Cancer Delivery Plan. April Betsi Cadwaladr University Health Board

Transcription

1 Cancer Delivery Plan April 2015 Betsi Cadwaladr University Health Board Page 1 of 22

2 1. Background and context Together for Health a Cancer Delivery Plan was published in 2012 and provides a framework for action by health boards and NHS trusts working together with their partners to improve cancer services. It sets out the Welsh Government s expectations of the NHS in Wales to tackle cancer in people of all ages, wherever they live in Wales and whatever their circumstances. The Plan is designed to enable the NHS to deliver on their responsibility to meet the needs of people at risk of cancer or affected by cancer. It sets out: The population outcomes we expect. The outcomes from NHS treatment we expect. How success will be measured and the level of performance we expect. Themes for action by the NHS, together with its partners. 1.1 What do we want to achieve? The Cancer Delivery Plan sets out action to improve outcomes in the following key areas between now and 2016: Preventing cancer Detecting cancer quickly Delivering fast, effective treatment and care Meeting people s needs Caring at the end of life Improving Information Targeting research 2. Betsi Cadwaladr University Health Board s Delivery Plan Betsi Cadwaladr University Health Board (BCUHB) produced its first delivery plan in Inour plan for 2014 we set a range of priorities which included (full list Appendix 2): Playing a greater part in cancer prevention and early diagnosis Treating cancer patients within the established target times Ensuring services have been Peer reviewed and plans prepared following peer review Addressing issues within key cancer sites and cancer treatment modalities Enhancing the holistic care we give to patients during and after treatment Enhancing our delivery of palliative care Whilst there has been progress made against these priorities there have also been challenges and both are discussed in brief below. Page 2 of 22

3 Playing a greater part in cancer prevention and early diagnosis We have continued to target education in schools delivering a cancer prevention talk to the many schools that have approached us. This approach has been well received with schools now re-booking the talk for 2015/16. We have also extended our cancer talk about it campaign on publictransport to mid 2015 when we will refresh the message in line with national cancer priorities. Treating cancer patients within the established target times Enormous effort has been made through 2014/15 to meet the cancer waiting times targets. Whilst we have regularly met the 31 day target we have struggled to meet the 62 days target month on month. Considerable work has been done to increase capacity and modify pathways and whilst this has meant that over 80% of patients have always been treated in line with the target in 2014/15 it is also the case that we have fallen short of the target of 95% too often. Ensuring services have been Peer reviewed and plans prepared following peer review. Four of our cancer services were subject to Peer Review inspection during 2014/15. They were; Colorectal Head &Neck Gynaecology Urology There was considerable clinical engagement with the inspection process and all of the visits proved successful with no major concerns being identified by the Peer Review team. All of the services identified will have their feedback reports available to the public and action plans agreed to address any of the issues raised. Our urology service was first subject to Peer Review in 2013/14 and this review revealed a number of concerns with the service that were made public through a number of routes not least the publication Peer Review. As part of the process this service was subject to another Peer Review in 2014/15 and this visit confirmed arange of positive actions taken by the service. Reflecting this we have successfully formed a single MDT, appointed a CNS in prostate cancer and gained access to robotic surgery on Wirral albeit as a result of ensuring adequate surgical capacity. Addressing issues within key cancer sites and cancer treatment modalities We identified a range of priorities amongst the different types of cancers and amongst a range of developments we have; Page 3 of 22

4 Successfully introduced subcutaneous Herceptin to a large cohort of patients, altering our approach and the patient experience Completed an external review of our referral process for patients with symptoms of possible bowel cancer Made changes to our urology services such as hosting a single MDT and accessing a range of providers of surgery to accommodate activity Rolled out further the plans for Pathology based around a single laboratory on the Glan Clwyd site Increased the use of digital photography in the referral of skin lesions Commenced an MDT approach for Cancer of Unknown Primary Seen the launch of our Patient Forums interactive website Enhancing the holistic care we give to patients during and after treatment In conjunction with Macmillan Cancer Relief we have continued to progress our programme of person centred care projects. Reflecting this more patients now have a Key Worker in line with the guidance issued during 2014 and more patients have access to health and well being events aimed at aiding recovery post cancer treatment. Linked to the above we have also commenced pilots around End of Treatment Summaries and Holistic Needs Assessment. Finally the project aimed at providing individualised cancer care in the community setting has come to an end. We have learnt much from this project and as part of the plan for 2015/16 we will seek to take the core elements from this project and deliver them across the Health Board. Enhancing our delivery of palliative care Our service has been under some pressure through 2014/15 due to changes in personnel and associated recruitment however despite this the service has continued to provide optimum care in concert with our partners in the third sector. The service has prepared a comprehensive plan for End of Life care, this features in Appendix The vision: For our population we want: Page 4 of 22

5 Our publicto understand how they can minimise their risk of cancer and take the necessary actions to prevent them becoming our patients in the future Our public to understand how they can maximise their chances of surviving cancer through early referral to primary care Diagnosis and treatment that is not only compliant with national target delivery times and best practice guidance, but is also efficient, affordable and sustainable. To recognise the patient as a whole person and provide a package of care during and beyond their cancer that meets their needs during and after treatment To ensure that our cancer incidence, mortality and survival rates are comparable with the best in Europe. 4. The drivers: There are a range of reasons why cancer remains a top priority for Betsi Cadwaladr University Health Board. Over the past decade North Wales has often witnessed a greater cancer burden in terms of cancer cases and referrals than the Welsh average, a feature that most likely reflects the higher percentage of the elderly amongst the population and areas of significant deprivation. Reflecting upon the decade that started in 2000 there are number of key statistical issues that are of note; There were 4048 cancers diagnosed in 2013/14 and this was the first time that the figure exceeded 4000 since Within the figure above 1600 were USC referrals and 2448 were non USCs. The latter category is a reduction from last year whilst the USC figure is an increase that has been seen year on year since The number of USC referrals was 40% of the total cancer cases diagnosed, the highest percentage recorded since The number of USC referrals received was 15465, an increase of 33% from 2013/14. 10% of these referrals converted to cancers. Overall these figures suggest considerably more referrals are being received from primary care but the likelihood of cancer being found remains relatively static in terms of what has been seen over the past 10 years in North Wales. The objectives of this plan and previous plans is to respond in a sustainable manner to the statistics above and the positive outcome to date is that despite Page 5 of 22

6 the challenges of the work above cancer survival at 1 and 5 years in North Wales remains at or above the Welsh average. The figures are also better than our neighbouring regions in North West England. 5. Organisation Profile 5.1 Organisational Overview BCUHB is the single NHS organisation in North Wales and serves a population of approximately 700,000. The secondary care element of the service is configured around three main hospital sites at Bangor, Glan Clwyd and Wrexham. Through 2015/16 BCUHB will continue the internal re-structuring of the organisation that commenced in Whilst this remains an evolutionary process it is clear that the organisation will function on a three area model with a single acute hospital structure overlaying the three areas. Complimenting this model will be a range of divisions that will be responsible for the standard of care within their designated specialties. One of these divisions will encompass cancer services such as oncology and clinical haematology. In terms of cancer the vast majority of cancer is diagnosed and treated within North Wales. Most surgical activity is either delivered locally or within services that have been rationalised to a single location for delivery as per NICE guidelines. Similarly oncology services are delivered across all sites except where rationalisation is appropriate, this refers in the main to provision of radiotherapy at the North Wales Cancer Treatment Centre at Glan Clwyd Hospital. Some services are not sustainable or appropriate based on the population of North Wales and in these cases patients access specialised services in England. 5.2 Overview of Local Health Need and Challenges for Cancer Services As previously mentioned North Wales has two significant features that predispose cancer, that of increasing age and background deprivation. These features amongst others underpin the fact that the cancer burden in North Wales remains generally higher than the average for Wales. This analysis most likely extends to chronic conditions in general and thus an increasing issue for patients with cancer is complexity caused by multiple co-morbidities. Though it is the case that new cancer cases have generally increased over the past decade and that North Wales has a greater burden than many other parts of Wales, it is also the case that the increase has been relatively limited with little significant impact year on year. The key challenge for cancer services is the timely processing and diagnosis of cancer referrals. As mentioned previously the number of referrals has Page 6 of 22

7 increased significantly in recent years and all of these referrals require some level of diagnostic intervention if only to eliminate cancer. The challenge on a strategic basis for cancer services is that the goal of better outcomes implies early referral and early diagnosis and thus the significant increase in referral activity is potentially a positive development. The key challenge to the service is managing this activity within resources and in a manner that ensures compliance with Tier 1 targets. 6. Development of Betsi Cadwaladr University Health Boards local delivery plan for cancer This plan has developed through a process of review, reference and consultation. In constituting the plan for 2015/16 the plan from last year has been reviewed and themes/objectives that remain from last year will have been considered for inclusion in the plan for this year. All Health Boards are preparing their 3 year plan for submission to Welsh Government and as such these plans will be expected to include cancer as an issue. This plan will reference the 3 year plan ensuring that they compliment each other. Reflecting the above the plan will be circulated amongst the various departments within BCUHB for comment prior to submission to Welsh Government. 7. Priorities for the coming year The Together for Health Cancer Delivery Plan sets out action to improve outcomes in key areas between now and Through the Cancer Implementation Group (CIG) the following national priorities have been agreed for 2015/16: A focus on lung cancer Delivery of a new cancer structure for Wales Development of a new single cancer pathway for Wales Development of a Primary care Oncology model Further patient experience developments BCUHB will support the implementation of the national priorities by participating in full at CIG and working with other members to deliver the agreed priorities. Specifically BCUHB will: Page 7 of 22

8 Contribute and comply as appropriate with any action plan regarding lung cancer Lead on the definition and implementation of a new cancer structure for Wales through the offices of the North Wales Cancer Network* Play a lead role in determining the definition and efficacy of a single cancer pathway and when appropriate ensuring its implementation at a local level. Play a lead role in defining this project and recruiting the individuals to the key positions on a national basis Participate as required in enhanced patient experience issues especially in ensuring full compliance with the need to participate in full with a further national cancer patient experience survey. * It is important to state that this national priority may have significant impact on BCUHB at a time when the organisation is undergoing internal reorganisation. As such it should be recognised that this plan is being prepared in advance of any national structural change that may impinge on BCUHB in terms of the resources it has dedicated to cancer. In addition to the national priorities described above BCUHB has identified the following priorities for 2015/16 and it is believed these reflect the needs of the local population. Preventing cancer Our priorities for 2015/16 are: To work with our partners in the Heath Board, Public Health and Local Authorities agreeing a robust and well supported strategy for cancer prevention. Agree a long term implementation plan that reflects the strategy described above. Implement a new local plan for the BCUHB sites, patients, visitors and staff As part of the CIG focus on Lung Cancer BCUHB will provide material and developments locally that reflect the national direction. Continue the educational programme in schools under the auspices of the Cancer Network. Detecting cancer quickly Our priorities for 2015/16 are: To work with our partners in Public Health, Local Authorities and Networks identifying and implementing a health promotion campaign 8

9 that informs the public of cancer alert symptoms and their need for early referral to primary care. As part of this approach BCUHB will work with CIG on prioritisation of lung cancer. To work with Networks and the CIG project on Primary Care Oncology, we will re-issue guidance to Primary care regarding cancer alert symptoms as published by NICE in To continue to work towards achievement of the Tier 1 Cancer targets in a sustainable manner and reflecting this will convene a cancer pathway workshop with the objective of identifying key objectives for attainment that will both achieve and maintain the target in As part of the above, through the Cancer Network, we will instruct the different cancer sites to review their diagnostic pathways with a view to ensuring consistency and efficiency. As part of the work above diagnostic bundles will be described that can be delivered in primary care. These bundles will increase primary care access to certain investigations and in doing so will increase the speed of diagnosis whilst maintaining the patient outside secondary care. Specifically we will modify the diagnostic pathway in colorectal cancer will be reviewed with straight to test being implemented where clinically acceptable. We will continue to work with CIG and implement the single cancer pathway model as required. We will complete the work on Pathology in terms of rationalisation to a single site, recruitment and introduction of new technologies. Delivering fast, effective treatment and care Our priorities for 2015/16 are: As described above to continue to work towards achievement of the Tier 1 Cancer targets. We will engage with all the Peer Review visits scheduled for 2015 and in doing so prepare action plans in response to the outcome reports when these have been agreed. As part of the above we will also reassess compliance with all the Peer Review plans produced to date by BCUHB. Through the Cancer Network we will ensure bi annual meetings of each Clinical Advisory Group (CAG). We will expect each CAG to produce an Annual Report that includes performance/activity data, clinical pathway/guidelines/standards and a development plan (see link to Peer Review plans) We will maintain a Cancer Board and in doing so identify a cancer leadership and performance team. A range of disease/modality specific priorities are identified in Appendix 1. 9

10 Meeting people s needs Our priorities for 2015/16 are: To ensure that every patient has a clinical nurse specialist or a nominated nurse at diagnosis To ensure that every patient has a Key Worker that remains throughout their cancer pathway. Make available information to every patient in the language and medium of their choice Develop further our ongoing work on Holistic Needs Assessment and End of Treatment Summaries with a view to having both substantially in place by the end of the year. Have Health and Wellbeing events available across North Wales on a regular and sustainable basis. Identify a successor programme to the project that would be available to all cancer patients and compliments the Health and Well Being events. Establish a Rehabilitation MDT that would function to provide a single vehicle for all Allied Health professions to consider the wider needs of the patient. Targeting research and audit Our priorities for 2015/16 are: Inconjunction with Cancer Trials to maintain and exceed the trial recruitment targets set annually. To maintain an audit programme that examines the service and provides evidence for what we do. Improving clinical information Our priorities for 2015/16 are: As part of the work done by CAGs to ensure all clinicians are able to view and interrogate their clinical data To be able to demonstrate our 1 and 5 year survival by teams To provide complete data to national and UK audits where required Caring at the end of life BCUHB have established an End of Life Plan and this can be seen in Appendix 4. 10

11 8. PERFORMANCE MEASURES/MANAGEMENT Together for Health a Cancer Delivery Plan (2012) contained an outline description of the national metrics that LHBs and other organisations will publish: Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales. National performance measures which will quantify an organisation s progress with implementing key areas of the delivery plan. Progress with these outcome indicators form the basis of each health board s annual report on cancer. We have already produced three annual reports that highlight our progress against these measures. Our next annual report will be published in October

12 Appendix 1. Modality and cancer specific objectives for 2015/16. Oncology Radiotherapy Prepare and submit business case for a replacement linear accelerator and use this 4 th machine as a full part of the available resource. To establish a functional standards/governance group in order to ensure adequate scrutiny of radiotherapy practice. To prepare 5yr plan for radiotherapy including plan and delivery of IMRT and investigation of strategic partners Chemotherapy Acute Oncology Environment Governance Implement Chemocare across all three sites Investigate and implement options around chemotherapy delivery in the community setting Ensure a protocol for the organisation and management of spinal cord compression is agreed Continue the work on Alaw to completion and ensure work on Mason Ward is commenced Continue to establish robust mechanism for review of Mortality &Morbidity oncology/haematology through further modification of the established meetings Cancer Sites Priorities Breast cancer Ensure all patients are seen as urgent and managed within appropriate timescales especially in light of organisational changes Ensure standards are maintained on a sustainable basis Participate in Peer Review. Colorectal cancer Implement the work done in 2013/14 on appropriate investigations ensuring greater use of straight to test. Review in Peer Review plan and deliver actions. Urological cancer Respond to Peer Review Report expected early 2015 Modify current Action Plan Recruit to permanent CNS post Implement PSA tracker system in year Upper GI cancer Implement a plan for the sustained availability of Endoscopic Ultrasound in North Wales Reassess Peer Review Action Plan prepared in Gynaecological cancer Establish pathway day to further establish the functionality of the gynaecology cancer service in North Wales. Prepare and deliver Peer Review Action Plan Skin cancer Review diagnostic pathway taking into account widespread use of digital photography Lung cancer Reassess and deliver the key elements of the Peer Review Action Plan prepared in Address issues related to availability of thoracic surgery Haematology Consider external report when received Complete JACIE accreditation work with a view to being accredited by March Establish a single MDT North Wales meeting 12

13 Deliver a plan for haemophilia particularly regarding relationship with comprehensive centre, out of hours care and child care Commencerepatriation of work from Liverpool Modernise supportive care, follow up and clinical management practices Head & Neck cancer Implement Peer Review plan once submitted Establish a suitable mechanism for access to non medical supportive therapies Neurological cancer Benchmark oncology protocols with other oncology centres in order to confirm their efficacy Sarcoma Consider changes to clinic if physical changes to the cancer centre take place 13

14 9. ACTION PLAN Priority To work with our partners in the Heath Board, Public Health and Local Authorities agreeing a robust and well supported strategy for cancer prevention. Actions required Perform scoping exercise of actions targeted at cancer prevention. Host multi agency workshop to identify strategy and actions Preventing cancer Actions Required Lead Due Date Expected Outcomes Roll out implementation programme Sept Sept 2015 Co-ordinated multi agency approach to cancer prevention that is more focused on cancer using different methodologies. Consequent reduction in cancer rates over the next 20 years Agree a long term implementation plan that reflects the strategy described above. Consider multi agency plan that has clear implementation targets and measurement. Monitor plan and modify Jan 2016 As above Implement a new local plan for the BCUHB sites, patients, visitors and staff As part of the CIG focus on Lung Cancer BCUHB will provide material and developments locally that reflect the national direction. Identify localised actions regarding the BCUHB sites and staff/patients /visitors on those sites Working with CIG establish what actions are required in N Wales. Inform the Lung CAG of any actions and ensure their engagement/involvement. Evaluate plans and modify Actions will depend on CIG priority Hospital Directors Damian Heron Dec Leadership within the scope of the NHS in terms of cancer prevention strategies Highlight the issue of lung cancer. Lower rates of lung cancer and improved survival over the next 20 years. Continue the educational programme in schools under the auspices of the Cancer Network. Implement local programme of work when identified Re- issue letter to schools for new academic year Deliver talk when requested Rolling DamianHeron Rolling Clear education to targeted audience regarding lifestyle choice and cancer prevention 14

15 Priority To work with our partners in Public Health, Local Authorities and Networks identifying and implementing a health promotion campaign that informs the public of cancer alert symptoms and their need for early referral to primary care. As part of this approach BCUHB will work with CIG on prioritisation of lung cancer. Actions required Commence discussion on All Wales basis/ local level regarding communication campaigns aimed at public awareness. Identify agreed approach. Implement locally or as part of All Wales campaign Detecting cancer quickly Actions Required Lead Due Date Expected Outcomes Review previous year and any evaluation available Cancer Network May 2015 Sept Increased awareness of cancer symptoms and the need for early referral to primary care. Reduction in advanced stage cancer being seen at the first appointment with the NHS. To work with Networks and the CIG project on Primary Care Oncology, we will reissue guidance to Primary care regarding cancer alert symptoms as published by NICE in Consider USC NICE guidance when published formally in Establish working group to identify communication to primary care with associated referral practices Cancer Network May August 2015 Improved referrals to secondary care of earlier cancers. Improved ratio of cancers being referred from primary care. Earlier stage disease leading to better outcomes. To continue to work towards achievement of the Tier 1 Cancer targets in a sustainable manner and reflecting this will convene a cancer pathway workshop with the objective of identifying key objectives for attainment that will both achieve and maintain the target in Implement new guidance Hold Cancer workshop with a view to considering new actions to attain achievement of the target. Establish new Cancer delivery plan monitored Cancer Performance Board. Monitor progress and Board function Reconsider repeat of actions dependent on performance May 2015 July 2015 Improved and sustained performance against Tier 1 target. 15

16 As part of the above, through the Cancer Network, we will instruct the different cancer sites to review their diagnostic pathways with a view to ensuring consistency and efficiency. As part of the work above diagnostic bundles will be described that can be delivered in primary care. These bundles will increase primary care access to certain investigations and in doing so will increase the speed of diagnosis whilst maintaining the patient outside secondary care. Describe concise requirements for each CAG. Distribute requirements to ach CAG Work with each CAG to provide information Work with Radiology to identify what investigations can be delivered to primary care by protocol. Establish protocols for investigation that identify expanded primary care element and then promote approach within primary care Formalise referral process to include enhanced investigations Continue work Cancer Network June 2015 Modernised pathways that are consistent across teams. Audit outcomes July 2015 Pathways will be more efficient with some current steps removed. Less impact on secondary care. Specifically we will modify the diagnostic pathway in colorectal cancer will be reviewed with straight to test being implemented where clinically acceptable. Identify project lead. Re-visit current status and confirm clinical advice Identify roll out programme and implement. Audit outcomes Cancer Network March 2015 More efficient pathway. Less demand on secondary care in terms of 1 st consultation We will continue to work with CIG and implement the single cancer pathway model as required. Ensure comms are adequate Participate in single pathway development Assess the impact locally and address any concerns Monitor progress and resolve any issues 2016 Consistency for all cancer cases. Removal of perceived delays for non USC patients Establish local 16

17 We will complete the work on Pathology in terms of rationalisation to a single site, recruitment and introduction of new technologies. implementation plan that addresses tracking and sustainable delivery. Continue to implement agreed strategy for Pathology particularly recruitment Rolling Pathology March 2015 More efficient and sustainable service Priority As described above to continue to work towards achievement of the Tier 1 Cancer targets. Actions required See above Delivering fast, effective treatment and care Actions Required Lead Due Date Expected Outcomes We will engage with all the Peer Review visits scheduled for 2015 and in doing so prepare action plans in response to the outcome reports when these have been agreed. As part of the above we will also reassess compliance with all the Peer Review plans produced to date by BCUHB. Receive timetable for forthcoming Peer Review visits. Respond to all data requests Coordinate Peer Review visits ensuring full engagement from clinical teams and efficient running of visits. Produce peer review plans as required after each Peer Review report/visit. Monitor progress against plans at the relevant CAG Rolling programme As per Peer Review calendar Rolling programme As per Peer Review calendar Services are scrutinised by external body and found to be safe. Areas of improvement are identified and addressed. Services will improve through identification of a plan and its delivery. Re-submit plans annually 17

18 Through the Cancer Network we will ensure bi annual meetings of each Clinical Advisory Group (CAG). Liaise with CAG chairs and agree dates for Consider national actions. Consider developments dates are set national before Cancer Network June 2015 Regular review of practice and clinical governance We will expect each CAG to produce an Annual Report that includes performance/activity data, clinical pathway/guidelines/standards and a development plan (see link to Peer Review plans) Ensure agreed dates are known to all CAG members. Define precise requirements for each CAG. Issue to each CAG with timetable for completion Facilitate the response from each CAG as required. Rolling programme annual Cancer Network Sept 2015 Will ensure good governance in terms of review of practice and activity. We will maintain a Cancer Board and in doing so identify a cancer leadership and performance team. As part of reorganisation confirm Executive lead for cancer and the management team. Continue to develop a Cancer Board. Rolling Sept 2015 Will ensure governance at a Health Board level Priority To ensure that every patient has a clinical nurse specialist or a nominated nurse at diagnosis Actions required Consider options where no CNS is identifiable. Implement process where no CNS evident ensuring that there is at least a named clinical nurse. Meeting people s needs Actions Required Lead Due Date Expected Outcomes Rolling P. Pilkington June 2015 All patients will have a Clinical Nurse Specialist or a named nurse and this will compliment their medical/clinical care. 18

19 To ensure that every patient has a Key Worker that remains throughout their cancer pathway. Make available information to every patient in the language and medium of their choice Assess current roll out of Key Worker project. Establish programme to complete Key Worker identification. Review policy and actions that exist in relation to language. Rolling P.Pilkington Sept 2015 All patients will have a key worker which will ensure a constant point of contact through a complex clinical pathway. D. Williams Oct All patients will be able to access information in the language required. Develop further our ongoing work on Holistic Needs Assessment and End of Treatment Summaries with a view to having both substantially in place by the end of the year. Establish progress to date. Identify implementation plan that ensures operational roll out in year. Establish plan for full roll out over next 2 years Rolling P. Pilkington May 2015 June 2015 Aug 2015 Patient will have assessment that concentrates on them and not their disease and as such will aid recovery. Treatment summaries will improve comms with Primary care and reduce enquiries and increase good clinical management of patients Have Health and Wellbeing events available across North Wales on a regular and sustainable basis. Agree a programme of Health and Well being events for the year. Establish a review of the events with a view to any modifications/feedback. Identify a sustainable solution that ensures such events are a sustained feature. Rolling J Garzoni June 2015 Patients will have the option of attending events specifically configured to help them recover from their disease/treatment. Improved independence and a reduction in readmission rates 19

20 Identify a successor programme to the project that would be available to all cancer patients and compliments the Health and Well Being events. Establish a Rehabilitation MDT that would function to provide a single vehicle for all Allied Health professions to consider the wider needs of the patient. Assess the feasibility of continuing the project across BCUHB Establish working group to project manage implementation Assess impact through limited cohort of patients Assess current progress. Identify barriers to progress. Agree implementation plan. Implement Rolling June 2015 Patient will have access to a non medical consultation that specifically concentrates on their well being and assimilation post treatment. Rolling J Garzoni July 2015 Access to rehabilitation services will be better managed with more patient being able to access the right services Priority As part of the work done by CAGs to ensure all clinicians are able to view and interrogate their clinical data To be able to demonstrate our 1 and 5 year survival by teams Actions required Identify with the CaNISC staff what can be accessed. Agree plan for data collection and interrogation. Ensure each CAG is appraised of data that is available and processes for data collection and release As above Improving information Actions Required Lead Due Date Expected Outcomes Rolling Cancer Network Oct Clinicians and clinical teams will be aware of their clinical outcomes and where there are concerns regarding outcomes actions can be taken to address these deficits 20

21 To provide complete data to national and UK audits where required Ensure that where there is a submission to a UK audit/database that data completeness is at the maximum Rolling Cancer Network July 2015 Benchmarking with other UK sites will allow BCUHB teams to consider their practice and identify any concerns. Priority In conjunction with Cancer Trials to maintain and exceed the trial recruitment targets set annually. To maintain an audit programme that examines the service and provides evidence for what we do. Actions required Liaise with cancer trails as required Agree Audit programme for 2015/16 through audit committee Targeting research Actions Required Lead Due Date Expected Outcomes Rolling J Morris March 2015 Sustainable clinical trial recruitment will aid research in to most effective treatment. New programme S Armstrong June 2015 Ongoing audit will provide governance overview of practice and challenge clinical teams to question and confirm their practice. Priority Actions required Caring at the end of life Actions Required Lead Due Date Expected Outcomes See End of Life plan 21

22 Priority Actions required Lung Cancer Will contribute to national programme as required with a particular interest in public information Cancer structure reorganisation Leading on re-structure programme. It is believed implantation will be auctioned by Sept Single cancer pathway Will contribute to national programme as required Primary care oncology Patient involvement Will contribute to national programme as required Will contribute to national programme as required Actions Required Supporting national priorities Lead Due Date Expected Outcomes Cancer Network Sept Refined national structure leading to more consistency and efficiency and less variation across Wales. More consistency across the current pathways. Less limited delays around patients currently on 31 day pathway More overt integration of primary and secondary care around cancer care. Renewed feedback from users. 22