the evidence
for a Hepatitis B vaccine and implement the Hepatitis C Improvement Frame- NHSE
work to protect against and reduce primary liver cancers (8)
Developing the UK National Radon Action Plan and provide leadership and DH, Local Authorities and
evidence on tackling radon exposure in homes and supporting employers other government depart-
and regulators to manage radon exposure in workplaces (8) ments
PHE will work with the Health Technology Assessment (HTA) to determine the
positive mortality outcome and cost-effectiveness evidence for lung screening UK National Screening
(13) Committee (UK NSC) HTA
We will work with the UK NSC when new data is available to re-assess the
cost effectiveness of ovarian screening (13) UK NSC
Continue to support the prevention of cancer through a wide range of
marketing campaigns beyond Be Clear On Cancer. In addition to encourag-
ing people to stop smoking with health harm advertising and the Stoptober NHSE, Third Sector, DH,
campaign, we will also have a major focus on increasing physical activity Local Authorities
and healthier diets for both adults and children through the One You and
Change4Life programmes (15)
8PHE Cancer Board Plan
Workstream 2. Drive a national
ambition to achieve earlier diagnosis
The earlier a cancer is detected, the better the Our ambitions:
chance of it being treated successfully. Earlier
diagnosis is facilitated through increased • Increase in the number of patients diag-
awareness of symptoms and signs to act nosed at an earlier stage and referred for
on, screening which detects cancers at an treatment sooner
earlier stage and strong links between primary • Reduce the inequalities of access to
and secondary care for timely referrals for screening and other detection and diag-
diagnostics and testing. PHE provides system nostic services through targeted service
leadership for early detection through cancer configuration and campaigns
screening, and its health marketing campaigns
support decision making on the design and
provision of front line services through cancer
intelligence.
A diagram demonstrating PHE’s key
areas of work and partnerships
Be Cle
ar o
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UK Roll-
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NSC of
HP
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PHE
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Macmillan
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Roll
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screening
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(2 8 d
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9PHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
We will work with NHSE to roll-out faecal immunochemical testing (FIT) for
bowel cancer screening and drive up uptake by 2020 (10) NHSE, UK NSC
We will lead a roll-out of HPV primary testing in cervical screening (11) NHSE, UK NSC
Examine inequalities in screening programmes and make recommendations
for action to reduce these and improve access and uptake to services NHSE, UK NSC
(10,11,12,13)
Continue to invest and deliver the Be Clear On Cancer (BCOC) campaigns
with at least two campaigns every year (15) CRUK, Macmillan, NHSE, DH
Continue to develop, pilot and evaluate the BCOC campaigns, looking
to increase efficiencies and exploring opportunities to raise awareness of
multiple symptoms and, therefore, a greater number of cancers, assessing CRUK, Macmillan, NHSE, DH
their effectiveness and potential for further roll-out as data becomes available
(15)
Continue to build on the BCOC digital and social media presence, including
opportunities to test and evaluate new approaches wherever possible (15) CRUK, Macmillan, NHSE, DH
Work with NHSE, DH Policy Research Unit, CRUK and Macmillan to evaluate
the Accelerate, Coordinate and Evaluate (ACE) early diagnosis intervention NHSE, CRUK, Macmillan, DH
programme (21)
We will support NHSE with the 28-day referral pilots by developing the
metrics and providing near real-time data showing the patient pathway and NHSE
the stage of diagnosis (24)
Building on the Routes to Diagnosis tool will develop an interactive version
and make this publicly available and scope other options for supporting the CRUK, Macmillan, NHSE
reduction of people diagnosed through A&E (24)
Support the international comparative analysis on cancer care and outcomes
for example through International Cancer Benchmarking Programme (ICBP) CRUK, Academia
Phase 2 work (Multiple Recommendations)
Deliver the data collection and evaluation of the primary care National Cancer NHSE, Third Sector, DH,
Diagnosis Audit (39,82) Local Authorities
10PHE Cancer Board Plan
Workstream 3. Make patient protected and used only for patient benefit at
experience as important as safety all times. We hope to improve patient
and clinical effectiveness experience by providing patients with their own
information and by making cancer data and its
meaning more accessible.
Our role is to support the NHS to improve its
services and provision of care, and patient Our ambitions:
and carer experience is the barometer of how
successful the system is performing. How • Continue to work closely with patient
patients experience the care pathway and to groups to enable the patient voice through-
what extent they are able to make informed out our work and provide patients with
decisions are fundamental to their quality of life access to their own data to support their
while living with and beyond cancer and at the decision making and understanding of their
end of life. PHE deeply values its relationship condition
with patients and their families and takes great
care in ensuring their data and information is
A diagram demonstrating PHE’s key
areas of work and partnerships ereditary Canc
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Meet mental he ry
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Digital Enablers & P ed
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ta
PHE
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ng
Patient
with
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experience CRUK
Atla s o f Va r i a ti o
on a par with
clinical
effectiveness
NHS Digital
Mac
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NHS
England
Ca
nc
er
Pat y
ie nt E e
xpe ri e n c e S u r v
11PHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
Work to embed the practice of meeting the mental health needs in everyday NHSE, HEE, Macmillan,
practice through staff training and new patient information materials (48) CRUK & Academia
Work with NHSE on the National Cancer Patient Experience Survey to
develop new metrics that measure and promote continuous improvement to NHSE, Macmillan
service provision (54)
Undertake linkage work to understand the links between patient experience
and outcomes (54) Macmillan
Develop tools and information to support patients and the public to better
understand how accessing their data can support their care and decision Third Sector, NHSE and
making (57) patient organisations
Roll-out of the National Hereditary Cancer Registry focussing initially on BRCA
testing for women at risk of breast and ovarian cancer (57/90)
Continue to deliver the data and analysis to support the Atlas of Variation and NHSE
a reduction in the variation of care (78)
Continue close engagement with patients groups, third sector partners and NHSE, Macmillan, CRUK and
others to ensure that our work is guided and endorsed by patients and meets other cancer charities, NCRI
their expectations patient partners.
12PHE Cancer Board Plan
Workstream 4. Transform our PHE’s National End of Life Care Intelligence
approach to support people living Network (NEoLCIN) monitors the quality of care
with and beyond cancer in end of life services which serves to drive
improvements across all sectors working in
partnership with NHSE, charities and academ-
There are an increasing number of people ia. The wealth of data collected by the National
living with and beyond cancer who will Cancer Registration and Analysis Service
experience new challenges post-treatment (NRCAS) allows us to model survival by stage,
and changing needs which will impact on compare patient pathways and provide data
their quality of life. This is an area of increasing on the variations in quality of services and
need as treatments and survival rates improve. care.
In addition, while end of life care is more Our ambitions:
developed, still there are significant unmet
needs; for example over 40% of patients • A significant increase in the quality of life
who die of cancer do so in hospital, despite for people living with and beyond cancer
wanting to die at home. by ensuring timely collection of patient
outcomes to drive immediate changes in
service provision, decision making and
understanding of their condition
A diagram demonstrating PHE’s key
areas of work and partnerships
Patient Re
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Link Ou
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Third sector
Academia Living with Academ
ia
and beyond
ONS
NIHR Patients
lan
Macmil
Third s
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De
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13PHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
Develop data gathering and monitoring systems to report on access to
services for those living with mental illness and or learning disabilities (48) NHSE
Work with the National Institute of Health Research (NIHR) and research
charities to develop a system to link patients with clinical trials (50) NIHR, Third Sector
Support the development of a new quality of life metric to drive improvements NHSE, Third Sector,
across services (64) Academia
Support the development of Patient Reported Outcome Measures (PROMs) NHSE, CRUK, Macmillan,
(64) Academia
Explore ways to support the work on recovery pathways and follow – up care
with partners (65) As appropriate
Support development of stratified follow-up pathways of care for other tumour NHSE, Commissioning
types, ideally including prostate and colorectal and some rarer cancer types including Specialised
(67) Commissioning
Understand the outcomes of treatment – for example 30 day mortality NHSE, CQC and NHS
following chemotherapy and surgery; work with NHSE and others to establish Improvement
online monitoring tools for key metrics
Publish 1 year stage survival analysis on an annual basis using near real-time
data (90/1) ONS, DH
Reduce unwarranted variation in quality of end of life care by geography, age
and in some instances ethnicity (73) Academia, DH, NHSE
At the local level support NHSE regional teams to ensure that there is
not inequality of access to health and wellbeing guidance and extending NHSE, DPH, Third Sector
preventative lifestyle advice to people living with and beyond cancer
14PHE Cancer Board Plan
Workstream 5. Make the necessary Anti-Cancer Therapy Dataset (SACT) and
investments required to deliver a Radiotherapy Dataset (RTDS). Furthermore, we
modern, high-quality service support NHS England, through the specialised
commissioning cancer Programme of Care
board and clinical reference groups, to devel-
Knowing where to invest and the impact of op evidenced based clinical policies to ensure
the investment is critical to improving services cancer services improve outcomes and impact
and care for all. PHE’s role is to support on reducing health inequalities.
NHSE, commissioners and service providers
to understand the prevalence, disparity and Our ambitions:
standards of cancer services by linking the
datasets we hold in the Cancer Analysis • Robust and near real-time data, metrics
System (CAS) through data analyses and and indicators to measure the effectiveness
metrics. This includes Prescription data, of new initiatives, inform value for money
Diagnostic Imaging Dataset (DIDs) Systemic commissioning and policy and decision
making to improve patient outcomes
A diagram demonstrating PHE’s key
areas of work and partnerships
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15PHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
Develop an algorithmic solution to determine prevalence of recurrence across Macmillan, academia
all cancers (9)
Publish the number of cancers diagnosed at stage 1 & 2 and via emergency NHSE
presentation on a quarterly basis each year (24,96)
Develop the software to provide individual patient pathways and make it NHSE, Third Sector and
publicly available (24,38,41,46,81) others as appropriate
Determine the variation in outcomes for patients dependent on their proximity Macmillan, CRUK
to cancer centres (27)
Support the development of the pilot metrics for cancer surgery CRUK, Royal College of
sub-specialties and make recommendations to the National Cancer Surgeons, NHSE, CQC
Transformation Board on next steps (28)
Support NHSE in the roll-out of new Linear Accelerators (LINACs) linked with NHSE
the Radiotherapy Equipment Register (29)
Work with CQC and providers to drive up SACT completeness in order to
enable a better understanding of drug use and spend to inform The National CQC, NICE, NHSE
Institute for Health and Care Excellence (NICE) decisions on the future of the
Cancer Drug Fund (35)
Provide the data and undertake with partners the analysis for cancer audits NHSE, Royal Colleges,
(82) CRUK, Academia
Use data on recurrence and relapse to identify and then optimise the care NHSE, Macmillan, other third
pathways for patients with metastatic cancer (46) sector
To support the monitoring, use and equitable access to genetic testing and NHSE, Specialised Com-
molecular diagnostics (36,37) missioning and Genomics
England
Provide data and analytical support to promote the use of electronic prescrib- NHSE, NICE
ing particularly in secondary care (34)
To support the data requirements for radiotherapy service provision – capital
investment planning, service utilisation, new therapies and outcome evalua- NHSE, CRUK
tion.
To provide the data infrastructure to support the efficient delivery of rarer NHSE
cancer MDTs (40) including for Paediatric Cancer (43,44,45)
Public health leadership and support for defined clinical cancer policies and NHSE
service reviews for the cancer Programme of Care board
Explore the potential to build on existing analytical investments and further All partners
collaborations
16PHE Cancer Board Plan
Workstream 6. Overhaul processes advice and systems leadership to improve
of commissioning, accountability and services, outcomes and reduce inequalities
provision at national, regional and centre level for the
specialist commissioning portfolio of cancer
services.
Through PHE’s role as chief public health
advisor to NHS England, PHE supports the Our ambitions:
translation of knowledge and intelligence into
strategic advice and policy for commissioners. • Provide public health leadership with rep-
The taskforce recommends timely metrics that resentation on the National Cancer Trans-
will allow rapid feedback and therefore enable formation Board and cancer Programme of
a more responsive commissioning of local Care Board
services. PHE will align its analysis outputs to • Active involvement with the National Cancer
those of the taskforce recommendations and Transformation Board plans and decision
work with partners to deliver these. Further- making
more, PHE recognises its responsibility in the • To develop an understanding of the costs
delivery of the taskforce recommendations and benefits associated with cancer
and will ensure its structures, governance programmes
and reporting mechanisms follow suit. We will
ensure robust, evidence based public health
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17PHE Cancer Board Plan
We will: Working with:
(*) denotes corresponding Cancer Taskforce Recommendation
Work with NHSE to develop and deliver a cancer dashboard of metrics to NHSE
support the work of CCGs, Providers and Alliances (1)
Work with NHS England colleagues to define the new Cancer Waiting Times NHSE
data collection service (24,38)
Develop a user-friendly tool to enable Clinical Commissioning Groups (CCGs)
and local commissioners for the first time to estimate costs and benefits at NHSE, CRUK, Macmillan,
a local level of improving outcomes in colorectal cancer and to make the Academia, McKinsey
business case for appropriate investment to improve early detection (95)
Provide the data collection, analysis and reporting functions to assist
with the delivery of efficient Multi-Disciplinary Team (MDT) working NHSE, NICE
(38,39,40,41,46,70)
Provide the data collection, analysis and reporting functions to support NHSE, NICE
efficient decision making and use of Cancer Prevention Drugs (6)
Provide the data collection, analysis and reporting functions to assist with the
delivery of efficient use of quality surveillance and the use of NICE and other NHSE, NICE, HEE
clinical guidelines (79)
Provide the analytical support capacity in partnership with the Cancer NHSE
Vanguard and Alliances (78)
Provide evidence of impact on national specialised commissioning cancer
products through the NHS England Cancer POC Board; and support NHSE
approaches to improving cancer services access and outcomes at Centre
and Region level
18PHE Cancer Board Plan
Section 2. Consolidating and accelerating
our cancer intelligence function
PHE is responsible for nearly all the data • Collect, quality assure and curate cancer
collection, reporting and analysis that under- data from the entire care pathway on
pins the work of the whole cancer system in all cases of cancer in the population in
England spanning public health, health care, England
commissioning, evaluation, research and • Co-ordinate cancer data collection and
individual patient choice. The National Cancer analysis across PHE and working with
Registration and Analysis Service collects partners in NHSE and other arm’s length
richer, more-timely data on greater number of bodies
patients than any other country; data quality for • Undertake and support academically
key data items such as cancer stage. robust data analysis on all aspects of the
cancer system in England including the
Joining up cancer intelligence & new ways new Cancer Alliances and Vanguards, and
of working: alignment with non-cancer specific ‘Sustain-
ability and Transformation Plans’ footprints
• Provide timely, high-quality data to all those
We have realigned the work between our
who require it within a robust information
registration and analysis teams with the imple-
governance framework
mentation of the National Cancer Registration
• Develop new resources to deliver relevant,
and Analysis Service (NCRAS) which replaces
timely cancer data and information to
the National Cancer Registration Service
all users such as the integrated cancer
(NCRS) and the National Cancer Intelligence
dashboard
Network (NCIN.) By bringing the functions
• Continue to interrogate the data and
together we now need to focus our ambitions
evidence and identify new areas of need to
on continuing to provide a near real-time, cost
inform the next national cancer strategy
effective, comprehensive data collection and
delivering an academically rigorous and stra-
tegically-driven analysis service. We have also We will:
enriched our collaborative working to support
our capabilities and build capacity and we will • Ensure that all our data collection, use
continue to explore further opportunities with and release is fully aligned with the recom-
stakeholders. For more information about our mendations of the National Data Guardian
work with partners see section 3. Review and emerging policy on data collec-
tion for National Disease Registers
Our ambitions: • Align the work of the National Cancer Regis-
tration and Analysis Service to the taskforce
• To set the standard for data collection, data needs as described in Section1 and
analysis and release deliver these in the timeframes given
19PHE Cancer Board Plan
• In partnership with others, continue to • Work to establish data collection and re-
drive-up data quality and completeness for porting from rarer cancer MDTs and sharing
all datasets including staging completeness, data with the 100,000 genome project
SACT, RTDS, DIDs, Prescription Data
To improving data access we will:
and the Cancer Outcomes and Services
Dataset (COSD)
• Continue to develop the PHE Office for Data
• Provide data and expertise on the design
Release (ODR) to manage the delivery of
and assessment of prevention interventions
timely data to all those who request it, within
including cost-effectiveness and return on
a robust information governance framework
investment
• Work with the Ministerial Information
• Work with the Office for National Statistics
Strategy Group and other partners including
(ONS) to produce official and national
the NHS Digital, Clinical Practice Research
cancer statistics for England
Datalink (CPRD) and ONS to harmonise
• Provide the timely, relevant and responsive
data access requests
evaluation of the Be Clear on Cancer
• Develop a range of online directories that
campaigns
allow users to discover what data we hold,
• Work with NHS England and NICE to pro-
and the quality and completeness of this
vide a robust data collection and evaluation
data
of chemotherapy treatments and outcomes
• Develop one or more physical safe haven
including those medications provided
facilities to allow secure data access in a
through the cancer drugs fund
controlled environment that guarantees
• Support the monitoring of Section 7a-fund-
patient confidentiality
ed activities including the roll-out of FIT and
• Provide online resources of data, informa-
HPV primary testing
tion and knowledge to support call users
• Provide data and expertise to support the
– including a CCG and Alliance dashboard,
assessment of inequity and variations in
the Public Health Outcomes Framework
access, treatments and outcomes
and Fingertips and Health Economics
• Provide data to support the work of PHE’s
modelling tool.
Chief Economist
• Work with colleagues in NCRI to improve
• Develop relevant metrics and indicators to
the use of data collected in clinical trials
monitor cancer pathways and outcomes
including monitoring the 28-day standard
and diagnostic capacity fund
• Develop and manage a national directory
of all Multi-Disciplinary Teams and the lead
clinician
• Review the role of the PHE Expert Advisory
Groups (EAGs) and their relationship with
other cancer clinical reference groups including
those supporting NCRI, NICE and NHSE
to improve effective engagement
20PHE Cancer Board Plan
Section 3. Working in collaboration
Cancer is a system-wide activity and PHE has • Be Clear on Cancer Campaigns working
a significant role in improving outcomes for alongside CRUK & NHSE
cancer but it is the system-wide approach that • Increased capacity of our cancer intelli-
will make the difference. We must be clear on gence function and enabling increased data
our part in this, while recognising the many access through posts funded by CRUK,
strengths of our partners, and how we can Macmillan, and NCRI
work better together to achieve the change in • Macmillan investment and expertise sup-
patient outcomes we all want. porting the work on recurrence
• Teenage Cancer Trust investment for data
The teams and functions delivering cancer-re- linkage and new work on children’s cancer
lated activities already have strong links with
partners including the Third Sector, Academia
Our ambitions
and other Arm’s Length Bodies (ALBs).
Building on current successes, we aim to Going forward, we will look to build our part-
strengthen our partnership working by consol- nership working with the Third Sector so that
idating existing relationships, and extending wherever possible we have a whole pathway
our collaborations with other ALBs, charities, approach which harnesses partners’ expertise
industry and academia to maximise on the in areas such as prevention, quality of life and
potential of collaborative working and achieve reducing inequalities and variation. We will:
our ambitions and those of our partners. We
recognise partnership working as an enabler of • Apply a strategic approach to future
joint success, bringing added value by working partnership development, scoping areas of
to organisational strengths and learning from need and exploring opportunities with our
one another. wide range of stakeholders
• Expand our working partnership with CRUK
to deliver an accelerated cancer intelligence
Our work with the Third Sector function and innovative ways of working
through additional capacity
• Build on our working partnership with
PHE already has a number of collaborations
Macmillan to ensure our resources and
with third sector partners which bring together
expertise are used to support activities in
organisational expertise in specific areas of the
the areas of Living With and Beyond Cancer
cancer patient pathway and/ or knowledge
and End of Life Care
and focus on specific cancers or skills.
• To scope other partnership opportunities
with our other third sector partners including
These include:
Teenage Cancer Trust, Braintrust UK, NCRI
and many others
21PHE Cancer Board Plan
Our work with academia & clinical and national priorities, supporting delivery of
engagement national programmes tailored to local need and
enabling others to improve health and reduce
variation.
Academic input to our work is crucial to pro-
ducing high quality, evidence based outputs,
At the regional level PHE provides overall
and clinical engagement informs the prioriti-
quality assurance and co-ordination of PHE
sation of our work, seeing that it is focused
functions, leading our work on the Sustainabil-
on patient care and service improvement.
ity and Transformation Plans (STPs) and acts
Across PHE we have a strong relationship with
as public health advisers to NHS England.
academia. For example, the screening team
work with health education institutes and Royal
The 9 Centres provide a tailored approach,
Colleges to develop education and training
reflecting geographical differences.
resources for thousands of front line clinicians,
and we work closely with clinicians to help
Centres work with NHS England, Health
inform our data and intelligence work through
Education England (HEE) and Directors of
the EAGs.
Public Health to support the breadth of public
health functions at the local level. This includes
representation on clinical senates, quality
We will:
surveillance groups, and work that supports
• Scope and develop academic partnerships improvement in outcomes, providing advice
and research collaborations building on and evidence on a wide range of cancer-re-
appointment of Senior Academic Epidemi- lated areas. This local position enables us to
ologist to provide challenge and academic support place-based approaches with local
rigour to our workforce and outputs public health teams. They provide a strategic
• Work with the Farr and emerging MRC link for the ‘national to local’ and ‘local to
health informatics initiative on data analysis national’ interface working.
and interpretation
• Work with the Chairs of the SSCRGs to Examples of the local role in supporting and
re-align clinical input as part of our efforts taking forward cancer-related activities include:
to ensure our work programme is based on
• Centres have strengthened their efforts
user needs
to improve cancer outcomes locally. They
• Expand our clinical engagement and input
successfully undertook the redesign and
with the appointment of clinical leads for
implementation of their screening and
domain areas
immunisation teams in conjunction with
local NHSE partners. This is helping to
Our work with local partners provide more appropriate services to meet
local needs. They continue to be creative
by instituting local initiatives aimed to
PHE’s local function is delivered through its
address challenges in the vulnerable and
Centres and Regions who work as part of
underserved populations
local health systems, contributing to local
22PHE Cancer Board Plan
• Through the STP processes, Centres • Health protection function in monitoring
support local government and NHS to radon exposure and advise on chemical
co-commission preventative services and environmental risks
aimed to improve health outcomes, • Screening & Immunisation staff sit under
reduce demand on the local health and NHSE Directors of Commissioning Opera-
care system, and secure a reduction in tions to deliver local screening programmes
variations in outcomes across and which are tailored to address variation and
between localities. inequalities to ensure maximum coverage
• Centres also work directly within wider as well as delivering HPV vaccinations
partnerships including Academic Health
Science Networks, CLAHRCs, Clinical
Networks, Health Education England and,
Clinical Senates to provide public health
advice and support
Section 4. Communications and Awareness
One of the keys to our success will be our of Informed Choice for Cancer Registration
ability to communicate our intentions and highlighted the need for PHE to increase its
actions in an accessible manner to engage transparency about how it obtains and uses
and inform staff, partners, stakeholders, data and its need to improve awareness of the
patients and the public. role of the cancer registry respectively, in par-
ticular with the public, cancer patients, carers
Internally, we have raised the profile of our can- and health professionals. We will work with
cer-related activities with all staff using targeted CRUK, Macmillan, and many other partners to
internal communications and events, inviting respond appropriately to the recommendations
staff to give feedback on how we can improve from both reviews.
their knowledge of our cancer-related work
and to support them in talking to stakeholders We will increase our presence with health
and partners in their roles. We will ensure all professionals, cancer patients and carers with
staff have access to the PHE internal cancer the review of existing materials and taking on
strategy and that the cross dependencies with new suggestions to improve accessibility to
department and teams plans are considered information, the patient’s right to opt-out and
as part of the annual business planning cycle. the benefits that patient data brings to the
whole system.
Both the National Data Guardian Review
of Security, Consent and Opt Outs and More widely, PHE recognises its role in
Macmillan and Cancer Research UK’s Review disseminating evidence and guidance to a
23PHE Cancer Board Plan
wide range of stakeholders to support delivery Patient and public engagement
and service improvements, but until now has
not coordinated its approach to cancer. The We value the significant input and feedback
establishment of the PHE Cancer Board has from the many patients and carers involved
already taken steps to address this with the with our work and seek to build on these activities
creation of the PHE Cancer Board Gov.UK to ensure the patient voice is reflected in all areas
page and dedicated communications support. of our cancer-related activity. At the current
time public engagement helps to shape many
To deliver on PHE’s commitments as part of of our services and campaigns including:
the Cancer Taskforce, particularly in relation
• The development of screening information
to prevention and data expertise, Cancer is
materials
one of the PHE communications priorities as
• Testing our health marketing campaigns to
outlined in our communications business plan.
maximise impact
• Informing NCRAS deliverables through
We will use national media, online and digital
patient representation on the EAGs
channels and direct communications to inform
• Ensuring the PHE Cancer Data and
stakeholders of our work in relation to cancer
Outcomes Conference has a distinct
in general and cancer prevention specifically.
patient and carer presence through patient
Our public facing messages on diagnosis and
bursaries
prevention will be delivered primarily through
• Project specific involvement with the many
our Be Clear on Cancer campaigns and
patient and consumer groups through our
screening communications work.
third sector partners
Key outputs outlined in the plan reflect the As we move forward we will seek further
priorities in the PHE cancer strategy for example: opportunity to engage with patients and the
public to help inform our work.
• Publication of national and CCG level
survival statistics
• Increase in primary screening for HPV and
national roll out of HPV testing in the cervical
screening programme
• National Be Clear on Cancer campaign on
respiratory symptoms
• Outputs of data analysis and cancer intelli-
gence work such as that on SACT
These will be delivered using a variety of
communications channels including print and
online national and regional media and direct
communications via our direct mailing bulletins.
They will be produced and amplified alongside
our partners in the Five Year Forward View and
the National Cancer Transformation Board.
24PHE Cancer Board Plan
Section 5. Investing in cancer activity
Annually, PHE invests Dedicated cancer functions Full Year budget (000s)
£22 million directly into
Be Clear on Cancer campaigns £4,390
dedicated cancer
National Cancer Registration and Analysis Service (NCRAS) £11,551
activities.
HPV-related cancers £478
Preventing infection amongst people with cancer £300
This includes screening
Cancer screening £6,170
and screening quality
assurance, cancer data Subtotal £2 2 , 8 8 9
collection and intelligence,
Be Clear on Cancer, Crosscutting functions benefitting cancer Full Year budget (000s)
radiation protection and with
Ionising radiation £7,000
an additional £38 million
Non-ionising radiation £500
allocated across all our
Chemical hazards £1,500
Directorates and teams
Hepatitis B and C £586
who support the delivery of
Health Equity and Place (Inequalities) £1,323
our cancer-related activities,
for example Healthcare Behavioural risk factors
Public Health teams in
Health & Wellbeing (Diet & Obesity/Alcohol/Tobacco Control) £5,686
our local Centres.
National Child Measurement Programme £205
NHS Health Checks £648
Physical Activity £43
Non-cancer marketing
Ageing Well (Early Diagnosis) £5,200
Living Well (Smokefree) £4,000
Living Well (Alcohol) £200
End of Life Care Network £436
Subtotal £27,327
* Budgets shown for
Centres and Regions * Full Year budget (000s)
Centres and Regions
are not dedicated to Immunisation and Screening £13,804
cancer-related activity, but Specialist Public Health £4,934
show the total resource for Health Improvement £8,245
cross-cutting functions that
impact on cancer Sub total £26,983
Overall total £77,199
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