Download Midland Cancer Network

Combined DHB Boards
Meeting
20 March 2014, Kingsgate Hotel, Hamilton
Dr. Humphrey Pullon
Medical Director
Midland Cancer Network (MCN)
Waikato/BOP/Lakes/Tairawhiti DHB’s
Facilitated
by
THE WHY: Why is Cancer important for people
of the Midland Region?
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Cancer is a leading cause of death, major cause of hospitalisation and significant
driver of cost
Increasing number – population growth and ageing – estimate 2.6% growth p.a.
Maori have 20% higher incidence rate; 80% higher mortality than non-Maori
Wide variation in survival rates between DHBs
Lower socio economic groups are more likely to develop cancer, less likely to have it
detected early, poorer survival outcomes – Tairawhiti & Lakes significant areas of
deprivation
Lung & colorectal cancer are national and Midland priority tumour streams
– Lung – registration rates higher for Lakes & Tairawhiti
– Lung – mortality rates higher for Waikato, Lakes & Tairawhiti
– Colorectal – mortality rates higher for Waikato
Complex patient pathways
Wide variation of systems and process across the Midland DHBs
Not all Midland DHB cancer patients have timely access to care
The Cancer workforce has several vulnerable areas
THE WHY: Why are cancer diagnostic and treatment
services important for the Midland region’s health
system?
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Regional strategic planning
Promoting best practice – doing the right thing at the right time, including
standardisation and reduce duplication of effort
Flexible policy response – national and regional to respond to population profiles and
geographical settings
Addressing inequalities – fairness for all
Improving patient experience and outcomes
Examples of OECD best predictors of survival outcome include:
Resources
Practice
– referral time < 30 days from GP to specialist
– Waiting time < 30 days between diagnosis and initial treatment
– Provision of optimal treatment (surgery, medical oncology, radiation oncology, palliative care)
Governance
– National cancer Plan
– Targets, timeframes, monitoring
– Case management (MDT approach)
– Cancer network – care coordination and networks for service delivery
THE WHAT: What initiatives are underway in the
Midland DHB’s that will improve cancer care and
treatment outcomes?
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Faster Cancer Treatment (FCT)
Cancer Care Co-ordination Nurses
National Tumour Stream Standards
Multi-disciplinary Team Meetings (MDMs)
Midland Radiation Oncology Service
Clinical IS
Workforce
MoH approach to FCT
Faster cancer treatment
targets
• A patient pathway approach that covers
surgical and non-surgical cancer treatment
• Measured by three indicators:
Faster cancer treatment targets
• Currently being reported by DHB’s via MCN to
the MoH
• Compliance by DHB varies considerably
• DHB Cancer trackers are trying hard, but IS
solutions are often lacking
• The 62-day indicator has now become a national
health target
• More effort is required by DHB’s and their staff
to deliver more timely cancer care
Faster Cancer Treatment (FCT)
• Aims to ensure that all NZers with a high suspicion of
cancer are assessed, diagnosed and have their cancer
treated faster
• Aims to ensure that NZers with cancer are diagnosed
and treated to a high standard in accordance with
international best practice
• Aims to help those who are in greatest need to
successfully complete their cancer treatment and have
appropriate follow-up
• Aims to improve cancer treatment outcomes for all
NZers
Faster Cancer Treatment (FCT)
FCT Audit of Lung Cancer at Waikato Hospital July 2013
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Presented at MDM
66%
Initial referral to ChemoRx
47% within 62 days
Initial referral to Radiotherapy 75% within 62 days
Initial referral to Surgery
0% within 62 days!!!
– Median wait time to surgery was 89 days!!!
• So management, thoracic surgeons, anaesthetists,
theatre staff and booking staff all worked together to
get more thoracic lists, and the situation is now much
improved.
What is Cancer Care Co-ordination?
• Supporting individual cancer patients through their
cancer (treatment) journey
• A big focus on equity of access and timeliness of cancer
care – trying to minimize those who “slip through the
cracks”….
• A big focus on psychosocial aspects of cancer treatment;
will use psychosocial tools to identify those who will need
the most support
• Will co-ordinate MDT meetings/presentation, and followup on MDT meeting outcomes.
• Will work with existing CNS’s, and the cancer trackers
Tumour (stream) standards
National Tumour Standards
• Lung
• Bowel
• Upper G/I
Gastro-oesophageal/Hepatobiliary/Pancreas/Duodenum
• Breast
• Gynaecological
• Haematology
Lymphoma/Myeloma
• Melanoma
• Head and neck Thyroid and H&N
• Sarcoma
Multi-disciplinary team Meetings (MDMs)
• These are tumour-specific meetings of surgeons,
oncologists, pathologists, radiologists and others…
• Patient-specific presentation and discussion about the
specific type of cancer, stage, co-morbidities, social
circumstances, diagnostic work up and optimal treatment.
• Overseas research shows MDMs expedite and improve
diagnostic work-up, optimize treatment, and help prioritize
cancer care.
• MDMs help co-ordinate cancer care, reduce wastage of
precious resources, and result in improved treatment
outcomes overall.
Midland
Cancer
Network
Midland Cancer
2012 Clinical Performance
Network
Conference
So what do Midland
DHB’s need to do to
support MDMs??
Midland
Cancer
Network
Midland Cancer
2012 Clinical Performance
Network
Conference
Support IT Connectivity
across the Midland area
to ensure that
teleconference facilities
are available for
regional MDMs
Midland Radiation Oncology Service
• Up until now RT has only been delivered at
Waikato
• RT Unit is now being built at Tauranga Hospital
– funded privately but on DHB land
• Due to commence operation on 1.10.14
• Working party to ensure smooth transition
• “one service – two sites”
Clinical Regional IS
• Most service improvement initiatives need
to be supported by functional IS
• Many of the improvements in regional
cancer care are being held back by
inadequate IS support
• This must become both a DHB and
regional priority, with targeted regional
solutions
Workforce
• A constrained and over-worked staff is limiting the
delivery of cancer care in the Midland region
• SMO’s
– MO’s, Haem, Gynae Onc, G/I Surgeons, Endoscopists
• MRT’s and Physicists
– Currently working very long hours
• Cancer trained nurses
– Essential to develop a workforce to cope with increasing
demand and complexity of treatment
What does each DHB need to do?
1. Engage with the regional and national
priorities for cancer care
- Improving FCT and backing IT solutions are top priority
2. Commit resources to ensuring your DHB
delivers good care to cancer sufferers
3. Remember good cancer care requires well
trained and committed staff
4. MCN are here to help…
Midland
Cancer
Network
Midland Cancer
2012 Clinical Performance
Network
Conference
THE END