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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? • • • • • • • • • • 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? • • • • • • 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? • • • • • • • 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 • • • • 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