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CANCER IN SCOTLAND SUSTAINING CHANGE
04 INVESTING IN STAFF AND TECHNOLOGY
OUR NATIONAL HEALTH CONFIRMED THAT WE WANT PATIENTS TO HAVE MUCH GREATER FLEXIBILITY IN HOW THEY ACCESS THE CARE THEY NEED MAKING THE BEST USE OF THE SKILLS OF THE WHOLE HEALTHCARE TEAM
Primary Care
Cancer in Scotland recognised the expanding role of primary care in cancer management as the average age of patients with cancer increases. It also suggested that the complexity and demands of looking after patients in the community would become greater.
Local Health Care Cooperatives and the emerging Community Health Partnerships (CHPs) have a leading role in delivering the cancer strategy in areas of education and health promotion, local needs assessment, establishing systems for early detection and appropriate referral; supporting local monitoring and delivery of treatment as part of MCNs; and ensuring the delivery of effective and integrated palliative care.
What has been achieved:
The Cancer Networks - A Focus on Primary Care workshop was held in March 2003 with 160 delegates from across Scotland. The workshop aimed to further enhance the development of the cancer networks focusing on the involvement of the primary healthcare team as integral to the development of cancer services.
In May 2003 NOF awarded 640,000 to support the development of the Gold Standards Framework (GSF) in Scotland. GSF is being used in practices throughout the UK, to improve the care of individuals requiring palliative care in the community. In Scotland the project is being enhanced to address community care needs of all cancer patients from the point of diagnosis onwards. The aim of the Framework is to provide primary health care teams with an effective method of empowering patients and improving the hands on care they receive during their illness. This joined-up approach is designed to ensure that Scottish cancer patients don't "fall through any cracks" and individual needs and wishes are addressed. The principles underpinning the Scottish development remain identical to those of the wider UK GSF project and there is continued emphasis on the provision of high quality palliative care. The most significant difference is that practices are encouraged to maintain a register of all cancer patients as well as a register of palliative care in order to ensure that everyone is appropriately supported at key points in their care pathway.
Each of the regional cancer networks has identified a Primary Care Lead GP who in some cases chairs the regional primary care group. The role of the leads and their respective groups includes the promotion of primary care issues, input to development and implementation of referral protocols and education and training.
NEXT STEPS: |
As outlined in
Partnership for Care the new Community Health Partnerships (CHPs) will seek to bridge the divide between primary and secondary care and between health and social care. The development of CHPs presents an opportunity for primary care to have a key role in the continuing momentum for the development of care services. The CHP will facilitate person-centred, integrated and quality services delivered safely as locally as possible, recognising that some services need to be regionally based. This is assisted by the new General Medical Service (GMS) contract which offers an outstanding opportunity to improve the quality of care patients receive in primary care. It focuses on quality, chronic disease management, health improvement and health promotion.
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Nursing Care
What we said we would do:
What has been achieved:
Cancer in Scotland central investment of around 200,000 to support the Cancer Nursing work programme including the appointment of the Cancer Nursing Development Coordinator in January 2002.
A Framework for Nursing People With Cancer in Scotland has been developed, overseen by an Executive group chaired by the Chief Nursing Officer. Consultation with nurses about the content was conducted through a series of four national conferences held between November 2002 and August 2003. The Framework sets out the strategic vision that will shape nursing services for people with cancer across NHSScotland, in all care settings and in all geographic areas. It is expected to improve patient care through focused and coordinated nursing services. The framework was published in April 2004 at the meeting of the European Oncology Nursing Society in Edinburgh.
NEXT STEPS: |
Development of a core competencies framework by NHS Education Scotland (NES). |
Pharmaceutical Care
Each of the three regional cancer networks now has a lead cancer care pharmacist to facilitate continued improvements in the delivery of pharmaceutical care through regional pharmacy cancer networks and working with the RCAG and MCNs. They are collaborating at both regional and national level and playing a pivotal role in ensuring national strategy relating to cancer is implemented at local level and facilitating local involvement in the development of national strategy.
What we said we would do:
What has been achieved:
NEXT STEPS: |
The paper-based pharmaceutical care planning tool for cancer has been successfully piloted and is now being rolled out across Scotland. Work is underway to integrate this model into the eHealth Programme (see below) with a view to developing a generic care plan for both primary and secondary care. |
Information and Communication Technology
Cancer in Scotland acknowledged the pressing need to harness the power of information technology to provide better access to information and to improve communication between clinicians and patients.
What we said we would do:
ECCI will deliver a number of objectives aimed at improving services for patients. For example the use of protocol based electronic referrals and online booking systems from the GP's surgery.
SCI will produce integrated systems across care sectors and put in place the necessary links between primary and secondary care systems.
What has been achieved:
Guidance on the evaluation of IT systems for the management of cancer in Scotland and
A National IM&T Plan for Cancer were published in December 2002 to support NHSS when considering, planning or developing IM&T systems to support cancer services. The foundation of the plan is the use of ECCI and SCI products to support the information needs of the journey of care.
A clinically-led Cancer IM&T Project Board was established with a Project Manager to take forward a pilot of the National Cancer IM&T Plan in four areas across Scotland who were developing or procuring IM&T systems to support cancer services. The pilot highlighted variations in:
- interfaces with national products, e.g. SCI Gateway and SCI Store;
- collection of national cancer datasets;
- scope and functionality of the systems, e.g. a complete patient record, support for multidisciplinary meeting or audit systems;
- coverage of cancer types, e.g. lung, breast.
A National workshop "Delivering an electronic cancer patient journey" was held in February 2004 to report on the findings of the pilot, share examples of good practice and to reach consensus on way forward.
Scotland's Health White Paper
Partnership for Care recognised the urgent need for an eHealth strategy driven by clinical leaders and set the goal to deliver an integrated care record.
To take this forward the eHealth Programme Board was established and under the chairmanship of the Minister for Health and Community Care has produced a National eHealth Strategy.
Dr Ken Robertson appointed as National Clinical Lead and each Health Board appointing a Clinical IM&T Lead to take the overarching national eHealth programme forward.
NEXT STEPS: |
To acquire a national generic clinical system and to put resources into using it to support cancer care which is an excellent model of multi-disciplinary and multi-site working. Linking local redesign to IM&T support using generic, nationally consistent tools will add value beyond the cancer sector, e.g. electronic referral process with built in decision support. Widespread implementation of e-based clinical systems will enable NHSS to fulfil its commitment to reduce variations in care and improve NHSS ability to monitor performance. Knowledge management systems will facilitate local access to high quality care for the increasing number of Scots living with cancer. The existing Cancer eHealth Group will reassess its structure and role to ensure continuing support and development of the generic national programme.
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Information for, and Communication with, Patients
Information and communication are crucially important for patients and their carers. We know that in Scotland people affected by cancer do not always get the information that they want at the time and format suitable to their needs. In a complex care system there can be a lack of clarity about who is responsible for information sharing at different points in the journey. Inconsistencies in the content and emphasis result in patients feeling distressed, anxious and more likely to complain.
The CSBS (NHS QIS) reviews of breast, lung, colorectal and gynaecological cancers consistently noted that while some staff had attended communication skills training, these courses were not generally attended by senior medical staff who are responsible for giving sensitive or bad news to patients and their families.
What we said we would do:
What has been achieved:
Guide to Securing Access to Information (Cancer Specific) published in March 2003.
Involving People Team published draft Guide to the
Production and Provision of Information about Health and Healthcare Interventions published for consultation in October 2003 and feedback is currently being considered.
Centre for Change and Innovation published a review in September 2003
Talking Matters: developing the communication skills of doctors which proposes the development of programme of support to help doctors across Scotland develop their communication skills.
40,000 secured from
Cancer in Scotland investment to provide communication skills training for senior clinicians within cancer networks. A facilitated training course was held in November 2003. This has created a resource of trainers who are able to cascade good practice throughout the cancer networks.
Work is also ongoing in other areas to address communications skills. For example, Argyll & Clyde have organised communications skills training for cancer clinicians over the past 3 years and Tayside have committed 40,000 to support roll out of communications skills training. SCAN has a training course up and running.
NEXT STEPS: |
Scottish Executive is committed to funding the accreditation of communication skills trainers from the national course. Clinicians from Tayside and Glasgow are working in partnership to organise further courses. |
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