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CANCER IN SCOTLAND: ACTION FOR CHANGE
04. RAPID ACCESS TO DIAGNOSIS AND TREATMENT
"To increase the probability of treatment success while at the same time minimising patient anxiety and stress, delays in investigation, diagnosis and subsequent treatment of cancer must be eliminated wherever possible."
What has been invested Scotland-wide for rapid access to diagnosis and treatment |
2001-02 | 2002-03 |
3.9 million | 3.8 million |
2.3 million for additional staff including at least 13 consultants, 3 clinical nurse specialists, 9 nurses, 17 radiographers, 5 endoscopists and 18 other support staff such as technicians and nursing assistants. 3.9 million on vital equipment such as MRI, CT scanners, endoscopy, ultrasound, mammography and pathology equipment. Examples of investments are: The development of an outreach colorectal diagnostic service in Grampian to improve local access to diagnosis and treatment for patients and reduce waiting times and facilitate early diagnosis. In South East Scotland an additional MRI scanning unit with staffing to increase access to the service thereby reducing waiting times. This will also improve the identification, diagnosis, staging and treatment of cancer. Investments in flow cytometry equipment and technical staff to improve services for haematological cancers in Lanarkshire. This will expand the range of tests and reduce waiting times for diagnosis and interventions. Access to specialist opinion will also be improved through a telemedicine link.
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Waiting Times
We know that once cancer is diagnosed most patients do not have to wait long for treatment, but improvements still need to be made. ONH and CIS therefore set new targets to cut waiting times.
By October 2001, women who have breast cancer and are referred for urgent treatment will begin that treatment within 1 month of diagnosis, where clinically appropriate.
By 2005, the maximum wait from urgent referral to treatment for all cancers will be 2 months.
Progress against the breast cancer target is being monitored quarterly and ongoing improvements are expected from CIS investments.
Referral Process
In May this year referral guidelines were issued to help GPs identify those patients requiring urgent investigation. The implementation of these guidelines and their translation into locally agreed referral protocols and pathways is being monitored through RCAGs and will be reported for the first time in the autumn of 2002.
One-Stop Clinics
There are at least 137 one-stop clinics across Scotland providing facilities for rapid diagnosis and earlier referral for treatment for cancer.
Examples of one-stop clinics |
A one-stop clinic for lung cancer in Dumfries and Galloway means that patients can undergo vital investigative tests the same day resulting in quicker diagnosis and speedier referral for further tests or treatment. The addition of a lung cancer nurse specialist to the team will improve the quality of patient care through co-ordination of diagnostic tests and treatment, providing continuity of care. The development of a one stop Fast Track Rectal Bleeding Clinic in Highland will improve access, reduce waiting times and speed up diagnosis.
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Workforce Planning
Workforce planning is an ongoing challenge against a backdrop of UK, European and world-wide staffing shortages in key specialties and the impact of the Working Time Directive on the time available for clinical contact with patients.
Some of the cancer investment has therefore been targeted at developing new ways of working in support services such as imaging (radiology) and pathology.
Examples of investments in radiology and pathology |
Through redesign of diagnostic radiology services in South Glasgow all suspected cancers are now seen in under 2 weeks with waits for routine ultrasound and bariums down to 5 weeks. Grampian is participating in a pilot where the role of biomedical scientists is being extended to include tasks normally undertaken by pathologists. This will free up consultant time and speed up diagnosis as well as improving departmental efficiency.
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A new grade of Advanced Biomedical Scientist Practitioner in Cervical Cytology has been established and guidance issued on the use of these posts to NHSScotland. RCAGs are tasked with advising on the possibility of adopting a Scotland-wide approach to the use of these posts, with the aim of ensuring consistency and take up.
The Scottish Cancer Group started work on capacity planning by commissioning specialty reports for radiology, medical and clinical oncology, radiotherapy, palliative care and pharmacy services. Further work will be undertaken aiming to develop a multiprofessional service model which will inform planning decisions by RCAGs and service networks.
Working for Health (WfH), the Scottish Executive's first ever Workforce Development Action Plan was launched in August 2002. WfH will drive immediate action on priority issues and also sets out medium- to long-term action to tackle recruitment and retention issues for all healthcare staff to help improve planning and delivery of health services to patients across Scotland.
WfH builds on the reports
Planning Together, on integrated workforce planning and the report by an Advisory Group led by Professor Temple on medical workforce -
Future Practice.
Three new regional workforce development centres and national teams will be established to support NHS Boards and Trusts on workforce issues.
In view of the spread of activity across professions and disciplines throughout NHSScotland work is underway with NHS Education for Scotland (NES) on areas where there is potential for shared learning and modelling in cancer services.
Imaging Technology
Before the end of 2002 the Health Technology Board for Scotland (HTBS) is expected to publish Health Technology Assessment and recommendations for the use of Positron Emission Tomography (PET) scanning in cancer management.
Prospective Audit
Major progress has been made in routine prospective collection of SIGN and CSBS datasets in services for lung, breast, colorectal and ovarian cancer patients. But there are still a few areas that do not routinely collect prospective audit data. CIS investment has been used to address this and there should be rapid progress once new equipment and staff are in place. Importantly, many areas are planning to extend audit activity into other tumour types. This is essential not only for clinical governance purposes, but also to support networks as they plan for the 2005 waiting times target.
Service Redesign
Redesign is underway across the three regional cancer networks to streamline services, reduce waiting times and improve patient experiences. These are being developed through a variety of local initiatives such as patient journey co-ordinators, skill mix and other national modernisation initiatives in lung, colorectal and gynaecological cancer services.
Examples of local redesign initiatives across Scotland |
Tayside Cancer Network is reducing the length of hospital stay for colorectal cancer patients and improving their pain control through the provision of ambulatory epidural. It is anticipated that this will result in a reduction in length of hospital stay by up to 50%. Redesign of breast cancer services in Lanarkshire with additional radiology and cytology support to facilitate the development of a one-stop clinic with nurse-led follow up will reduce waiting times for diagnosis
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