Transformation Unit

Redesign of Specialist Cancer Services

Patient and Clinical Engagement

The Client

NHS England Specialised Commissioning Team and Trafford CCG, acting as Lead CCG Commissioner for Cancer Services on behalf of the 12 Greater Manchester CCGs.

The Challenge

Oesophago-Gastric (OG) & Urology cancer surgical services across Greater Manchester do not meet national standards and cancer survival rates in Greater Manchester are currently below the national average.

NHS England and the Greater Manchester CCGS worked together to develop the strategy and future arrangements for the collaborative commissioning and provision of Specialised Services, within the context of Greater Manchester Devolution.

We were commissioned to develop and implement a robust commissioning process that would enable the transformation of Oesophago-Gastric (OG) and Urology cancer surgical services across Greater Manchester, in order to ensure compliance with Improving Outcomes Guidance (IOG) and to go further by specifying standards that will enable delivery of ‘world class’ outcomes.

The process had to be clinically-led and jointly developed by clinicians, patients, carers, provider trusts and other key stakeholders.

Our Approach

We undertook a co-design transformation process involving extensive clinical and patient engagement, independent clinical review and assurance, evidence-based identification of clinical and patient experience standards, identification of service access requirements and co-dependencies.

A standards-based commissioning approach was used, putting patient experience at the heart of the redesign work, with patient standards of care being designed in parallel with clinical standards.

Workshops involving a broad group of clinicians and patients were co-ordinated to co-design and then refine the standards. The standards were based on local, national and international evidence of best practice and local experience of existing services.

The final standards were assured by a multi-disciplinary, independent External Clinical Assurance Panel for each speciality including surgical, oncological, nursing and patient members.

Local clinicians and patients were involved throughout the transformation process. A detailed engagement plan was developed and implemented. Our engagement approach included the following:

  • A Greater Manchester Clinical Cancer Summit;
  • Patient representation on the External Clinical Assurance Panel;
  • Online surveys to gather patient insight;
  • Development of patient champions to communicate the change;
  • Co-design workshops to develop service specification, service access framework and a model of care; and
  • Testing the model of care with patients through experience based design


The transformation process we undertook was robust, supported throughout by patient and clinical engagement and was assured at every step by a range of external experts and groups.

In July 2016, the GM Joint Commissioning Board (JCB) agreed to:

1) Advise NHS England that the public involvement process that has been undertaken is robust, effective and compliant with its statutory duty to involve the public;

2) Endorse the public involvement process and recommend this to NHS England;

3) Advise NHS England to commission specialised OG and Urology cancers in accordance with the new specifications.

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