NORTH OF SCOTLAND PLANNING GROUP

Transcription

1 Meeting: NoSPG Date: 27 th April 2011 Item: 24/11 NORTH OF SCOTLAND PLANNING GROUP PET/CT Funding Implications of Proposed Changes This paper has been written to inform members of Scottish Government plans to devolve the funding for the national PET service to Boards and consider the impact on NoS Boards. Background Health Department Letter (2003) 63 1 proposed an all Scotland approach to the implementation of PET Scanning across Scotland and in June 2005 an inter-regional group, chaired by Annie Ingram, with membership drawn from across Scotland, submitted a proposal to Scottish Government on how PET/CT Scanning should be established in Scotland. The plan, to build on the service established within NHS Grampian, included phased implementation of PET/CT services in Glasgow, Edinburgh and Dundee; phased activity planning, developed from the available cancer scenarios available at that time and a number of underlying principles in support of the plan. The Plan did not replace the need for individual business cases from the Boards that planned to introduce PET/CT services. The inter-regional group also agreed a number of financial principles to underpin the plan, as follows: There should be a national tariff for PET/CT scanning. No Board hosting the service should be financially exposed through hosting this service. NHS Scotland must seek to balance clinical appropriateness, equity, access and VFM from PET/CT. Fixed costs should be based on Arbuthnott, shared across Scotland, regardless of site, until such time as there is sufficient activity to demonstrate usage shares. Through this method no Board should be charged more than once for the fixed costs of this service. NHS boards would be charged for variable costs on the basis of utilisation. Variable costs will include the cost of FDG and other supplies, etc. If an NHS cyclotron were commissioned then the bulk of the recurring revenue cost for FDG source from that locality would be fixed. Through this method the tariff for PET scanning can be built up, with allowance made for additional NHS investment. The model for costing would be reviewed once the implementation phase is complete. Capital will be used to support the development of PET/CT scanners. The capital requirements for the development of NHS cyclotrons are excluded from this paper. The inter-regional Business Plan was agreed by all NHS Boards at the Board Chief Executives meeting on 7 th December 2005 and subsequently a new clinical service for Scotland was established, supported by top-sliced funding, which was seen as necessary until the service was fully established. The inter-regional business case was updated in 2007, taking into account revised guidance on the applicability of PET/CT in the staging and treatment of cancer and a revised timetable for the commissioning of scanners. 1 North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 1

2 Current PET Service in Scotland There are currently four established scanners in Scotland, the original scanner in Grampian, a scanner in the West of Scotland Cancer Centre and scanners in both Edinburgh and Dundee, which operate on a part time basis. The Dundee scanner was planned as 50% NHS/50% University and has only been operating since March /11 was the first full year of clinical activity. Activity for 2010/11 was 3571 scans across all sites, against a projected 7341 for 2009/10 2. The summary of activity by Board and applications for Scotland is attached at Appendix 1, with the activity by scanner provided at Appendices 2-5. The top-slicing arrangement remains in place, with PET Centres notifying Scottish Government of costs and top-slicing of funds based on those costs. In , the Scottish Government top-sliced 4.857m (of which 1m was a top-slice from a recurring base and further 3.857m based on costs supplied by PET Centres). Proposal to Change Funding Approach It was never the intention that the PET/CT service would be funded through top-slicing in perpetuity. It was, however, always recognised that the West of Scotland would require a second scanner and it was planned that this should be commissioned by , or once the Glasgow activity exceeded 3000 scans per year, which was assumed to be the maximum level of activity per scanner. The West of Scotland Regional Planning Group have been developing a Business Case for the establishment of the second scanner, which is planned for commissioning during and have for some time been pushing for clarity on the timescale for moving from a top-sliced approach to funding, towards a regional approach. In January 2011, SGHD established a short life working group to consider the options for devolving funding. Prof Peter Sharp, Harry Norton, Dave Carson and Annie Ingram have been identified as NoS representatives on this group. Options A number of options have been identified for the future funding of these services, including: Option 1: Devolution of funds to Boards on an NRAC basis. In this option, PET Centre would recover fixed and variable costs from receiving Boards on the basis of activity levels. This option would have an impact on the shares of funding required from three of the four host Boards, with Grampian, Tayside and Glasgow, all adversely affected and does not support the agreed ethos of a pan-scotland service. Option 2: Devolution of funds to Boards on an NRAC basis and recovery of proportionate share of NRAC funds on activity. This option would have a significant impact on NHS Grampian ( 200k) and Tayside ( 227K), with a shortfall of funding in both units, an over recovery of funds for Lothian and Glasgow. Option 3: Devolution of Funding but Bottom-Sliced National Risk Share. There are currently concerns regarding the risk share approach and Chief Executives may not be keen to increase the number of areas where such an approach is used. Option 4: Devolution of Funding but Bottom-Sliced Regional Risk Share. This assumes that funds are developed to Boards and pooled on the basis of the regional cancer networks. Two issues are identified with this option, an immediate shortfall for recovery of the costs of PET in Tayside and Grampian; and the wider implications for 2 (2007) Review of Inter-Regional Business Case: Phase 1 and Beyond March 2007, Inter-regional Group for Implementation of PET Services for Scotland North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 2

3 PET, which will require consideration for the management of PET beyond cancer. The immediate shortfall for the Boards is estimated at 323k for Tayside and 124k for Grampian; however, some of this might be mitigated for Tayside, if the Fife and Forth Valley activity continues to be referred. In this scenario, the Tayside shortfall might be limited to 103k. Option 5: Combination of (50%) NRAC and (50%) Rolling 3 Year Averages. This would be overly complex and has been identified as the least relevant option. Option 6: Status Quo. Whilst this option has a high degree of stability and credibility, there are issue for the west of Scotland that would require either to come into the arrangement or be managed in some other way. The projected running costs for the second scanner are 1.247m and, if included, would inflate the top-slice by this amount. Option 7: Maximise the existing assets but could potentially mean not commissioning the second scanner in the west. The Glasgow scanner is already achieving more than two thirds of the expected activity and far in excess of the other centres. The west scanner serves more than half of the population of Scotland and the time-lag between business case approval and commissioning would suggest that a decision to commission is required. Option 8: Temporarily decommission inefficient scanner(s) until such times as the activity in other centres reaches the previously projected levels. This option is likely to affect the North and be extremely unpopular. The Grampian facility remains the only Scottish facility with access to a locally based cyclotron, for manufacture of FDG and would be unlikely to be considered. This would suggest that the scanner to be considered by this option would be Dundee, which has by far the lowest level of activity (336 scans during 2010/11). The service in NHS Tayside has only started in the last year and it would be expected that it would take time for the service to grow and there will continue to be fixed costs which would require to be met even if the scanner was mothballed. Decision Required The national short life working group are continuing to meet, however, members are invited to: Note the potential financial pressure for North Boards identified by this proposal; Advise on the preferred approach from a North perspective; Commission the NoS representatives to undertake more detailed modelling of the cost impact of each option from a NoS perspective. Dr Annie Ingram Director of Regional Planning and Workforce Development North of Scotland Planning Group 18 April 2011 North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 3

4 Appendix 1 PET SCANS FOR NHS SCOTLAND 3 APRIL 10 - MARCH 11 NHS Board of Residence Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Total AYRSHIRE AND ARRAN BORDERS DUMFRIES & GALLOWAY FIFE FORTH VALLEY GRAMPIAN GREATER GLASGOW & CLYDE HIGHLAND LANARKSHIRE LOTHIAN TAYSIDE Totals Total 3743 CRC GYNAE HEAD AND NECK LUNG LYMPHOMA OESOPHAGEAL OTHERS Totals Total 3657 BADGED STUDIES Total Activity for March is only available for NoS Boards. Full Activity for NHS Scotland will require to be updated. 4

5 Appendix 2 NHS Board of Residence Apr- 10 PET SCANS APRIL 10 - MARCH 11 - NHS Grampian May- Jun- Jul- Aug- Oct Sep Nov- 10 Dec- 10 Jan- 11 Feb- 11 Mar- 11 Total AYRSHIRE & ARRAN BORDERS DUMFRIES & GALLOWAY FIFE FORTH VALLEY GRAMPIAN GREATER GLASGOW & CLYDE HIGHLAND LANARKSHIRE LOTHIAN TAYSIDE Total 490 COLORECTAL GYNAE HEAD AND NECK LUNG LYMPHOMA OESOPHAGEAL (upper GI) OTHERS (Cancer & Non Cancer NHS Patients) Total 490 BADGED STUDIES Total 29 5

6 Appendix 3 PET SCANS APRIL 10 - MARCH 11 NHS Tayside NHS Board of Residence Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Total AYRSHIRE & ARRAN 1 1 BORDERS 0 DUMFRIES & GALLOWAY 0 FIFE FORTH VALLEY GRAMPIAN 0 GREATER GLASGOW & CLYDE HIGHLAND 0 LANARKSHIRE LOTHIAN 0 TAYSIDE COLORECTAL GYNAE HEAD AND NECK LUNG LYMPHOMA OESOPHAGEAL (upper GI) OTHERS (Cancer & Non Cancer NHS Patients) BADGED STUDIES

7 Appendix 4 PET SCANS APRIL 10 - MARCH 11 NHS GG&C NHS Board of Residence Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Total AYRSHIRE & ARRAN BORDERS DUMFRIES & GALLOWAY FIFE FORTH VALLEY GRAMPIAN GREATER GLASGOW & CLYDE HIGHLAND LANARKSHIRE LOTHIAN TAYSIDE Total 2045 COLORECTAL GYNAE HEAD AND NECK LUNG LYMPHOMA OESOPHAGEAL (upper GI) OTHERS (Cancer & Non Cancer NHS Patients) Total 2045 BADGED STUDIES Total 0 7

8 Appendix 5 PET SCANS APRIL 10 - MARCH 11 - NHS Lothian Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Total AYRSHIRE & ARRAN 0 BORDERS DUMFRIES & GALLOWAY FIFE FORTH VALLEY 0 GRAMPIAN 0 GREATER GLASGOW & CLYDE HIGHLAND 0 LANARKSHIRE 1 1 LOTHIAN TAYSIDE 0 Total 856 COLORECTAL GYNAE HEAD AND NECK LUNG LYMPHOMA OESOPHAGEAL (upper GI) OTHERS (Cancer & Non Cancer NHS Patients) Total 856 BADGED STUDIES Total 162 8