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CANCER IN SCOTLAND: ACTION FOR CHANGE

07. INVESTING IN OUR STAFF AND IN TECHNOLOGY

THE HEALTHCARE TEAM

OUR NATIONAL HEALTH CONFIRMED THAT WE WANT PATIENTS TO HAVE MUCH GREATER FLEXIBILITY IN HOW THEY ACCESS THE CARE THEY NEED BY MAKING BEST USE OF THE SKILLS OF THE WHOLE HEALTHCARE TEAM.

PRIMARY CARE

Primary care professionals contribute to the care of cancer patients across the whole range of services - including cancer prevention, effective screening, emotional and psychological support and palliative and terminal care. Community based nursing staff facilitate working between different agencies to provide a more effective patient-focused service.

As continuing improvements in therapeutics and drug delivery systems will allow more patients to be treated in the community, it is important that they are helped and supported. Every member of the primary care team can help contribute to supporting patients in their desire to stay as close to home as possible. One example is the role of the community pharmacists who can help patients understand and take their medicines.

The role of primary care in cancer management is likely to expand over the next decade as the average age of patients with cancer increases. Similarly, the complexity of the task of looking after patients in the community will become greater.

Local Healthcare Co-operatives (LHCC's) will have a key role in delivering this cancer strategy through their involvement in health education and health promotion; locality needs assessment; establishing systems for early detection and referral for investigation; supporting local delivery of treatment as part of cancer MCNs; and ensuring the delivery of effective and integrated palliative care.

Nursing Care

Cancer nursing is not restricted to specialist Cancer Centres but occurs across all health service sectors. Multi-disciplinary cancer MCNs are either in place or are being developed across the country. Nurses and other clinical disciplines are integral to these networks. In addition significant benefit for patients may be achieved from the development of cancer nursing networks, not as a substitute for nursing contributions to and involvement in cancer MCNs, but as a complementary activity which would enhance cancer services overall.

For the future nursing expertise should be better focused and co-ordinated to maximise opportunities for development of services, to enhance continuity of care and to secure continuous improvements in cancer care generally.

The implementation of this strategy presents significant future challenges and a need for clear direction of cancer nursing services.

The Nursing and Midwifery Practice Development Unit (NMPDU) was established in 1999 with the remit to ensure the development and dissemination of good practice across Scotland. Already nurses have enthusiastically welcomed the establishment of such networks, and have recognised their potential for benchmarking and improvement of standards of care.

• The NMPDU will work with nurses providing cancer care to explore the potential benefits of establishing formal networks to allow sharing of best and innovative practice across cancer MCNs throughout Scotland.
• We will therefore secure additional support for NMPDU to ensure that a strategic and comprehensive approach is taken to the development of cancer nursing services in all settings.

As with the rest of this strategy, this work will be subject to routine monitoring through the NHSScotland performance and accountability framework.

Pharmaceutical Care

Pharmacists have a pivotal role in cancer care and in the safe delivery of clinically effective chemotherapy services. More recently, within multi-disciplinary teams, they have redesigned the preparation process to enable patients to receive treatment with minimum disruption to their lives and those of their carers. Pharmacists working within communities have developed new roles contributing to cancer prevention and early detection.

As the pattern of treatment varies throughout the course of their care, patients require access to services that provide the required level of active, supportive or palliative care in their preferred care setting. Integrated pharmaceutical services that provide consistent standards of care must therefore be readily and easily available.

Pharmaceutical services must also keep a close watch on research and rapid developments in technology, biotechnology and gene therapy to ensure they remain flexible and responsive to the pace of change.

Continuity of pharmaceutical care depends upon good inter-professional communication, which in turn depends upon effective records.

• A National Pharmaceutical Working Group has developed and is currently piloting a paper-based system for documenting the pharmaceutical care of patients with cancer. If proven effective, this should be developed into an appropriate software package to enhance the quality of cancer care as patients transfer within and across health care sectors. Software integration capability will need to be assured such that the systems developed can be incorporated into the current patient administration systems in primary and secondary care.

These initiatives are already happening but to ensure their effective implementation and to accelerate the pace of change we will:

• work with relevant interests to achieve better integration and co-ordination with national organisations and professional bodies;
• develop strategies for minimising the risk in relation to the preparation and administration of chemotherapy in all care environments including capacity planning for pharmaceutical services;
• collaborate with others to develop safe and effective electronic prescribing and medicine administration systems;
• identify priorities for developing and delivering a research strategy that will lead to improved treatment and services for patients.

Clinical psychology

A diagnosis of cancer can often be devastating and patients need emotional and psychological support while they come to terms with the implications of their diagnosis. Most of this support is given by family and friends although the important role of the voluntary sector in supporting patients through the psychological stresses of cancer cannot be overstated.

Elsewhere in this document we have indicated that a human resource sub-group will be set up to consider workforce planning issues surrounding the delivery of effective cancer services. How best to develop services to support the psychological needs of patients will be an important part of this group's work.

• These topics will be considered within the context of the work of the Clinical Psychology Advisory Group with whom discussions will be held as soon as practically possible to explore the role of clinical psychology, not only in providing direct care to patients, but also in training other professionals to provide better emotional and psychological care. Recommendations will be brought forward during 2002.

Scientific and Technical staff

Patients and public are often unaware of the services provided by scientific and technical staff who have an essential "back room" role in ensuring continuity of care services. They work in many different departments providing a variety of vital support services such as ensuring the safe and appropriate clinical application of medical radiation, maintenance of high-tech equipment, undertaking of laboratory tests as well as a host of other crucial healthcare services. As demand for cancer related services has continued to grow scientists and technicians have, along with other clinicians in the team, come under increasing pressure.

There are recognised problems emerging throughout the UK and in some cases worldwide with recruitment and retention of such specialist staff.

The Executive already has in place a review mechanism for ensuring that ageing radiotherapy equipment is renewed and replaced. Hand in hand with this review goes the need to match staffing needs to support the equipment. While the situation is manageable at the moment, projections for the next few years suggest that there will be increasing recruitment and retention difficulties. We need more staff, we need to keep staff and we need to train people now to meet our future needs.

Every effort will therefore be made to work with service providers, employers and appropriate education and training bodies to seek to secure sufficient numbers of scientists and technicians with the necessary skills to meet future demand. This will take time and it will be necessary in the interim to seek new and different ways of working to maintain important support services.

• The education, training and service requirements for these groups of staff will therefore be a core element of the work of the human resources sub-group which will report with recommendations in 2002, (see Chapter 4).

Professions Allied to Medicine (PAMs)

Cancers develop in different ways and every patient's need is individual. The PAMs are recognised members of the cancer services team, each bringing their particular skills and expertise to bear in delivering care and support for patients.

PAMs comprise a group of individual specialised clinical professions including, for example, physiotherapists, radiographers, dieticians, speech and language therapists and occupational therapists. The contribution of any or all of the PAMs group of professions is crucial to ensuring appropriate provision of diagnostic and therapeutic care and support at some point or on several occasions throughout a patient's care programme.

As is the case with other healthcare groups, there are increasing service pressures on the PAMs and in particular, some emerging shortages of therapeutic and diagnostic radiographers with recruitment and retention issues evident across the UK.

• Education, training and service requirements for PAMs will also therefore be included in the remit of the Human Resource Sub-Group.

Co-ordinating Patient Care

As noted earlier, the risk of cancer increases with age. Most patients with cancer are elderly and this trend will continue into the future as more people live longer. Ten years from now, more patients with cancer will be frail, lack social and family support and have other illnesses that make cancer treatment more complicated. The services we have at present for supporting these patients are poor. In many surveys, patients with cancer have commented on the lack of information they receive from the NHS and the general lack of support available to them. We must do better. The need for support and information will be more pressing in future and we need now to establish better ways of helping cancer patients in the community.

However, we need to do more than simply make information available. We want to explore the possibility that support focused on their journey along the care pathway might bring added benefit for patients. At present very little resource goes into managing a patient's transition from primary to secondary care or between hospital and hospice. We can find no evidence that this approach to the management of services, which is focused on the patient rather than the institution, has been achieved in the UK, but that should not prevent us from seeking alternative approaches 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.
• NHSScotland will work with professional groups, patients and voluntary organisations to develop better ways of managing the cancer journey for patients.
• This will seek to identify measures aimed at establishing how best the patient's care pathway can be better co-ordinated and managed.

Information and Communication Technology

There is a pressing need to harness the power of information technology to provide better information to patients and to improve communication between clinicians and patients. Modern information technology can help us to deliver more streamlined, better integrated services which will greatly enhance patient experiences and help simplify the process of care.

• ECCI will deliver a number of objectives aimed at improving services for patients. For example, by removing one source of delay and inconvenience to the patient, the use of protocol-based electronic referrals and online booking systems from the GP's surgery will relieve some of the anxiety for patients and reduce the cumbersome paper systems currently in existence.
• The SCI programme is another major national initiative which is developing NHSScotland-owned IT systems and standards for local use. The SCI programme will produce integrated systems across care sectors and put in place the necessary secure links between primary and secondary care systems. This will allow all information related to an individual's care to be readily available online to those caring for them, thereby accelerating the exchange of information and facilitating continuity of care.

When fully implemented the combination of these initiatives will transform communications about patient care, improving efficiency and relieving stresses throughout the system.

Information for patients

People need clear and sound information on the measures they can take to help minimise their risk of developing cancer. Similarly, patients who have cancer require high quality information about their disease and treatment options to allow them to make informed choices and improve outcomes. Making relevant information easy to get, understand and use is a key responsibility of NHSScotland. Much work has already been done to meet this need.

Online information

We have developed and are extending electronic means of providing accurate information which is locally and generally relevant, as well as organising it so that people can easily find what they want. NHS 24 and NHS 24 Online, linking to Scottish Health on the Web (SHOW) and the National Electronic Library for Health (NeLH), should ensure the availability by telephone and on the Internet, of high quality, publicly accessible information about cancer and cancer services, including a national directory of support groups and other relevant organisations.

However elsewhere there are substantial variations in the quality of the information that patients can easily find, especially if reliance is put on the general Internet rather than 'kite-marked' web sites.

Telemedicine

Telemedicine is a rapidly developing field with great potential to improve access to high quality care irrespective of distance. Examples include the use of videoconferencing and electronic transmission of x-ray images. Used to support MCNs, telemedicine can improve rapid access to up-to-date information and provide better access to specialist advice leading to faster diagnosis and more efficient use of resources. For patients, particularly those in remote and rural areas, there will be greater scope to receive the care they need closer to home.

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