Specialised colorectal services require a critical mass of expertise in surgery, medicine, radiology, pathology and nursing. This is possible only in units large enough to allow specialisation in all of these disciplines, and it is only in units receiving referrals from a wide geographical area that sufficient experience is gained in dealing with the more difficult and complex cases.
This Clinical Reference Group (CRG) covers:
- services for patients with Type II and Type III intestinal failure (including the provision of home parenteral nutrition)
- complex surgery for complex inflammatory bowel disease
- complex surgery for faecal incontinence
- complex inflammatory bowel disease
- interventions for rectal and anal cancers
- specialised cytoreductive surgery.
Chair: Mr Mark Chapman, Consultant Colorectal Surgeon, Heart of England Foundation Trust.
Gordon Carlson, North
Rick Saunders, North
Charles Maxwell-Armstrong, Midlands & East
Bandipalyam Praveen, Midlands & East
Carolynne Vaizey, London
Richard Cohen, London
Ian Daniels, South
Nicholas Beck, South
Heather Weaver, Lead Pharmacist
Sarah Squires, Patient & Public Voice
Sarah Crane, Patient & Public Voice
Andy Hughes, Lead Commissioner, firstname.lastname@example.org
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
- Intestinal Failure (Adult)
- Colorectal Distal Sacretomy (Adult)
- Colorectal Complex Inflammatory Bowel Disease (Adult)
- Colorectal Faecal Incontinence (Adult)
- Colorectal Transanal Endoscopic Microsurgery (TEMs) (Adult)
- Colorectal Cytoreductive Surgery (Adult)
- Cancer Anal (Adult)
- Pseudomyxoma peritonei service (Adult)
- Autologous Intestinal reconstruction (Adult)
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Cytoreductive Surgery for Patients with Peritoneal Carcinomatosis
- Sacral nerve stimulation (SNS) for faecal incontinence (Adult)
Not routinely commissioned:
Adult Intestinal Failure Service Review
NHS England are currently reviewing services for adults with intestinal failure. This review will include nationwide engagement with clinicians, providers, commissioners, patients and the public on the priorities and future model of the service, as well as the interface with the HPN (Home Parenteral Nutrition) Framework and paediatric intestinal failure services, both of which are outside the scope of the review. Once this has been completed, a new commissioning strategy will ensure the right services are commissioned in the right place to meet the needs of patients and the national standards agreed by clinicians.
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