Item No | Plan | 2003-04
Allocation
| Target Dates | Responsible Lead | Status (Achieved
In Progress - on schedule
In Progress - delayed) | If delayed, Reasons Why and Actions to resolve | Estimated New Target Date | 2003-04
Spent
| 2003-04
Remaining
| Measurable Benefit/
Expected outcome | Evidence |
Rapid Access to Diagnosis |
Grampian 19 | Continued appointment of Staff Grade Doctor | | March 03 | Mr Z Krukowski | Achieved | | | | | Reduce waiting times for the Breast Service to CSBS essential levels. | Clinic throughput has risen. Significant improvement made against 2005 2 month target. Latest figures show that 81.3% of patients are being treated within 2 months from date of referral. |
Grampian 21 | General Surgeon
Capital costs for office renovations | 44,000 | From Oct 02 | Mr Z Krukowski | Achieved - appointed July 2003 | | | 44,000 | 0 | To redesign networking across Grampian. Equity of service delivery as specified by CSBS. Address waiting time targets. | Mr. Alastair Coutts has been appointed and is based in Dr. Gray's Hospital in Elgin. Mr. Coutts uses videoconferencing to link into relevant MDTs and Focus Groups, and is taking part in redesign initiatives.. |
Grampian 22 | 2 extra Theatre Sessions | 240,000 | From Oct 02 | Ms Deb Grant | In progress - on schedule | | | 240,000 | 0 | To maintain CSBS waiting time standards in light of increased demand. | Extra sessions have been created for both breast and CRC surgery, by using out of hours sessions for other types of surgery. |
Grampian 27 | Development of outreach diagnostic service
Peripheral hospital conversions; Endoscopy equipment, Nursing staff, Van/Trailer/Driver, Van Driver, Medical Supplies, Service Costs, Labs Supplies | 272,000 | From Nov 02 | Ms Deb Grant | Achieved | | | 137,500 | 134,500 | Improving local access to diagnosis and treatment for Grampian patients. Reduce waiting times and facilitate early diagnosis. | Nursing staff and driver have been recruited, and all necessary equipment purchased. The service has begun in Aboyne and Stonehaven, and is also due to commence shortly in Banff and Peterhead. Service to be expanded in the near future to include cystoscopy using funding from New Opportunities Fund. Further opportunities exist to expand the service in line with developments around Diagnostic and Treatment Centres throughout Grampian. |
Highland 02 | Fast Track Rectal Bleeding Clinic | 10,000 | Immediate | Mr James Docherty | Achieved | | | 10,000 | 0 | Development of one stop clinic , reduces waiting times. Quantified by: the number of patients being seen in the clinic. Introduction of this weekly clinic will improve the quality of care by reducing waiting times for diagnosis for patients displaying symptoms of cancer. | Clinic introduced from 01.10.02 and has seen 260 new outpatients in the first year. Being able to maintain a maximum outpatient waiting time of 2 or 3 weeks for this diagnostic procedure will contribute towards the overall standard of cancer patients having treatment started within 2 months of referral. |
Highland 06 | Tissue Processor | | Immediate | Dr Jim McPhie | Achieved | | | | 0 | Provide optimum processing of surgical specimens. This equipment will be used for cancer specimens providing an improved quality of material for diagnosis, thereby enhancing the diagnosis process. Quantified by: the number of processed cancer samples. | Interim 'Pathlore' model delivered and commissioned early November 2002 and replaced with state of art 'Excelsior' model in March 2003 at no extra cost. The number of cancer samples that will benefit from this in a full year are: colorectal - 170; breast (invasive) - 167; lung - 100; prostate - 81; nodal lymphomas - 40; extranodal lymphomas - 10. This machine processes tissues samples to a higher level of reliability with greater protection to staff in respect of exposure to solvents and also greater reduction in waste solvent production. The flexibility of processing programmes allows 'fast tracking' of certain types of biopsy e.g. core biopsies from breast cancers and consequent early diagnosis. The core biopsy diagnostic reporting time has been commended during the recent QIS visit in respect of the Breast Screening Programme. |
Highland 06 | Automated Immunocytochemistry Stainer | | Immediate | Dr Jim McPhie | Achieved | | | | 0 | This equipment will automate a previously manual process used in particular for the diagnosis of lymphomas. The automation will enable a faster diagnosis e.g overnight processing.
Quantified by: a reduction in the average processing time and the number of samples processed. | Equipment fully commissioned since end of January 2003. The number of cancer samples that will benefit from this in a full year are: colorectal - 170; breast (invasive) - 167; lung - 100; prostate - 81; nodal lymphomas - 40; extranodal lymphomas - 10. The immediate benefits relate to enhanved quality of the immunostained preparations available for interpretation thus facilitating diagnosis. |
Highland 06 | Cytogenetics fluorescent microscope and image analysis equipment | | Immediate | Dr Jim McPhie | Achieved | | | | 0 | Allow chromosomal abnormalities testing to be carried out within the Pathology Department This is to replace an outmoded piece of equipment, and to meet the CPA requirements for the testing for chromosomal abnormalities.
Quantified by: the volume of samples processed using the equipment. | Microscope fully commissioned December 2002. Image analysis software installed and commissioned late March 2003. The number of cancer samples that will benefit from this in a full year are: colorectal - 170; breast - 167; lung - 100; prostate - 81; nodal lymphomas - 40; extranodal lymphomas - 10. The initial impression indicates increased accuracy and flexibility in analytical procedures including FISH analysis of lymphomas. |
Orkney 03 | Colonoscope and supplies | 0 | 2002/03 | Kathleen Bree | Achieved | | | | 0 | To reduce waiting times. | |
Orkney 02 | Cancer Registry for Orkney - Register Co-ordinator, Admin Support, IT Supplies | 3,000 | 2002/03 | Kathleen Bree | Delayed | In progress but delayed due to initial recruitment difficulties. Slippage of 12,230 from lst year (02-03) to be spent on this project next year (04-05) in addition to 3,000 now slipping from this year (03-04) so total on project in 04-05 will be 15,230 | Aug 2004 | 0 | 3,000 | Develop an electronic patient management system to record prospective data. Meet CSBS standards Improve the integration of cancer and palliative care services utilising IT links | |
Orkney 01 | Needs Assessment - Coordinator and Admin Support | | 2002/03 | Kathleen Bree | In progress but delayed | Delayed due to difficulties in identifying appropriate skilled staff for data transcribing. New source identified "of island" and will commence transcribing interviews in next 4 weeks. This spend is against slippage carried forward from 02-03 so is not really an overspend. | Jun-04 | 19,800 | -19,800 | Ascertain strengths and weaknesses in service provision, identify areas for improvement. Meet CSBS standards. | |
Shetland 01 | Development of Radiographer barium-led enema service
Training, locum, and service costs. | 9,000 | | Steve Jack | Training completed. Service introduction frozen. | Negotiations with mainland hospitals underway. Previous timeframe has proved unrealistic | | 900 | 8,100 | Earlier diagnosis and reduced waiting times in line with CSBS standards and improved treatment protocols. | Diagnostic protocols in place. Reduced waiting times. |
Tayside 05 | Radiography staff | 79,000 | 2002/03 | Dr John Dewar | Achieved | | | 78,700 | 300 | Reduction of waiting times for radiotherapy, meet CSBS standards/ SIGN guidelines. | Patients now treated within national guidelines. A = 100%, B = 100%, C = 80%, D = 88%. Two new stff have been recruited in July 2003. The additional funding provided to the service is being used presently to employ agency radiographers to fill vacant posts. 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. |
Tayside 12 | Portable SIA Scope | 8,000 | Equipment Delivery - July 02. Audit of impact March 2003. | Dr Colin Fleming | Achieved | | | 8,000 | 0 | 10% reduction in excision surgery of pigmented lesions. Achievement of 2 month waiting standard | Equipment purchased audit of impact March 2003. recent audit results - 144 patients scanned, 45 biopsies not needed due to information from siascope, 11 patients with multiple atypical naevia under surveillance. |
Tayside 14 | MRI Scanner Contribution to running costs | 100,000 | Commissioning dates yet to be agreed by NHS Tayside | Dr A Cook and Mr S Menhenick | Achieved | | | 23,000 | 77,000 | Reduce waiting times, meet presently unmet need, improve equity of access as machine will be sited in Perth | Building work to commence March/April 2003 and the PRI scanner installed in Perth Royal Infirmary December 2003. Building work in progress and on schedule. Magnet operational January 2004. Waiting times have remained constant due to large backlog of patients. However, scanner will increase capacity by approx 65 per week. |
Tayside 20 | 2 Histopathology/ Cytopathology Consultants, support staff and consumables | 218,000 | Recruit by June 02; Specialist Service Sept 02 | Dr F Carey | Achieved | | | 166,500 | 51,500 | Support for new diagnostic initiatives, improved turnaround times, better audit data | Waiting time for skin biopsy eliminated. 5% increase in cancer pathology activity. Mohs surgery introduced for difficult skin cancers. New consultant appointed, allowing specialised pathology for all patients in Tayside and increased support to MDTs through reorganisation of pathology service. |
Tayside 21/22 | Nuclear Medicine/Imaging Technician/Radiopharmacy Technician | 33,000 | Recruit by June 2002 | Dr R A Lerski | Achieved | | | 33,000 | 0 | Reduce waiting times for bone scan to less than 3 weeks | Extra hours being worked by existing staff in imaging and radiopharmacy. Urgent bone scans reduced from 10 weeks to 2 weeks (less than target) It is expected that this will be maintained. waiting time for bone scans on cancer patients now 2 weeks (down from 10). 453 additional bone scans performed in 2002/03. 156 additional this financial year so far. Now 3 to 4 additional bone scanning sessions per month. From April 03 to March 04 - 444 additional bone scans carried out during 34 additional sessions performed. |
Tayside 24 | Digital Photography for Electronic Referral | 15,000 | Implementation January 03 | Mr J H Stevenson | Achieved | | | 0 | 15,000 | Reduce waiting times to assessment and treatment; reduce patient travel | Software development and programming progressing. Upgrading of IT links between Primary Care and Plastic Surgery Dept are being installed as more practices are upgraded to use the technology for accurate digital image referral. Estimate 80% of IT work now complete, fully functional by Sept 04. |
Tayside 28 | Additional Consultant for Clinical Genetics | 75,000 | Recruit by June 2002 | Dr David Goudie | Achieved | | | 66,100 | 8,900 | Reduce waiting times through extra clinics | 0.8 wte clinical geneticist appointed plus A&C3 support. 0.5 consultant geneticist started 1/7/03, with 0.3 increase in admin hours. Nursing support was in place but person currently on maternity leave. |
Tayside 30 | Cervical Screening Services Equipment - capital charges | 6,000 | Summer 2002 | Dr C McKenzie | Achieved | | | 6,000 | 0 | Colposcopy acts to reduce the number of patients developing cervical cancer | LLETZ machine received and in use. |
W Isles 01 | Audit of referral times and mapping of patient pathway | | Completed by December 02 | DPH/LHCC | Superceeded | Discussions with the Scottish cancer Therapy Network have established that much of the information is obtainable through them and the remainder through the LHCC. The project can be achieved with existing resources | | | 0 | Baseline for redesign and improving rapid access to services in compliance with standards. This will enable the Board to assess performance in relation to PAF 4.11, the timescales set in Section 7 of Our National Health and to improve referral times in line with the National Cancer Plan. Would enable standard 1.2 and 1.3 of CSBS standards to be met. | |
Improving Cancer Treatment and Care |
Grampian 20 | Consultant Gynaecological Oncologist, Admin Support, Implementation Manager, Data Manager, Medical and Admin Supplies | 134,000 | From Oct 02 | Dr D Parkin | Achieved | | | 82,666 | 51,334 | Development of MCN, redesign of service, meet relevant CSBS standards. Equity of access, establishment of combined database. | Gynae-oncology network well established in the North. Prospective audit data being collected for all 4 gynae cancers. Work now underway to formalise MCN structure. New consultant now in post and working on follow up protocols for endometrial and cervical cancers. |
Grampian 23 | Nurse Development Post | 14,000 | Oct 02 - Sept 03 | Kate Copp | Achieved | | | 14,000 | 0 | Contribute to MCN, identify and implement actions to address unmet CSBS standards, development of nurse led services. | Nurse in post. This has allowed patients to be offered support at a much earlier stage of the patient journey. CSBS review showed that the team were now meeting the vast majority of standards for CRC. The new postholder also took part in the redesign process with the CSIP facilitators. |
Grampian 26 | Nurse Staffing | 31,000 | From Oct 02 | Ms A Hancock | Achieved | | | 31,000 | 0 | To provide clinical, educational and consultative support for patients, carers and professionals. Improved communication with patients with regard to treatment. | Person in post from May 2003. Currently undergoing training to enable development of a nurse-led cystoscopy service. The postholder has also been involved in collecting local audit data on the pathway for bladder cancer and prostate cancer patients; and has produced patient information leaflets for both of these cancers. The uro-oncology MDT also benefits from the specialist nurse's input, and this has improved case ascertainment. |
Grampian 28 | Medical/ Clinical Oncologist | 75,000 | From Dec 02 | Mrs H Gauld | In progress - delayed | Consultant appointed but not available to take up post till Oct.2004. Locum cover being provided in the meantime. | | 6,000 | 69,000 | To reduce waiting times to meet CSBS standards | Some locum cover being provided by an existing Consultant until the new postholder can take up post in October of this year. |
Highland 01 | Integrated Breast Unit | 300,000 | As soon as possible | Mr Patrick V Walsh and Dr Alison Graham | Achieved | | | 247,000 | 53,000 | Reduce waiting times, development of MCNs, meet CSBS standards. Quantified by: reduced waiting times and achieving CSBS targets. | This will provide a significant contribution towards the full business case for an integrated breast unit including the appointment of a second breast surgeon and supporting costs. The surgeon took up post in July 2003 and this will help to reduce the current waiting times being achieved by the proviously singlehanded consultant. The new Integrated Breast Unit is due to open late April 2004. |
Highland 03 | 1 G grade Oncology Nurse - West Directorate (Belford Hospital) | 34,000 | Oct 02 | Dr David Whillis and Mr J Cromarty | Achieved | | | 33,750 | 250 | An additional appointment to expand and improve the provision of cancer care in the local area, improving equity of access in Highland. The appointment will allow us to begin pharmaceutical care planning as per the Scottish Cancer Plan - Action for Change Quantified by: number of chemotherapy patients seen. | Post filled Jan 03. Four new chemotherapy patients per week and a monthly oncology outpatient clinic. All newly diagnosed cancer patients will also be seen. There has been improved staffing cover and training, improved patient safety and education, training of GPs and hospital staff, palliative care support and local delivery of care. |
Highland 03 | Chemotherapy Nursing Team - 1 G grade 2.5 E grade | 108,000 | | | Achieved Achieved | | | 108,000 | 0 | Additional staffing for the new Macmillan day case unit enabling the delivery of a redesigned day case chemotherapy service. Quantified by: number of patients using the new unit. | G grade in post Sept 2002, E grade in post Oct 2002. An average of 86 patient episodes per month are going through the new Unit. The opening of the Chemotherapy Day Unit in February has enabled complete redesign of the chemotherapy service. |
Highland 03 | Chemotherapy Nurse 0.20 wte F Grade : Caithness | 5,000 | | | Achieved | | | 5,000 | 0 | To secure the continued nursing input to the chemotherapy service in the north Highlands, improving equity of access. Quantified by: number of chemotherapy patients seen. | In post Aug 2002. An estimate 170 chemotherapy patient episodes will be carried out each year. Improved staffing cover and training, patient safety and education and a local delivery of care. |
Highland 03 | Oncology Pharmacist, Grade C | 32,000 | | | Achieved | | | 32,000 | 0 | Staffing of the new Macmillan day case unit enabling the delivery of a redesigned day case chemotherapy service. Quantified by: number of patients using the new unit. | Post was originally filled 1 May 2003. After 1 month in post the appointee went on sickleave and remained as such until they gave notice in September 2003. The post went back out to advert and was sucessfully filled in November 2003. The post supports the work of the Chemotherapy Day Unit and the Oncology Ward at Raigmore. The post is also helping to address the challenges identified in "Action for Change" and "The Right Medicine". It is intended that the post will in the future extend out to Children's services, Urology and the peripheral clinics that are held in a number of venues across Highland. |
Highland 03 | A&C3 for Oncology Day Case service | 16,000 | | | Achieved | | | 15,500 | 500 | Staffing of the new Macmillan day case unit enabling the delivery of a redesigned day case chemotherapy service. Quantified by: number of patients using the new unit. | Appointed Jan 03. An average of 86 patient episodes per month are using the new Unit since its opening in February 03. The opening of the Chemotherapy Unit in February has enabled the complete redesign of the chemotherapy service. This post is dedicated to the chemotherapy day unit ensuring that the administration of each patient's journey is as smooth as possible acting as a point of contact for any queries or concerns that the patient may have. |
Highland 03 | Pharmacy (Cytotoxic Reconstitution) - SATO 1 wte and MTO2 0.5 wte | 24,000 | Oct-02 | Mr J Cromarty | Achieved | | | 24,000 | 0 | Enable the CSBS standards to be met. Quantified by: CSBS statistics | Posts filled from Aug and Sept 2002 respectively. The new Aseptic Dispensing Facility was built and commissioned within the last 9 months. A large effort has been made in decanting to the new facilities and writing new operating procedures whilst maintaining the service. Training of the new technicians has allowed the workload to increase from 900 items per month to 1200 items per month with no change to waiting times. |
Highland 04 | Grade H Colorectal Nurse | 24,000 | Oct 02 | Mr James Docharty | Achieved | | | 24,350 | -350 | This is the third specialist cancer nurse that will enable better support and access to stoma and colorectal care for patients throughout Highland. Meets CSBS requirements on specialist nurses needed for cancer care. Quantified by: the number of additional patients seen by the specialist nurse. | Appointed Nov 02. The appointee underwent induction until end March 03. Full service in place from 1 April 03. This post means that all bowel cancer patients will now have access to a specialist nurse, not just Stoma patients. Since January 03, 66 new colorectal cancer patients other than stoma patients have received this service. This enhanced service enables home visits to all colorectal cancer patients throughout Highland. The post also provides an education role to other health professionals. |
Highland 04 | Senior 1 Physiotherapist for Oncology/Haematology 1 wte | 30,000 | Oct 02 | Dougal Sim | Achieved | | | 30,000 | 0 | Enhance quality and level of patient care, facilitate earlier discharge, improve multidisciplinary team working. Quantified by: the number of additional patients seen by the physiotherapist. | Post filled 30 September 2002 enabling the range of Physiotherapy services to cancer patients to be increased including pain management, rehabilitation programmes, respiratory care, measure and supply of mobility aids. Increased number of clinical areas now receiving dedicated, specialist physiotherapy input including provision of service for radiology patients ie to mobilise stiff shoulders to facilitate radiotherapy treatment in breast cancer patients. Rapidly developing Oncology, MDT Team and team working (CSBS standard). Further benefits include the establishment of an education/advisory resource for Physiotherapy colleagues throughout the Highlands; the provision of emergency duty Physiotherapy respiratory service to Highland Hospice, in the absence of the Hospice Physiotherapist (pilot Dec 03 - Mar 03); and joint educational and working initiatives with the Hospice Physiotherapist and staff. Establishing professional links with specialist Oncology Physiotherapists throughout Scotland / UK. In patient treatments over same period (Oct - Mar) last year have increased from 14 to 76 (new) and 60 to 638 attendances. Outpatients increased from 1 to 17 (new) and 13 to 96 attendances. |
Highland 04 | 0.5wte Senior Staff Nurse (with interest in Urology) 0.5wte Senior Staff Nurse (with specialist interest in Gynaecology Cancer and Colposcopy) | 36,000 | Oct 02 | Mr S Bramwell and Mr N Hobson | Achieved Achieved | | | 36,000 | 0 | Enables holistic care from diagnosis through to post operative care and follow-up. Will also enable education and awareness of nursing staff; establishment of a MCN with Aberdeen; and research. Quantified by: the number of additional cancer patients seen by the nurse | Senior staff nurse with interest in urology nurse in post Nov 02. Senior staff nurse with interest in gynaecology cancer and colposcopy in post May 03. The appointment of these post will enable education and awareness of nursing staff; establishment of a MCN with Aberdeen and clinical research. |
Highland 04 | 1 radiographer aide 1 basic grade radiographer 2 senior radiographers | 70,000 | Oct 02 | Dr David Whillis | Achieved Achieved Achieved | | | 70,000 | 0 | Reduces waiting times for patients by extending the working day. Enables extra imaging to be done that improves the quality of treatment for the patients and brings the service into line with recommendations of the College of Radiographers. Improves the skills of staff and enables professional development. Quantified by: reduced waiting times and increased throughput of patients. | Appointments made 1 July 2002, Nov 2002 and Jan 2003 respectively. Waiting times have reduced from 4/5 weeks to 2 weeks maximum. It has enabled the introduction of Electron Portal Imaging and Electron Therapy in line with the Royal College of Radiographers recommendations. There is also improved quality of accuracy and service to patients and increased opportunity for staff training. |
Highland 04 | Psychologist B Grade (1.0wte), secretarial (0.5wte) | | Oct 02 | Laura Lee | Achieved | | | | 0 | Meet CSBS standards. The key objectives of the position will be to:
Establish and develop collaborative working relationships with local clinical staff
Raise awareness through teaching
Facilitate support groups by firstly determining the need to establish new cancer support groups for people affected by cancer
Develop a programme of psycho-educational courses according to the local needs by offering
Enhance the skills of the healthcare professionals and supplement these with one to one sessions, subject to evaluation of needs, by offering at least 6 sessions a week after 6 months in the post. This will maximise the cancer support available in the region.
The position will be evaluated and monitored on an ongoing basis. In particular,
- the postholder will be monitored by the Programme Co-ordinator at their monthly meetings.
- evaluations of presentations, courses and support groups will be achieved by providing feedback forms. | The clinical psychologist has been involved in various activites, particularly: one to one clinical sessions, relaxation and stress management workshops, meditation workshops, living with cancer workshops, teaching, study days, meetings, talks, continuing professional development and research. From Sept 03 to March 04 there was a total of 40 new people and a total of 156 appointments given. |
Highland 07 | Audit 0.5WTE (ENT, Gynae and Urological) | 10,000 | Oct 02 | Dr David Whillis | Achieved | | | 10,000 | 0 | Provision of clinical audit in ENT, gynaecological and urological cancers. | Post filled end of June 2003. Initially this post is assisting to clear the audit backlog in lung, ovarian and colorectal cancers. |
Highland 07 | Audit 0.5WTE (GI)** | | | NHS Highland | In progress - delayed | Currently out to advert | | | 0 | Extend audit to cover GI | |
Shetland 02 | Extension of Nursing hours, ongoing Nurse training costs | 7,000 | Immediate. | Dr Patrick O'Connor | Achieved | | | 10,100 | -3,100 | Facilitating equity of access to pain management. Compliance with SIGN guidelines. | One day per week additional nurse clinic time. Increased numbers of patients seen. Reduction in waiting times for pain clinic from 2 to 1 month for first appointment, complementary therapies now available. |
Shetland 04a | Oncology Support Nurse, initial training costs | 14,000 | Appointment of additional post Dec 2002 | Alison Mustard | Achieved | | | 21,300 | -7,300 | Increased support to meet local needs. Continuity of care assured. | Specialist training undertaken. |
Tayside 16 | Psychological /Psychiatric Support to Cancer patients | 27,000 | Initiate Service August 2002; Develop protocols January 2003 | Dr A M Stewart | Achieved | | | 27,000 | 0 | Improve detection of co-morbid psychiatric disorders; develop protocols for rapid assessment and treatment; promote clinical research and audit in psychosocial aspects of cancer treatment | Service initiated in August 2002. Recruitment commenced to CSO funded trial "The impact of Venlafaxine on Psychological Morbidity and Cognitive Functioning in Newly Diagnosed Lung Cancer Patients". Group therapy protocol established. Psychotherapy groupwork should provide access for selected patient populations to an environment designed to address various pscyhological problems which are currently poorly managed. Timing and setting of groups is to be integrated with each patient's established treatment plan. Regular psycho-oncology seminars to junior doctors in training. Undergraduate medical student teaching. Development of a joint psycho-oncology interest group - University of Dundee/Aberdeen. New Referrals between August 2003 and January 2004 - 53; patients under review - 37. CSO Study Recruitment - 42 patients. Group Therapy for People with Cancer Sessions initiated. |
Tayside 17 | PAMS support to Oncology patients | 26,000 | 2002/03 | Kath Fairgrieve | Achieved | | | 26,000 | 0 | To improve patient function and quality of life | Appointment of Senior OT on 1st September 2002. This appointment will work alongside the current part time physio and dietician to develop an Oncology Team. This post will also be looking at the appropriate outcome measures which will give some robust clinical measurement of the effect of input by March 2003. In process of recruiting a generic therapy assistant. Patients are now assessed within 2 working days whereas previously patients were only seen "when possible". Oncology - new referral 01.02 - 07.02 73NP. New referrals 01.03 - 01.03 173 NP = 136% increase |
Tayside 18 | Tayside Lung Cancer SSG Group | 19,000 | As soon as possible | Dr Peter Brown | Achieved | | | 19,000 | 0 | Improve communication between primary/secondary care, increase efficiency of multi-disciplinary working | Appointed 23rd August 2002. Audit measurable benefits March 2003. Contact details are given with the bronchoscope appointment and patients are able to speak to the department regarding their tests/arrangements. Patients under investigation for lung cancer now leave their first out patient appointment with a bronchoscopy, CT and follow up appointment. The percentage of lung cancer patients discussed at the MDT is now 85% compared with approximately 55% prior to me being post. Monthly reports are now available to the lung group. |
Tayside 19 | LINAC - additional physicist support. | 35,000 | As soon as possible | Alan Orr | Achieved | | | 35,000 | 0 | Maximise utilisation of capital equipment, eliminate bottlenecks, provide oncall rota | Mechanical engineer appointed August 2002. Audit of reduction in waiting times for Radiotherapy will be done in conjunction with Oncology department by March 2003. Waiting lists have been reduced due to reduction in machine downtime as a result to increased technical cover. The weekend cover has treated a further 23 patients as part of the sustainable on call service. Weekend maintenance cover, now available is a signifcant improvement in the service to patients. The quality of care is considerably improved by the additional physicist available in the department and the weekend cover. Downtime is minimal with fast repairs/recalibrations. |
Tayside 11 | Development of Medical Thoracoscopy | 32,000 | | Dr John Winter | Achieved -equipment | | | 32,300 | -300 | Improved patient morbidity and reduction in number of inpatient days | Difficulty in gaining anaesthetic sessions. Thoracoscopes received July 2003, testing August 2003. Nurse training arranged with Edinburgh Royal Infirmary. Mr Walker, Consultant Thoracic Surgeon, attending twice monthly to give instruction in thoracoscopic technique. |
Tayside 29 | Paediatric Oncology - 0.5 wte Pharmacy Technician 0.5 wte Pharmacist Grade C | 25,000 | Implement new systems within 6-9 months | Jo Richards | Achieved | | | 25,000 | 0 | Delivery of safe and effective pharmaceutical care. Implement system for discharge prescriptions and new chemocare prescribing system | Audit to be undertaken by April 2002 to ensure effective pharmaceutical care. All patients are now counselled on the use of their medicines by the paediatric pharmacist. Hopefully this has led to improved compliance and understanding. Ward stock management has improved stock control therefore reduced nursing workload. |
Tayside 31 | Paediatric Oncology - Dietetic Service | 5,000 | Individual nutrition plan within 3-6 months | Dr Rosalie Wilkie | Achieved | | | 5,000 | 0 | Will enhance present service and enable expert advice to be given to outpatient department and community | 0.2 WTE Paediatric Dietician now in post since 02/09/2002. Audit of service will be undertaken by March 2003. The children attending the paediatric oncology clinic no longer have to wait to be seen. Before this post was instigated the children were no seen regularly at clinic.
In patients March - August 4 new, 28 returns
Out patients March - August 2 new, 127 returns |
W Isles 02 | Increase sessions from visiting oncologist | 11,000 | By September 02 | Dr I Clark | In progress - delayed | Negotiations with mainland hospitals underway. Previous timeframe has proved unrealistic due to national staffing shortages | Not Known | | 11,000 | Improved access for patients and reduced requirement for travel. This will enable more patients to receive chemotherapy close to home and support equity of access for Western Isles patients in line with the National Cancer Plan. | |
W Isles 03 | Outpatient clinic for Haematology | 11,000 | In place by September 03 | Dr I Clark | In progress - delayed | Negotiations with mainland hospitals underway. Previous timeframe has proved unrealistic due to national staffing shortages | Not Known | | 11,000 | Improved access for patients to diagnosis and treatment. Reduced requirement for travel. Improved access to follow up support. | |
W Isles 04 | Colorectal nurse | 36,000 | By October 02 | Mr A Sim | Achieved | | | 10,146 | 25,854 | Improved access for patients to diagnosis and treatment.Contributes to service redesign and provides hospital and domicilliary support to patients | Postholder recruited late in financial year and underwent induction training and shadowing.Evidence of benefit will be clearer at next monitoring return. |
W Isles 05 | Focus groups on the patient's journey | 0 | Completed by March 03 | Ms Norma Neill | Achieved | | | | 0 | Contributes to staff education and redesign towards patient centred service in line with the guidance in "Patient Focus and Public Involvement" and the National Cancer Plan. | Telephone interviews and 4 focus groups held. Report produced and video made by patients and carers on specific island issues relating to cancer. |
W Isles 06 | Patient held records | | 2002/03 | Dr G Gray | Achieved | | | | 0 | Would contribute to meeting CSBS Assessment and care Planning standards. | 200 Patient held Records printed and introduced. |
W Isles 07 | Clinical Psychology Sessions | 11,000 | By October 02 | Dr I Clark, Medical Director | Achieved | | | 9,051 | 1,949 | Provides support for patients in line with Standard 4 of breast cancer CSBS Standards | Service available at WIH for one day per month. Open to any cancer patients |
W Isles 08 | Staff training for lymphoedema | 0 | By November 02 | Ms Jane Adams | In progress | | | 3,270 | -3,270 | Enables provision of service which is currently not available locallyand improves equity of access to treatment. | One physio. and one Macmillan nurse are currently undergoing the training |
Palliative Care |
Grampian 24 | Specialist Pharmacist, Specialist Nursing Support, additional Admin Support, Medical Staff holiday cover | 83,000 | From Oct 02 | Dr M Leng | Achieved | | | 83,000 | 0 | Improve equity of access to multi-professional specialist palliative care support; Improve informational needs of patients, carers and professionals. | The palliative care pharmacist means we now have a pharmacy presence at Roxburghe House for the first time and she now attends and inputs to medical ward rounds, regularly reviews prescriptions, counsels patients, prepares medication aids at discharge, engages with medical staff to optimise medication.etc. |
Grampian 25 | Transport and supplies costs for Ellon Day Unit | 4,000 | From Oct 02 | Mrs E Towsey, and Mrs Claire Hutcheson | Achieved | | | 4,000 | 0 | To enhance the local accessibility and provision of palliative care services to patients | All places at the Day Unit now fully utilised. |
Grampian 42 | Specialist Palliative Care Nurses for Primary Care | 62,000 | From Aug 02 | Mrs F Francey | Achieved | | | 62,000 | 0 | Equity of access through the redesign of Specialist Palliative Care Nursing provision. | 2 community Macmillan nurses in post. Based at Roxburghe House but covering a wide geographic area. |
Highland 05 | Palliative Care Specialist Pharmacist 0.50 wte | 21,000 | Immediate | Ken Proctor and Mrs Joan Munro | Achieved | | | 20,500 | 500 | To enable the range of pharmacy services to cancer patients to be increased including pain management, rehabilitation programmes, respiratory care, measure and supply of mobility aids. | Appointed 30 September 2002. The community pharmacy service has been redesigned with the implementation of the new model scheme. Three of the nine LHCCs are now participating in the model scheme. Others are being actively encouraged and it is expected that a further two LHCCs will join the scheme in the next few months. Training of community pharmacists and other healthcare professionals is ongoing. Posts meets QIS cancer standards and SIGN 44. |
Highland 05 | Macmillan Nursing Service Development - 1 wte - Fort William, - 1wte - East Highland | 68,000 | Oct 02 | Helen Spratt, Director of Nusing, HPCT | Achieved Achieved | | | 68,000 | 0 | Equitable access to specialist palliative care. Improve quality of services to patients. Enhance the macmillan nursing service. Enable staff to undertake audit, research and education. Enable the training of the primary care team. | The Fort William post filled from November 2002. This has enhanced the Macmillan serivce in Lochaber from 1wte to 2wte. This post has improved the quality of care to patients and their carers by attendance at out patient clinics. The Macmillan nurses are able to provide local training to other healthcare professionals. The East Highland post filled from April 2003. This has enhanced the Macmillan service in East Highland and has enabled a Macmillan nurse to be based in the LHCC. The Macmillan nurse has facilitated some training with other members of the primary care teams and has contributed to a palliative care workshop as part of East Highlands' protected learning time initiative. |
Highland 05 | 0.50 wte Palliative Care Consultant (0.5 wte funded by Hospice) | 45,000 | Immediate | Mrs Joan Munro | Achieved | | | 44,900 | 100 | Development of courses and training for healthcare professionals; development of consultant service in Skye, Lochalsh and Lochaber; implementation and audit of CSBS standards. Quantified by: in a 12 month period - 12 clinical visits to Lochaber; in a 12 month period - 12 clinical visits to Skye, Lochalsh; increase from 3 to 4 sessions at Raigmore Hospital; develop proposals for increase of palliative care to non-malignant, end-stage COPD and fibrosing alveolitis; reduce on call for Medical Director of 50% i.e. now 1 in 2 ratio; Teaching sessions - 12 per year; 2 x weekly session to patients in day hospice; support training to SPR - 6 months in next year; support GP principal training - 2 Hospice attached GPs per year. | Increasing specialist palliative medical care input to Lochaber and Skye and the service to Caithness continues. A total of 41 visits to Lochaber, 55 to Skye and 9 to Caithness. Educational input to all 3 areas and Lochcarron. Contributes to the Marie Curie/Highland Hospice Education Programme. Scheduled input to the chest unit in Raigmore. Service development proposals include: breathless clinic and care pathway for the dying. |
Highland 05 | Training of integrated palliative care key workers | 5,000 | Training ongoing during 2002 and 2003 | Helen Spratt, Director of Nusing, HPCT | Achieved | | | 5,000 | 0 | Four nurses trained each year. Course from Sept 2002 for 10 weeks - 4 participants. Objectives - encourage collaboration between specialist palliative care services and primary care; promote personal development of key nurses; enhance palliative care skills within Primary Care Teams (Inverness LHCC, Badenoch and Strathspey LHCC); improve the quality of service to patients and carers with palliative care needs. Course combines clinical and theoretical aspects provided by Highland Hospice and Macmillan Nursing service. | 14 nurses have now completed the Key Nurses Course and now work as key workers within their LHCCs (Inverness LHCC, Nairn and Ardersier LHCC, East Highland LHCC, Badenoch & Strathspey LHCC). This will enable a wider range of patients to have access to effective palliative care. This course has encouraged collaboration between Highland Hospice and Primary Care. |
Highland 05 | Development and improving standards of palliative care | 50,000 | On-going during 02/03 | Helen Spratt, Director of Nusing, HPCT | Achieved | | | 50,000 | 0 | To improve the quality of service to patients;enhance palliative care skills of healthcare professionals; improve clinical practice. The main project has been a series of Communication Workshops held in Sept/Oct, January and February. These courses covered Breaking Bad News, Counselling Skills and Working with Difficult and Demanding People. These workshops were open to all staff within NHS Highland. A clearer understanding of what key communication skills make the difference to patient outcomes; the process underlying effective communications; a greater clarity about areas of their own practice they feel would benefit from improvement and skills; techniques and knowledge to make adjustments; a greater understanding of what they currently do well and how to build upon it. Funds have been released to all nine LHCC's to enable them to develop and run their own programmes to meet their requirements. | Over 200 Healthcare Professionals (Nursing, AHPs, Consultants, Pharmacists, GPs, Admin and Clerical and Service Managers) have attended the workshops. All workshops have received excellent feedback. The LHCCs have used their funds to enable nursing staff to undertake Marie Curie Modules (22+ nursing staff across the Trust); to offer a 2 day course for 30 nursing assistants on physical and emotional care of dying patients; one day course for 15 GPs/Nurses on caring for Cognitively Impaired Patients with Palliative Care; 2 local Breaking Bad News Courses; training sessions with REACT on pain management; one day event and two evenings on palliative care education for 76 healthcare professionals; a study day for the MacMillan Nurses; test books and resources. |
Highland 05 | Day Hospice Service | 36,000 | Oct 02 | Mrs Joan Munro | Achieved | | | 36,068 | -68 | Support additional 15 places per week; support for carers; increase complementary therapies; improve efficiency service. Quantified by: number of patients attending, every patient attending day hospice will receive a full assessment on admission and an appointment for a 6 week review; weekly carers group offering support, information and advice; additional 5 patients per week given out-patient complementary therapy appointments; additional 5 patients per week for out-patient physiotherapy appointments; development of a young person support group; enhancement of skill of additional 3 volunteers though occupational therapy skills training; occupational therapy available to patients on a daily basis; services of chaplain available on daily basis; services of family support (social worker) on a daily basis. | The aromatherapist has delivered (72) sessions plus 3 x 2 hour sessions for qualified staff on massage technique and 1 x 1 hour session for Rachel House. 165 contacts with Day Hospice patients by the OT. In addition domicilary visits are now provided (15 in the report period). A reminiscence group has been established. 7 hours of chaplaincy to the day service. |
Highland 05 | Family Support Service - Bereavement Support | 20,000 | Oct 02 | Mrs Joan Munro | Achieved | | | 20,088 | -88 | Bereavement training for volunteers; professionals and assistants. Quantified by: development of a full information pack to assist parents managing children facing bereavement and following bereavement - to be available within 12 months; development of an education package for health and education professionals working with children facing death in the family - will be available within 12 months; delivery of education on bereavement - 8 sessions per year. | The additional counsellor is now working with a maximum number of clients (8). The Family support team set up a bereavement support group in November 03. Currently undertaking a survey of bereaved people to identify need for additional support groups. A new risk assessment form is being piloted in the in-patient unit. The 2 day Loss and Bereavement programme is now part of the Marie Curie education programme and delivered 2x per year by the Family Support Team. Since Nov 03 10 bereavement packs have been distributed. A pre-bereavement pack is now being developed. A team member has undergone the training to deliver Seasons for Growth programme and is due to start late spring. |
Highland 05 | Needs assessment for palliative care** | | Immediate | Dr John Wrench, Director of Public Health, Highland NHS Board | Achieved | | | | 0 | Consultation with staff, patients and carers re palliative care needs across Highland. Consultation with upto 9 LHCCs, AHPs questionnaire, GP questionnaire, specialist palliative care services, non-malignant specialist nurses, childrens services, care homes and specific project with patients / carers. | Needs assessment complete and recommendations being progressed. |
Tayside 13 | Palliative Care in Perth and Kinross Nursing Homes | 71,000 | Assessment of impact March 2002 | Ann Gourlay | Achieved | | | 71,000 | 0 | Improve quality of care by provision of local services. Improve training and development of NH Standards. | This project has been amended to spot purchase in December 2003. There have been 10 episodes of care (9 patients) at Westminster Ochil, Perth and length of stay ranged from 2 to 35 days, with only episodes exceeding a fotnight in length. Levenglen had one patients with 2 episodes of care, for 15 and 40 day stays. Rumbling Bridge had plans to admit one female, who died before transfer. |
Tayside 15 | Primary Care - LHCC Cancer Liaison Leads | 15,000 | By Oct 02 | Dr Sonia Devereux | Achieved | | 01/12/2002 | 15,000 | 0 | Primary Care engagement in cancer and palliative care - MCNs, Site Specific Groups, assisting in improving the patient journey | Allocation to various Site Specific Groups as liaison leads. Team objectives and workplan developed for 2004/05 |
Shetland 03a | Updating of professional knowledge and skills in Oncology and Palliative Care | 30,000 | During 2003/04 and ongoing uptake of training. | Dr Bruce Cleminson | Achieved - but this is an ongoing programme of skills updating. Some expenditure is being used in slippage plan for additional knowledge and skills updating in cancer management for theatre staff. | | | 11,928 | 18,072 | Meet CSBS standards for communication. Increased knowledge base among health, social care, education, carers and voluntary sector staff. | Numbers of staff trained via recognised programmes |
W Isles 09 | Formation of a peripatetic palliative care team with hospital clinic | 70,000 | By October 02 | Dr G Gray | Achieved | | | 70,000 | 0 | Improve access for patients and integration and delivery of palliative care services in line with National Cancer Plan chapter 6 | |
W Isles 10 | Palliative Care symptom control drug boxes for all GP practices | 0 | By October 02 | Dr G Gray | In progress - delayed | Appropriate drug boxes have been sourced and lists of contents drawn up. Issues about ordering and carriage of drugs still to be resolved | Dec-04 | | 0 | Meet CSBS Standards -timely access to drugs and equipment | |
W Isles 11 | Training in Palliative care for new team and other staff | 0 | By December 02 | Ms J Adams and Dr I Clark | In progress - delayed | Pain nurse has yet to be recruited to team, advertisement agreed. | Dec-04 | | 0 | Achievement of CSBS Standards - Education and training in relation to palliative care | |
Investing in Staff and Technology |
Grampian 14 | 2 x Pharmacists, MTO2 Technician | 83,000 | Appointments by Oct 02 | Mr B Jappy | Achieved | | | 83,000 | 0 | Increased staffing to improve safety standards | Greater cover for oncology and haematology. This has meant that we can write more of the prescriptions, review more of the patients side effects and the drug therapy needed to control them, introduce care planning to selected groups of patients and counsel more patients. The pharmacist grade C in aseptic dispensing has enabled us to reduce the pressure of workload leading to a safer methods of working. She has also enabled us to prepare a comprehensive summary manual of all protocols used throughout Grampian which will contain all relevant information and will be available to all prescribers using the service. |
Grampian 15 | Role extension of Biomedical Scientists in Pathology | 45,000 | Oct 02 | Dr M McKean | Achieved | | | 45,000 | 0 | Early diagnosis and treatment of patients; reduce waiting times by addressing bottlenecks in diagnosis. | Pilot completed in June 2003. Results written up and presented nationally. |
Grampian 16 | Recruitment of Admin staff for Pathology | 12,000 | Oct 02 | Dr M McKean | Achieved | | | 12,000 | 0 | Contribute to robust service for diagnosis and treatment of patients with cancer. | Admin staff in place. Contributing to overall improvements in service |
Grampian 17 | Radiographer, Radiotherapy Assistants, training | 49,000 | Oct 02 | Mrs L Forsyth | Achieved | | | 49,000 | 0 | Develop skill mix to support clinical practice and maintain waiting times. Support development of essential services e.g. Electronic Portal Imaging, Conformal Therapy, and Intensity Modulated Radiation Therapy. | Skill mix project very successful. Used as a model for other areas to follow. |
Grampian 18 | Nurse Education | 10,000 | Oct 02 - Sept 03 | Mrs U Lyon | Achieved | | | 10,000 | 0 | Develop a nurse led service for the management of common problems; ensure the provision of high quality patient care | Breast care nurses now able to take on expanded role. Nurse led clinic in operation. Breast care nurses closely involved in current redesign project within the symptomatic breast service. |
Grampian 29 | Investment in clinical audit - equipment and IT | | From Oct 02 | Jane Kane | Achieved | | | | 0 | Enhancment of QA
Meet CSBS standards | Reports completed for lung, colorectal and breast cancer. Work now underway to address unmet standards. |
Grampian 30 | Electronic Patient Record - Training | 6,000 | From Oct 02 | ALCG | Achieved | | | 6,000 | 0 | Improve clinical decision-making, communication and audit data collection. Piloted in Lung before roll-out to all cancers. | Training undertaken. Software installed. EPR in use from November 2003. Information and decisions taken at MDT meeting now directly input to the EPR in real time. |
Grampian 31 | Nurse Staffing | | Mar 03 | Lynn Adams | Achieved | | | | 0 | Development of the skills and knowledge of nurses involved in the delivery of cancer care, in primary and secondary care. | Education & training programmes for nurses and support workers undertaken. Links made with Joint Future initiative and joint training to be set up for joint health and community care teams. |
Grampian 32 | Breast Intervention Chair | | Oct 02 | Dr H Deans | Achieved | | | | 0 | Improved facilities for patients undergoing interventional breast procedures. | Increased comfort for patients undergoing procedures such as FNA. Chair used for 2 clinics per week - up to 30 patients per clinic. |
Grampian 35 | Service contracts to support capital investment | 48,000 | From Mar 03 | GUHT | In progress - on schedule | | | 9,523 | 38,477 | Service Contracts for to support the major capital investment | Has not been required this year - used to fund slippage projects (see under slippage spreadsheet). |
Grampian 36 | GP Education and Training | | Immediate | Dr P Kiehlmann | In progress - on schedule | | | | 0 | To release and train Primary Care staff to implement redesign solutions | Primary care reference group established. GP reps on each of the site specific groups. Also involved in redesign workshops for site specific cancers, e.g. colorectal and lung. |
Grampian 37 | 2 x 0.5wte Medical Secretary | 14,000 | From Oct 02 | Dr M Nicholson and Mr T O'Kelly | Achieved | | | 14,000 | 0 | To support the co-ordination of multi-disciplinary assessment and asssit with redesign. | MDT meetings well co-ordinated, including videoconferencing with Shetland, Orkney and Elgin. Improved communication with primary care about patient management plans. Postholder has recently left but recruitment process underway for replacement. |
Grampian 38 | Additional Technical post (Electronics) | 22,000 | From Oct 02 | Graeme Robertson | Achieved | | | 22,000 | 0 | Ensure safe and timeous services through LINAC maintenance. | 3 LINACs now fully operational. |
Grampian 39 | Upgrade of Pharmacy Clean rooms | 7,000 | From Oct 02 | Brian Jappy | Achieved | | | 7,000 | 0 | Improved Pharmacy facilities to enhance the safe delivery of treatment | Upgrade completed in Dec. 2003. Clean room now meets all relevant safety standards. |
Grampian 40 | Radial Scanning Endoscope | 6,000 | From Oct 02 | David Tosh | Achieved | | | 6,000 | 0 | Improve the efficiency of the existing sessions, and reduce waiting times | Has improved the ability to accurately stage gastric and oesophageal cancers, and therefore improved treatment. |
Shetland 2 | Bereavement training for hospital and community staff | 18,000 | Participation in year (7 staff in 2002/03, 6 staff in 2003/04) | NHS Shetland | Achieved | | | 17,250 | 750 | Increased skills among generic staff. Improved support in crisis/ bereavement to patients & carers/relatives and other staff | Numbers of staff trained via recognised programme |
W Isles 12 | IT based links with mainland to support development of MCNs | 7,000 | By December 02 | Dr I Clark | In progress - on schedule | | | | 7,000 | Compliance with CSBS standards - multidisciplinary working | |
W Isles 13 | Communication training packages for professionals working with cancer patients | 0 | By December 02 | Dr I Clark | In progress - on schedule | | | | 0 | Compliance with CSBS standards - Education and training | |
W Isles 14 | Training packages for clinical pharmacists and technicians in oncology and cancer care | 0 | By December 02 | Ms D Tiernan | In progress - delayed | Staff shortages in Pharmacy may delay progress of this project | | | 0 | Compliance with CSBS standards - education and training. To enable pharmacists to operate as part of the multidisciplinary team. | |
W Isles 15 | Link' nurse training for ward nurses | 0 | By December 02 | Ms J Adams | In progress - delayed | Staffing pressures have made it difficult to identify suitable staff | Dec-03 | | 0 | Improved standards of care. Improved multidisciplinary working and communication. In line with National Cancer Plan Chapter 7. | |
W Isles 16 | Patient Care co-ordinator | 26,000 | By October 02 | LHCC | Achieved | | Dec-03 | 9,233 | 16,767 | Promotion of integrated patient's journey in line with National Cancer Plan Chapter 7 - "At present very little resource goes into managing a patient's transition from primary to secondary care or between hospital and hospice.… alternative approaches [are required]to bring about the changes needed to better co-ordinate patient care across all care settings.
LHCCs are ideally placed to promote integration across primary and secondary care as one of the key elements of cancer MCNs" | Postholder has been in place for three months. Work is in progress on the development of protocols for GP referrals and mapping of referral patterns. |
Making it Happen |
Grampian 13 | Provision of local management support to NESCCAG through substantive funding for Lead Cancer Clinician, Manager, Finance Manager and Admin Support | 98,000 | Immediate | Prof N Haites | Achieved | | | 98,000 | 0 | Provide co-ordination and management support for Cancer and Palliative Care across Grampian, Orkney and Shetland. | NESCCAG work now fully supported by dedicated time as evidenced by NESCCAG being most advanced within NOSCAN on establishment of new focus groups and other elements of cancer plan. |
Highland 6 | Contribution to local administration for Highland | 23,000 | | Dr John Wrench, Director of Public Health, Highland NHS Board | Achieved | | | 22,983 | 17 | Provide co-ordination and management support for cancer and palliative care across Highland area and Wesiern Isles. | Post holder in post 22 April 2002. Restructuring of Highland & Western Isles partnership groups and action groups taken place enabling areas to work on local priorities and to come together for common issues e.g. referral pathways. Action plans for both areas for 2003-04 agreed and implemented including co-ordination of regional and local MCNs including lung, gynae and colorectal. Action plan for 2004-05 drafted and resource implications identified. Working groups established for patient and public engagement and involvement, audit and IT, and soon to be formed, palliative care. |
Highland 6 | Risk against slippage / advertising costs | | From Oct 02 | Human Resources | - | | | | 0 | Contribution to recruitment costs arising from Highland Investment Plan | |
Highland 6 | Contribution from NHS Highland Health Plan | -41,000 | 2002/03 | NHS Highland | - | | | -41,000 | 0 | Contribution to Highland Cancer Investment Plan from NHS Highland Health Plan | |
| Sub-Totals | Allocation | | | | | Sub-totals | Spent | Remaining | |
| 3,327,000 | | | | | | 2,757,406 | 569,594 |