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CANCER IN SCOTLAND: ACTION FOR CHANGE - Fifth Monitoring Reports: 1 October 2003 - 31 March 2004

North of Scotland Cancer Network (NOSCAN)
Fifth Monitoring Report

1 October 2003 to 31 March 2004

1. Investment plans/Monitoring

Full details of all investment and slippage are reported in the financial return. Highlights and issues this return include:

NOSCAN

Gynae-oncology consultant now in post in Aberdeen covering NESCCAG and Highland, making the NOSCAN Gynae-oncology team now complete.

NESCCAG

Grampian's 3 ^rd LINAC is now operational with funding found for partial staff cover through redesign within oncology services.

A comprehensive programme of training opportunities and skills updates is in place in Shetland. Six staff from primary care have taken up opportunities for skills and training updates within a hospice setting south for palliative/terminal care.

Highland and Western Isles

All investments in Highland are now complete. The Western Isles have slippage in some developments mainly in those, which are dependent on other areas, e.g. provision of haematology clinics by Raigmore. Negotiations are ongoing.

Tayside

Delays in investment plans continue to be caused by national shortages in key professions, particularly radiotherapy. However, the funding for these posts was transferred to bring on MRI development earlier, and the Acute Division of NHS Tayside have agreed to 'ring-fence' resource to fill these vacancies when staff become available.

2. Regional Cancer Advisory Group

During the last three months NOSCAN has been conducting a Strategic Review of all activities. This has been through a number of events, meetings, papers and consultations. We are approaching the conclusion and hope to report soon on implementation. The main thrusts of the outcome are to: build on the successes so far such as clinical networking, but to formalise the support of all our networks; to make equity of service and access to service a more explicit top priority; to minimise duplication of effort; and to be more active in regional planning. We are also to be chaired by Tony Wells, NHS Tayside Board Chief Executive in the future.

3. Managed clinical networks

See attached summary at Appendix - other issues include:

NOSCAN

Along with the other two RCAGs are applying to NHS QIS for quality accreditation, after which it is thought we will be able to locally accredit our MCNs.

All our MCNs will be formally required to create and report against work plans and will receive dedicated central support to implement the work.

Gynae

The last six months have seen some major advances in the development of the proposed Managed Clinical Network for Gynae Cancer. Meetings have been held on a regular basis between the three areas covered by NOSCAN and protocols are being developed and agreed across the area. Following the last meeting a follow up protocol for endometrial cancer has been agreed and will be put into practice. Chemotherapy protocols are nearly completed. There is a newly formed Patient Information Group.

The weekly MDT video link between Raigmore and Aberdeen is well established and has improved the referral time of patients from Inverness. The communication of patient details has improved and this link has provided a forum for discussion for the ongoing care of patients. There is now an established pattern of referral of data down to Aberdeen for inclusion in the ward round database, and a return of data with the decisions made at the MDT meeting, together with letters dictated at the end of the meeting. There is a constant appraisal of the patient care pathway by all the team and changes are made to procedures where necessary. There is no doubt that communication would be easier with an EPR but as yet there have been no firm developments in that area, except that all three areas agree that one is needed.

The appointment of another Gynae Oncologist has meant that the proposal for a Gynae Oncology operating list at Raigmore has become a reality. It is hoped to have a combined follow up clinic at Raigmore established as well but problems had arisen because of accommodation. This has now been solved and hopefully an operating list and combined clinic will be set up at Raigmore in the near future.

Upper GI

Mr Ken Park has been appointed as the lead of the recently established Upper GI network.

Lung

No update since the last report but support to this and all other MCNs is top of the agenda for the NOSCAN Strategic Review.

Haematology

The group are occupied with implementing the changes arising as a result of changing blood cancer audit nationally, agreeing national protocols, and deciding which work is best handled nationally, regionally and locally.

Palliative Care

The Scottish Partnership for Palliative Care and the North branch are in the process of reviewing membership nationally and locally. Discussions are ongoing regarding their role as our MCN and their independent status as a charity in light of our strategic review. A key topic of service interest at the moment is improving Lymphoedema services.

NESCCAG

NHS Grampian is in discussion with NESCCAG about how to integrate MCNs into the new NHS single system, to help improve communication and collaboration between all MCNs in Grampian. Closer links have been forged with NHS Grampian strategic groups through ongoing communications with NESCAG and NOSCAN meetings and video-conferencing. NHS Shetland is now represented on all of the site-specific focus groups and staff participate in MDT meetings using local video-conferencing facilities.

Highland and Western Isles

All detail included in Appendix

Tayside

An initiative to extend the role of the Cancer Audit Department in Tayside to include MDT co-ordination within their role is being project tested over 2004-05. It is anticipated this will free up valuable clinical time, maximise the existing resource and, strengthen the expertise available to the MDT members. Funding for three MDT/Audit Facilitators has been secured for a fixed term of one year. Throughout the year extensive evaluation will take place in order to measure how much time has been freed for clinical staff and what difference this makes to patient care. If the initiative is proven to be successful there will be a requirement to identify recurring resource to make the posts permanent.

4. Redesign

NOSCAN CANCER SERVICE IMPROVEMENT PROGRAMME

REGIONAL FACILITATOR REPORT- March 2004

Process Mapping and Follow-Up events have taken place in Tayside, Grampian & Highland. The maps completed for lung and colorectal cancer patients in the North show:

Many of the change ideas generated reflect the issues listed above

LUNG CANCER

Grampian team generally feel that the Lung Cancer Pathway works well. A number of issues regarding slow referral into the acute setting are being addressed and the changes implemented will hopefully show an improved outcome, including improved chest x-ray reporting and referral to Respiratory Physicians for patients from Shetland & Orkney.

• Reduction in time from GP to chest x-ray of max. 2 weeks to 2 days anticipated

Again redesign is on the quarterly Lung Focus Group meeting and provides a focus for further review and discussion with a wide representation of the lung team. Most recent audit data available is December 2002, lack of current data makes it difficult to gauge the current service provision against the waiting time target.

Highland and WI: 6 change cycles generated 1 cycle in early stage of implementation

Progress in Highland has been difficult due to the small numbers of staff within the team and their availability to commit to the programme. Poor attendance at the follow-up event resulted in only a small number of change ideas being generated and some of these are dependent on the future recruitment of staff. Following the NOSCAN Conference, the surgical and medical directorate managers have agreed to meet with the regional facilitators and network co-ordinator to discuss ways of progressing in Highland.

• Clearer pathway of care for Western Isles patients

The audit team in Highland are currently gathering 2003 audit data for lung and it is anticipated that validated data will be available in the near future.

Tayside : 9 change cycles generated 6 change cycles implemented

Significant progress has been made in Dundee in improving the time to diagnosis through streamlined GP referral into the acute setting and co-ordination of investigations. Monitoring of these is ongoing and it is hoped that further progress can be made in the coming months. The change to outpatient chemotherapy is minimising delays to start of treatment by reducing dependency on inpatient beds. Local targets for commencement of treatment (12 days from seeing the oncologist) are currently being agreed and this again will assist the Lung Team in their endeavour to attain the 62 day waiting time target. Spread of the successful changes across Tayside to be progressed.

• Chest X-ray to Seeing Resp. Physician reduced from median 23 days to 10days

• Increase from 45% to 83% of patients seen within 62 days as at Dec.2003

Redesign is a fixed agenda item on the Lung Group's monthly meeting and this provides an excellent opportunity to review progress and impact of changes with the multidisciplinary team, including monthly audit updates.

COLORECTAL CANCER

NESCCAG: 6 change cycles generated with 17 change ideas in early stages of progress

Grampian team generated change ideas that include: clear referral and follow up protocols; improve upon the time taken to report investigation results; communication to GP after MDT and development of a common waiting list for endoscopy and surgery. The colorectal team are now progressing these changes but none are complete yet.

The quarterly Colorectal Focus Group meeting provides a focus for further review and discussion with prospective audit data available.

Highland and WI: 7 change cycles generated with 15 change ideas in early stages

The Clinical Nurse Specialist has improved communication to GP's by gaining access to the electronic discharge system and now enters nursing details before it is printed out and sent to the GP. Resulted in saving time with less duplication in producing records and the GP will now get the information they need to care for the patient at home quicker.

The Highland team's other ideas include: clear referral protocols; video links for MDT with rural and island staff; coordinate local follow up and review of out patient clinics with plans for a nurse led clinic working alongside the Consultant again freeing up additional new patient slots.

The audit team in Highland have waiting time data only for colorectal cancer patients but have recently employed additional staff and should have the full colorectal dataset available soon. There is no colorectal group meeting in Highland.

Patient Involvement

In liaison with the RCN Leadership programme, patient stories are being undertaken in Tayside and Highland. In Grampian, the Macmillan Patient & Public Involvement worker is helping to undertake patient stories. In all areas, the lung cancer specialist nurses are identifying patients willing to participate. Issues identified within these are being fed back quickly into each of the local multidisciplinary teams and are included within the improvement change cycles.

Tayside : 8 change cycles generated with 27 change ideas progressing well

Considerable progress has been made in Dundee in improving the number of patients who are waiting to be allocated an out patient appointment by changing vetting procedures, allowing the Colorectal Specialist Nurse access to the electronic referral system, telephone/written consultation to patients, extra clinic sessions and planning a new nurse led clinic to see return patients, allowing the Consultant to see more new patients.

• Pre change, 460 patients on waiting list for appointment, now 290

• Pre change, maximum wait of 8 weeks for referral letters to be vetted, now 2 weeks

Both of these changes are being monitored and the teams are continually trying to improve upon these.

Both referral and follow up protocols have been drafted and should be finalised by the end of March. A rectal bleeding clinic for Angus and the introduction of epidural care in the surgical ward, freeing up HDU beds is being planned. An MDT coordinator is currently being appointed and a review of the waiting lists secretaries and audit of the out patient clinic completed. All of these changes would not have been possible without the commitment and enthusiasm of the Colorectal Specialist Nurse and the Group Manager of Surgery and Oncology.

Redesign is discussed at the colorectal group's quarterly meeting along with robust prospective audit data.

Conclusion

For the areas of lung and colorectal we will continue to facilitate and support the teams in implementing, monitoring and sustaining their change ideas to improve the service but we very much need the help of the Cancer Network teams across the North to achieve this.

LOCALLY LED REDESIGN

Grampian

During Jan-March 2004, an external consultant worked with the Symptomatic Breast Service in Grampian to undertake demand and capacity analysis. The outcomes of the analysis were presented to the Breast Focus group and a small working group was set up to examine the information in more depth, and propose solutions. To date, a pilot one-stop clinic has been held, which appears to have been successful for both patients and staff. Unfortunately, staff shortages in radiology and pathology have led to a delay in running this clinic for a sustained period for evaluation purposes, but this is planned for July 2004.

Highland

Some urology mapping completed and a Palliative Care Working group being established to take forward recommendations from Palliative Care Needs Assessment. Group being funded for 2 years by Macmillan Cancer Relief

Tayside

Local level service mapping has taken place for Urological Cancer, building on the successful work of the CSIP facilitators. Redesign has now become an integral part of urology service planning and has resulted in:

• Direct radiology referral for CT on viewing suspicious Ultrasound/IVU

• Increasing transrectal ultrasound (TRUS) capacity at PRI

• Haematuria referral redesigned to support frank conditions

• Open access ultrasound for scrotal swellings.

Surgical Out Patient Redesign

The main aim of this work is to achieve the 26 week waiting time target for an outpatient appointment but a sub aim is to have an impact on the waiting times for clinic appointments for "urgent" and "soon" referrals. The main focus includes work on vetting procedures, clinic cancellations, return/follow up patients and exploring new ways of working, for example telephone reviews, virtual clinics and more nurse-led initiatives.

Radiotherapy

Radiography staff being trained to undertake radiotherapy planning for breast patients to allow them to start treatment even when consultant unavailable. Estimated start date 2005.

5. Scottish Cancer Research Network

Infrastructure

Significant progress has been made in establishing the infrastructure for the SCRN in the NOSCAN region. Recruitment of research staff to the network is complete. A local induction process has been developed for appointed staff which includes a training needs-assessment and subsequent identified training.

Listed below is a breakdown of staff recruited to the network as at April 2004.

G01

Each team member will be available to support all clinical staff wishing to increase accrual to cancer trials, as required, rather than being assigned to specific disease areas/oncologists. This should ensure efficient and equitable use of resource at all times.

Training and Continuing Professional Development

Training of new staff and on-going education of new staff will be critical to the success of this project, and will help to ensure that GCP standards for data management are achieved. The Network Co-ordinator will be responsible for ensuring that all staff are adequately trained, and will work with the other Scottish Regional Networks to develop training materials.

The first SCRN-North training day took place on February 3rd 2004, with 17 research staff from across NOSCAN in attendance. The event was open to all staff working within cancer trials regardless of their funding source. Topics covered included:

• Background to the SCRN and an overview of its development (Shelagh Bonner-Shand)

• Introduction to Data Management in Cancer Clinical Trials (Eleanor McFadden)

• A presentation from the Grampian Research Ethics Committee Manager on Applying for Ethical Approval, EU directive, research governance (Kellie MacLeod)

Good Clinical Practice Guidelines (Eleanor McFadden)

Budgets

Delays in recruitment of staff across the network have resulted in an under-spend on salaries. Agreement has been reached with individual health boards to carry this funding over into the 04/05 budget.

6. Audit/Waiting times/CSBS

Audit

NESCCAG

• Appointment of fixed term Upper GI audit staff in Grampian has taken place. Central funding provided for haematology audit/MDT co-ordinator has yet to be utilised.

• CSBS/NHS QIS progress report for Colorectal Cancer presented to the GUHT Clinical Governance Committee in November 2003. Significant progress made with the majority of standards now being met. Local CRC protocol currently being reviewed by CRC focus group.

• Lung cancer NHS QIS progress report underway.

• The Shetland colorectal working group is taking a review of SIGN 67 forward. Local audit activity is being developed to underpin the implementation of the guideline.

• Work is also taking place in Shetland to support the collection of audit data in respect of clinical management and the monitoring of cancer waiting times. An arrangement has been put in place with personnel based in the Clinical Effectiveness Department at NHS Grampian to transfer data via video-linking so as to move towards a prospective data collection process.

Highland and Western Isles

Highland's audit of breast is up to date; waiting times have improved with appointment of an additional surgeon. Other audits are not as up to date, and temporary additional resource (to end May 2004) brought in to address this has not been able to do so, due in part to the additional audits being added to the portfolio. It is hoped to use some NOSCAN slippage to provide another temporary resource for 6 months to assist. However the issues of manually intensive process, inadequate resource and increasing audit portfolio remain. Audit previously undertaken by Highland will now be completed by the Western Isles

Tayside

Tayside Cancer Audit has expanded from the 4 main cancer sites and prospective audit is now established for Head & Neck, Upper GI and Urology. In the next few months this will be extended further to include Skin (Melanoma and Basal Cell Carcinoma) and Blood Cancers in order to be able to provide waiting times information for a total of 10 different cancers.

Waiting Times

NOSCAN 2005 Waiting Times Group

NOSCAN has established a virtual group across all boards comprising of the overall waiting time directors, cancer waiting time managers, cancer lead clinicians and network managers, supported by audit and redesign staff. The purpose is to collate reporting, share information and ideas regarding improvement towards the 2005 target. At this stage most boards groups are still extremely lacking in data to inform them of the current position. NOSCAN has been helping to collate and distribute all know data to facilitate this process and hopes to share information on the NOSCAN website, but confidentiality remains an issue to be resolved.

NESCCAG

As Above

Highland and Western Isles

A review of waiting times is underway using the current available data and once reviewed, any remedial action required can then be considered.

Tayside

A Tayside Cancer Waiting Times Group has been established by Tayside NHS Board's Director of Health Strategy, Dr Peter Williamson. Its aim is to monitor progress towards the 2005 target, identify issues in relation to delays along the patient journey, develop an action plan for each of the site specific cancers. This will be used to support resource neutral redesign initiatives where appropriate and to support development of costed business cases for presentation to the relevant resource allocation groups. A Cancer Waiting Times Co-ordinator post is being developed to provide a dedicated and identified resource for the management and data analysis in support of 2005 cancer waiting times target. It is hoped, this will include refining the present high level data, to include a more detailed breakdown of the patient journey into sub sections not presently covered by the existing audit collection. The post should allow analysis of where bottlenecks and interface challenges occur, and provide evaluation data where subsequent process changes have been made.

CSBS/QIS Action Plan updated annually, last report compiled August 2003 for Clinical Governance Committee approval. Action Plan being developed following publication of results NHS QIS review of Specialist Palliative Care Services.

7. Cancer IM&T

NOSCAN

Although strictly outwith the reporting timeframe of this report, a picture is now developing of SEHD's plans to acquire a national EPR system. Whilst we have concerns about the likelihood of success of such a large scale programme, especially given limited financial commitment and probable cultural resistance to imposed national change we are committed to supporting the approach and are consulting on how best to integrate with the project. The main issue is that this approach does not fit with current plans in parts of the network but will be assessed to minimise problems.

NESCCAG

Lung EPR launched within timescale. Staff find it relatively easy to use, although initial training and support was very time consuming. The purchase of a laptop has enabled the direct input of patient information and management decisions at the MDT meeting - thereby ensuring that all those involved in the care of the patient can readily access the most up-to-date information from their computers immediately after the MDT.

The Breast Cancer EPR group are currently working on the potential scope for the EPR - slippage funding has been allocated to this project which is also being supported by NHS Grampian.

ECCI - the pathway for Suspicious Pigmented Lesions was launched on the Grampian Clinical Guidance Intranet in November 2003, and is already being well used by local GPs. Other cancer pathways in development include: Upper GI, Head & Neck, Gynae and non-melanoma skin cancers.

In Orkney an electronic patient record incorporating cancer activity is currently being designed. The clinical pathways (ICP's) are in final draft format and the part of the electronic record (discharge component) is being used in the cancer services. The next few months will see continued progression in the software development.

Highland

NHS Highland commissioned a short-term piece of research to investigate Electronic Patient Records, the outcome of which has been previously submitted. It is the opinion that the use of SCI products is fundamental to the success of any EPR system developed and we would welcome the opportunity to actively participate in any discussions on the possibility of national procurement.

The Western Isles are aligning with both NOSCAN and WOSCAN (following their patient journeys) and it is envisaged that they will try to participate in the use of EPR systems advocated by the RCAGs within budgetary and logistical constraints.

WISDOM 2 - A draft high level specification has been developed. Appointment of a Project Manager is ongoing and they will further refine the system specification.

8. Patient information and patient/public involvement

• 3 PPI Workers across NOSCAN recruited and in post January 2004 (1 day per week post for Orkney remains vacant).

• Development of a co-ordinated approach to the planning and delivery of patient and public involvement across NOSCAN. This includes a development of a corporate identifier and marketing plan to raise awareness of PPI work and patient and public involvement guidelines including clarity on policies for reimbursement of patient's expenses. Future work will include integration of PPI work into Managed Clinical Networks as part of NOSCAN's strategic review.

• Mapping of clinical, non-clinical and non statutory cancer services (NHS Highland)

• Mapping of all Cancer Focus Groups at Aberdeen Royal Infirmary and Cancer Support Groups (NHS Grampian)

• Identifying and recruiting patients for specific pieces of work such as patient information, patient representation for local projects, research, network projects, and work with SEHD.

• Development of literature to promote PPI work in collaboration with patients and patient groups:

• G01 Patient information leaflet about involving patients (NHS Tayside)

• G01 Patient/carer information leaflet about role of PPI Worker (NHS Grampian and Shetland)

Training undertaken:

• PPI Worker for NHS Tayside and NHS Highland both gained Certificate in Patient & Public Involvement.

Research:

• Research into level and forms of patient and pubic activity within NHS Highland cancer services. PPI Worker involved in data analysis and findings with aim to produce evidence of cost effectiveness and benefits of PPI work.

• Cancer Service Improvement Programme - interviewing of patients regarding redesign of colorectal and lung cancer services (NHS Grampian).

• Highland and Western Isles share a 3 day a week Macmillan Patient Involvement worker. Deb Cooke has been in post since mid January. She has been working with the research project team, a collaboration between NHS Highland, the Scottish Executive Health Department Involving People Team, the University of Aberdeen and the University of Glasgow to document the process of public and patient engagement, and to identify the acceptability and value of the methods used

This project will contribute to national knowledge on public and patient engagement by examining the methods used in the development of NHS Highland's Cancer action plan, identifying the added value of patient and public involvement, and disseminating this nationally

The research is underway and the first phase of desk top research and literature review is complete, second phase has been in depth interviewing of as many individuals as possible involved in cancer services and this is soon to report.

• Deb has also been working with the other Macmillan patient involvement workers to develop a NOSCAN approach to patient involvement.

• In September 2003, the Western Isles NHS hosted 2 cancer seminars in Balivanich and Stornoway to discuss the outcomes from the research carried out in February 2003. The purpose of the research by Linda Benn and Prof Linda McKie, was to find out from people living with cancer, what they felt needed to be done to improve cancer services. The seminars brought together a wealth of people living on the Islands whose lives had been affected by cancer. It provided them with an opportunity to discuss findings of the research with health service providers.

The main issues from the research discussed during the seminars were:

• Telecommunications: now and in the future

• Communication

• Information

As a result of the seminars a number of initiatives are underway including: Western Isles representatives visited the Beatson Oncology Centre in February this year and with staff from the Beatson and other cancer services providers in Glasgow agreed to investigate the possibility of video conferencing for multi-disciplinary team meetings and possibly in the future, patient consultations. Other key outcomes included using the Western Isles 'The Price We Pay' video as a teaching aid for healthcare staff on the mainland as a reminder on the scale of the Western Isles Patient Journey; and a Patient Information Pack for patients who travel off the Islands for investigation and treatment to be developed

• The Western Isles Patient and Carers Information Project (WIPCIP) is aimed at providing accurate and appropriate health information to NHS services users and their carers, addressing the requirements of the Patient & Public Involvement literature. The project will be the first of its kind in Scotland. WIPCIP is funded by Volunteer Development Scotland, Western Isles NHS Board and Western Isles Association for Mental Health.

A touch screen health information system 'Intouch with Health' has been located in the Western Isles Hospital providing access to patients, carers, and visitors and staff alike. ' Intouch with Health' has been designed by practising doctors and pharmacists to provide all the latest health information available on medical conditions and surgical operations, as well a offering a comprehensive guide to NHS services from check ups and screening to home visits. It also provides useful tips on how to take care of yourself and prevent illness. ' Intouch with Health' is proving very popular and future plans are to provide the information service via the NHS Western Isles Intranet, which will enable all NHS staff to opportunity to access information regardless of their location.

Volunteers - In conjunction with the ' Intouch with Health' system a number of trained volunteers will be available at a variety of agreed NHS and community based sites throughout the Western Isles at set times, providing assistance in accessing and searching for health information.

9. New Opportunities Fund

ROUND II SLIPPAGE

• Patient and Public Involvement

Project plans for the project described above and have been submitted to NOF.

• Gold Standards Framework Scotland (GSFS)

The GSFS Project covers all of Scotland but is hosted in NOSCAN on behalf of all three networks.

Background

The GSFS project aims to help every general practice team in Scotland to improve care of cancer and palliative care patients by improving teamwork, communication, structured working and reflective practice. It is based on the GSF project initiated by Dr Keri Thomas initiated in England. A central project team based in Perth have set the Scottish project up are recruiting facilitators in every board area to work with practices.

Strategy

Whilst the team is endeavouring to meet the needs of daily enquiries to the office, there also needs to be a 'top down' approach to the project i.e. facilitation. Therefore the project team and members of the steering group are about to embark on negotiations with Health Boards to establish what the current facilitators (whether in or out of grant) deem is necessary (within a budget) to roll the project out over the 15 Health Board areas. This combined with a 'bottom up' approach of networking, and highly motivated and interested staff co-ordinating at practice level, should provide a robust and sustainable roll out.

Adoption

The following figures indicate the number of Baseline Questionnaires (BQ) received (from practices adopting the framework) into the project office so far:

NOSCAN: Grampian (15), Tayside (24)

WOSCAN: Argyll & Clyde (3), Forth Valley (7), G Glasgow (21), Lanarkshire (7)

SCAN: Lothian (1)

This spread of practices adopting the framework reflects where GSFS facilitation and support is currently available. As the project progresses the spread promises to increase.

Very encouragingly there are questionnaires winging their way to us on a daily basis now. Payment of 200 will be made to the 77 practices from NOSCAN and WOSCAN shown above in this, the March payment run. Going forward payments will be made as part of a monthly cycle to practices that have completed and returned their BQ. (SCAN practices have already received funding covered by the cancer register project.)

Resources

Facilitator folders and practice folders have so far been distributed to Tayside, Forth Valley, G Glasgow, Lanarkshire, Ayrshire & Arran. All the contents of both folders are available electronically from the project team.

Evaluation

Analysis of the BQs received to date will be presented at the next Steering Group meeting scheduled for April 23 (14:00-16:30). Please expect the next newsletter on June 25.

ROUND III

NOSCAN

An action plan has been approved by NOF for NOSCAN's Umbrella management of the scheme. All boards have received funding from NOF via NHS Grampian and recruitment of a co-ordinator is underway. Boards are now in the process of distributing and supporting projects. Tayside appear to be the furthest advanced with most projects having recruited. One project in Grampian appears to be at highest risk of losing the funding due to problems with the host organisation but NOF, NOSCAN and NHS Grampian are supportive of the contingencies being discussed to allow continuation of the project.

10. Communication/Events

GSFS roll out events held for 3 LHCCs in Grampian, with plans in place to cover the remaining areas.

Highland and Western Isles 3 ^rd edition of the Newsletter produced this week

Weekly communication of cancer news and events sent out and posted on NOSCAN website

Tayside Cancer Network Conference, June 2004 - providing opportunity for all Site Specific Groups to meet and discuss audit data, discuss specific and generic problems and develop future action plans.

NOSCAN Website - Local sections of NOSCAN site are being populated throughout the region.

11. Any Other Local or Regional Issues

Palliative Care Needs Assessments Updates

NESCCAG

The Needs Assessment in Grampian was completed in October 2002. NOF palliative care bids based on the identified needs have been successful, and projects have now commenced. These include:

• Expansion of the Primary and Social Care professionals education programme at Roxburghe House.

• Enhancing the quality of community based palliative care nursing.

• Increasing the provision of home based respite care.

• A further recommendation identified in the Needs Assessment relates to improving communication. A consultant from Roxburghe House is attending the national communication skills 'Train the trainer' course, and will be rolling out this programme in Grampian in the near future.

The assessment in Orkney was initially delayed due to recruitment and staffing difficulties. However, the last 3 months has seen rapid progress in the assessment, with the report due in 3 months.

The pilot project in Shetland providing respite support to carers of people with palliative care needs facilitated by the charitable organisations Crossroads and Macmillan is ongoing.

Bereavement

A review of the effectiveness of rapid referrals and assessment processes was also undertaken and updated in Shetland.

The 2002/2003 Bereavement Screening audit identified that primary care teams in the main felt they were able to provide care and support to relatives/carers who had recently been bereaved. However it also identified that community nurses in the main were the primary assessors of the team and they stated that additional knowledge and skills in communication would help them to assess more effectively. Therefore six staff from primary care have already undertaken places on a local COSCA (Certificate in Counselling Skills) course and more places will be made available in 2004/05.

Highland and Western Isles

The Highland Needs Assessment is complete and is informing the planning of a Palliative Care Working Group. Western Isles have formed a working group to steer the needs assessment for the Islands

NESCCAG RARARI Project update

Progress continues with all key objectives.

• Draft policies and procedures for chemotherapy have been produced and reviewed and are ready to be fully adopted.

• Video-conferencing equipment now installed in radiology. This has enabled staff from Orkney, Shetland and Elgin to participate in weekly MDT meetings. The purchase of a ceiling microphone will also enable videoconferencing from within the pathology department (for Clinical Pathology Conferences, MDTs etc.)

• The results of the GP questionnaire are currently being analysed. Recommendations will be tabled at the next RARARI meeting for consideration. Some of the RARARI funding will support cancer care CPD for GPs.

• Shared care chemotherapy protocols are facilitating the increase of chemotherapy administration in Orkney and Shetland. 0.5 of a pharmacist and backfilling of oncology nursing posts in Orkney and Shetland will support a further increase through the identification of other chemotherapy regimens suitable for administration, and development and implementation of shared care protocols.

Actively recruiting Upper GI surgeons as replacement for Prof Munro

NOSCAN PHARMACY ANNUAL REPORT MARCH 2004

• Lead Cancer Pharmacist for NOSCAN

During the course of the year it was agreed that there was a need for one of the Cancer Centre Lead Pharmacists to represent pharmacy on the NOSCAN Executive. It was agreed that this post would be rotated on a 2 yearly basis between the three Lead Cancer Pharmacists in Aberdeen Royal Infirmary, Ninewells Hospital, Dundee and Raigmore Hospital Inverness. Ian Rudd, Lead Cancer Pharmacist in Raigmore Hospital was appointed to the post. Whilst manageable in the short term, consideration will have to be given supporting the post-holder in the future

• Meeting of Lead Cancer Pharmacists

Meetings have taken place quarterly throughout the year. The Acute Hospital Trust Chief Pharmacists have also attended.

• NOSCAN Executive

Ian Rudd attended these meetings either in person or by video link. Several reports were provided by Pharmacy, both written and oral. Items covered, included Pharmacy's involvement in MCNs, safe handling of cytotoxic chemotherapy and electronic prescribing.

• Managed Clinical Networks

Pharmacy was well represented on the Gynaecological Cancers MCN. Pharmacy had also had some input into the Lung Cancer MCN. It is planned that Pharmacy will have input into the Haematology and the Upper GI MCNs. Pharmacy intends to be involved in the Breast and Colorectal Cancer MCNs when they are established.

• NOSCAN Pharmacy Work Plan 2004/5 - attached.

• Capacity Planning

NOSCAN Pharmacy contributed to the National Capacity Planning Report for Pharmacy Services. Note the continuing rise in Aseptic Dispensing and the very steep increase in the demand for Oral Chemotherapy prescriptions. Also day Case Chemotherapy as a whole is increasing rapidly.

According to the capacity model the deficit of pharmacists in clinical pharmacy services (including pharmaceutical care planning) for NOSCAN is 6.1WTE.

Deficit of pharmacists, pharmacy technicians and assistant technical officers in aseptic dispensing services is 5.4, 7.6, and 3.2 WTEs respectively. There has been a 15% increase in the number of aseptically dispensed cytotoxic chemotherapy in the last 2 years. There has been a 13% increase in the number of oral cytotoxic chemotherapy prescriptions in the last 2 years. This is likely to be an under reporting as statistic collection methods are not well developed.

Thus the investment from the National Cancer monies in pharmacy services over the last 3 years has allowed pharmaceutical services to patients with cancer to merely stand still. Further investment is required to allow pharmaceutical services to develop.

• Chemotherapy Protocol Process

Ian Rudd has being in discussion with Paul Welford, NOSCAN Manager, regarding, firstly the standards for Chemotherapy Protocols, and secondly the process by which all protocols are approved by NOSCAN. This work is on going

• Safe Handling of Chemotherapy

NOSCAN Pharmacy is assisting with the Audit of the Safe Handling of Chemotherapy as per HDL (2001) 13. The intention is that all sites in NOSCAN that administer cytotoxic chemotherapy will be audited within the next 3 or 4 months.

• Intrathecal Chemotherapy guidance HDL (2002) 22

NOSCAN Pharmacy has undertaken to assist in re-auditing the above document and feed results to the relevant Cancer Centre Lead Cancer Clinicians.

• Electronic Prescribing

NOSCAN Pharmacy has bid to NOSCAN to use slippage money to support the setting up of a standardised ChemoCare Electronic Prescribing Chemotherapy Protocol Template across NOSCAN.

• The Right Medicine

Under the Right Medicine oncology pharmacy services are required to develop two main services,

1. Pharmaceutical Care Planning.

a. This under way mostly rolled out in Tayside, partially implemented in Grampian and in the process of being developed in Highland.

2. Electronic Prescribing

a. This is almost complete in Highland and being implemented in Tayside and Grampian

• Cancer In Scotland; Action for Change

a. Under Action for Change Pharmacy is required to develop pharmaceutical care planning. This is under way as above.

• CONCLUSION

Pharmacy is making every effort to assist in the provision of cancer services across the NOSCAN Area. Pharmacy is working hard to ensure consistent and equitable care for all patients within the NOSCAN area.

There has been particular success in integrating pharmacists into the MCNs. The completion of the capacity planning work will allow pharmacy to improve planning for the future.

The area of biggest concern is the lack of progress in the implementation of pharmaceutical care planning. Significant extra resource is required if this is to be achieved for all patients.

Ian Rudd, Lead Cancer Pharmacist, NHS Highland and NOSCAN

Susan Healy, Lead Cancer Pharmacist, NHS Grampian

Mark Parsons, Lead Cancer Pharmacist, NHS Tayside

NOSCAN PHARMACY CANCER NETWORK

WORK PLAN 2004/5

• SOPPG = Scottish Oncology Pharmacy Practice Group

• SCPG = Scottish Cancer Pharmacy Group

• NOSCAN = North of Scotland Cancer Area Network

• RGU = Robert Gordons University

• CP = Chief Pharmacists

• BOPA =British Oncology Pharmacy Association

• ASTCP = Association of Scottish Trust Chief Pharmacists

• ASSIG = Aseptic Services Special Interest Group

• QASIG = Quality Assurance Special Interest Group

• IR - Ian Rudd, SH - Susan Healy, MP - Mark Parsons

NOSCAN Nursing Network

Lead Nurses across NOSCAN have created the core of a NOSCAN nursing network and are consulting on how best to add value and support colleagues throughout the network.

12. Plans for the next 12 months for regional/local cancer services

Grampian timescale now altered due to changes within NHS Grampian. Operational Plans to be produced by July 2004.

Highland and Western Isles

Awaiting outcome of bid to Clinical Planning Group in NHS Highland to fund the Action Plan. At this point it looks as if the bid is unsuccessful and if this proves to be the case, the 12-month action plan will require to be adapted

Tayside Cancer Services Framework - initial draft out for wide consultation with internal and external partners.

Cancer Liaison Leads - Cancer in Scotland and Macmillan monies have funded development in each of the Tayside LHCC areas. These posts are a central reference point for cancer services in each area to smooth interface working between secondary and primary care.

Shetland

Various health promotion strategies are being developed by the Food Forum, Tobacco Control Forum and SADAT, which highlight the importance of cancer prevention issues.

Appendix

Summary of Cancer MCN Progress - Highland (March 04)

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