NHS Lanarkshire Board Meeting Wednesday 23rd November Boardroom, Kirklands Corporate HQ NHS Lanarkshire Headquarters, Kirklands Fallside Road, Bothwell G71 8BB www.nhslanarkshire.co.uk BETTER CANCER CARE AND THE FUTURE PROVISION OF CANCER CARE IN NHS LANARKSHIRE 1 PURPOSE The purpose of this paper is to update the Board on Better Cancer Care - An Action Plan which was published in October 2008. The paper sets out a model to work collaboratively with Macmillan Cancer Support to continue to develop cancer services in Lanarkshire and to ensure that Cancer Services in NHS Lanarkshire are fit for the future and the challenges that lie ahead. 2 BACKGROUND A Scottish Cancer Taskforce has been established to oversee implementation of the Action Plan. Responsibility for the Action Plan lies with the Cancer Division within Acute Services. In 2006 NHS Lanarkshire s A Picture of Health, set out the future strategy for the delivery of healthcare across the region. One of the key objectives within this strategy was to establish a Cancer Centre for the population of Lanarkshire. Further to this the Scottish Government published its national strategy for cancer care, Better Cancer Care An Action Plan, in 2008 which described 8 key themes and recommended actions across the cancer patient experience. Further to this the 2009 NHS Scotland Quality Strategy means that services must be safe, effective and patient centred and any development of services must meet this quality ambitions. The aim of Better Cancer Care is to improve prevention, early detection, treatment and support for patients and families affected by cancer across Scotland. A key issue for the Cancer Division is to ensure there are clear links across within primary and acute care and with multi-agency organisations including the voluntary sector. The Division is also responsible for ensuring that there are links between Lanarkshire and regional and national services. Where links do not exist the Cancer Division has ensured that they are developed. The Cancer Division, via the Cancer Strategy Board has taken forward the following 8 key themes: 1
Prevention Early Detection Genetic & Molecular Testing - Smoking cessation - Cervical Screening - Education Network - Healthy weight - Bowel Screening - Alcohol - HPV Referral & Diagnostics Improving Quality of Cancer Care for Patients - Health Promotion - Scottish Patient Safety Programme - Skin Cancer - Better Together - Electronic Referral - 62 and 31 Day Targets - Liverpool Care Pathway Treatment - Audit - Demand and Capacity - CEPAS and CEPORT CEPAS implementation in NHSL Jan 2012 - Horizon scanning for new cancer medicines, Scottish Medicines Consortium (SMC) and non SM approved drugs. - MHRA inspection June 2010 Living with Cancer Delivery - Survivorship - RCAG - MacMillan/CAB Partnership - CDMT Cancer Division - LTC - Capability Framework - MDT - e-health - Timed Patient Pathways - QID Core Standards - Patient Tracker links - Self Care Progress to date is at different stages in each of the eight sections. The role of the Cancer Division is to oversee work in progress whilst establishing a framework to enable completion within agreed timescales. The Cancer Division has re-established the Cancer Strategy Board. Terms of Reference have been agreed and three meetings have taken place. Membership includes: Public Health Lead GP for Cancer General Manager, Cancer Associate Medical Director Lead GP for Palliative Care Community Nursing Volunteer sector Director of Nursing (Acute) Partnership Patient representative Macmillan General Manager 2
3 CURRENT CHALLENGES The future vision for cancer care in Lanarkshire will be influenced not only by the policy context but by the changing landscape of cancer across the region. There has been a significant increase in incidence and prevalence of people diagnosed and living with cancer and the development of new techniques and treatments over the next decade will further impact on services. NHSL Public Health Annual Report 2010/11 predicted that there will be approximately a 19% increase per year 2018-2022 of patients diagnosed with cancer. Currently 3,174 new cases of cancers occur in Lanarkshire every year. Projected change in cancer incidence in Lanarkshire between 2008-2011 and 2018-2022. 2008-12 2013-17 2018-22 Difference between 2008-12 and 2018-22 Number % Hodgkin s lymphoma 79 83 86 7 8.8 Testis 112 116 119 7 6.0 Cervix 138 129 125-13 -9.2 Brain and CNS 207 211 213 6 2.9 Corpus uteri 301 324 341 41 13.6 Pancreas 340 368 402 62 18.3 Ovary 349 369 385 36 10.3 Leukaemia 380 422 465 85 22.2 Stomach 384 382 398 14 3.5 Kidney 426 476 517 91 21.4 Oesophagus 476 533 590 113 23.7 Non-Hodgkin s lymphoma 554 632 699 146 26.3 Skin 601 709 799 197 32.8 Head and neck 610 677 740 130 21.2 Bladder 878 941 994 116 13.3 Prostate 1571 1926 2344 772 49.1 Other 1743 1907 2080 337 19.3 Colorectal 1964 2170 2390 426 21.7 Breast 2359 2575 2765 406 17.2 Lung 2398 2432 2482 84 3.5 All cancers 15870 17383 18933 3063 19.3 Average annual incidence 3174 3477 3787 613 19.3 All cancers except cancers of the cervix are predicted to increase in terms of numbers of new cases. The increase in incidence is greatest for prostate, colorectal, lung and breast cancers, reflecting that these cancers represent the greatest proportion of all cancers. It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime and that around 48% of cancers among adults in Lanarkshire occur in men 52% of cancers among adults in Lanarkshire occur in females. The prevalence 3
of cancer in the Scottish population increases with age for people over 65 and the largest proportion of the increase will occur in the elderly population. It is therefore incumbent on Boards to plan for the future given the advances in technology and treatment. The consequences of the disease and treatment impact not only physically but also on an individual s psychological, financial and social functioning ability. Emerging evidence proposes that services for cancer patients and their families should: 1) Have an individual care plan, arising from an assessment of the disease, the treatment, and the individual s personal circumstances following diagnosis. 2) Receive information that meets individual needs, is timely, accessible and promotes confidence, choice and control. 3) Have a risk stratified follow-up approach to cancer care. 4) Enable self management with support, and rapid access to appropriate professional care when problems arise. In order to deliver safe, effective and patient centred care as described in NHS Scotland Quality Strategy, 2009, it will be essential to critically appraise current models of care and to identify the potential for meeting projected demand, including innovative models of delivery incorporating all of the above. 4 PLAN/NEXT STEPS This paper sets out the model to work collaboratively with Macmillan Cancer Support to continue to develop cancer services in Lanarkshire. In order to develop a detailed case for action, the Cancer Division will work with Macmillan to set out the parameters for a Cancer Centre within NHS Lanarkshire. This will incorporate both the need to redesign cancer care within the current/planned resources envelope and to pilot and evaluate new approaches to care. This will also involve undertaking a critical appraisal of current cancer care in Lanarkshire and propose new models for the future which ensures improved efficiency, productivity and effectiveness. It is anticipated that this will include primary, secondary and tertiary health care, local authority, third sector, e-health and will be underpinned by patient and public involvement. The Scottish Government is currently embarking on a Detect Cancer Early Initiative and has produced a draft implementation plan. A local implementation group chaired by the Cancer Division has been established to support this work. A new HEAT target will be developed to increase the proportion of patients diagnosed and treated when their cancer is at the earliest stages by 25%. The aim of the implementation plan is to raise awareness and increase diagnostic capacity in the NHS. The proposal is to concentrate on three main areas:- lung cancer, breast cancer and colorectal cancer. 4
Underpinning the Detect Cancer Early Initiative is the principle of moving towards an outcomes-based target and a whole systems approach as echoed in this proposal along with shifting the balance of care and redesigning models of care. The vision is to drive improvement to improve the cancer survival rate in Scotland. A national launch event is planned for Autumn/Winter of 2011 to raise public awareness of this initiative and to allow NHS Scotland to reflect on how it will achieve the aims of the programme. All of the above will necessitate a major redesign of how cancer services are delivered. MacMillan Cancer Care are very keen to support this work with NHS Lanarkshire using a programme based approach. In the delivery of the joint programme with Macmillan, the following principles will provide the necessary foundation and the necessary criteria with which to assess and commission test/evaluation sites. The transformation of care will first and foremost do no harm; clinical safety will be paramount in the design and delivery of new models of care. Patients and their families will be well prepared for and actively involved in the planning for their lives after the intensive anti-cancer treatment phase ends and supported to manage the consequences of their condition. The redesign of care will seek to encourage whole system change, integrating and aligning strategies and service delivery across the entire public sector in Scotland. The programme will seek to redesign care within the parameters of current or planned resource. The process of change will incorporate the development of a robust evidence base to ensure the spread of success beyond specific planned pilots. The success of the proposed programme will be measured against the delivery of the following four key objectives: 1. Reshape the provision of care to provide capacity for the predicted increase in cancer incidence and prevalence; 2. Promote and initiate an integrated and sustainable approach to the provision of care involving health, social care and third sector partners that drives a shift in focus from treating the disease to health and wellbeing; 3. Create a culture of confidence in patients and professionals which supports people to regain control of their lives, facilitates self-management, develops new approaches to surveillance and reduces unnecessary reviews; and 5
4. Facilitate shared decision-making with patients in cancer follow-programmes that promote co-design of high quality, safe ongoing care. At the heart of the approaches to this challenge in other parts of the UK is the critical need to stratify ongoing care and support, based on a sound understanding of clinical risk and the wider holistic needs of the patient and their family. The diagram below presents a summarised representation of the methodology being adopted by National Cancer Survivorship Initiative (NCSI) and the Transforming Follow-up in Northern Ireland and as such could provide the proposed programme in Scotland with an evidenced starting point. In the delivery of the overall aim and the specified objectives, it is proposed that the programme would focus on four main areas of whole system change: 1. Redesign of current models of cancer follow-up. 2. Development and implementation of Personalised Care Plans. 3. Managing the transition between acute care and home. 4. Enablement and support for effective self-management. The work in progress is described below. December 2011 2012 2013 2014 Building a case for action Partner engagement Defining new models of Pilot & evaluation Commission new services 6 NHS L Board
The first step of this process will be to describe in detail, our collective aspirations for the future of cancer care in Lanarkshire, present a programme governance framework and timeline for its delivery and to specify the programme resource Macmillan will provide to support the process. It is envisaged that while new models of provision will be informed by this, the final focus for the pilot/evaluation phase will arise from effective engagement and dialogue with local partners and beyond. During this phase, the programme group will deliver the 4 key objectives noted above by: Defining the clinical model in NHSL, taking account of current activity, incidence, mortality, prevalence, referral patterns, stage at diagnosis and patient pathways. In addition to validated performance publications, consider updating any patient / carer experience data that have identified how cancer services are currently performing in NHSL Explore innovative practice elsewhere in the UK and internationally that could be applied to the NHSL health economy Explore potential for applying improvement methodology to cancer services provision in NHSL. Design the engagement phase to ensure that it is underpinned by patient and public involvement. Identify resources required from Macmillan Cancer Support and develop case for action. The anticipated outcomes are: A redesigned service incorporating whole system change Sustain increase in demand in NHSL A redesigned service within the current financial envelope Patients and families well prepared for and involved during and after the active treatment phase 5 CONCLUSION The Board is asked to note this work and seek feedback towards the end of the 2012 calendar year. 6 FURTHER INFORMATION For further information about any aspect of this paper, please contact: 7
Name: Rhona Roberton Designation: General Manager, Cancer Services Division Name: Hakim Ben Younes Designation: Associate Medical Director, Cancer Services Division Rosemary Lyness Director of Acute Services November 2011 8