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National Cancer Programme: July 2016 update
I am sure you’ll agree that there is never a quiet month in health, and nowhere is this more
the case than in the ongoing work in cancer. While it has been a while since our last National
Cancer Programme update, as you will see this isn’t due to a lack of activity! This year’s
Budget saw the announcement of a progressive roll-out of a national bowel cancer screening
programme. This is an incredibly exciting development and you can read
more about what’s proposed in this update.
We also highlight the upcoming Faster Cancer Treatment Forum, and keep you up-to-date
on the Ministry’s current work programme.
And for those of you with an interest in the future of the cancer programme, we have details
on the new governance structure to lead us forward. I am extremely proud of all that has
been achieved to-date, but also excited about the opportunities ahead of us to improve
cancer outcomes.
Some of you may be aware that I am currently the acting Chief Medical Officer at the
Ministry of Health. It’s a fascinating time to be in this role, with the Ministry having recently
refreshed the New Zealand Health Strategy which sets the direction of health services to
improve the health of people and communities.
While I am on secondment, the Ministry is looking to appoint a fixed-term, part-time Clinical
Advisor, Cancer Services to provide additional support to the Cancer Services team and
clinical input into the National Cancer Programme. This is a great opportunity to gain
experience working in the Ministry, supporting the development and implementation of
national policy. A request for Expressions of Interest in this role will be sent out shortly and
I am happy to be contacted to discuss any aspects of the role further.
Of course I continue to take a close interest and be involved where I can in our work to
improve cancer care. I hope you enjoy this newsletter.
Dr Andy Simpson
Acting Chief Medical Officer
Ministry of Health
Roll-out of National Bowel Screening Programme announced
The roll out of a national bowel screening programme will begin next year, giving more New
Zealanders access to early detection for one of the country’s most common cancers.
Once fully implemented, the national programme will invite more than 720,000 people every
year to complete a bowel screening test.
The progressive roll-out will see Wairarapa and Hutt Valley District Health Boards (DHBs)
begin screening eligible people aged 60 to 74 years from mid-2017, with a further nine DHBs
expected to join the programme in 2018 and the remaining eight in 2019/20.
The order in which other DHBs will join the rollout will be confirmed after discussions with
DHBs to determine their readiness. DHBs will need to meet strict criteria to ensure they can
deliver a quality programme that is safe and equitable.
Bowel screening will continue to be offered at Waitemata DHB, which will transition from a
pilot to the national bowel screening model over the course of the roll-out.
More than 80 percent of cancers found through the Waitemata DHB bowel screening pilot
have been in people aged 60 to 74 years. Screening people within this age range will
maximise the number of cancers found while minimising the number of people who have
a colonoscopy where serious problems are not found.
Information from the bowel screening pilot confirms there will be sufficient clinical workforce
to deliver the additional colonoscopies that result from the screening programme.
A national coordination centre is expected to be established by 2018. It will manage and send
screening invitations and coordinate the processing, analysis and management of tests and
results.
Four bowel screening regional centres will support clinical leadership, manage quality and
equity in their area and ensure a colonoscopy or other appropriate bowel investigation is
offered to people with a positive result.
Budget 2016 provides $39.3 million over four years to begin implementation of a National
Bowel Screening Programme (NBSP). This funding will cover the design, planning and
set-up phases. Additional funding has also been set aside for work on the national IT system
and infrastructure needed for a national programme
About 3000 New Zealanders are diagnosed with bowel cancer each year and more than 1200
die from it.
National Forum to support Faster cancer treatment
To support DHBs to achieve the Faster cancer treatment (FCT) health target, the Ministry is
hosting a second national FCT forum at Te Papa on Wednesday 3 August 2016.
Although good progress has been achieved since the FCT health target was introduced,
concern remains about the pace of improvement. The latest results published in May 2016
showed national achievement at 75 percent. While this is up from the 65.8 percent when the
target was introduced in quarter 2 2014/15, further improvement is needed with achievement
of the 85 percent target expected from quarter 1 2016/17.
The Forum is an opportunity for DHBs and regional cancer networks to share their activities
and learnings, review progress to-date and identify actions and ideas to take forward.
The Forum is being opened by the Minister of Health, Hon Dr Jonathan Coleman, and is being
attended by a representative from each DHB and regional cancer network.
MDMs first focus for the Cancer Health Information Strategy
To support clinical decision-making and the value cancer multidisciplinary meetings (MDMs)
have for those delivering cancer services, an MDM Future State workshop is being held on
4 August 2016 in Wellington. The Forum is intended to validate the national MDM future state
business processes, system and data requirements as part of the Cancer Health Information
Strategy programme
Developed by more than 50 stakeholders, the objectives of the Cancer Health Information
Strategy are to improve:
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clinical information across the cancer pathway,
service delivery information across the cancer pathway and
information to cancer patients.
A Governance Board has been established to provide national visibility and decision-making
over the Cancer Health Information Strategy programme, based on agreed priorities. The
Board is chaired by Ailsa Claire, Chief Executive of Auckland DHB and is made up of sector,
ministry, clinical, management and technical representatives.
Di Riley, Manager of the Southern Cancer Network, has been appointed part-time to the role
of National Programme Director, Cancer Health Information Strategy. Di has an extensive
background in the role cancer informatics can play to help hospitals and teams understand
how local cancer services can be delivered, to support evidence based medicine and
implementing change, whilst at the same time keeping the patient and family as the central
focus. The aim of the Cancer Health Information Strategy programme is not to create new
data systems and processes, but to maximise the value of the data already collected as part
of routine clinical practice across the health sector for the benefit of all interested parties.
Cancer Nurse Coordinators advancing care coordination
A forum of Cancer Nurse Coordinators has had a snapshot of findings from an evaluation of
the initiative.
Liz Smith from Litmus Limited, which has undertaken the evaluation, gave a summary of her
findings to the two-day forum in May. Liz’s overall comments were that the initiative is making
good progress in achieving its objectives, and there is evidence of success. She drew on a
patient perspective, in which the cancer nurse coordinators had made their cancer journey
less dramatic, smooth and stress free, because they were their ‘go to person’ avoiding the
feelings of being ‘lost’.
Liz acknowledged the people who have taken the time to provide the information that has
informed the evaluation, including people with cancer, their families and whanau, the nurses
themselves as well as and other DHB staff.
The final report of the evaluation will be publicly available in September 2016.
The Cancer Nurse Coordinator forum involved all cancer nurse co-ordinators and interested
members of the wider team who are involved in care coordination. The theme for the forum
was ‘Te Poutama o Tane Nui Rangi – advancing care coordination’. This was to challenge the
nurses to expand knowledge in key areas of care coordination and discuss what resources
are required to enable improved care coordination.
Dr Lynne Maher, Director of Innovation from Ko Awatea, gave an energetic discussion on
strategies to change behaviour. She acknowledged that the role of cancer nurse coordinators
can be testing due to cancer patients receiving care across a number of different services and
directorates. She explained that engaging well with multiple different health professionals to
facilitate change is important.
Improving access to psychological and social support services
for cancer patients
Patients are now able to access improved cancer psychological and social support
services as progress continues with implementation of the Budget 2014 workforce initiative.
The regional lead psychologists have been appointed in each of the six regional cancer
centres, and the recruitment of additional psychologists and social workers across the country
is almost complete.
Awareness of the expanded service is growing and already there has been positive feedback.
On 5 May 2016, Health Minister Dr Jonathan Coleman opened the first Cancer Psychological
and Social Support Forum which centred on workforce support and focussed on:
    Enhancing understanding of the roles and how the initiative fits within the Faster cancer
treatment programme
 Promoting integration between existing and new psychological and social support workers
 Developing and strengthening networking with cancer supportive care colleagues and
stakeholders.
For many of the workforce this was also the first opportunity they had to meet face to face with
their colleagues.
Sapere Research Group will be undertaking an external evaluation of the initiative. The
evaluation will help the Ministry, DHBs, and Regional Cancer Networks understand whether
the service objectives of the initiative are being met, and what impact the roles of
psychologists and social workers have on patient outcomes. Identification of possible
improvements and recommendations for any changes to the service will be sought as well.
Refreshing the governance of the National Cancer Programme
With the changing priorities driven by the New Zealand Cancer Plan 2015-18 and the New
Zealand Health Strategy, the Ministry has established a refreshed governance structure for
the National Cancer Programme to ensure that it can best deliver on these new priorities.
The Cancer Programme Steering Group and the Cancer Treatment Advisory Group have been
disestablished.
A Cancer Programme Leadership Board is being established as the main governance body
overseeing the National Cancer Programme. The Board will include a cancer academic,
nominated members from Hei Âhuru Môwai and Cancer Consumer New Zealand, as well as
senior Ministry and DHB leaders.
The medical oncology, radiation oncology and haematology work groups will all continue to
provide advice through to the National Clinical Director, Cancer.
The Board has the mandate to drive and support long term strategic direction for cancer and
will consider the establishment of a time-limited advisory group to develop a refreshed cancer
strategy for 2018 and beyond.
A cancer sector collaborative will also be established to ensure operational engagement with
the sector. It will provide a shared opportunity to provide advice, build knowledge and share
experiences and learning through a virtual platform, annual forums, and time limited advisory
groups.
New National Cancer Programme Governance Structure
A new name for the national cancer consumer group
There’s a new name for the group that provides valuable consumer input to the work of the
National Cancer Programme.
The National Cancer Consumer Representative Advisory Group is now known as Cancer
Consumer New Zealand (Cancer Consumer NZ).
The Ministry recognises the importance of consumer participation across levels of decision
making to contribute to improved health outcomes.
Cancer Consumer NZ’s work programme will remain the same. They will continue to
support the consumer voice by participating in relevant committees, working parties and
advisory groups across the cancer sector. They also provide input in the planning and delivery
of cancer treatment and services.
Reducing unwarranted variation in radiation oncology
Sector consultation has commenced on an updated radiation oncology national linear
accelerator and workforce plan. The plan will take a broader perspective than the previous
plan released in 2014 and will inform both clinical service planning and capacity/workforce
planning. A service planning tool has been developed for use by the cancer centres, DHBs and
the Ministry.
As part of the project, all nine private and public cancer centres submitted a historical
minimum dataset from 2012-2015. An aim of the project is that regular reporting to the Ministry
will be introduced. Reports formulated from the data will be used to identify variation in
radiation oncology treatment throughout the country. The Radiation Oncology Work Group will
provide advice to the Ministry on this matter. In future the data will form part of a cohesive hub
of cancer information, as guided by the Cancer Health Information Strategy.
AYA standards nearing completion
The Adolescent and Young Adult (AYA) cancer network is for young people in the 12-24 age
group and recognises they have unique cancer treatment needs that are not covered by
either child or adult cancer services. Young people do much better when they receive care
that is planned by both services and is delivered in a way that is age appropriate.
Feedback from public consultation on the draft AYA standards has been positive, including
good engagement via CANTEEN. The public consultation and stakeholder visits have
raised the awareness and needs of this age group and achieved good sector engagement
and commitment for progressing work in future.
Working groups have now been established to explore improving access and availability to
clinical trials and the feasibility of the development of an AYA data set.
The next steps include looking how to monitor and evaluate the standards and development of
an implementation plan / national strategy for AYA cancer care.