Cancer Network ReviewCancer Network Review

Peter Gent & Peter KingPeter Gent & Peter King

Do We Need A Regional Overview Do We Need A Regional Overview Of Cancer Services?Of Cancer Services?

Collectively we account for less than 20% of the Collectively we account for less than 20% of the national cancer incidence – strength in national cancer incidence – strength in partnership rather than in isolationpartnership rather than in isolationAffects 1:3 of the population in a lifetime and has Affects 1:3 of the population in a lifetime and has a significant health burden on families and a significant health burden on families and individualsindividualsEscalating costs associated with diagnosis, Escalating costs associated with diagnosis, staging and treatment (chemotherapy treatments staging and treatment (chemotherapy treatments have gone up from 8000-28000 in Grampian have gone up from 8000-28000 in Grampian alone) presenting challenges around delivery, alone) presenting challenges around delivery, capacity & affordability capacity & affordability

Regional costs associated with Regional costs associated with chemotherapy treatments alone are £30m chemotherapy treatments alone are £30m (excluding research funded treatments) (excluding research funded treatments) with considerable evidence that with considerable evidence that efficiencies can be achieved through a efficiencies can be achieved through a collective approachcollective approachWorkforce distribution issues and Workforce distribution issues and evidence of imbalance that could be evidence of imbalance that could be addressed through joined up planning and addressed through joined up planning and redesignredesignIsland clinical services will be at risk if not Island clinical services will be at risk if not part of a wider clinical network of care part of a wider clinical network of care

Current & emerging governance issues in Current & emerging governance issues in relation to clinical care which should be relation to clinical care which should be regionally and or nationally agreed, thereby regionally and or nationally agreed, thereby stripping out unnecessary duplication of effort at stripping out unnecessary duplication of effort at Board level e.g. CEL 17, HDL (29) 2005, Board level e.g. CEL 17, HDL (29) 2005, NCEPODNCEPODAddressing recommendations arising from Addressing recommendations arising from ‘Radiotherapy in Scotland‘Radiotherapy in Scotland’ 2010 that have a ’ 2010 that have a regional context, particularly for the northregional context, particularly for the northSome clinical services are delivered and Some clinical services are delivered and managed regionally e.g. gynae, lungmanaged regionally e.g. gynae, lungA formal footprint & structure for regional A formal footprint & structure for regional planning & working exists – i.e. NoSPGplanning & working exists – i.e. NoSPGWOSCAN have demonstrated the value of WOSCAN have demonstrated the value of taking on difficult service configuration decisions taking on difficult service configuration decisions

Requirement for service contingencies Requirement for service contingencies when either manpower issues or key when either manpower issues or key equipment failures force alternative patient equipment failures force alternative patient pathways or capacity / service support pathways or capacity / service support through neighbouring Boards through neighbouring Boards

Too many excuses are made of the ‘3 Too many excuses are made of the ‘3 Cancer Centre’ position in the northCancer Centre’ position in the north

Major service planning and delivery issues Major service planning and delivery issues in relation to remote and rural geographyin relation to remote and rural geography

A Case For Change?A Case For Change?

Board priorities are different from when Board priorities are different from when NOSCAN was established and the current NOSCAN was established and the current workplan is not necessarily aligned to the major workplan is not necessarily aligned to the major pressing issuespressing issuesNetworks no longer a conduit for funding which Networks no longer a conduit for funding which has changed the dynamics with serviceshas changed the dynamics with servicesMajor focus initially was preparing the Boards for Major focus initially was preparing the Boards for the 2005 waiting times targets which has now the 2005 waiting times targets which has now moved onmoved onThe ‘brand’ is bigger than the service – The ‘brand’ is bigger than the service – NOSCAN is actually a region and not a NOSCAN is actually a region and not a departmentdepartment

Increasingly good argument to move some Increasingly good argument to move some tumour specific networks into a national tumour specific networks into a national forumforumIncreasingly best practice clinical Increasingly best practice clinical guidelines and clinical standards are guidelines and clinical standards are marginalising locally available services marginalising locally available services e.g. breast cancer servicese.g. breast cancer servicesClinical engagement has improved but key Clinical engagement has improved but key decision makers are missing i.e. finance, decision makers are missing i.e. finance, senior management and planning leaving senior management and planning leaving keys gaps in representation to deal with keys gaps in representation to deal with the major and pressing prioritiesthe major and pressing prioritiesToo many ‘information’ meetingsToo many ‘information’ meetings

What Might We RetainWhat Might We RetainRegional Planning ForumRegional Planning ForumStrengthen alignment to NoSPGStrengthen alignment to NoSPGDefault to national tumour specific MCN’s & Default to national tumour specific MCN’s & regional only where explicitly justified regional only where explicitly justified Central Government link - Government use the Central Government link - Government use the existing network structures as a major existing network structures as a major communication conduit and co-ordinating point communication conduit and co-ordinating point for multiple national workstreams concerning for multiple national workstreams concerning cancercancerCancer information services & governanceCancer information services & governanceClinical engagementClinical engagement

What Ought We Add?What Ought We Add?Improved regional forum, with revised Improved regional forum, with revised membership, fewer meetings but membership, fewer meetings but empowered to make decisions and empowered to make decisions and provide the Boards with high-level advice provide the Boards with high-level advice around a more focused and challenging around a more focused and challenging workplanworkplanRe-brandingRe-brandingOpen dialogue with WOSCAN & SCAN Open dialogue with WOSCAN & SCAN around more nationally organised MCN’s around more nationally organised MCN’s (it’s what most clinicians seem to want)(it’s what most clinicians seem to want)

Improved links to Board information Improved links to Board information services to generate the important data services to generate the important data (activity, finance etc) that will support the (activity, finance etc) that will support the efforts of a regional planning forum and efforts of a regional planning forum and allow greater insight and challenge of allow greater insight and challenge of existing systems & servicesexisting systems & servicesSupport constituent Boards in cross Board Support constituent Boards in cross Board service developments which may be service developments which may be outwith the north grouping outwith the north grouping Monitoring of regionally agreed SLA’s and Monitoring of regionally agreed SLA’s and relevant ongoing service evaluation of relevant ongoing service evaluation of thesethese

Suggested PrioritiesSuggested PrioritiesFewer workstreams more focused around the Fewer workstreams more focused around the current Board prioritiescurrent Board priorities

1.1. Lead on regional efficiency programmes in Lead on regional efficiency programmes in relation to cancer servicesrelation to cancer services

2.2. Performance monitoring & QA of the key Performance monitoring & QA of the key cancer CEL & HDL’s (external peer review)cancer CEL & HDL’s (external peer review)

3.3. Address the regional issues emerging from Address the regional issues emerging from Radiotherapy In ScotlandRadiotherapy In Scotland

4.4. A detailed cancer services benchmarking A detailed cancer services benchmarking exerciseexercise

5.5. Pursue some national alignment of current Pursue some national alignment of current workwork

Example of approachExample of approach

A requirement that any cancer service specific A requirement that any cancer service specific development costing e.g. £75k or above development costing e.g. £75k or above includes evidence of regional considerationincludes evidence of regional consideration Test out that regional solutions have been considered Test out that regional solutions have been considered

and appropriately evaluated and appropriately evaluated Instil business as usual approach to regional planningInstil business as usual approach to regional planning Improved transparency of investment and help Improved transparency of investment and help

address some of the imbalance and existing equity address some of the imbalance and existing equity issuesissues

Engages operational teams with regional planning Engages operational teams with regional planning processesprocesses