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CANCER IN SCOTLAND SUSTAINING CHANGE
INTRODUCTION
CANCER IN SCOTLAND: ACTION FOR CHANGE WILL SOON BE 3 YEARS OLD AND IT IS TIMELY TO SHARE WHAT WE HAVE LEARNED DURING THIS TIME. SOME OF IT WILL BE FAMILIAR FROM PREVIOUS REPORTS, MANY OF YOU WILL RECOGNISE YOUR OWN ACHIEVEMENTS, BUT THE BREADTH AND RICHNESS OF THIS PROGRAMME ADDS ADDITIONAL VALUE AND MEANS THAT A COMPREHENSIVE OVERVIEW IS USEFUL.
This report therefore aims to summarise where we are now, outline what we are doing about challenges encountered on the way, celebrate achievements and set out the direction for future travel.
We have used the framework of the national strategy as a template and to remind ourselves that the initial scope remains unchanged, from prevention, through diagnosis and treatment, supported by sensitive and appropriate care, enhanced by research and delivered by multidisciplinary teams working in a coordinated way to explicit and measurable standards.
The emphasis on individual priorities may vary from time to time and in different parts of the system, but they always reflect the needs of patients and take account of national standards.
Cancer in Scotland used a number of new ways to secure implementation of the national strategy and continuous, sustainable improvement in the services. From the outset the principles underpinning implementation were:
patients are at the centre of all decision making;
services perform to national standards and use local implementation and regional multidisciplinary decision making to achieve them;
transparent prioritisation and investment processes with accountability for and public reporting of the expected outcomes.
That these principles are working can be seen and appreciated by patients and clinicians alike. The investments have reached locally agreed priorities, partnerships between clinicians and managers are developing and cancer centres and the populations they serve are being linked in a much more formal and explicit way. Progress and improvements are reported for all to see on
www.cancerinscotland.scot.nhs.uk .
There is much more to be done. The new relationships are still fragile and could be affected by the turbulence that we are experiencing in the wider NHSS as the new organisational structures bed in and regional planning arrangements evolve. If circumstances forced a retreat it would be a betrayal of the trust, enthusiasm and sheer hard work that all those involved have brought to the current process and confirmation for the sceptics who suspected that networks may be just another NHS reorganisation.
We all realise that this must not happen and we are supported and encouraged by the wider NHSS community to go forward for the good of cancer services and the benefits for the wider Service. Getting and maintaining interest may be more difficult without the focus and encouragement of more new money, but from the start we knew that the funds supporting implementation of
Cancer in Scotland were not going to solve all the problems and that we would need to ensure that we use all the available resources in the most effective way. The continuation of ring fencing which recognises the success of our approach so far should enable us to review the investment plans and make adjustments if (necessary) in the current additional
Cancer in Scotland 25 million funding stream.
But what about the baseline resources - are we using these optimally? What can we learn by benchmarking comparisons and more explicit linkage between resource and activity? How do we address the challenges of new technology applied to historical systems - what are the choices and who makes them?
We are not alone in facing these dilemmas, nobody has the answers, but everyone agrees that there are fundamental principles that help a system to navigate through these difficult and largely uncharted waters. These are the ones articulated and governing the
Cancer in Scotland programme. Think of them as tools and use them to help you to face the challenges.
The programme of modernising the NHSS workforce may be one of the areas in which to test this approach. Clarity about senior medical workforce contributions, defined roles and responsibilities of the multidisciplinary teams, shared care arrangements between different health care sectors all play a part if we are to solve this complex jigsaw. We need to look at patient-centred planning models to test and evaluate some of the assumptions. The cancer programme is ideally suited to take this on - we have broad agreement on service content and distribution and nationally agreed indicators of performance. We also have a national audit programme that can measure the effects. Unchecked the global forces will drive centralisation - regional networking may be able to sustain services nearer to patients and ensure clarity and consistency on what needs to move and why.
The other tools are information and patients themselves. Prospective audits are beginning to inform service redesign and reduce waiting times with the help and coordination from the Cancer Service Improvement Programme (CSIP). National datasets are being defined, agreed and fed into the national data dictionary in preparation for electronic data capture in the course of routine clinical care. Websites and information networks are making access to knowledge and protocols easier and enable anyone to check what the planned process of care is meant to be. This will reduce uncertainty, variation and improve patients' satisfaction. It is one of the most important determinants of a high quality health care system and our aspiration to be the "best in the world" demands a systematic approach to achieving it. The clinical systems will be a challenge. Integration of a variety of existing data sources across a number of organisational and technical barriers will test the ingenuity and determination of the ambitious National eHealth Strategy. The cancer networks bring clarity about a number of prerequisites that need to be met and we will be enthusiastic partners in the proposed demonstration projects.
Patients are the reason for most of our actions and at the centre of our plans. It is not by accident that we are amongst the first to start turning the national policy of patient involvement into routine practice. Again, much more needs to be done both in terms of developing the systems, learning what and how best to do it and supporting patients who are generous with their time and commitment to help us get it right. Their trust and support means a lot to us.
This work will be done by you in the networks within your local NHSS environment and if it is to retain its clinical relevance that is where it needs to stay.
So what is the role of the national (Scottish Executive) team? Think of us as the coordination hub - acting as links between the geographical areas, disease specific and generic networks and between the cancer programme and other NHSS initiatives. Much of this work is "invisible" and if it is to succeed should remain so. If all goes well you don't notice us, but if the going gets tough we are in the frontline of action. The principles governing our work are the same as yours, we share your aspirations and the relationships and trust that we have developed over the first 3 years help us through the sometimes robust discussions necessary to achieve the improvements that we all want to see.
The progress that has been made so far and the work ahead of us would not be possible without the contribution, enthusiasm and commitment of a lot of people. The ones I know best are the small cancer team at the Scottish Executive Health Department and the clinicians and managers developing the regional networks who have taken the framework set out in
Cancer in Scotland and made it real. I would also like to acknowledge our appreciation of the trust and support that we have received from the leadership of the NHSS. Together we have started to turn the tanker and are beginning to see the benefits which encourage us to go on. The aim to be "best in the world" is achievable if we continue with the same energy and dedication that you have all shown in the last 3 years. Thank you for going on and helping to make it happen.
Dr Anna Gregor
Lead Clinician for Cancer Services in Scotland
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