Dr Fergus Macbeth, Director, and Dr Andrew Champion, Centre Manager, describe the work of the NCC-C
The National Collaborating Centre for Cancer (NCC-C), launched in April 2003, is the most recent of the seven collaborating centres set up by NICE. The NCC-C is responsible for developing guidance for the NHS in England and Wales on treating and caring for people with cancer.
NICE established the national collaborating centres to develop clinical guidelines, service guidance and clinical audit methodology for the NHS. Each collaborating centre is a partnership of professional organisations, academic units and patient/carer organisations with the expertise, experience and resources to fulfil this role.
Close links are being established between the NCC-C and existing collaborating centres, to exchange ideas, provide support and avoid duplication in overlapping areas of work.
The work of the NCC-C
The NCC-C is hosted by Velindre NHS Trust in Cardiff and operates in partnership with the University of Wales College of Medicine. It is the first collaborating centre to be hosted by an NHS Trust and the first to be based in Wales.
The vision of the centre is to establish an efficient and effective means of producing cancer service guidance and clinical guidelines. The centre will have strong links with all appropriate organisations representing health professionals involved with the management of cancer patients in England and Wales and with groups representing cancer patients and their carers.
The partners of the NCC-C are represented on the management board (Box 1, below), which includes an official from NICE who acts as an observer. The board was carefully assembled to ensure a broad representation from all areas of healthcare associated with the delivery of cancer services.
|Box 1: Membership of the NCC-C management board|
Service guidance and clinical guidelines
Service guidance is intended to help commissioners in planning cancer services, focusing on those aspects of the service that are likely to have a significant impact on health outcomes. It should also recognise the broader political framework of NHS management and cancer strategy.
Service guidance should also recommend which professionals should be involved in the delivery of cancer services and how, broadly, their activity should be organised and co-ordinated. It should describe in general what kinds of service should be made available for which groups of patients, but should not make recommendations about specific technologies or treatments unless they are likely to have a significant effect on the service delivery and configuration. By contrast, clinical guidelines are aimed at individual health professionals to help with individual clinical decisions and should focus more on particular interventions.
An important issue is that of the evidence to support the recommendations. Whereas clinical guidelines will consider conventional research studies, especially randomised trials, such evidence will be less applicable to service guidance. Other sources of evidence, such as descriptions of models of care and local or national audit reports, will be used.
The Improving Outcomes series of cancer service guidance was started following the publication of the Calman-Hine report on cancer policy in England and Wales in 1995.1 They have been produced until now by a team led by Professor Bob Haward based at the Northern and Yorkshire Cancer Registry Information Service and the University of Leeds.
The guidance was initially published by the Clinical Outcomes Group of the Department of Health, until overall responsibility for them was taken over by NICE in 2001. A list of the published documents can be found on the NICE website: www.nice.org.uk.
The NCC-C work programme
The NCC-C will now be completing the set of cancer service guidance documents. The first cancer service guidance topics to be undertaken by NCC-C were allocated by NICE early in 2003. Full details of the work programme and anticipated publication dates of the guidance are shown in Box 2 (below).
|Box 2: The NCC-C’s programme of work|
|Guideline||Publication date (anticipated)|
|Child and Adolescent Cancer||February 2005|
|Skin Tumours including Melanoma||April 2005|
|Tumours of the Brain and Central Nervous System||August 2005|
When these four topics of service guidance have been completed, the NCC-C will produce clinical guidelines on cancer topics. These topics have not yet been allocated.
Guidance development as described by NICE is an inclusive and transparent process and follows a well defined and proven methodology.2 Similar methodologies will be employed by the NCC-C for both service guidance and clinical guidelines.
The main stages in the process are:
- Agreeing the scope – what the guidance will cover
- Establishing a guidance development group to manage the work
- Searching, appraising and synthesising research evidence
- Accessing and incorporating expert opinion where appropriate
- Developing key recommendations for the NHS
- Full consultation on the provisional guidance
- Publishing and disseminating the guidance to the NHS.
The guidance development group will be composed of health professionals all of whom are involved at a clinical and/or academic level in the treatment and management of cancer, together with at least two patient/carer representatives.
The group will differ slightly from its clinical guideline equivalent by having stronger representation from commissioning bodies from across England and Wales, for example primary care trusts in England and local health boards in Wales.
If appropriate, the guidance development group may invite key clinical and academic experts not already represented on the group to contribute to the review of parts of the guidance.
Patient representatives, who will be full members of the group, will be patients themselves, carers or individuals working with voluntary sector organisations. As with other NICE guidelines, patient representatives will be supported by the Patient Involvement Unit of the College of Health.
Expert health economics advice and assessment is essential to the service guidance development process. A health economist based at the University of Wales, Bangor will work closely with the guidance development group, ensuring that cost-effectiveness is properly considered.
How will the NCC-C improve patient care?
Service guidance for the NHS, introduced in 1996, has been influential in shaping service delivery and defining a detailed practical framework for modern cancer care.
Achievements have included building on the Calman-Hine recommendations of multidisciplinary team working,1 patient-centred care, greater collaboration between neighbouring healthcare providers and the advent of cancer networks.
Recommendations on implementation rest with the commissioners and are outside the remit of NCC-C and NICE.
Lack of adequate resources for major service change at a local level and of key specialist personnel create a barrier to effective implementation. Cancer networks in England and Wales will begin to play an increasing role in the implementation process.
Once agreement is reached between commissioners, implementation of service guidance and clinical guidelines should ensure uniform national standards for the delivery of cancer care to all cancer patients.
|national collaborating centre for cancer|
|Objectives||To develop service guidance and clinical practice guidelines on cancer topics for publication by NICE for use in England and Wales|
|Funding||Funded by NICE, which provides infrastructure costs to support the day-to-day running of the centre and additional variable funding for each project|
Dr Fergus Macbeth
|Centre Manager:||Dr Andrew Champion|
|Dr Mary Webb, Dr Christina Maslen|
|Dr Andrew Morton|
|Health Economist:||Pat Linck|
National Collaborating Centre for Cancer
|Tel:||029 2050 2417|
|Fax:||029 2050 2330|
- Calman K, Hine D. A policy framework for commissioning cancer services. London: Department of Health, 1995.
- National Institute for Clinical Excellence. The Guideline Development Process Series No. 3 – Information for National Collaborating Centres and guideline development groups. London: NICE, 2001.