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Background
The Cancer Service Improvement Programme ( CSIP) was officially launched by the then Minister for Health and Community Care, Malcolm Chisholm, in October 2002 to underpin the redesign of cancer services across the three regional cancer networks in the north, west and south east of Scotland. Funding of £1.8 million over 3 years was provided by the Centre for Change and Innovation ( CCI) to deliver a national, co-ordinated improvement and change programme to support service redesign within NHSScotland's cancer services.
The programme's primary goal was to improve the experiences and outcomes for patients with suspected or diagnosed cancer, consistent with the goals set out in the Cancer Strategy.
- Detect and treat cancer early
- Rapid access to diagnosis and treatment
- Improvement of treatment and care
The programme's aim was to accelerate the pace of change and bring improvements to existing systems and processes across the three regional cancer networks and to support the achievement of a maximum wait of no more than 62 days from urgent primary care referral to first treatment by the end of December 2005.
The Programme's focus was to support improvement and to enable clinical teams and their support staff to make changes happen.
How did the Programme work?
In close collaboration with the 3 Regional Cancer Advisory Groups ( RCAGS), it was decided to support specific cancer tumour types in each region. The Clinical Standards Board for Scotland ( CSBS) now NHS Quality Improvement Scotland ( NHSQIS), published reports indicating the need for improvements in the delivery of particular cancer types. In the initial stages of the programme, the focus in each region was on the following cancer types:
The North of Scotland Cancer Network
( NOSCAN) Lung and Colorectal
The West of Scotland Cancer Network
( WOSCAN) Lung, Gynaecological and Colorectal
The South East of Scotland Cancer Network
( SCAN) Lung and Gynaecological
The programme's structure was based on Service Redesign Methodology, piloted across Scotland since 1997 and the collaborative improvement methodology adopted by the Cancer Services Collaborative programme in England.
Recruitment
A team consisting of 7 regional facilitators was created to provide practical support and expertise to improve patient care. This team was led by a Programme Manager and supported by an Information Manager. The facilitation team were seconded from across the NHS in Scotland, initially working regionally and later becoming a fully integrated national team.
Engagement
Across Scotland, regional facilitators engaged with clinical leads and cancer teams and used process mapping methodology to detail the patient journey. This allowed bottlenecks and delays to be highlighted, demonstrating where improvements were required. Using a tried and tested improvement tool, the PDSA cycle (plan, do, study and act), change ideas were implemented to be tested.
Spread
The regional facilitators shared outcomes and ideas nationally to ensure a rapid and sustainable spread of ideas. The team regularly shared their learning and regional improvements with each other to ensure generic findings were communicated to other areas across Scotland who could benefit from similar changes.
Sustainability
By monitoring the effects of each change on a monthly basis, the team were able to demonstrate benefits to patients and their carers. In some instances there were immediate improvements which encouraged staff to make further sustainable changes which led to improvement work becoming embedded into day to day working practice. From monthly reports, it is clear that early improvements (from 2003 onwards) have been sustained.
"There must be something in this redesign, we have noticed changes over the last 6 months" (oncologist)
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