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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 setup 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: 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.