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8. DELIVERY
NHSScotland makes a significant investment every year in the delivery of cancer care across primary, community, acute and tertiary services. As demand continues to grow and new opportunities emerge, it is incumbent on NHS healthcare professionals to ensure the best possible use of the available resources.
New Cancer Drugs
The Scottish Medicines Consortium ( SMC) has a remit to examine the clinical and cost effectiveness of all newly licensed drugs in Scotland and provide advice to NHS Boards on their use. Regional cancer networks have established robust horizon scanning mechanisms that identify new drugs that are likely to become available post clinical trials and enable NHS Boards to make appropriate financial provision for their introduction.
Cancer networks support NHS Boards to deliver the range and quality of services required to meet the needs of their local populations. Therefore, they must keep abreast of clinical and technological developments and patient/carers' experiences by, for example, addressing variations in clinical practice, where progress has already been made through the development of agreed clinical protocols. Scottish Intercollegiate Guidelines Network ( SIGN) clinical guidelines for specific tumour types, hand in hand with routine clinical audit, also underpin quality assurance (see also under Assuring Quality of Care).
Service Planning
There are three regional cancer networks - West of Scotland ( WoSCAN), South East Scotland ( SCAN) and North of Scotland ( NoSCAN). Each of these is responsible for the planning of cancer services and is supported to do so through a Regional Cancer Advisory Group ( RCAG), chaired by an NHS Board Chief Executive. These networks have proved extremely valuable in implementing the actions set out in Cancer in Scotland: Action for Change, clarifying the complexities of clinical pathways and service delivery and supporting continuing qualitative improvements in the delivery of care.
Better Health, Better Care committed to reviewing planning arrangements across NHSScotland at a national, regional and local level. This it argued, would require the development of an agreed planning framework covering all services, which clarified roles and responsibilities at each level of planning and ensured an integrated approach to financial, service and workforce planning. There are also potentially further opportunities to improve planning and service delivery by:
- providing Community Health Partnerships with a broader range of delegated resources and greater flexibility in decision making
- reviewing the purpose, objectives and ways of working of Scotland's Special NHS Boards to ensure that they maximise the value they can add to NHSScotland as whole, and
- enhancing the role of managed clinical networks more generally across Scotland to ensure effective clinical leadership in the development of services.
e-Health and Cancer Services
Clinical care requires a variety of sophisticated data capture, information storage and communication processes. There are a plethora of e-health support systems across NHS Board areas and over time significant efforts have been made to ensure that these systems can (where possible) be "joined up" to provide a cohesive eHealth approach across the country. This process will be reflected in the new e-Health strategy for NHSScotland due to be published in spring 2008.
The development of the Generic Clinical System ( GCS) is well underway, providing a confidential, comprehensive and powerful tool that brings together information on all aspects of clinical care without the need for paper records. Work is progressing on a regional basis on systems for breast cancer ( SCAN), gynaecological cancers ( NoSCAN) and head and neck cancers ( WoSCAN). It has also been agreed to begin planning the development of systems for colorectal and lung cancer services within NoSCAN and SCAN respectively.
GCS offers the prospect, not only of clinical record keeping to support patients and healthcare professionals, but also of a confidential and robust method of electronic data capture. A GCS waiting times module has also been developed that has been piloted in
2 NHS Board areas and is now capable of being rolled out to provide electronic means of gathering performance information.
Clinical Leadership
Recognised specialists provide clinical leadership for each of the 3 regional cancer networks and managed clinical networks for specific tumour types. Given the breadth of the challenges and opportunities identified in this discussion document there may also be a case for reappointing a national lead clinician charged with engaging clinicians throughout Scotland in the development and delivery of national cancer policy.
Issues to Consider
- How could cancer networks be developed further to ensure efficiency and effectiveness of cancer care? Is the current balance optimal? What further steps do you think should be considered? Are you aware of duplications of work which could be eliminated?
- Is there a need for a new lead clinician role to drive change and support clinical leads and networks across NHSScotland?
- Which aspects would you prioritise to maximise efficiency and effectiveness of cancer services?
- What are the most important factors which should be taken into account when considering the optimum use of resources? How should we engage people in these decisions?
- What further opportunities do you see for taking this forward through cooperation and collaboration between the NHS and its partners, e.g. between and across cancer networks?
- What should we do to ensure continuing focus on e-health and tele-health to support clinicians and to underpin continuous improvement in cancer services?
- How can the new e-health strategy better support quality assurance and help make best use of available resources?
- Which key performance indicators would best focus NHSScotland on continuing to ensure the most efficient and effective cancer services possible?
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