Dr Chris Harrison – Christie Hospital NHS Foundation Trust, Manchester, UK
Manchester Cancer Services, which is a new enterprise for Manchester which brings together all the cancer services across Greater Manchester into one body, a network of services if you like, and I’m continuing to chair the board of that on behalf of the Chief Execs and Medical Directors of the hospitals.
Why was this set up?
Really just to bring all those services together so that we can think about cancer services in a coherent way and a more structured way than we’ve been able to do previously. The difference is that previously we’d had a cancer network but it combined both the provision of cancer care and the commissioning of cancer care. What we decided to do was have arrangements and organisation of the hospitals and primary care services together separate from the commissioning arrangements which means that we’ve got a stronger ability to think about cancer care in networks across organisations and to integrate our clinical services with the teaching and research that goes on across all those organisations.
How does this work?
For example, the development of acute oncology services, which has been a big thing in the UK of course, providing more expert care at earlier stage in patients’ admissions into hospital, avoiding hospital admission if at all possible. In Manchester we have the Christie Hospital, which I was the Medical Director of, and oncologists from the Christie go across the whole of this Greater Manchester Cancer Services, all our partner organisations, to provide acute oncology care. So that’s the sort of thing that we’re better able to organise and agree on how it’s going to work with the new, more structured, formal arrangements than we had before.
How would this affect a patient treated in a small hospital?
It means two things, one is it’s much more likely that that patient will be able to get their routine treatment, outpatient assessment, chemotherapy and other forms of care at the local hospital. But it also means that for much more specialist treatments we’re able to designate and ensure that patients have access to very specialist treatments, that’s other hospitals but not to be competing for that but to be organising the care so that, from a patient’s point of view, it’s not about being artificially referred and the barriers between organisations don’t get in the way of their care. It’s something that we’ve developed in London, two integrated cancer systems in London are now up and running, and I think increasingly it’s a model which certainly in the bigger cities we’re likely to see more examples of as we try out different models to see whether they have the effect of being able to allow us to coordinate care better for patients. Of course in the London situation one of the big aims is to improve the experience for patients so again the importance of thinking about caring pathways and not allowing the barriers between different hospitals, different organisations to get in the way of that care. It also means that we’re able to move towards offering more patients the chance to be involved in clinical trials, if that’s what they wish, wherever they’re treated across these networks. So it opens up the possibility of involvement in trials to a lot more patients.
What about quality of care and survivorship issues?
The notion of a pathway of cancer care from stages before diagnosis right the way through the pathway, it’s the whole of that pathway that these new systems are designed to be able to take a view of; getting away from thinking about cancer care in small chunks that an individual organisation provides or delivers so that you see the whole. One of the important things about that in the care context is that not only do we try to organise ourselves as the providers of care in that way but we’ve moved to commissioners of care, the payers of care, wanting to pay for whole pathways as opposed to individual episodes of care in individual hospitals. So the two changes match each other and will lead to an improvement of care for patients because it means that we think about care in a more patient-orientated way rather than an institutional or a professional way.
