Introduction

This quality standard covers the care of men referred to secondary care with suspected or diagnosed prostate cancer, and men having follow‑up for prostate cancer in primary care.

It does not cover the recognition and referral of men with suspected prostate cancer in primary care. This topic is expected to be covered by a quality standard on suspected cancer.

For more information see the prostate cancer topic overview.

Why this quality standard is needed

Prostate cancer is the most common cancer in men and makes up 26% of all male cancer diagnoses in the UK. According to Cancer Research UK's prostate cancer statistics there were 10,837 deaths from prostate cancer in the UK in 2012.

Prostate cancer is predominantly a disease of older men (aged 65–79 years) but around 25% of cases occur in men younger than 65.

Family history has been shown to be a risk factor. The relative risk rises as the number of first‑degree relatives diagnosed with prostate cancer increases.

Ethnicity has also been shown to be a risk factor for prostate cancer, with higher rates seen in men of black African or Caribbean family origin and the lowest in men of Asian family origin.

Cases of prostate cancer are expected to increase, even if the incidence rate stays constant, because of the ageing population. The financial burden of treatment, including the need for treatment facilities and trained specialists, will grow as more men are diagnosed with the disease.

Men with prostate cancer have more emergency than elective hospital admissions during their last year of life (National End of Life Care Intelligence Network 2012). In those dying from prostate cancer, the average cost of hospital admissions is nearly half (47%) of the average cost of care during the last year of life (National End of Life Care Intelligence Network 2012). The estimated total cost of inpatient care per man during his last year of life is reported to be £6931 for prostate cancer.

The quality standard is expected to contribute to improvements in the following outcomes:

  • quality of life

  • the need for care and support

  • premature deaths from prostate cancer

  • patient experience of hospital care.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life*

Outcome measures

People manage their own support as much as they wish, so they are in control of what, how and when support is delivered to meet their needs

1B Proportion of people who use services who have control over their daily lives

1C Proportion of people using social care who receive self‑directed support, and those receiving direct payments

Carers can balance their caring roles and maintain their desired quality of life

1D Carer‑reported quality of life*

2 Delaying and reducing the need for care and support

Outcome measures

Earlier diagnosis, intervention and reablement means that people and their carers are less dependent on intensive services

2B Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services**

3 Ensuring that people have a positive experience of care and support

Overarching measure

People who use social care and their carers are satisfied with their experience of care and support services

3A Overall satisfaction of people who use services with their care and support

3B Overall satisfaction with social services of carers

Placeholder 3E Effectiveness of integrated care

Outcome measures

Carers feel that they are respected as equal partners throughout the care process

3C The proportion of carers who report that they have been included or consulted in discussions about the person they care for

People know what choices are available to them locally, what they are entitled to, and who to contact when they need help

3D The proportion of people who use services and carers who find it easy to find information about support

People, including those involved in making decisions on social care, respect the dignity of the individual and ensure support is sensitive to the circumstances of each individual

This information can be taken from the Adult Social Care Survey and used for analysis at the local level

4 Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm

Overarching measure

4A The proportion of people who use services who feel safe*

Outcome measures

Everyone enjoys physical safety and feels secure

People are free from physical and emotional abuse, harassment, neglect and self‑harm

People are protected as far as possible from avoidable harm, disease and injuries

People are supported to plan ahead and have the freedom to manage risks the way that they wish

4B The proportion of people who use services who say that those services have made them feel safe and secure

Placeholder 4C Proportion of completed safeguarding referrals where people report they feel safe

Aligning across the health and care system

* Indicator complementary

** Indicator shared

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1B Life expectancy at 75

i Males

Improvement areas

Reducing premature mortality from the major causes of death

1.4 Under 75 mortality rate from cancer*

2 Enhancing quality of life for people with long‑term conditions

Overarching indicators

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long‑term conditions

2.2 Employment of people with long‑term conditions**,*

Enhancing quality of life for carers

2.4 Health‑related quality of life for carers**

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

3a Emergency admissions for acute conditions that should not usually require hospital admission

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

ii GP out‑of‑hours services

4b Patient experience of hospital care

4c Friends and family test

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to in‑patients' personal needs

Improving access to primary care services

4.4 Access to i GP services

Improving the experience of care for people at the end of their lives

4.6 Bereaved carers' views on the quality of care in the last 3 months of life

Improving people's experience of integrated care

4.9 People's experience of integrated care**

Alignment with Adult Social Care Outcomes Framework (ASCOF) and/or NHS Outcomes Framework (NHSOF)

* Indicator is shared

** Indicator is complementary

Indicators in italics are in development

Table 3 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.5 Mortality from cancer

Alignment with Adult Social Care Outcomes Framework (ASCOF) and/or Public Health Outcomes Framework (PHOF)

* Indicator is shared

** Indicator is complementary

Indicators in italics are in development

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to prostate cancer.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for prostate cancer specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole prostate cancer care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to men with prostate cancer.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality prostate cancer service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating men with prostate cancer should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting men with prostate cancer. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.