Quality Standards for Melanoma

11th October 2012

James Larkin FRCP PhD Royal Marsden Hospital /Consultant Medical Oncologist Institute of Cancer Research

London

Overview

• What are quality standards?

• How does this fit in to NICE?

• The Melanoma Taskforce

• Melanoma Pathway Expert Working

Group

• Quality statements

• Conclusions and next steps

What are quality standards?

• ‘NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care’

• Evidence-based; NHS and social care• 22 at present; 19 in development• E.g. breast , colorectal, lung, ovarian cancer; hip

fracture, COPD, glaucoma, heart failure• 100+ are in ‘topic library’ for future development

http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp

Purpose of NICE quality standards

• Patients, carers and the public can use NICE quality standards to provide information about the quality of care they should expect

• Health and social care professionals and public health practitioners can use the quality standards in clinical audit and governance reports or in professional development and validation

• Provider organisations can use the quality standards to provide high quality services for patient care and monitor quality improvements or to show successful performance in a national audit or inspection

• Commissioners may use the quality standards to ensure that high quality care is being commissioned through the contracting process or to incentivise provider performance by using the indicators in association with incentive payments such as Commissioning for Quality Improvement (CQUIN)

http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp

Purpose of NICE quality standards

• Patients, carers and the public can use NICE quality standards to provide information about the quality of care they should expect

• Health and social care professionals and public health practitioners can use the quality standards in clinical audit and governance reports or in professional development and validation

• Provider organisations can use the quality standards to provide high quality services for patient care and monitor quality improvements or to show successful performance in a national audit or inspection

• Commissioners may use the quality standards to ensure that high quality care is being commissioned through the contracting process or to incentivise provider performance by using the indicators in association with incentive payments such as Commissioning for Quality Improvement (CQUIN)

http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp

Cancer quality standards

http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp

• Breast cancer (P)• Colorectal cancer (P)• Lung cancer (P)• Ovarian cancer (P)• Prostate cancer• Cancer chemotherapy• Haematological malignancies• Head and neck cancer• Sarcoma• Skin cancer (including melanoma)• Children and young people with cancer• Metastatic spinal cord compression• Referral for suspected cancer• Radiotherapy services• Bladder Cancer

PublishedPublished

In ‘topic library’

In ‘topic library’

Other types of NICE guidance

Clinical guidelines• Guidance on the appropriate treatment and care of people with specific diseases and conditions.

Public health guidance• NICE public health guidance makes recommendations to the NHS local authorities and other organisations in the public,

private, voluntary and community sectors on how to improve people's health and prevent illness and disease.

Technology appraisal guidance• NICE technology appraisal guidance makes recommendations on when and how new and existing medicines and treatments

should be used in the NHS. Interventional procedures guidance• NICE interventional procedures guidance advises the NHS on whether new interventional procedures are safe and effective

enough to be used routinely. Medical technologies guidance• NICE Medical technologies guidance is designed to help the NHS adopt efficient and cost effective medical devices and

diagnostics more rapidly and consistently.

Diagnostic guidance• NICE diagnostic guidance makes recommendations to the NHS on the efficacy and cost effectiveness of new diagnostic

technologies.

Cancer service guidance• NICE cancer service guidance supports the implementation of The NHS Cancer Plan for England, and the NHS Plan for Wales

Improving Health in Wales.

Quality standards• NICE Quality standards define the standard of healthcare that people can expect by indicating when a clinical treatment (or a

set of clinical procedures) is highly effective cost effective and safe, and is viewed a a positive experience by patients

http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7165

Other types of NICE guidance

Clinical guidelines• Guidance on the appropriate treatment and care of people with specific diseases and conditions.

Public health guidance• NICE public health guidance makes recommendations to the NHS local authorities and other organisations in the public,

private, voluntary and community sectors on how to improve people's health and prevent illness and disease.

Technology appraisal guidance• NICE technology appraisal guidance makes recommendations on when and how new and existing medicines and treatments

should be used in the NHS. Interventional procedures guidance• NICE interventional procedures guidance advises the NHS on whether new interventional procedures are safe and effective

enough to be used routinely. Medical technologies guidance• NICE Medical technologies guidance is designed to help the NHS adopt efficient and cost effective medical devices and

diagnostics more rapidly and consistently.

Diagnostic guidance• NICE diagnostic guidance makes recommendations to the NHS on the efficacy and cost effectiveness of new diagnostic

technologies.

Cancer service guidance• NICE cancer service guidance supports the implementation of The NHS Cancer Plan for England, and the NHS Plan for Wales

Improving Health in Wales.

Quality standards• NICE Quality standards define the standard of healthcare that people can expect by indicating when a clinical treatment (or a

set of clinical procedures) is highly effective cost effective and safe, and is viewed a a positive experience by patients

http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7165

What about clinical guidelines?

• 159 clinical guidelines on diverse topics including breast, lung, colorectal, prostate and ovarian cancers

• 61 in development including bladder cancer and melanoma (projected publication date June 2015)

• Lung cancer clinical guideline is 200 pages long!• No planned guidance on oesophageal, stomach,

pancreatic cancers or NHL (consider incidence and mortality)

• Hopefully melanoma quality standard will be developed alongside melanoma clinical guideline

The Melanoma Taskforce

The Melanoma Taskforce

The Melanoma Taskforce

‘Quality in Melanoma Care’ commissioned late in 2011

‘Quality in Melanoma Care’ commissioned late in 2011

Melanoma Pathway ExpertWorking Group

• Simon Davies, Chief Executive Teenage Cancer Trust and Chair, Cancer52

• Stephen Kownacki, Executive Chair, PCDS• Charlotte Fionda, Development Director, Skcin• Paul Lorigan, Medical Oncologist• Jerry Marsden, Dermatologist and Chair, MSG• Julia Newton-Bishop, Dermatologist and Chair, Skin Site Specific

Clinical Reference Group, NCIN• Gill Nuttall, Founder Factor50• Veronique Poirier, Principal Cancer Intelligence Analyst, SWPHO• Barry Powell, Plastic Surgeon and National Clinical Advisor in Skin

Cancer• Saskia Reeken, Skin Cancer CNS and Chair, BDNG• Daffyd Roberts, Dermatologist• Neil Shroff, GPwSI Skin Cancer, Committee Member PCDS• Meirion Thomas, Surgical Oncologist• Jacky Turner, Principal Oncology Pharmacist, GSTT• Catherine Wheelhouse, Skin Cancer CNS and Chair, British

Association of Skin Cancer Specialist Nurses

Melanoma Pathway ExpertWorking Group

• Simon Davies, Chief Executive Teenage Cancer Trust and Chair, Cancer52

• Stephen Kownacki, Executive Chair, PCDS• Charlotte Fionda, Development Director, Skcin• Paul Lorigan, Medical Oncologist• Jerry Marsden, Dermatologist and Chair, MSG• Julia Newton-Bishop, Dermatologist and Chair, Skin Site Specific

Clinical Reference Group, NCIN• Gill Nuttall, Founder Factor50• Veronique Poirier, Principal Cancer Intelligence Analyst, SWPHO• Barry Powell, Plastic Surgeon and National Clinical Advisor in Skin

Cancer• Saskia Reeken, Skin Cancer CNS and Chair, BDNG• Daffyd Roberts, Dermatologist• Neil Shroff, GPwSI Skin Cancer, Committee Member PCDS• Meirion Thomas, Surgical Oncologist• Jacky Turner, Principal Oncology Pharmacist, GSTT• Catherine Wheelhouse, Skin Cancer CNS and Chair, British

Association of Skin Cancer Specialist Nurses

Multidisciplinary and

geographically

representativeMultidisciplinary and

geographically

representative

Melanoma Pathway ExpertWorking Group: Process

• Meetings in February and May 2012• Other work outside meetings• 5 core teams (primary care, dermatology,

surgery, oncology and survivorship/end of life care)

• Cross-cutting group reviewed work of teams• Developed 16 quality statements and other

recommendations; they describe the…

Quality Statements

Quality Statements

Quality Statements

Quality Statements

Conclusions and next steps

• Positive that clinical guideline and quality standard planned for melanoma

• Hopefully the quality statements we have developed will be taken into account by the group working on these

• Whether there is any scope for this to inform quality of care before 2015 is unclear

• There may be disagreement about some of the statements but unity as a community is vital

• Comments and suggestions gratefully received

Acknowledgements

Sian James MP

Expert Working Group

Secretariat, particularly Daniel Cambers and Katie Russell

Thank you

http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp#How are topics selected?

How are quality standards developed?

How are quality standards developed?

http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp#How are topics selected?

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