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Cancer Commissioning Toolkit (CCT)
Training
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By the end of the training you will:
Be comfortable and competent with the use of the toolkit
 Have a good understanding of the history of the CCT
 Know how to set up and personalise your account
 Know how to navigate around the CCT
 Be able to read and interpret the dashboards and charts
 Know how to export reports
There is a mix of presentation and live working sessions - we have a lot to cover!
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HISTORY
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The Cancer Commissioning Toolkit (CCT) was developed to realise the aims of
the Cancer Reform Strategy (CRS)
“The Cancer Reform Strategy identified better information and stronger commissioning
as two of the key drivers to achieve our goal that cancer services in this country should
be amongst the best in the world.
The launch of this Cancer Commissioning Toolkit represents a major step forward in
relation to both of these drivers for quality improvement.”
Prof Mike Richards
National Cancer Director
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Information is key to high quality commissioning
 Commissioning of cancer services is complex
 Commissioners need to take account of a wide range of factors to make informed
decisions
Ready access to high quality information about local services and how they compare
with services elsewhere is essential for good commissioning
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CCT is a “one stop solution” for access to cancer commissioning information
to inform decision making
Pre-CCT
DH cancer
waits
End of life
NCIS
Registries
Post-CCT
ePACT
C-PORT
HES
HES
microsite
NCASP
Screening
CQuINS
RT – equip
survey
Smoking
cessation
Programme
budgeting
Pharmac
ists
 This toolkit brings together information
from all of the sources, in a user
friendly format
• Guidance contains suggestions for
questions which commissioners can
ask service providers
• Advice on how to interpret data
• Analysis of quality and confidence of
sources
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There are 100s of important metrics that must be taken into account when
making commissioning decisions
% PCT Collective Measures Met
1
All
FCE / incidence
Trust 4
Comments: …
1995
1
Comments: …
All
Choose Trust
1
2
3
£
Trust 3
2006
All Trusts
Source: HES, Date
PCT 1
PCT 2
Actual
numbers
PCT 3
PCT 1
Choose PCT
All PCTs
T3
PCT4
%
%
%
%
%
T1
T3
T1
T3
Test results 2005 - 2006
Women aged 25 – 64
2005 - 2006
SHA 2
SHA 1
SHA 3
View Dyskaryosis
Level
PCt 1
pCT 3
PCT 2
Data
LCT2
LCT 3
LCT1
User notes
Add to basket
Rate of
% success
quitters by quitters at 4
100,000 pop
weeks
PCT 1
2000
PCT 3
PCT 2
Data
User notes
% Not
Referred as
TWR
62 day
trend
# TWR with cancer diagnosis - All cancers
All cancers
Target (99%)
PCT1
PCT3
England Average
PCT2
PCT1
PCT
Jul
Notes
Aug
In trust and
transfer
breakdown
% of TWR meeting Standards - All cancers
PCT1
PCT1
100%
PCT 1
PCT 2
In Trust
treatment
England
Trust
transfer
% of all TWRs
% of all TWRs
PCT
PCT 3
July
Aug
PCT
Jul
England
Aug
Sept
Source: HES Date
Aug
Sept
Source: CWT, CIS, Date
All PCTs
Comments: …
# not referred as TWR
% admissions without a diagnosis of cancer
by PCT – LUNG
Excess Bed-days time trend - LUNG
Excess
– LUNG
Itembed-days by PCT Description
(normalised by incidence)
PCT 3
%
PCT 1
PCT 1
PCT 2
PCT 2
PCT 3
PCT 3
All PCTs
1995
All PCTs
Source: HES, Date
Average LoS by PCT – LUNG
• Here the user could type action items that he/she considers important
• …
• …
• …
Average LoS
PCT 2
Excess Bed-days
PCT 1
PCT 1
England average
Source: HES, Date
Comments: …
2000
2006
All PCTs
Source: HES, Date
Source: HES, Date
Comments: …
PCT
England
National Target
of TWRs meeting standard (98%)
Jul
Source: CWT, CIS, Date
Aug
Sept
62 day
trend
In trust and
transfer
breakdown
% of 62 days meeting Standards Vs National
Target All cancers - PCT1
% 62 days meeting National
Standards
Assumptions: England population = 55 million, Network population = 1m, PCT population = 100,000
% of 31 days meeting Standards Vs National
Target All cancers - PCT1
£ etc…
% 31 days meeting National
Standards
£ etc…
PCT
England
In house treatment
Trust transfer
Aug
Sept
Excess bed-days
per cancer type,
trust and PCT
Lung
PCT 1
PCT 2
PCT 3
All PCTs
National Target
of TWRs meeting standard (995)
Jul
# not referred as TWR /100,000
Source: CWT, CIS, Date
Total Costs per PCT / Network
Sept
Comments: …
All cancers - PCT1
Etc
…
England
Source: CWT, CIS, Date
Trend % of TWR with cancer diagnosis
Jul
1. …
2. …
3. …
4. …
Sept
Comments: …
62 day cases breakdown – all cancers
%
All cancers (2006)
B
Aug
Source: CWT, CIS, Date
All PCTs
% TWR with
Cancer
Diagnosis
C
Bed-days / PCT incidence
Drug budget per
indication and
network and PCT
Jul
England
Source: IC, NHS Date
Comments: …
A
PCT
Source: CWT, Date
2006
% of TWR with cancer diagnosis
Drug Indication Manufacturer Status
PCT1
All PCTs
TWR target
Number of patients Expected
Previous
Incidence per expected in PCT / total costs
year
100,000
network per
per drug
spend (£)
annum
(£)
# not referred as TWR - All cancers
% of TWR meeting Standards
% Successfully quit after 4 weeks
Source: IC, NHS Date
Zoom up
Cost per
patient per
annum (£)
Mild
Dyskaryosis
Negative
All PCTs
England
# TWR with
cancer
diagnosis
Source: CWT, CIS, Date
Test Results
(self report)
ManageComments: …
scenarios
NICE
guidance
PCT 3
PCT 2
All PCTs
T1
All PCTs
Source: HES, Date
All cancers
PCT 1
% success
rate
1995
or
1
abc
Comments: …
T1
Add to basket
Etc.
Choose Network
Source:
HES,
Date
Choose
Scenario
PCT 3
PCT 2
PCT3
%
T1
% Successfully quit at 4 weeks
All PCTs
Comments: …
Prostate
T1
All SHAs
Planned expenditure of current drugs
PCT 3
T3
There is a wealth of
information in the CCT
2006
100%
PCT 2
T1
%
Women aged 50 – 64
% costs due to excess bed-days
Breast
T1
Coverage
% bed-days above trim point
100%
%
All PCTs
Cancer Source: HES Date
Detected
# of TWR with cancer diagnosis
%
%
Rate of cancer detected
Source: HES, Date
Comments: …
PCT 1
Coverage
PCT 1
Comments: …
PCT 3
PCT 2
PCT 1
PCT1
%
Source: Screening Date
£ / FCE
FCE / incidence
Trust 1 Trust 2
All cancers
Costs by FCE
Costs of emergency admissions by Trust (not
normalised) - LUNG
Source: HES, Date
Lung
PCT 3
PCT 2
Source: HES Date
2000
Activity trend per PCT - LUNG
PCT 1
England average
PCT 1
PCT 1
England average
Source: HES, Date
2000
2006
Activity trend per PCT - LUNG
Trust 1 Trust 2 Trust 3
1995
2000
% of cancer deaths in hospital
All cancers
All PCTs
Choose PCT
FCE
FCE
1995
Choose procedure
Source: HES, Date
All Trusts
Choose PCT
%
% of cancer deaths in the Hospice
# TWR with cancer Diagnosis
/100,000
Episodes by PCT (not normalisied) - LUNG
Elective
Non-elective
Trust 3
Comments: …
Choose procedure
Which Hospital - All cancers
Comments: …
Episodes by trust (not normalisied) - LUNG
Activity per
admission type
and PCT
Female UK
1
All
Choose PCT
Choose procedure
Source: HES, Date
Male UK
Source: CIS, Date
3
All
All
Trust 1 Trust 2
Source: C-Quiins Date
% meeting TWR standard
2
Female PCT 1
% successfully quit
1
All PCTs
Source: CWT, CIS, Date
All Localities
2016
Place of death
per PCT of
patient and
trust
PCT 3
PCT 2
# not referred as TWR /100,000
2006
2001
All cancers
PCT 1
% meeting TWR standard
Female UK
Here commentary about assumptions made in projections
Choose admission type
Choose procedure
LCT 3
LCT1
Male PCT 1
% of cancer hospital deaths by
Trust
All PCTs
Male UK
Source: CIS, Date
Choose trust
Source: C-Quiins Date
% of women screened
PCT 3
Female PCT 1
Age-standardized /100,000
Age-standardized /100,000
PCT 2
PCT 1
All Localities
LCT2
Comments: …
5-year rolling average mortality All Cancers
Male PCT 1
LC 1
LC 3
LC 2
LC 1
% of cancer deaths in hospital
Age-standardized /100,000
PCT 3
PCT 2
2006
LUNG incidence past and projections
PCT 1
PCT 1
2000
Source: CIS, Date
Source: CIS, Date
Prevalence LUNG Cancer
Female
Male
1995
At 2/3 of
meetings
LC 3
LC 2
# TWR with cancer Diagnosis
/100,000
All PCTs
Survival trends
per cancer
type and PCT
All Cancers
At ½ of
meetings
# not referred as TWR /100,000
PCT 3
PCT 1
# not referred as TWR
All Cancers
Named Core
team
Members
% Compliance with # of core Members
Present at meetings
% compliance
H&N
Female UK
Rate per 1000 women
screened
Skin
Source: CIS, Date
Female PCT 1
Male UK
% of cancer deaths in the
Hospice
Colon
PCT 2
Male PCT 1
% successfully quit
Breast Lung
PCT 3
PCT 2
PCT 1
Core
present at
meetings
5-year rolling average mortality LUNG
Age-standardized /100,000
Age-standardized
Age-standardized /100,000
PCT-1
% compliance
Prevalence All Cancers
Female
Male
Actual incidence
Source: CWT, CIS, Date
Sept
Comments: …
Comments: …
Comments: …
The toolkit contains over 100 reports, with more to come
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Careful consideration needs to be given to the way the data are interpreted
and used
1. Is a start of a conversation and not an answer in itself
2. Data drives insight and questions, not necessarily answers
3. Need to read the guidance and interpret the data accordingly
4. Not an in-year planning tool
5. Relies on existing data sources
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The CCT broadly follows the chapters and sections of the Cancer Reform
Strategy
Cancer “patient journey” in the toolkit
Log in screen
Awareness,
Screening
and Early
detection
Peer
Review
Summary
Cancer
Landscape
Assessment,
diagnosis and
staging
Treatment
Living with
cancer
Inpatient
Welcome
screen
Building
for the
future
End of
life
Funding
cancer
care
Toolkit
Toolkit
overvie
w
overview
.
The
Challenge of
cancer
Burden of
disease (all
cancers)
Outcomes
(all cancers)
Burden of
disease (at
cancer type
level)
Outcomes (at
cancer type
level)
Cancer and
Inequalities
Demographic
s
.
.
Quality of
service (all
cancers)
Prevention
Key Cancer
Rates
Lifestyle
trends
Quality of
service (at
cancer type
level)
Screening (at
cancer type
level)
.
Referrals (all
cancers)
Referrals (at
cancer type
level)
Assessment,
diagnosis
and staging
.
Waiting times
(summary)
Waiting times
per cancer
type
Cancer
Medicines
Radiotherapy
Current
Drugs
.
Chemothera
py
Drug Horizon
scanning
Information
Follow up
appointments
Efficiency
.
.
.
Patient
experience
(all cancers)
Place of
death (all
cancers)
Activity and
cost
(summary
Screen)
Patient
experience
(at cancer
type level)
Place of
death (at
cancer type
level)
Activity and
Cost per
cancer type
Activity and
Cost per
procedure
Procedure
cost
calculator
.
Unbundl
ed
Calculat
or
Programme
Budgeting
Case mix
activity and
cost
Case mix
calculator
Case mix
benchmarks
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Partnership working has been critical to the development of this toolkit
National Cancer
Intelligence Network
National Cancer
Action Team
NHS Improvement
UK Association of
Cancer Registries
National Cancer Services
Analysis Team
Pharmaceutical
Oncology Initiative
National Cancer Screening
Programmes
Department of
Health
AT Kearney
Section owners
National
interviews
Database
administrators
Usability testers
Pilot sites
CCT Steering
Group / Team
Concentra
To name a few ...
Feedback from
NDP 2008
Your ongoing
feedback...
=
Continuous
improvement!
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Development of the CCT is being supported by member companies of the
British Pharmaceutical Industry (ABPI)
Pharmaceutical Oncology Initiative (POI) Group
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The main users of the toolkit will be PCT commissioners, cancer networks and
trusts
As of October 2006
there are 152 PCTs in
England
There are 158 trusts in
England
There are 30 Cancer
Networks in England
 Other users of the toolkit:
•
Cancer charities
•
Pharmaceutical companies
•
Public, in due course
Users external to the NHS have restricted access to some metrics and small data sets
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The NHS is providing content and data support for CCT users, while Concentra
is providing technical support
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TOOLKIT
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The CCT is a web-based tool so you can log on anywhere you have access to
the internet
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The dashboard contains the key cancer metrics and allows you to compare
your performance to the national average
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50%
The size of each section
will depend on the
spread of scores, not
the number of
organisations
25%
Top Quartile
25%
Top Quartile
Top Quartile
Organisations are distributed between the ‘best’ and ‘worst’ score with the
top 25% in green and the bottom 25% in red
25%
50%
50%
25%
25%
25%
Some metrics are inverted, i.e. high scores are not at the top if that’s not the ‘best’ result
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Manage your account and set your default organisations through the User
settings menu option and select User Profile
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Each metric can be observed in more detail with information on sources and
guidance
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A cancer specific dashboard contains another selection of metrics that can be
analysed for each cancer type
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The index contains links to each chapter and section – which lead on from the
CRS
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Each issues raised in the sections of the CRS are informed by the charts in the
relevant section
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Each chart is fully interactive and contains sources and guidance – filter
options on the right hand side change depending on the individual charts
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Timelines allow you to view performance over time, but please note that you
can only currently view one organisation at a time
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Peer review data is provided in a slightly different way, with a tick for
compliant and a cross for non compliant on given metrics
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Charts can be pre-customised with selected networks, PCTs, trusts or SHAs by
selecting ‘Favourites’ in the User setting menu option
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Reports can developed within CCT and exported into a word document, with
all relevant source, commentary and comments
Report outputs are fully editable in MS Word
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Add charts and dashboards by setting up the parameters required in the
report and using the ‘report basket’ button
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Once named, the charts and dashboards will appear Report Cabinet to run
reports from
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The Horizon Scanning section of CCT pulls information from many sources of
information for cancer medicine horizon scanning
 Journals
 Specialist media
 Industry
 Licensing agencies
 Clinical specialists
Cancer Commissioning Toolkit
(CCT)
- Horizon Scanning -
 National “horizon scanning” groups
•
National Horizon Scanning Centre
•
London New Drugs Group
•
National Prescribing Centre
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There are a number of key principles of the CCT Horizon Scanning section
 Requests for additions to toolkit will be submitted to a central point and may be submitted by
multiple sources
 All agents will be considered provided they fall under the definition of "chemotherapy" which
has yet to be fully defined
 Requests for additions to toolkit must have published supporting evidence. This may be a fully
published trial report or an abstract
 New drugs/regimens should have an expected EMEA licensing date within 18 months of
addition to the database
 Drugs/regimens will be removed 18 months after licensing for the listed indication or 3 months
after a decision by NICE, whichever occurs first
 CNPF will consider requests for new drugs/regimens three times a year as part of NDP
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The Cancer Medicines section contains reports on drug uptake
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The Horizon Scanning reports inform users of upcoming medicines
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Costs are based on patient numbers, medicine costs and number of cycles
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The costs of each treatment can be compared across multiple scenarios
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The cost over time can be seen, based on the expected launch dates of each
treatment
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Data from the Horizon Scanning section can be exported into Excel by
selecting the ‘Generate XLS’ link
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The Activity Planning reports will inform the user of the uptake and costs of
current medicines but is still under development
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The Activity Planner calculates the cost of current regimens based on patient
volumes
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C-PORT is an online capacity planning tool that helps with planning resources
for hospitals delivering chemotherapy
Chemotherapy
Planning
Online
Resource
Tool
C-PORT development and support is being driven by NCAT and Concentra
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C-PORT allows the user to simulate the activity within a unit and therefore
understand and plan capacity
C-PORT models the
activity within
chemotherapy units
This data is centrally
hosted and is accessible
through a web-based
application
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The Financial Module in C-PORT allows users to allocate costs and revenue for
each regimen
Revenue calculations
National
standard
regimen list
Activity calculations
Human &
physical
resources
Local regimen
list
Cost calculations
Resource cost
Medicine cost
Tariff income
Overheads
REVENUE
Activity
COST
MARGIN / COST RECOVERY
In the future this information will be automatically imported into CCT
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SCENARIOS
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Scenarios have been developed to demonstrate the capabilities of the toolkit
 Scenario 1 – High mortality in specific cancers
 Scenario 2 – Inefficient spend
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High mortality in specific cancers
SCENARIO 1
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A PCT Director of Public Health scans the cancer dashboard to investigate
high mortality in colorectal and lung cancers
Scenario 1 - High mortality in specific cancers (1/6)
 While she was aware of the high mortality rates, she was less aware that...
1. the PCT has made less progress than
the majority of the country in reducing
mortality levels in the last 10 years
2. there are low one and five year
survival rates for colorectal and lung
cancers (in lowest quartile)
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She finds that a high proportion of colorectal and lung cancers are diagnosed
through means other than TWR
PCT-X
An adjacent PCT
has a significantly
lower rate
PCT-Y
Scenario 1 - High mortality in specific cancers (2/6)
TWR = Two Week Referral; this is from the time the GP refers
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Smoking cessation levels are low in the area, which may be a result of poor
success rates with quit smoking campaigns
Scenario 1 - High mortality in specific cancers (4/6)
Smoking cessation metrics
are poor
% success rate for quit smoking over time is falling
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Another concern is that the PCT’s lung multi-disciplinary teams (MDT) are
non-compliant
Scenario 1 - High mortality in specific cancers (5/6)
The peer review report shows that this is due to the lack of a thoracic surgeon and
palliative care team member
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A quick look around the toolkit raises a lot of questions and identifies some
issues that need addressing
Scenario 1 - High mortality in specific cancers (6/6)
 Questions
•
Why is staging data not being collected? It is already required...
•
What are the reasons behind the low 1 and 5 year survival rates?
 Strategies
•
Feed back staging information on all newly diagnosed cases promptly to GPs, to support a locally agreed
audit on recognition of symptoms
•
Introduce a strategy for prevention and increased population awareness of signs and symptoms in lung
and colorectal cancers, based on a social marketing approach
•
Ensure lung MDT compliance to improve curative resection rates and quality of care
These outputs give a flavour of the type of information available in the toolkit - clearly more
analysis is required, and taken as a whole could lead to the following decisions
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Inefficient spend
SCENARIO 2
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A PCT Director of Finance assumed that spend on cancer looked appropriate
but further investigation revealed problems
Scenario 2 - Inefficient spend (1/5)
Cancer spend is just above the
national average, but ...
this appears to correlate with an
above average mortality from
cancer for the PCT population
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This investigation also explained why the cancer network team were
suggesting increased investment in certain areas
Scenario 2 - Inefficient spend (2/5)
Radiotherapy:
Fractionation rates relatively low
Chemotherapy:
Uptake of NICE drugs relatively low
Screening: coverage is low for both breast and cervical cancer
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From the CCT, the team could demonstrate possible causes for a higher than
average spend on inpatient care
Scenario 2 - Inefficient spend (3/5)
2. Higher than average number of deaths in hospital
PCT-Z
1. Higher than average
level
of emergency bed days
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They also discovered a high number of cancer emergency bed days above
trim point
Scenario 2 - Inefficient spend (4/5)
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A quick look around the toolkit raises a lot of questions and identifies some
issues that need addressing
Scenario 2 - Inefficient spend (5/5)
 Questions
•
What is driving the high number of cancer emergency bed days?
•
Why are more people dying in hospital in this PCT than most others?
•
For each cancer type, what are the reasons for so many excess bed days above the trim point?
 Strategies
•
Develop community based support for end of life care and incorporate this work into existing PCT project
on early discharge with social services
These outputs give a flavour of the type of information available in the toolkit - clearly more
analysis is required, and taken as a whole could lead to the following decisions
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THANK YOU
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