Download Purpose of Paper / Brief Management Summary: The Children and

Subject : Commissioning of Children’s Cancer Services
22 August 2012
Purpose of Paper / Brief Management Summary:
The Children and Young People Improving Outcomes Guidance recommends that:
‘Planning, commissioning and funding for all aspects of care for children and young people with
cancer, across the whole healthcare system should be co-ordinated to ensure that there is an
appropriate balance of service provision and allocation of resource.
The Children’s Cancer Peer Review measures assess this through:
1) The Children and Young People Coordinating Group, with its specific membership and
terms of reference;
2) The agreement that children’s cancer commissioning will be overseen by one body for the
population of the Children’s Cancer Network, the Specialist Commissioning Group (SCG)’
NESCOG is asked to consider and agree the following recommendations in order that the
cancer peer review evidence can be updated for the peer review cycle 2012.
Risk Rating:
Green: milestones / targets are on track and financial balance assured
Amber: controls / actions are in place to bring milestones / targets / financial balance in place
by the end of the financial year
Red: milestones / targets / financial balance not expected by to be achieved by the end of the
financial year
North East Regional Operating Group
North West Regional Operating Group
Yorkshire and the Humber Regional Operating Group
Committees previously discussed or agreed at:
NESCG September 2011
Action requested of Board:
NESCOG is asked to consider and agree the following recommendations in order that the
cancer peer review evidence can be updated for the peer review cycle 2012
Contact:
Roy McLachlan
Nominated SCG Lead on Children and Young People Coordinating Group
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Children’s cancer peer review measures
1) Chair of the Children and Young People Coordinating
Group
Children’s cancer peer review measures require that a commissioner chairs
the Children and Young People Coordinating group. Teenage and Young
Adult cancer peer review measures require that a specialist commissioner
chairs the meeting.
15 September 2011 NESCG agreed the Children and Young People
Coordinating Group terms of reference including the role and responsibilities
of the Chair, Mark Adams (appendix one). The specified time for the role of
Chair was agreed as two days per month.
Mark Adams is no longer able to chair this group due to his new role. David
Gallagher was identified to take over this role but since then his role has also
changed.
Recommendation
NESCOG is requested to suggest and agree a new chair for the
Children and Young People Coordinating Group who will carry out the
responsibilities in appendix one.
2) SCG Lead for Children’s Cancer
15 September 2011 NESCG agreed that the Director of North of England
Cancer Network (NECN) should fulfil the role of the named SCG Lead for
Children’s Cancer on the Children and Young People Coordinating Group
Recommendation
NESCOG is asked to confirm that the Director of NECN continue to
fulfil the role of named SCG Lead with the responsibilities outlined in
appendix two
3) The Delegation Agreement
The children’s cancer peer review measures ask for an agreement for each
organisation which specifies:
 Which organisations are responsible, including cancer networks,
individual PCTs, children’s cancer networks (i.e. networks dealing with
children’s services in general), local authorities and practice-based
commissioners;
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What each organisation is responsible for, covering where relevant,
which patient pathways or parts of pathways, which geographical parts
of the network and which part of the commissioning function;
Who is responsible for monitoring the performance and quality and
feeding back to the contract lead
Last year in order to provide evidence for compliance with the cancer peer
review measures associated with this recommendation, NESCG agreed the
application of their existing delegation agreement which explains its role when
commissioning on behalf of its constituent PCTs.
Recommendation
Given changes to NHS commissioning functions and an updated
NESCOG Establishment Agreement, appendix three, NESCOG is
requested to agree the application of the new Establishment
Agreement to children’s cancer services
4) The Service Specification
The children’s cancer peer review measures ask for an annual service
specification which fulfils the following:
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It specifies the patient pathways
It refers to the milestones for service change required by the
commissioning strategy
It has components specific to all providers
It is integrated across the North of England Cancer Network as
evidenced by its agreement by all identified commissioning bodies
The Children and Young People Coordinating group have agreed a service
specification (appendix four) which fulfils the above criteria
Recommendation
NESCOG considers and agrees the attached service specification.
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Appendix One
Responsibilities of the Chairperson
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The Chair of the CYPCG is required to provide leadership for children and
young people’s cancer services
The Chair should participate in Network Board meetings as needed and will
work closely with the Lead Clinicians of the Principal Treatment Centre (both
Children and Teenage Young Adult ), Network Medical Director and Network
Director
The Chair shall be responsible for ensuring the CYPCG adheres to the terms
of reference and agrees an annual work programme with the SCG
The Chair will ensure that the CYPCG meetings are arranged, recorded and
actions progressed.
Appendix Two
Roles & Responsibilities for named SCG lead for children’s cancer
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To be the named lead from North East SCG for commissioning the Children’s
Cancer Network
For overseeing production of the five year commissioning strategy for
Children’s Cancer Services
For overseeing production of the Health Needs Assessment every five years
and ensure it’s incorporated into the Joint Strategic Needs Assessment.
To obtain agreement from all organisations that commission aspects of the
children’s pathway their responsibilities of the commissioning function
To oversee production and obtain agreement for the Service specification for
the Children’s Cancer Network with commissioning bodies
To ensure inclusion in the contracts / Service Level Agreements for children’s
cancer of the relevant parts of the service specification and measures
To ensure service monitoring is brought to the CYPCG every 6 months and
remedial action is agreed.
Appendix Three
Establishment agreement for the North of England Specialised
Commissioning Group
Appendix Four
SCHEDULE 2 – THE SERVICES
Schedule 2 Part 1: Service Specifications
Service / Care Pathway Children and Young People with cancer 0-18 years
old
Commissioner Lead Anya Paradis, Head of Commissioning, NHS North of
Tyne
Provider Lead Russ Watkins, Senior Contracting Manager, Newcastle upon
Hospitals NHS Foundation Trust
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Period 1 April 2012 – 31 March 2013
Date of Annual Review Dec 2012
1. Purpose
The purpose of this specification is to:
 outline the nature of specialist children’s cancer services in North of
England Children’s Cancer Network
 set out the model of care
 indicate quality standards
 outline eligibility criteria
1.1 Aims
The aims of the service are to:
 To ensure patients with cancer are treated and supported in line with
the North of England Children & Young People Coordinating Group
(CYPCG) agreed pathways and policies
 To ensure patients with cancer are treated in line with the national
children’s cancer protocols or agreed Children and Young People
Coordinating Group treatment protocols or guidelines
 To ensure that parents and children have co-ordinated care across the
whole pathway and feel supported during their cancer journey.
 To monitor survival outcomes in conjunction with the Children’s Cancer
Research Group (CCRG) in Oxford using data supplied by them
1.2 Evidence Base
The documents which support the services to be provided and this
specification include:
o NICE National Guidance for Children and Young People with Cancer
(2005).
o National Cancer Peer Review Programme, Manual for Cancer Services
(National Cancer Action Team)
o NCRN Children’s Cancer and Leukaemia CSG/CCLG guidelines for
treating children with cancer
o The National Service Framework for children (2004)
o Health Services Commission: Improving Services for Children in
Hospital (2007).
o Specialised Services National Definition Set (2010)
1.2.1 The Rarity of Childhood Cancer
National guidance recognises cancer in childhood is rare and includes a wide
range of cancers with small numbers of patients with each type of cancer
(classified as rare cancers). Hence in order to improve cancers the national
approach is to commission these services for large populations to maximise
the opportunities for standardising care and evaluating outcomes.
About one in 600 children develops a cancer by age 15 years. There are
approximately 1400 new cases of cancer among children 0-15 years in the
UK each year; an annual incidence rate of approximately 1:7700. The
incidence of cancer in adolescents is less certain due to data collection
problems, but rates calculated by Birch (2003) and endorsed by UKCCSG
suggest about 1:7000 per year among adolescents 15-19 years
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Most of the cancers affecting children differ from those affecting adults. They
occur in different parts of the body, appear different under the microscope and
respond differently to treatment. Cure rates among children are much higher
than for most adult cancers and overall 70% of children are completely cured,
according to CCRG data, although a proportion of these will experience long
term side effects from their treatment.
1.2.2 National and International Trends
Increases in childhood cancer incidence since the1960s and 1970s have
been reported in Europe and the rest of the world. In Great Britain, the World
age-standardised incidence rate has increased by more than two fifths (43%)
since the late 1960s, from 107 cases per million children in 1966-1970 to 152
cases per million in 2001-2005. Between 1966 and 2000 there has been a
statistically significant average annual increase of almost 1% per year, though
this varies between 0.5% and 2.5% per year by tumour type. Over a twenty
year time period, the World age standardised incidence rate for Europe
increased significantly by an average of 1.1% per year, from 120 per million
children in 1978-1982 to 141 per million in 1993-1997. This varied across
Europe, ranging from an average annual increase of 1.0% per year in
Northern Europe to 1.4% per year in Eastern Europe.
While some of the worldwide increases are likely to be due to real changes in
risk, improvements in the efficiency of systems for the diagnosis and
registration of childhood cancers since the 1960s and 1970s will also have
played a part.
1.2.3 UK Commissioning Reviews
Around the UK, specialised commissioners have initiated reviews to ensure
the configuration of cancer services for children meet modern clinical
standards.
In addition, surveys were conducted to determine current clinical needs at
current children’s centres (Commissioning Tertiary and Specialised Services
for Children and Young People, Royal College of Paediatrics and Child
Health, 2004).
Three key national findings were:
o Limited capacity to care for children with malignancy due to lack of
trained medical and nursing staff.
o Reliance on voluntary organisations for the provision of services.
Childhood cancer charities, particularly CLIC Sargent Cancer Care for
Children, Teenage Cancer Trust, Macmillan and Cancer and
Leukaemia in Childhood provide a significant proportion of the funding
required by local multidisciplinary teams
o The need to ensure adequate provision of designated age appropriate
facilities for adolescents and young people.
1.3 General Overview
The Provider, the Newcastle upon Tyne Hospitals NHS Foundation Trust
(NuTH) will provide care for children and young people with cancer to the Co7
ordinating Primary Care Trust (NHS North of Tyne) and all other Primary Care
Trusts across NECN in line with this specification.
1.4 Objectives
The Provider will deliver cancer care and improve outcomes in accordance
with the NICE National Guidance for Children and Young People with Cancer
(2005).
This includes meeting the national standards for:
 specifying appropriate referral pathways
 adhering to and facilitating the cancer specific referral pathways
 establishment and management of Multidisciplinary Teams by cancer
type
 provision of appropriate psychosocial support for children and young
people and their families
 treating patients in line with the National Cancer Research Network
(NCRN) Children’s Cancer and Leukaemia Clinical Studies Group
(CSG)/CCLG trials
 treating patients in line with CCLG and CYPCG agreed guidelines
where an appropriate trial is not available or consent for recruitment not
given
 facilitating transition to teenage and adult services
 supporting and developing shared care services
 maintaining and developing supportive care guidance (taking account
of NICE supportive and palliative care IOG)
 delivering and supporting palliative care services across the
pathway(taking account of NICE supportive and palliative care IOG)
 developing and delivering a long term follow up model
 delivery of age appropriate care in age appropriate settings
 delivery of care by a workforce specialised in the care of children with
cancer
 supporting families and carers of children with cancer
 training for staff to deliver the children’s cancer service
 development and production of appropriate patient and carer
information
 supporting regional and national cancer data collection
 entry of patients to clinical trials
 have an active audit programme and be able to demonstrate that the
team is delivering services in line with the NICE Improving Outcomes
Guidance and NUTH standards
1.5 Expected Outcomes
 Provision of age-appropriate services to children with cancer
 Provision of safe, effective and timely services to children with cancer
 Services will meet relevant Patient Reported Outcomes Measures
 Services will be provided in accordance within national waiting times
 National guidance will be met
2.Scope
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2.1 Service Description
The Provider provide care for children and adolescents (0-18 years old) with
cancer.
The Provider will expect to treat a minimum of 70 new patients per annum in
accordance with the national model to have centralised services although I tis
recognised that this number may fluctuate year on year.
The Provider is the Principal Treatment Centre for the care of children and
adolescents with cancer 0-18 years inclusive. Patients aged 13 – 18 years
will usually be treated in the Teenage Cancer Unit within the Great North
Children’s Hospital (GNCH) or, if admitted into another ward or unit, their care
will remain the responsibility of the PTC.
The Principal Treatment Centre will serve the catchment population of NECN,
approximately 3 million population and will expect to treat around 100 – 120
new patients a year (0 – 18 years inclusive).
Paediatric oncology is the term used to encompass all malignant conditions
among children with cancer, including blood conditions such as leukaemia.
The doctors involved, paediatric oncologists and paediatric haematologists,
and other clinical personnel involved in the service, will work within a national
framework to ensure they provide the most effective care.
Treatment for each type of childhood cancer follows specifically designed
protocols - a national UK protocol or in some cases an internationally agreed
protocol. The Provider will provide the service in line with protocols
developed by the NCRN Children’s Cancer and Leukaemia CSG/CCLG, a
national network of multidisciplinary organisations which advance the care of
children with cancer through clinical research. The ultimate objective of these
groups is to improve the outcome of children with poor prognosis and
maintain high cure rates among children at lower risk, whilst reducing long
term toxicity associated with treatment. The NCRN Children’s Cancer and
Leukaemia CSG/CCLG is a network of over 20 UK treatment centres. The
expertise of these organisations is acknowledged by the associated Royal
Colleges and by NICE.
In addition BMT (Blood and marrow transplantation) is an accepted and
effective treatment for children with specialised malignancies as listed in UK
Indications table. The Provider will adhere to agreed protocols and guidance
related to provision of this service.
2.2 Accessibility/acceptability
The Provider will ensure that the service offered is respectful and must not
discriminate on the grounds of age, gender, sexuality, ethnicity or religion.
The service should be sensitive to the needs of patients whose first language
is not English and those with hearing, visual or learning disabilities. All
aspects of the service must be compliant with Equality and Diversity and the
Provider must comply with current legislation and local and national policies
and standards in relation to Equality & Diversity.
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The Provider has in place policies and practices for ensuring that its services
are accessible to all, and deals sensitively with all service users, potential
service users and their family/friends and advocates.
Some patients in the region may have to travel significant distances for
specialist care. The Provider and the Children & Young People Coordinating
Group will develop shared care arrangements to ensure that patients receive
appropriate care closer to home when clinically appropriate to do so and in
line with Peer Review requirements. The NUTH Paediatric Oncology
Outreach Nurse Specialists also provide palliative care in patient’s homes.
2.3 Whole System Relationships
The Provider hosts the majority of services required from the IOG including :
o Specialist children’s surgery and, for the purposes of this specification
includes neurosurgery
o Other Site Specific MDTs
o A Teenage Cancer Unit
o A Young Adult Cancer Unit
o Radiotherapy services
o Paediatric and adult intensive care units, on site
The Provider works in conjunction with the Paediatric Oncology Shared Care
Unit at West Cumberland Infirmary in Whitehaven. As shared care
arrangements with other Trusts and units develop, the Provider will work in
partnership with those organisations.
2.4 Interdependencies
Occasional referrals are made to specialist services out with the North of
England Cancer Network catchment area. Referrals to these services will be
made on a case by case basis according to specific criteria:
o Retinoblastoma service at Birmingham Children’s Hospital
o Major paediatric hepatic surgery (supra-regional units, Birmingham or
Leeds)
o Specialist Radionuclide therapy at University College Hospital
o Proton Beam Therapy Units (currently based overseas) as determined
by the Proton Therapy Selection Panel
2.5 Relevant Networks and Screening Programmes
The Provider will input into Networks and Screening Programmes as
appropriate. These will include but may not be limited to:
o Children’s Cancer Research Group based at the University of
Newcastle’s Northern Institute of Cancer Research
o North of England Cancer Network
o National Cancer Research Network (NCRN)
3. Service Delivery
3.1 Service Model
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The service model provided by the Provider will reflect the NICE IOG and
cancer peer review measures.
The following will apply to all groups of patients:
 Discussion of all cases will take place at the weekly Children and
Young People MDT and Site Specific MDT as appropriate
 For those patients aged 16 – 18 years old they will also be discussed in
the TYA MDT
 As per the NICE guidelines where there are open therapeutic trials
(e.g. via the NCRN Children’s Cancer and Leukaemia CSG), the
Provider will ensure that this group of patients has access to those
trials
 In the absence of an appropriate clinical trial the patient will be treated
according to CCLG determined guidelines unless there is an agreed
indication at the appropriate MDT for an off-protocol therapy or in the
case of a young person, clear evidence of better outcome on an adult
protocol
3.1.1 Shared Care
The North of England Children & Young People Cancer Network’s shared
care philosophy is based on the assumption that children and young people
with cancer will benefit from care delivered in partnership with a paediatric
oncology shared care unit located closer to home at appropriate times.
The Provider will support any designated paediatric oncology shared care
units to achieve the above. The Provider will also support the development of
further appropriate shared units as agreed at the Children and Young People
Coordinating Group.
A level 1 (option 2) shared care arrangement is in place at the West
Cumberland Infirmary at Whitehaven. There should be a formal Trust to Trust
agreement between the Principal Treatment Centre and the Paediatric Shared
Care Unit covering both the managerial (activity/costs) and the clinical
(standards, guidelines, treatment protocols, drug lists etc) aspect.
3.2 Care Pathways
In line with national guidance Principal Treatment Centres must have written
referral pathways. The referral pathways below summarise the agreed
pathways for referral to the Principal Treatment Centre or specialised centre
3.2.1 Haematological Cancer
Leukaemia and Lymphoma
All patients in whom a diagnosis of leukaemia is suspected will be referred to
the consultant paediatric haematologist or paediatric oncologist on call at the
NUTH who will then arrange admission for initial investigations – history and
physical examination, haematological and bone marrow examination and
lumbar puncture where indicated.
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Patients will be discussed at the Children and Adolescent MDT and will be
managed within the NUTH.
3.2.2 Central Nervous System Tumours
The preferred initial referral route for patients under 16 years will be to the
paediatric oncologist on-call who will arrange assessment and liaise with the
paediatric neurosurgeon. The consultant paediatric neurooncologist,
consultant paediatric neurosurgeon and the Multidisciplinary Team will inform
each other of any referrals.
Patients will be discussed at the Children and Adolescent MDT which includes
Neuro-oncology specialists hosted by the NUTH as one of the two
Neurosurgical Centres for the North of England. For all patients neurosurgery
will be at the NUTH.
3.2.3 Solid Tumours Pathway
All patients in whom a diagnosis of malignant solid tumours is suspected will
be referred to the consultant paediatric oncologist on call at the NUTH.
He/she will then arrange for out-patient, day care or in-patient admission at
the NUTH for initial assessment.
Patients will be discussed at the appropriate MDT and in an additional site
specific MDT if appropriate
Bone Sarcoma
For all patients in whom a diagnosis of bone sarcoma is suspected referral is
either directly to the Orthopaedic Oncologists at the NUTH for biopsy or to the
on-call paediatric oncologist for initial assessment and referral for biopsy.
Treatment planning and subsequent non-surgical therapy will be carried out
by the paediatric and adolescent oncologist team at the NUTH.
Bone sarcoma services are provided in conjunction with the National
Specialised Services Commissioning Group (NSSCG) requirements.
Retinoblastoma
Patients with Retionoblastoma are managed in conjunction with the NSSCG
Retinoblastoma service at Birmingham Children’s Hospital.
3.2.4 Bone Marrow Transplantation (BMT)
Patients referred for bone marrow transplantation will be discussed at the
Paediatric BMT Multidisciplinary Team meeting
Bone Marrow Transplantation services are provided on site at the children’s
Haemopoietic stem cell transplant unit at the NUTH. The NUTH is seeking
JACIE accreditation of the BMT services
3.2.5
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Radiotherapy
The radiotherapy service for children and adolescents at the NUTH patients is
well established. It provides most aspects of radiotherapy and radionuclide
therapy services required. Very young children requiring therapeutic
radionuclide e.g. MIBG therapy for neuroblastoma will be referred to the unit
at University College London. Occasional patients requiring proton beam
therapy are referred (after agreement with the national panel) to one of the
units based overseas.
3.2.6
Chemotherapy and Supportive Care
Chemotherapy and supportive care is provided at the NUTH
3.2.7 Long Term follow up
Long term follow up is an important requirement of the NICE Improving
Outcomes Guidance. Long term follow up will be delivered by the NUTH and
will follow national guidance.
The NUTH initiative on redesign of ‘transition’ of care is ongoing and aims to
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To standardise LTFU approach and documentation
To ensure access to fertility support is clear
4 Referral, Access & Acceptance Criteria
4.1 Geographic Coverage/Boundaries
This specification covers specialised children’s cancer services for those
children and young people (0 – 18 years) living in those Primary Care Trusts
(PCTs) covered by the North of England Cancer Network and North East
Specialised Commissioning Operational Group. It relates to all treatment coordinated and delivered by the Principal Treatment Centre (PTC) at the
NUTH.
There may be occasions where children and young people aged 0 -18 years
from outside the area choose to be treated at the NUTH or are admitted as
emergencies and the management and treatment of these cases will be
covered by this specification.
4.2 Location(s) of Service Delivery
All services except those specified in section 2.4 Interdependencies are
provided at the NUTH and the majority of these are provided at the Great
North Children’s Hospital on the Royal Victoria Infirmary site.
4.2.1 Inpatient, Day Care, Outpatient, Surgical, Diagnostic, Intensive
Care and Radiotherapy Facilities at NUTH
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Inpatient Care: For children and young people aged 0-18 years, inpatient care will be at Great North Children’s Hospital Royal Victoria
Infirmary providing cancer diagnosis, cancer treatment expertise,
psycho-social support and surgical cancer therapy. Inpatient care for
young people aged 13 – 18 yrs will usually be provided in the Teenage
Cancer Unit
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Radiotherapy treatment will be provided at Northern Centre for
Cancer Care, at the Freeman (FRH) site of the NUTH. Where general
anaesthesia is required this is provided by FRH paediatric anaesthetist.
As stated in section 2.4 Interdependencies, occasional referrals are
made outside of the NUTH for radionuclide treatment, radiotherapy for
retinoblastoma and proton beam therapy
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Day Care facilities: There will be separate day care facilities for
children and young people with cancer which will include waiting and
play areas. Day care at Great North Children’s Hospital Royal Victoria
Infirmary will include outpatient chemotherapy, blood transfusion,
patient assessment, bone marrow examinations and administration of
intrathecal chemotherapy. General anaesthetic facilities for children
and young people undergoing painful procedures (bone marrow
examination and administration of intrathecal chemotherapy) will be
provided at the Great North Children’s Hospital Royal Victoria
Infirmary.
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Outpatient facilities: There will be separate outpatient facilities for
children and young people at Great North Children’s Hospital Royal
Victoria Infirmary
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Cancer Surgery: Surgery for children and young people with solid
tumours, including bone sarcoma and liver tumours will usually be
undertaken at RVI/NUTH. Surgery for children with retinoblastoma will
be undertaken by Children’s Hospital, Birmingham.
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High Dependency Care / Intensive Care Children and young people
requiring intensive care will be rapidly assessed by the 24 hour on site
paediatric and anaesthetic teams and transferred to the PICU
(Paediatric Intensive Care Unit) within Great North Children’s Hospital
Royal Victoria Infirmary as required.
4.3 Days/Hours of Operation
Inpatient Services: 24 hours / seven days a week for new referral of patients
and acute referrals
Day case: 5 days a week Monday to Friday
Outpatient Clinics: 5 days a week Monday to Friday
4.4 Referral criteria and source
The NICE National Guidance on the referral of children with suspected cancer
is incorporated into local network referral and treatment pathways. Either a
practitioner believes a child has a suspected cancer or initial tests have
determined a cancer is present.
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4.5 Referral routes
The referral routes are:
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GP referral to a local paediatric service or direct to the Principal
Treatment Centre under the 2 week wait rule
Referral from a District General Hospital paediatric service
Acute referral from an A&E department
Acute Referral from another specialist children’s cancer or non cancer
service
Occasionally referral will be made from an adult cancer or other adult
service
In all cases referral should be made to the on-call paediatric oncologist or
paediatric haematologist preferably via telephone or fax to the Provider. The
Provider aims to see patients within 48 hours, via early referral routes.
4.6 Any Exclusion Criteria
In rare but appropriate circumstances it may be acceptable for a patient over
19 years old at diagnosis to be treated by the Provider’s Paediatric Oncology
Team but the majority of young people over 19 years old are excluded from
this specification.
Certain components of specialised treatment may need referral onwards as
highlighted in the service model section
4.7 Response Time and Prioritisation
The Provider will respond to referrals in line with national guidance.
If the Provider does not have capacity to accept the patient the service must
liaise with other Principal Treatment Centres to arrange an alternative
admission to a Principal Treatment Centre or specialist service. The Provider
must inform the Lead Commissioner of capacity issues or any other reason it
cannot provide the services as detailed in this specification within 1 working
day.
5 Discharge Criteria and Planning
Principal Treatment Centres are required to work with other Principal
Treatment Centres and shared care units to proactively manage transfers and
discharges.
The Principal Treatment Centre will ensure timely and appropriate
communications with services who are expected to provide other parts of the
patient’s pathway in compliance with national and children’s cancer guidance.
6 Prevention, Self Care and Patient and Carer Information
The Provider will provide information, advice and support as described in the
Improving Outcomes Guidance
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7. Continual Service Improvement/Innovation Plan
The Provider will seek to continue to improve services and detail these in its
work programme, which will be shared with Commissioners, and contribute to
the Children & Young People Coordinating Group work programme. This will
help inform how the service is being provided, areas where improvement or
developments could be made and suggestions as to how these could be
effected. This may include, but is not restricted to, some or all of the following
areas: capacity, referrals, staffing issues, quality issues.
8 Service Monitoring
The Provider will, in accordance with Peer Review measures, provide service
monitoring information on a 6 monthly basis to the Children & Young People
Coordinating Group. This will cover the following:
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performance against waiting times
cancer registration specified clinical outcome audits
clinical trial entry rates
patient reported outcome measures
providing data required to support designation process.