The Scottish Government

« Previous | Contents | Next »

Listen

CANCER IN SCOTLAND SUSTAINING CHANGE

03 IMPROVING ACCESS TO TREATMENT AND CARE

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

Waiting Times

What we said we would do:

• By October 2001, women who have breast cancer and are referred for urgent treatment will begin that treatment within one month of diagnosis, where clinically appropriate.

• By 2005, the maximum wait from urgent referral to treatment for all cancers will be two months.

What has been achieved:

• National quarterly reports show that approximately 80% of women are treated within one month of diagnosis and services are working on improving this further. It is recognised that not all women should be, or want to be, treated within a given period. All services continue to monitor those cases that do not meet the target to ensure that appropriate action is taken if delays are due to process rather than for clinical reasons. Referral guidance to support development and implementation of local protocols has been published (see below).

• All NHS Boards are formulating plans to achieve the 2005 target.

• Work is ongoing to ensure that all services will be able to routinely monitor their performance against the 2005 target for all cancers.

Cancer Service Improvement Programme (Service Redesign)

What we said we would do:

• Establish a major redesign initiative aimed at improving the patient journey from referral to treatment.

What has been achieved:

• In October 2002 the Minister for Health and Community Care announced an additional 1 million investment over 3 years to underpin the redesign of cancer services. As a core programme of the Centre for Change and Innovation the Cancer Service Improvement Programme (CSIP) aims to accelerate the pace of change and bring additional improvements to existing systems and processes across the three regional cancer networks in Scotland. The primary goal is to improve experiences and outcomes for patients with suspected or diagnosed cancer.

• Regional Facilitators for CSIP have been in post since June 2003 and are working closely with clinical leads and members of the three regional cancer networks. Initial support is being provided for lung, colorectal and gynaecological cancer networks. Work has been undertaken to map out the many steps across the patient journey from referral, through to diagnosis, treatment and follow up and has involved a wide range of staff. A substantial number of change ideas have been generated from process mapping events and these improvements are now beginning to show exciting results.

• At the heart of the programme are the patients and carers and their experiences throughout the cancer journey. Different techniques such as patient stories are being used to capture these through interviews with patients and carers.

Referral Process

What we said we would do:

• Referral Guidelines will be developed to help identify those patients requiring urgent investigation to confirm or otherwise a diagnosis of cancer.

What has been achieved:

• Scottish Referral Guidelines for Suspected Cancer were developed by a multi-disciplinary group involving clinicians, the voluntary sector and patients and published in May 2002.

• The implementation of these guidelines and their translation into locally agreed referral protocols and pathways is being monitored through RCAGs.

• Implementation is also being taken forward through the work of the National Cancer eHealth Group. The guidelines are available online across Scotland through the SCI Gateway (a component of Scottish Care Information (SCI)) to enable secure transmission of referral/discharge information.

Imaging Technology

What we said we would do:

• The Health Technology Board for Scotland (HTBS) will undertake a review of PET scanning technology. Future investment decisions will need to take account of their advice.

What has been achieved:

• In October 2002 the then HTBS recommended that a PET (Positron Emission Tomography) imaging facility including a cyclotron for both clinical use and for specific health services research applications, should be set up in Scotland as rapidly as possible to allow Scottish patients and researchers to realise the potential benefits of PET imaging in cancer management.

• The Minister for Health and Community Care set up a Working Group to consider the recommendations and to propose how they should be implemented. The Group's report and Guidance was published in October 2003 - (NHS HDL (2003) 63).

• In March 2003 the Minister for Health and Community Care announced 5 million capital investment from 2004-05 to support the development of PET services in Scotland.

Workforce

Cancer in Scotland recognised the challenges presented by workforce shortages. It committed to setting up a Human Resources Sub Group of the Scottish Cancer Group to consider the issues. In light of the subsequent establishment of national, regional and local workforce planning initiatives there did not seem to be any advantage for the Scottish Cancer Group to look at the needs of cancer services in isolation specifically as many of the major challenges lay in services not unique to cancer. The focus has therefore been on ensuring appropriate central, regional and local links to the new workforce planning structures. However, in order to support earlier diagnosis and treatment actions have been pursued in specific services such as radiology and pathology as detailed below.

What has been achieved:

• Workforce development arrangements are being put in place at national, regional and local level to enable NHS Boards to take a more strategic approach to workforce development, improve the supply of workforce information to inform decision making and interact with service planning and redesign.

• The Scottish Health Workforce Plan: 2004 Baseline, published in April 2004, is the first of an annual publication providing leadership and guidance on workforce numbers at the national level. The National Workforce Plan is part of a comprehensive workforce strategy and will help identify gaps in services now and in the future and to take the right action to fill those gaps. It will provide an essential focus for the work of NHS planners and leaders in NHSS as a platform not only for increasing staff numbers but also for shaping the development of new roles and new ways of working on which sustainable care depends.

• An additional 24 radiology and 16 pathology training posts have been established between 2001 and 2003.

• In 2004 the Scottish Executive is investing 600,000 to support PathAlba, the Scottish pathology telemedicine network that allows microscopic images to be examined by colleagues in other parts of the country to further support the excellent national quality assurance scheme that has long been recognised internationally as an exemplar in its field.

• A workshop organised jointly by the Scottish Executive Health Department, Royal College of Radiologists, Scottish Radiological Society and the Society of Radiographers was held at the end of April 2004 to discuss in an open forum capacity and demand issues in the patient pathway with specific reference to radiology and to review experiences from around Scotland that have emerged from the CSIP that have been successful in addressing these. These include projects in the Borders, Livingston and Tayside.

PATIENTS MUST HAVE READY ACCESS TO CLINICALLY-EFFECTIVE TREATMENT, DELIVERED SAFELY AND WITH MINIMUM DISRUPTION TO THEIR LIVES

Improving Quality

Cancer in Scotland signalled a new drive to improve the provision of cancer services across the country, with the experiences and needs of patients central to the changes.

What we said we would do:

• Cancer Managed Clinical Networks (MCNs) will be fully established by 2002.

• By a process of prospective audit and continuous assessment of services provided, regional cancer networks will provide a consistent framework of quality assurance in Scotland.

What has been achieved:

• Regional cancer networks are well developed with multidisciplinary tumour specific networks for most cancers.

• A national networks' development programme has been established focusing on key themes including quality improvement, audit, redesign of services, waiting times, protocols and patient involvement and information.

• Tumour specific workshops have been held for breast, colorectal, gynaecological, lung and prostate cancers. A list of workshops is included in Appendix 1 and summaries of past workshops are available on www.cancerinscotland.scot.nhs.uk .

• Clinical Standards Board for Scotland (CSBS) (now NHS Quality Improvement Scotland (NHS QIS)) reports on breast, lung, colorectal and ovarian cancer services provide a baseline assessment of these services in 2001-02. A significant number of the changes and service improvements funded by Cancer in Scotland are aimed at meeting CSBS standards. Details of these investments have been published on www.cancerinscotland.scot.nhs.uk , as have 6-monthly progress reports of their impact.

• Quality Improvement Framework developed to support accreditation of regional cancer networks by NHS QIS.

• National audits established in lung, breast, colorectal and ovarian cancers covering 47% of all cancers.

Radiotherapy

Radiotherapy continues to be an essential component of quality cancer services. New technological developments and increasing combination with surgery and chemotherapy are expanding and changing its role in the management of cancer patients. Because of its high capital value and complex implementation it needs a national approach to planning and development.

What we said we would do:

• Scottish Cancer Group will have a rolling brief to monitor the age and effectiveness of radiotherapy equipment and to make recommendations for further long-term capital equipment.

• Provision of Continuous Hyperfractionated Accelerated Radiotherapy (CHART) facilities in Scotland will be assessed as a priority with a strategic review of the future needs for radiotherapy delivery.

• Against that background and in the face of the recognised pressures on the Beatson Oncology Centre which treats 50 to 60% of Scottish cancer patients, the review of radiotherapy activity pathways was fast tracked at the request of the Minister for Health and Community Care.

What has been achieved:

• Radiotherapy equipment capital programme - 33.07 million has been spent on replacement and additional radiotherapy equipment since 1997. The programme has replaced old equipment in all 5 cancer centres and is now adding to the existing complement. By the time of completion (commissioning) of the next planned (4th) wave in 2005-06, Scotland will have 24 modern linear accelerators, about 5 per million population.

• Continuous Hyperfractionated Accelerated Radiotherapy (CHART) - an intensive radiotherapy treatment for lung cancer - is now provided in Edinburgh and Glasgow.

• The fast-track review by the Radiotherapy Activity Planning Working Group reported to the Health Department Management Board (HDMB) in April 2003. It recommended that a more in-depth review was required to confirm initial assessments that over the period to 2014 there was a high risk that currently available and planned radiotherapy equipment would be insufficient to meet the projected needs of a growing population of cancer patients ( Cancer Scenarios).

• A meeting involving NHS planners, clinicians and patients was held in November 2003 to help map out the actions needed to support the in-depth review of all forms of radiation therapy and future requirements including future developments in technology/techniques. The consensus view was that work should concentrate on: technology, workforce planning and patient issues.

• A Project Manager to support the review was appointed in March 2004 and the first meeting of the new steering group was held in late April.

• To help to address some of the skills shortages 150,000 was made available to support a project for role development and skills enhancement in diagnostic and therapeutic radiographers and their support staff. This initiative is underway, starting with a Scotland-wide collaborative scoping exercise to establish a baseline of skill mix and role development.

• Recommendations for a national framework for education and training for diagnostic and therapeutic radiographers will be produced.

Chemotherapy

Cancer Scenarios estimated that demand for chemotherapy might as much as double over the period to 2010-14.

What we said we would do:

• Evidence-based protocols would be put in place for the prescribing, preparation and administration of chemotherapy and supportive treatment across MCNs.

• Review the current guidance for chemotherapy administration.

• RCAGs will be required to demonstrate that their investment plans support equity of access to and the safe delivery of chemotherapy for everyone who needs it.

• Schemes for pharmaceutical care planning for patients with cancer are currently being piloted. If demonstrated to be effective, RCAGs will require to consider how best to secure implementation.

• The Scottish Executive, HTBS and regional cancer networks will work together so that patients have fair and equitable access to cancer drugs and other treatments on the basis of a common view of their effectiveness and affordability.

What has been achieved:

• Guidance on the Safe Administration of Intrathecal Chemotherapy was issued in 2002 - NHS HDL (2002)22.

• In March 2004 guidelines on a standardised approach to the development of chemotherapy protocols was issued to regional cancer networks for them to take forward as part of the Quality Improvement Framework.

• An increasing number of prescriptions for chemotherapy are being dispensed in primary care. The appropriateness of the guidelines for the Safe Use of Cytotoxic Chemotherapy is under review.

• Over the 3 years almost 10.5 million has been invested in equipment, facilities and staff to ensure equity of access and the safe delivery of chemotherapy.

• Care planning was piloted initially for patients with breast, lung, ovarian and colorectal cancer. Pharmaceutical care planning is a key component of a capacity plan for pharmacy cancer services developed by senior NHS pharmaceutical staff, published in the Pharmaceutical Journal and supported by the Scottish Cancer Group. The outcome of this work has meant that the RCAGs have demonstrated their commitment to delivering pharmaceutical care in their investment plans.

• The Scottish Medicines Consortium (SMC), established in October 2001, reviews all new drugs and new indications for existing drugs for use in Scotland at the time when they are licensed. It forms the single source of advice for all NHS Boards across Scotland. NHS QIS provides comment on the application of NICE guidance in Scotland.

• NHS Boards must ensure that drugs or treatment recommended by SMC, NICE/NHS QIS are made available to meet clinical need within 3 months of the publication of that advice or within the time frame specified within any national implementation plan for that drug or treatment.

• Where the SMC consider that a drug is unique and innovative NHS Boards are expected to make this drug available according to clinical need. This is in line with NHS HDL (2003)60.

• Responsibility for the implementation of SMC/NHS QIS recommendations lies with NHSS and thereby regional cancer networks. So as not to lose focus on the issues and reaffirm the importance of national consistency a lung cancer chemotherapy workshop was held in April 2004 to explore with industry the usefulness and applicability of pharmaco-economic models to NHSS and relevance to patient care. This meeting also provided an opportunity to compare chemotherapy protocols used by the three regional lung cancer networks.

Children and Young Adults

Children's cancers are comparatively rare. Almost half of children's cancers each year are cancers of the blood or lymphatic system and Scotland's record compares well with other European countries.

The publication Childhood Cancer in Scotland in January 2004 shows for the first time the picture of all children's cancers in Scotland and that significant improvements have been made. Incidence of children's cancers has gone up over the last 30 years as have the improvements in 5-year survival overall from 50% to 76% in 1999 show and huge and welcome change.

A classification system for adolescents and young adults with cancer has recently been developed and statistics for cases diagnosed in 1976-2000 and survival to 2002 was published in November 2003. This showed that while incidence of cancers amongst adolescents and young adults has gone up, the 5-year survival has improved from 60% to 79%. These cancers account for 0.7% of all cancers in Scotland.

What we said we would do:

• We recognise the lack of dedicated facilities for teenagers who have cancer in Scotland. The Scottish Cancer Group will consider how best to improve services for young adolescents with cancer, including the possibility of partnership initiatives between NHSS and the voluntary sector.

The comprehensive nature of the work programme to support implementation of Cancer in Scotland is bringing improvements across all cancer services including those for young people. However, there are a number of specific initiatives across Scotland that warrant mention in this context.

What has been achieved:

• The Teenage Cancer Trust is working in partnership with the West of Scotland Cancer Centre to develop the new centre at Gartnavel. It is hoped that the new facility will be up and running in late 2006/early 2007.

• In January 2004 SIGN published guidelines on the long-term follow-up of survivors of childhood cancer.

• Refurbishment and extension of the National Paediatric Stem Cell Transplant Unit at Yorkhill Hospital to provide a safe and age appropriate environment for children and better support family centred care through a 500,000 grant from New Opportunities Fund (NOF).

• NOF grant of 268,503 to Sergeant Cancer Care to provide a flexible range of practical home-based support services to families in Glasgow where a child or young person (0-21 years) has been diagnosed with cancer.

Older People

Adding Life to Years recognised that cancer is commoner in later life. Around one-third of all cancers are diagnosed in people over 75, who form only around 7% of the total population. Some common forms of cancer may be less aggressive in older patients but in general terms results of treatment are less good. For a variety of reasons older people with cancer are currently less likely to undergo detailed investigation, and also receive less treatment than younger cancer patients.

What we said we would do:

• To ensure the particular needs and difficulties faced by older people with cancer are addressed, the Scottish Cancer Group will work alongside the Chief Medical Officer's Expert Group on the Healthcare of Older People.

What has been achieved:

• The Scottish Cancer Group contributed to Adding Life to Years, the Report of Expert Group on the Healthcare of Older People published in January 2002. It recommended that:

- Older people with cancer should have full access to the service developments that follow from the implementation of Cancer in Scotland: Action for Change;
- Older patients should have access to appropriate investigation and treatment of cancer on the basis of their individual clinical needs;
- NHS QIS standards should adequately assess care provided to all age groups including older people;
- Older patients with cancer should have access to rehabilitation to enable them to cope with the impact of disease and treatment.

• Responsibility for taking forward the recommendations of the report lies with many agencies, NHS Boards, Local Authorities, education bodies, voluntary agencies and patient groups.

• First annual report published in December 2003 reflects the discussions at the first national conference exploring the main themes of the Expert Group Report. It reviews progress, identifies developments and looks beyond healthcare to the wider set of policies on ageing.

West of Scotland Cancer Centre (Beatson Oncology Centre)

The past difficulties at the Beatson Oncology Centre in Glasgow have been well aired. Much has been achieved since 2001-02 fuller details of which are available from the Cancer in Scotland website, however, a few significant examples are set out below.

What has been achieved:

• 2 million of Cancer in Scotland investment specifically for the Beatson has resulted in at least 100 additional staff which has improved the quality of care for patients.

• In June 2003, Professor Alan Rodger was recruited from Melbourne, Australia as Medical Director of the West of Scotland Cancer Centre.

• Six new consultants have been appointed with at least another three anticipated to be in post by mid 2004. By October 2004, 27 new radiographers will have been recruited from countries as far afield as USA, Australia, Greece, Northern Ireland and the rest of the UK. However, shortages still remain in physicist posts with recruitment efforts ongoing.

• The new 87 million for Phase II of the West of Scotland Cancer Centre at Gartnavel is the biggest ever public investment of this type in Scotland. Work will start on the five floor hospital unit in July 2004. It is due to open in 2007.

Palliative Care

PALLIATIVE CARE IS AN INTEGRAL PART OF ALL CLINICAL PRACTICE WHICH TAKES AS ITS STARTING POINT THE QUALITY RATHER THAN THE QUANTITY OF LIFE REMAINING

While it was acknowledged that significant progress had been made in the establishment and development of palliative care services for cancer, Cancer in Scotland recognised that more needed to be done.

What we said we would do:

• By March 2002 NHS Boards were to undertake comprehensive needs assessments for palliative care including the need for joint working across care sectors and agencies.

• The National Care Standards Committee to ensure that palliative care is included in the standards they set.

• Standards for specialist palliative care currently being developed.

What has been achieved:

• Over 5 million additional investment in palliative care services over the last 3 years.

• Palliative Care needs assessments have been pursued in a variety of ways best suited to local requirements. Published Local Health Plans for 2003 - 2004 and Cancer in Scotland Monitoring Reports published on www.cancerinscotland.scot.nhs.uk indicate that many NHS Boards have completed these assessments. In some areas this exercise has been overtaken by the development of palliative care strategies arising from the establishment of palliative care networks.

• National Care Standards for Care Homes issued in November 2001. National Care Standards for Hospice Care issued in March 2002 include a standard that clinical care should reflect CSBS (now NHS QIS) standards for specialist palliative care.

• Standards for specialist palliative care were developed and published by NHS QIS in June 2002. To assess performance against the standards peer review visits to all specialist palliative care services in Scotland were conducted between January and August 2003. A National overview report and local reports of these assessments were published in January 2004.

• NHS Boards will fund 50% of the agreed running costs of the 13 adult voluntary hospices in Scotland, and a Health Department Letter was issued in April 2003 clarifying the basis on which the 50% calculation should be made. The NHS Boards' contributions amount to about 10 million a year.

• The Scottish Executive is providing core funding of 70,000 in 2004-05 to the Scottish Partnership for Palliative Care in recognition of the Partnership's need to engage with a broader range of voluntary bodies and develop expertise in relation to a wider range of conditions, so as to assist the pursuit of the Executive's policy that palliative care should be available to anyone suffering from an incurable progressive condition.

« Previous | Contents | Next »