Wales Cancer Network. An Introduction to the Wales Cancer Network January Part of the NHS Wales Health Collaborative

Transcription

1 Wales Cancer Network An Introduction to the Wales Cancer Network January 2019 Part of the NHS Wales Health Collaborative

2 2 Contents Page About Us Page Cancer Delivery Plan Page 6 3. CIG/Collaborative Cancer Plans 2018/19 Page 7 4. Funding Page Update on Current Work Streams Page Prevention Page Detecting Cancer Earlier (DCE) Page Single Cancer Pathway (SCP) Page Delivering Fast, Effective Treatment & Care Page Oncology Portfolio Page SACT Page Radiotherapy Page Acute Oncology Services Page Cancer Centre Collaboration Page Surgery Page Specialist MDT Governance Page Upper GI Services South Wales Page Lung Cancer Initiative (LCI) Page Patient Awareness Campaign Page Lung Prehabilitation Project Page Pathway Improvements Page Bowel Cancer Initiative (BCI) Page Cross Cutting Programmes Page Person Centred Care (PCC) Page Patient Engagement Page Macmillan Primary Care Cancer Framework (MPCCF) Page Information & Intelligence (I&I) Page Research Page Cancer Site Groups (CSGs) Page Systems of Quality & Performance Assurance Page Peer Review Page National Clinical Audit Page National Cancer Conference Page Working with Partners Page 29 Contacts Appendices

3 1. About Us 3 The Wales Cancer Network (WCN) is a collaboration between Health Boards and Trusts, health professionals, the third sector and other stakeholders to develop and improve cancer services with the aim of improving cancer survival, and quality of life and experience of those living with the impact of cancer. It works towards this aim by supporting, advising and reviewing cancer services whilst highlighting inappropriate variation in services and facilitating innovation in service delivery. The WCN also supports Health Boards and Trusts to meet the requirements of the Welsh Government s Cancer Delivery Plan, and other national strategic plans and frameworks for cancer, and provides advice and guidance to Welsh Government on policy relating to cancer care in Wales. The WCN has offices in Cardiff, Swansea and North Wales. The Cancer Implementation Group (CIG) is the Executive level multi-stakeholder body for cancer in Wales and it functions as the WCN Board. The WCN is, in essence, the delivery arm of CIG. The CIG leads policy and strategy on behalf of NHS Wales and oversees the development and delivery of the Cancer Delivery Plan. This plan seeks to support the prevention of cancer where possible, but when it does occur to ensure the delivery of fast and effective, high quality care, and to continuously improve patient outcomes, namely survival, quality of life and experience. Like many other Clinical Networks, the WCN is part of the NHS Wales Health Collaborative which is directed

4 4 by Health Board Chief Executives and serves to oversea programmes and projects on behalf of NHS Wales. Both the CIG and the NHS Wales Health Collaborative are required to produce an annual plan. A high level summary of the key milestones and deliverables from the WCN s 2018/19 plan is reflected within the attached NHS Wales Health Collaborative Work Plan (Appendix A see Section 3.1 for WCN) with progress reported to NHS CEO s quarterly. 2. The Cancer Delivery Plan This plan was developed by the Wales Cancer Network through the engagement of all cancer stakeholders in Wales on behalf of the Cancer Implementation Group (see appendix 2). The eight domains of the plan were maintained from the previous plan, namely: 1. Preventing cancer, 2. Detecting cancer earlier, 3. Delivering fast, effective treatment and care, 4. Meeting the needs of people with cancer, 5. Caring for people with cancer at the end of life, 6. Improving cancer information, 7. Targeting cancer research, and 8. Cancer service performance and plan delivery Broadly, these domains which align with other service delivery plans, have driven the establishment of the five CIG subgroups:

5 5 1. Prevention 2. Detecting Cancer Earlier (DCE) 3. Patient Centred Care (PCC) 4. Information and Intelligence (I&I) 5. Research. Palliative care has its own National Board. In addition, there is the Macmillan Primary Care Cancer Framework, which whilst having its own board, reports to CIG and is managerially responsible to the WCN. There has also been a focused piece of work to improve lung cancer outcomes through a Lung Cancer Initiative which reports through the Cancer Site Group (CSG) directly to CIG and there will soon be a similar Bowel Cancer Initiative (BCI) which will effectively do the same. There have also been proposals regarding the establishment of a Fast, Effective Treatment and Care CIG Sub-Group to broadly cover planned non-surgical care (radiotherapy and systemic anticancer therapy (SACT)) and unscheduled care relating to cancer or acute oncology services (AOS), although the governance around this is yet to be finalised. The diagram below depicts the current CIG subgroup structure together with an illustration of where various stakeholders input into the cancer agenda.

6 ` 6 3 The CIG/ NHS Wales Health Collaborative Cancer Plans 2018/19 The plan encompasses the breadth of cancer issues and is aimed at identifying deliverable objectives within 2018/19 as part of the wider 2016/2020 Cancer Delivery Plan. As above, WCN has work streams that address the majority of the issues within the plan through formal sub groups of CIG, are recognised priorities for CIG (Macmillan Primary Care Cancer Framework, Lung Cancer Initiative, Bowel Cancer Initiative etc.) or are core WCN based organisational functions to deliver the work of CIG (e.g. Cancer Site Groups, Peer Review etc.). WCN now ensures that all pieces of work have a project plan and an allocated project team. Whilst plans are updated in real time, WCN hold a quarterly review meeting to ascertain progress and risks. A quarterly progress report is submitted to CIG.

7 4. Funding The Network is linked to three sources of funding: 1. Wales Cancer Network Core budget provided centrally by WG to the NHS Wales Health Collaborative for the purposes of the WCN and maintains previous investment in the different Networks and Cancer National Service Advisory Group (NSAG). 2. External Project Specific funding primarily from Third Sector partners to support specific projects e.g. Macmillan Primary Care Cancer Framework (MPCCF) m Cancer Innovation Fund currently this money is made available to CIG on an annual basis. WCN advise CIG who oversee the prioritisation and allocation process. Welsh Government has provided assurance of this funding for and , after which, funding across all delivery plans (not only cancer) is to be reviewed. 5. Update on current work streams Below is a list of themes/topics that currently feature within the WCN s work programme. Many of the themes are cross-cutting. In recognition of this, the WCN has established a team of project and programme managers to manage delivery and ensure there is consistent and timely collaboration in areas of interdependency.

8 A brief description of each of the WCN workstreams / programmes are given below and have been categorsied according to the 3 broad areas of work: 8 1. Cancer Pathway Programmes & Projects (Grey), which includes: a. Prevention b. Detecting Cancer Earlier (DCE), including the Single Cancer Pathway (SCP) c. Fast, Effective Treatment and Care / Oncology (incluing SACT, Radiotherapy, Acute Oncolgy Services, Cancer Centre Collaboration and Surgery) d. Specialist MDT Governance e. Upper GI Review f. Lung Cancer Initiative (LCI) (including Prehabilitation) g. Bowel Cancer Initiative (BCI) 2. Cross-cutting Programmes & Workstreams (Teal Blue) a. Patient Centred Care (PCC) b. Primary Care / Macmillan Primary Care Cancer Framework (MPCCF) c. Information & Intelligence (I&I) d. Research e. Cancer Site Groups (CSGs) 3. Systems of Quality and Performance Assurance (Light Blue) a. Peer Review b. National Clinical Audit

9 Cancer Pathway Programmes (Grey) Prevention The CIG Prevention Subgroup has a key aim to advise on evidence-based interventions to minimise the population level risk of cancer. This can be achieved through facilitating a co-ordinated, coherent, prudent and evidence-based approach to cancer prevention in Wales. The subgroup is led by Public Health Wales (PHW) who, following a cancer prevention workshop, determined that the majority of primary cancer prevention should be incorporated into a wider chronic disease approach and aligned with wider programmes of work across PHW to prevent other forms of preventable health conditions such as heart disease. Using a similar approach, the Prevention of Cancer work programme will focus on prevention work within Local Health Boards and Trusts seeking to address smoking, poor nutrition & obesity, physical inactivity, sun protection and alcohol misuse.

10 How primary, secondary, tertiary and the voluntary sector services can support this strategy is to be determined and it may be that the WCN will focus its efforts on secondary and tertiary prevention such as prehabilitation, initiatives such as Making Every Contact Count (MECC) and rehabilitation through enhanced patient support. Discussion regarding this refocus are currently ongoing with PHW colleagues. 5.2 Detecting Cancer Earlier (DCE) 10 The Cancer Delivery Plan describes an ambition for a relentless drive for earlier diagnosis of cancer as one of the best opportunities to improve patient outcomes. The DCE CIG subgroup operates through a programme board structure that incorporates initiatives across the patient pathway from population awareness and screening to referral from primary care, through diagnosis to start of treatment. Projects and focus of work include increasing screening uptake specifically addressing bowel cancer screening, vague symptom/rapid diagnosis pilots within ABM and Cwm Taf Health Boards, a smoking cessation project led in Hywel Dda and various pathway improvement projects. The programme is underpinned by information (stage at diagnosis being a surrogate for survival), enhancing the primary/secondary care interface by improving and strengthening education, support and communication across the primary/diagnostic intervals of the patient pathway. Strategic work continues with the other home nations and the third sector in terms of learning from each other

11 and identifying ways in which patients can be diagnosed earlier. The Single Cancer Pathway (SCP) is recognised as a key driver to detect cancers earlier and therefore forms an integral part of the DCE Programme Single Cancer Pathway (SCP) It has been long argued that the existing Welsh Government Cancer Waiting Time Targets (CWT), namely the Urgent Suspected cancer (USC) and non- USC targets do not reflect actual patient experience, describe the capacity gap in cancer diagnostic services or drive improvement. Whilst the SCP has been developed to improve the timeliness of access to care, through recording and reporting all patients from the point of suspicion of cancer (PoS), it soon became apparent that the development of more robust and standardised structured site specific and generic pathways also gave the opportunity to overcome longstanding challenges for cancer services; to develop information systems to support referral, recording, tracking and reporting of whole pathway and component waiting times. The Cabinet Secretary for Health and Social Service announced in November 2018 that the SCP target will be adopted in Wales and formally report from June It is intended that adopting the SCP will: Prospectively support patients through intelligent pathways and drive improvement through comparing performances across cancer sites and Health Boards. Develop the information required to understand the current capacity gap in diagnostic and treatment services and also predict the future demand and allow services to plan accordingly The SCP also gives the platform to improve patient support, through better and more consistent use of information, prehabilitation and communication between patients and healthcare professionals and across all levels of care.

12 5.4 Delivering fast, effective treatment and care * This is not as yet a recognised CIG Subgroup (but is currently under consideration). There are, however, a number of active areas of WCN work Oncology Portfolio 12 **Note a portfolio approach to this work is still under consideration The Oncology Portfolio within the WCN brings together a strategic direction for improving oncology services and pathways in Wales through a national governance structure supported by a range of initiatives aligned to the Delivering fast, effective treatment and care section of the Cancer Delivery Plan This includes All Wales initiatives and collaborative programmes of work such as acute oncology, multidisciplinary teams, systematic anti-cancer therapies (SACT), and metastatic disease care. A single view of all national change initiatives will be supported by a refreshed governance structure covering the key elements of oncology services and pathways in Wales SACT Key initiatives involve advice to the Welsh Government regarding a One Wales initiative as well as advice to All Wales Medicines Strategy Group (AWMSG) and their operational group, the All Wales Toxicology and Therapeutics Committee (AWTTC). There is also work through the Cancer Information & Intelligence Group (CIIG) to develop a single instance of e-prescribing in Wales. This will give unprecedented opportunity for a Once for Wales approach to SACT but also to develop a consistent approach to the SACT dataset, the SACT treatment pathway in the SCP and value based healthcare by linking activity to patient outcomes through the new cancer information solution (CIS).

13 5.4.3 Radiotherapy This has a standing all Wales group known as the Clinical Oncology Sub Committee (COSC) which the 3 radiotherapy (RT) centres in Wales contribute to regarding all aspects of RT service, development and research Acute Oncology Services These are broadly divided into 3 groups: Services that support patients with previously undiagnosed cancer e.g. Malignancy of Unknown Origin (MUO) and Cancers of Unknown Primary site (CUP) 2. Services that support patients with complications of cancer e.g. metastatic spinal cord compression (MSCC) 3. Services that support patients with complications of cancer treatment e.g. neutropenic sepsis Cancer Centre Collaboration The Cancer Delivery Plan highlights the need for collaboration and integration between key cancer agencies in Wales to ensure equity of access and delivery of service quality. The three cancer centres in Wales have been approached to consider areas where collaboration and joint working may be beneficial as well as how there could be joint oversight of the work described above. At this time they have suggested that a workshop be held to further explore common issues where collaboration may be appropriate.

14 5.4.6 Surgery ** **It is as yet undecided how the network will work to ensure consistent access to surgical services other than through Peer Review of Cancer Services and National Clinical Audit. 5.5 Specialist MDT Governance 14 Through Peer Review and the review below it has been recognised that the governance of multi-health Board/Trust MDTs is unclear. The WCN have commenced work to ensure that all such MDTs have a Memorandum of Understanding (MOU) that will identify organisational ownership and a clear response to any issues within these MDTs. 5.6 Upper GI Review South Wales The Network undertook an external review of the structure of Upper GI Cancer Surgical Services in South Wales in The recommendations of this review were accepted by the NHS Wales Health Collaborative Executive Group and they agreed that the core recommendations would be taken forward jointly by Cardiff & Vale and Abertawe Bro Morgannwg Health Boards, with support from the Wales Cancer Network. Discussions are now underway with both Health Boards to establish a task and finish group to develop a service specification. 5.7 Lung Cancer Initiative (LCI) Lung cancer continues to be a national priority and the WCN has taken forward a number of separate projects as part of its Lung Cancer Initiative. These include:

15 5.7 Lung Cancer Initiative (LCI) 15 Patient Awareness Campaign Lung Prehabilitation Project Pathway Improvement, including straight to test pilots and a joint working project with Novartis Patient Awareness Campaigns The awareness campaign intervention targeted anyone over 50 years of age and urged them to visit their GP if they had persistent cough symptoms for three weeks or more. This was advertised on television (S4C and ITV), radio stations, other adverts (e.g. online), and with posters (in pharmacies and on buses) between 11th July and 11th August The campaign evaluation was undertaken by the Welsh Cancer Intelligence & Surveillance Unit (WCISU) and is due to report its findings imminently Lung Prehabilitation Project Prehabilitation is a process that occurs between the time of cancer diagnosis and the beginning of acute treatment and includes physical, and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health. It is a multidisciplinary concept that aims to prepare the patient for any pending treatment. The LCI: Prehabilitation and Optimisation Programme (POP) was an innovative multi-modal programme which included dietitians, occupational therapists, physiotherapists and therapy support workers working collaboratively in Health Boards across Wales.

16 Patients were signposted by their specialist nurse or doctor into the innovative prehab service at suspicion of lung cancer at rapid access lung clinics rather than at diagnosis to ensure that the teams had the maximum time to optimise a person s health, wellbeing and fitness. The prehab team provided interventions for patients including exercise classes, nutritional advice, and assessments of health and wellbeing to ensure they were as fit as possible up until their treatment start date, they would then signpost patients into relevant services to support them with any ongoing concerns during and beyond their treatment. 16 This project was supported through the 1m Innovation Fund as part of the Lung Cancer Initiative and is nearing an end having reached the evaluation stage. The project recently won a UK Innovation award from Macmillan Cancer Relief. The WCN recognise the benefits of prehabilitation in all patients pre-treatment and will now seek to identify ways of incorporating nationally agreed work programmes within the Single Cancer Pathway and pathways more generally Pathway Improvements Considerable work has been undertaken to improve the lung cancer pathway, including a joint working project with Novartis, testing the benefits of straight to CT, developing a computer-based risk assessment tool and community pharmacy access to chest X-Ray (CXR). Discussions are on-going on a decision to pilot lung cancer screening in high risk patients in Wales. Formal publication of the results from the NELSON trial, which

17 17 was designed to assess the effect of low-dose CT screening on lung cancer mortality, are awaited but initial indications from the trial are very positive. Prior to the outcome of this trial, it was agreed in the first instance that the National Optimal Lung Cancer Pathway (NOLCP) and Pulmonary Nodule Pathway are embedded across all Health Boards in Wales before piloting lung cancer screening in high risk patients. 5.8 Bowel Cancer Initiative (BCI) The CIG have suggested that colorectal cancer be given significant national focus and prioritisation. The WCN support this and will be recommending the optimum approach in terms of national oversight and synergies between current work streams. Working closely with the third sector, Colorectal Cancer Site Group (CSG) for their clinical expertise and other key stakeholders, the Bowel Cancer Initiative provides a coordinated national approach to improving pathways and outcomes for patients with, suspected of having, or at risk of colorectal cancer. This provides a strategic direction and activity towards the stated outcomes in the Cancer Delivery Plan and will need to address the areas of demand and capacity analysis, infrastructure development and workforce planning. In particular, the BCI will focus upon two main areas: Screening (supporting the implementation of the Faecal Immunochemical Test (FIT), an incremental reduction in the screening age-limit and increasing endoscopy capacity), and; Pathway improvement (supporting the introduction of Lynch Syndrome testing for all colorectal cancer patients, developing national optimal pathways and exploring Straight To Test models)

18 6 Cross Cutting Programmes (Blue) 6.1 Person Centred Care (PCC) The Meeting Peoples Needs section of the Cancer Delivery Plan has helped people to understand the importance of making sure that we are providing person-centred care in Wales. In 2017 a new group was set up under the CIG, known as the Person- Centred Care (PCC) CIG sub-group. The PCC sub-group includes healthcare and other professionals from Welsh Government, Health Boards, Primary Care, Universities, and Cancer Charities in Wales. 18 The PCC sub-group works with a range of healthcare professionals from all Health Boards and Primary Care settings across Wales. It works at a national level to identify and share examples of good person-centred care. These examples show new ways of working before, during and after treatment. The aim is to improve the standard of cancer care, improve the outcomes of care and improve how people feel about, or experience, their care across Wales. The PCC sub-group develops standards which can be used to record and report on quality of care. These are then used to contribute to the performance framework, used by Health Boards and Welsh Government to monitor progress. This ensures that people affected by cancer have a say, and that what matters to them, is taken into account during the planning and completion of their care. During the PCC sub-group have been addressing the following priorities:

19 19 Planning for the implementation of the 3rd version of the Wales Cancer Patient Experience Survey in partnership with Macmillan Cancer Support and Welsh Government. Communicating with health care professionals in both primary and secondary care to ensure that the fundamental elements of person centred care and the recovery package are embedded in the National optimal cancer site pathways (e.g. key worker, holistic needs assessment and associated care plans, treatment summaries, prehabilitation and rehabilitation) Working in partnership with Cardiff University and teams in health boards across Wales to start to understand the challenges Wales faces, with regards to the cancer workforce following the Macmillan Cancer Nursing workforce census. Ensuring that there is suitable information provided for people affected by cancer, on the Wales Cancer Network directory of services website page. Within the PCC sub-group will be supporting teams to implement the consistent use of the Holistic Needs Assessment, allocation of key worker and use of treatment summaries in lines with the cancer site optimal pathways. The sub-group will also be looking to evaluate the range of selfmanagement programmes that are offered to people affected by cancer, and current access to welfare benefits advice across Wales. In addition to this they will be engaging with health boards to explore consistently embedding Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS) into service delivery. Following the workforce review, the group will begin

20 developing an action plan to ensure we have a national consensus on how we sustain the cancer nursing workforce across Wales Patient Engagement and Experience in the WCN 20 There is a dedicated Patient Engagement and Experience coordinator within the WCN whose remit is to ensure the patient voice and experience is core to all work streams and programmes. The Patient Engagement and Experience work ensures the improved ability to understand the experience of care from the patient s perspective and to deliver the service improvement vision accordingly. Patients have a voice in the Peer Review process by providing feedback on their experience of treatment and care. 6.2 Macmillan Primary Care Cancer Framework (MPCCF) The Macmillan Primary Care Cancer Framework (MPCCF) is a Macmillan funded project to create a community of practice within primary care that focuses on cancer and innovation. As a result of this project each HB has a designated lead Cancer GP and Community Nurse within their locale. This work includes close interaction with DCE in terms of recognising early symptoms and getting access to diagnostics. The MPCCF Programme provides clinical leadership aimed at supporting primary care health professionals, producing a framework of tools and resources and improving the integration between Primary and Secondary Care.

21 21 In partnership with Health Boards, the Wales based MPCCF Programme is involved in a range of service improvement projects to support primary care to provide the wide breadth of cancer care required in communities. From diagnosis and supporting through treatment to living with the long-term consequences of cancer and its treatment. A new initiative for 2018 to 2020 focuses on the development and rollout across GP Practices in Wales of the Macmillan Cancer Quality Toolkit to support service improvement in the quality of cancer care. There is increasing evidence that the leadership shown by our Health Board GP Cancer Leads is raising the awareness and the importance of primary care in cancer service improvement. Further information can be found here: Visit our webpages 6.3 Information & Intelligence (I&I) The Cancer Intelligence & Information Sub-Group (CIISG) have identified a number of key priorities arising from Cancer Information and Intelligence: A Digital Health Strategy for Cancer in Wales : Cancer Informatics Solution NHS Wales Haematological Malignancy Data Solution National Cancer Standards for Wales (National Cancer Datasets) National Audits National Oncology E-prescribing Solution National Reporting and Performance Measures

22 22 These priorities will be taken forward through a number of work streams and projects, and project teams have been established for each of them. To ensure a co-ordinated approach, a Cancer Informatics Programme Board (CIPB) maintains oversight to ensure any interdependencies are identified and exploited, which in turn reports to the CIISG. Arguably the most important is the development of a Cancer informatics Solution which will replace Canisc and provide a fit for purpose cancer information solution fully integrated into the wider NHS Wales national informatics architecture, enabling it to link to other clinical systems such as the Welsh Clinical Portal, primary care etc. A Business case is being developed for submission to Welsh Government in Autumn Linked to the above, the Wales Cancer Network, NHS Wales Informatics Service (NWIS), Welsh Government and Janssen Cilag are collaborating on a project to develop a national database for haematological cancers, starting with myeloma. There was a commitment in the most recent Cancer Delivery Plan to develop a performance framework for cancer in Wales developing, recording and reporting metrics that reflect the quality of care being delivered. This work will include the development of clinically appropriate performance measures together with the development of business intelligence tools to allow performance to be easily reported and analysed. As part of this work, the Cancer Network has recently appointed its first senior data analyst. The WCN Cancer Information Specialist Team continues to support NHS Wales participation in the

23 five National Cancer Audits, as well as providing support to operational users of Canisc across Wales in collecting and analysing patient data. Work is also underway to improve NHS Wales s participation in the national cancer audit programme. A new lung e-form has been developed with NWIS to collect additional audit data and other work streams include improving clinicians access to their own audit data and developing tools to help improve data quality and completeness. 23 Underpinning all the work streams is a project to develop a new National Cancer Data Standards for Wales. This involves the development of cancer datasets that cover all parts of the patient pathway and will support the management of care for cancer patients and greatly enhance the ability to measure performance and clinical outcomes. 6.4 Research CIG and the WCN recognise the importance of excellent quality cancer research, not only for its own sake but in enabling and driving quality, innovation, best practice and optimising outcomes for patients. The Cancer Delivery Plan contains a number of actions including the development of an all Wales Cancer Research Strategy, with CIG agreeing a Research sub-group to take these forward. The production of a National Cancer Research Strategy for Wales has been identified as the first workstream to take this forward, and the WCN and Wales Cancer Research Centre (WCRC) are working in partnership to support and develop this.

24 The initial scoping and planning phase is nearing the end and the structure to develop the strategy is starting to meet, bringing together the NHS, academic, third sector, the public and other stakeholders. The strategy will emphasise the value of embedding research in to service as it is recognised that participating in research if often a surrogate marker of service quality, likely to be associated with improved outcomes, early adoption of new treatments and technologies. 24 The WCN and WCRC are working together to provide information on available trials and recruitment for Clinicians, MDTs, Health Boards/Trusts and to support peer review, and have jointly funded a research post to identify and undertake pathway research. 6.5 Cancer Site Groups (CSGs) These have been formed from the previously National (Cancer) Service Advisory Group and regional network site-specific groups and support service development, improvement and research across Wales through the development of high quality local, regional and national cancer site services. They have recently been reformatted and established as Clinical Site Groups (CSGs). The CSGs provide expert advice to the Wales Cancer Network (WCN) and the Cancer Implementation Group (CIG) on policy development and support the delivery of Together Against Cancer; The Cancer Delivery Plan

25 Working together with the WCN, the CSGs support the national work programme, aiming to drive service improvement and enhance patience experience through collaboration, sharing best practice and highlighting areas of improvement. 25 CSGs form the WCN clinical structure and have a diverse professional membership drawn from the associated multidisciplinary teams (primary, secondary and tertiary care) involved in the care of patients within individual cancer sites. CSGs provide the clinical leadership and expertise for key topics that fit with National priorities and members support the dissemination of information amongst local MDT and service. Each cancer site has a clinical lead, supported by clinical leads for specific priorities including audit/information, pathway improvement, with project management and admin support being provided by the WCN. Some examples of the function of the CSGs include providing clinical expertise for and validation of: national clinical audit the measures and standards for peer review cancer information and dataset development development and national optimal patient pathways development and input into national and UK clinical guidelines There are 13 CSGs currently identified as part of the CSG structure of the WCN:

26 Brain Head and Neck Lung Upper GI Sarcoma Teenage & Young Adults Gynaecological Breast Haematology Thyroid Colorectal Paediatrics Urology 26 Each Cancer Site Group will hold a minimum of two business meetings per year and a workshop every 1-2 years. A number of CSGs are currently focusing on developing National Pathways in collaboration with the SCP programme and are outlining the routes and optimal care processes that should be considered to ensure services diagnose and treat patients in a timely and efficient manner. Adopting these optimal pathways will aim to improve survival outcomes for the future and overall patient experience. 7 Systems of Quality & Performance Assurance 7.1 Peer Review Peer Review, by definition, is the evaluation of scientific, academic, or professional work by others working in the same field and constitutes a form of self-regulation by qualified members of a profession. Peer review of cancer services in Wales is a required directive of Welsh Government under WHC/ that uses clinical consensus through the Wales Cancer Network, to measure quality and performance against cancers standards and national guidance as a tool for quality improvement.

27 The review programme is the quality assurance mechanism spanning secondary and tertiary care, by using qualitative and quantitative information that is interrogated by a panel of peers and discussed with the providers of services. Further information including the review calendar can be found on our SharePoint or Website pages. 7.2 National Clinical Audit 27 As described above in 6.3, the WCN Cancer Information Specialist Team supports Health Board participation in five National Cancer Clinical Audits. This process enables clinical services to assure themselves of their quality and also a vital tool to support benchmarking and improvement. 8. A National Cancer Conference The WCN provides a national conference for the cancer community in Wales to enable the sharing of good practice, highlight innovation and provide networking and educational opportunities. In 2019, the WCN is considering a different type of conference. It is suggested that all of the UK home nations should be invited to Cardiff to discuss issues that feature in their strategic plans but with different responses. The WCN is commencing work to prepare the groundwork and infrastructure for such an event. 9. Working with Partners The WCN has developed some highly productive relationships with partner organisations and agencies within the field of cancer in recent years. These fruitful relationships help drive and support

28 28 our mutual ambition to improve cancer outcome for the people of Wales. In particular, the WCN places significant value on its positive relationship with the third sector through the Wales Cancer Alliance (WCA) and the Network s research partners, for example the Wales Cancer Research Centre (WCRC) as is described in an earlier section. The WCN also has a well-established working relationship with 1000 Lives Improvement Service, the NHS Wales Delivery Unit (DU) and the NHS Wales Informatics Service (NWIS), particularly more recently in support of the planning and preparatory work for the single cancer pathway. The DU has lead the national work around modelling the demand and capacity to understand the implications of implementing the SCP, developing the methodology used by HBs and analysing the results. NWIS has also been instrumental in developing the informatics infrastructure to enable reporting against the SCP metric and will support HBs in the use of Tracker 7 systems going forward. The 1000 Lives Cancer Services Improvement Programme works with both the Network and the Health Boards to take forward improvement work that will support the delivery of the Wales Cancer Plan. The support offered by 1000 Lives runs throughout the activities of the Network. Support activities range from dedicated improvement capacity and support, data analysis and communications help. The following are only some examples of how closely 1000 Lives has supported the WCN work programme:

29 29 Core members of the group tasked with designing, planning and testing the implementation of the Single Cancer Pathway. Planning, facilitation and funding of SCP workshops Support to the design and delivery of the DCE programme Pathway improvement work in all Health Boards IQT Cancer cohorts for the Network 1000 Lives continue to work closely with the Cancer Network and the Health Boards on the Cancer Improvement agenda in Wales. Priority areas for 2019 include ongoing data analysis work for the Single Cancer Pathway, work with the DCE programme, and further work to help Health Boards to understand their activity and demand. Contacts For further information on the work streams and activity of the Wales Cancer Network please visit: Website: Social Media: #CancerInWales You Tube: Wales Cancer Network Appendices Appendix 1: Collaborative Plan 2018/19 Appendix 2: Cancer Delivery Plan