Download West of Scotland Cancer Network (WoSCAN)

West of Scotland Cancer Network
Year End Report
April 2014 – March 2015
Mr Robert Calderwood
Chair, Regional Cancer Advisory Group
Chief Executive, NHS Greater Glasgow and Clyde
Dr Hilary Dobson
Regional Lead Cancer Clinician
West of Scotland Cancer Network
Evelyn Thomson
Regional Manager (Cancer)
West of Scotland Cancer Network
Contents
1. Introduction ....................................................................................................................................... 3
2. Managed Clinical Networks ............................................................................................................. 8
2.1 Breast Cancer ............................................................................................................................... 8
2.2 Colorectal Cancer ......................................................................................................................... 9
2.3 Gynaecological Cancer ............................................................................................................... 10
2.4 Haemato-Oncology ..................................................................................................................... 11
2.5 Head and Neck Cancer............................................................................................................... 13
2.6 Lung Cancer ............................................................................................................................... 14
2.7 Skin Cancer ................................................................................................................................ 15
2.8 Upper Gastro-Intestinal Cancer .................................................................................................. 17
2.9 Urological Cancer ....................................................................................................................... 18
2.10 National – HepatoPancreatoBiliary ........................................................................................... 19
2.11 National – Sarcoma .................................................................................................................. 21
2.12 National – Adult Neuro-Oncology ............................................................................................. 22
3. Clinical Audit ................................................................................................................................... 25
4. West of Scotland Pharmacy Cancer Network ............................................................................. 26
5. West of Scotland Cancer Nurses Group ...................................................................................... 28
6. Regional Systemic Anti-Cancer Therapy Executive Steering Group ........................................ 29
7. West of Scotland Primary Care Cancer Network ........................................................................ 30
8. Scottish Cancer Research Network.............................................................................................. 32
9. West of Scotland NHS Boards ...................................................................................................... 34
9.1 NHS Ayrshire and Arran ............................................................................................................. 34
9.2 NHS Forth Valley ........................................................................................................................ 38
9.3 NHS Greater Glasgow and Clyde ............................................................................................... 41
9.4 NHS Lanarkshire ......................................................................................................................... 53
10. Conclusion .................................................................................................................................... 56
Glossary of Acronyms ....................................................................................................................... 57
APPENDIX I – Consolidated Regional Work Plan 2014/15: End Year Position ............................ 58
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
2
West of Scotland Cancer Network
Year End Report
1. Introduction
Cancer remains a strategic priority as reflected by national, regional and local cancer plans.
During 2014/15 the West of Scotland Cancer Network (WoSCAN) has delivered a wide and
varied programme in partnership with a diverse range of organisations and highly dedicated
teams of clinicians, managers and patient representatives across the West of Scotland
(WoS).
The impact of the Network and its constituent Managed Clinical Networks (MCNs) is seen in
the output and outcomes from the many groups, partnerships and collective efforts described
in this report. Our work covers the whole cancer journey, from prevention and early
detection, to ensuring excellent treatment and care, offering choice beyond the acute
treatment phase, supporting patients to self manage or offering choice for people at the end
of life.
Previously reported national and regional priorities remain extant with work being progressed
in all areas. In summary:
•
Detect Cancer Early: Launched in February 2012 this national programme promotes
awareness of symptoms for breast, colorectal and lung cancers with earlier presentation
to NHS services. A further £2.8 million revenue was allocated to WoS NHS Boards to
support managing the impact of the programme for both diagnostic and treatment
services. Bids were also sought against £750k capital funding and a further £800k was
allocated to practices across Scotland to support implementation of the second and final
year for the Quality Outcomes Framework initiative.
•
Cancer Modernisation: Including surgical oncology, acute oncology and radiotherapy:
£72k, £240k and £480k respectively has been allocated to WoS NHS Boards to further
embed enhanced recovery models, sustain acute oncology services and to assist cancer
centres to increase capacity and optimise radiotherapy services.
•
Transforming Care After Treatment: £5m over 5 years is being made available, via a
partnership agreement between Macmillan Cancer Support and NHS Scotland, to
support the development of innovative models of care that will transform how services
are delivered after treatment. In 2014/15 the second tranche of this funding was made
available to support 8 innovative projects in the WoS. A total of £741k was provided to
support this.
•
Quality Assurance and Improvement:
- Quality Performance Indicator (QPI) development has now been completed, and
implementation, assessment and service improvement are ongoing.
- National comparative reporting has commenced with national reports published for
breast, upper gastro-intestinal and lung cancer.
- Patient experience QPIs have been finalised and implementation is being taken
forward by NHS Boards.
•
Efficiency and Productivity: An extensive range of Clinical Management Guidelines
(CMGs) have been reviewed and updated to better reflect current, agreed, optimal
patient pathways and ensure consistency of care across the region. Horizon scanning of
new cancer medicines is ongoing with refreshed budget impact plans in place.
The Regional Cancer Advisory Group's (RCAG) 2014/15 year end consolidated regional
work plan (see Appendix 1) details the extensive programme of work in relation to regional
cancer services that has been taken forward. The section that follows highlights key work
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
3
streams and activities that have been undertaken in 2014/15 across pathways and
organisations which have made services better for local people. These include:
Cancer Access Standards
WoS Boards continue to strive to deliver the 62-day urgent referral to treatment standard,
with all Scotland validated performance of 94.2% for the quarter ending 31st December 2014
(range 93.7% - 95.6% for WoS NHS Boards) and the 31-day decision to treat to first
treatment, with validated performance of 97.5% for the same time period (range 97.8% 99.4% for WoS NHS Boards). Attention is focused on those areas where WoS Boards fall
fractionally short of meeting the required standard to ensure that pathways are managed as
efficiently as possible. Colorectal, head and neck, melanoma, ovarian, upper gastro-intestinal
and urology pathways each continue to pose challenges due to their complexity and service
demand.
Detect Cancer Early
During 2014/15, under the auspices of the Scottish Cancer Taskforce, national social
marketing campaigns for breast cancer, colorectal cancer and lung cancer were revised. The
revised bowel campaign results indicate an encouraging increase in kits (9%) returned to the
Scottish Bowel Screening Centre. The revised lung campaign includes a symptoms based
call to action with NHS Boards prospectively monitoring chest x-ray referrals. Regional breast
screening campaigns have also been established. Data from 2012/13 combined (2 year) was
published on the 29th July 2014. The data shows encouraging improvements in recording of
cancers at stage 1 (4.7% increase) from baseline data. The full impact of the Detect Cancer
Early social marketing campaigns will not be apparent until the 2014/15 staging data is
available.
NHS Greater Glasgow and Clyde, together with Cancer Research UK, have established a
primary care engagement programme to provide General Practitioners (GPs) and other key
primary care practitioners with practical support, information and educational resources to
improve cancer outcomes. The programme works with GP practices to improve early
diagnosis and reduce barriers to participation in the national screening programmes.
Screening
•
Bowel Cancer Screening: The latest uptake figures from October 2013 show that overall
uptake was 56.1% (53.3% for men and 58.8% for women). In the WoS the lowest uptake
is seen in NHS Lanarkshire with 47.8% and 51.9% for men and women respectively. The
highest positive screening test result rates for men and women were in NHS Lanarkshire
and NHS Greater Glasgow and Clyde (2.98 per 100 and 2.92 per 100 populations
respectively). Considerable work is ongoing to increase the uptake of screening and
target efforts to those areas where uptake is lowest.
•
Breast Screening: Performance standards 31/3/14 (data one year in arrears) indicated a
slight fall from 73.5% in the period 201/13 to 72.9% in the period 2011/14. Both exceed
the minimum standard of >70%. NHS Greater Glasgow and Clyde’s uptake sits at 67.8%
(all other Boards have achieved >70%). During the same time period the invasive cancer
detection rate has increased slightly to 6.8 per 1000 population. Progress with the
transition to digital mammography continues with completion scheduled for July 2015.
Introduction of the new IT system to support breast screening is on track. The move to
digital will provide the opportunity to review current processes and procedures with a
view to streamlining these.
•
Cervical Screening: From 1st April 2016 the age range and frequency of cervical
screening will change for routine screening to 3 yearly from the age of 25 and 5 yearly
from the age of 50-64 (currently 3 yearly from 20-60 years).
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
4
Surgical Service Provision
•
Enhanced Recovery Models of Care: Further work was undertaken in 2014/15 to
complete exemplar pathways for urological cancers and sarcoma, which will assist
Boards taking forward local implementation.
•
Immediate Breast Reconstruction: Data on current practice and referral pathways is
currently being reviewed to ascertain the need for further work to be undertaken to
ensure equitable access to the full range of reconstructive procedures across the WoS.
Further work will be undertaken in early 2015/16 to review and agree any further service
change that is required to support this.
•
Radical Oesophagogastric Resection: Work to review current service provision concluded
in June 2014 and recommendations to retain 3 resection centres in the WoS were
accepted by the RCAG. Acceptance of this recommendation was on the basis that
outcome data would continue to be closely monitored. Further work to update results has
been undertaken by the WoS Cancer Surveillance Unit which validate that outcomes
remain good across units.
•
Minimally Invasive Radical Prostatectomy: Work was initiated to look at the future
provision of minimally invasive radical prostatectomy within the WoS. It was concluded
that the WoS should move toward one centre for the region and that planning to achieve
this should commence. A business case, which has now been endorsed, to support the
move to robotic surgery has been prepared and submitted to the Regional Planning
Group.
Specialist Oncology Services
•
Radiotherapy: The national radiotherapy group is currently undergoing review and is
being reconstituted to ensure appropriate representation from regions/cancer centres.
Capacity pressures within the Beatson WoS Cancer Centre (BWoSCC) persist with
extensive work undertaken to optimise available capacity and manage demand. A 12th
linear accelerator will operate at the BWoSCC from spring 2014 to autumn 2015.
Building of The Lanarkshire Beatson commenced and is well underway with opening of
the service scheduled for December 2015 when 2 linear accelerators will be operational.
The project has progressed without incident, on time and is within planned budget.
•
Systemic Anti-Cancer Therapy: Chief Executive Letter (30) was published in 2012 that
sets out a mandatory programme of peer review across NHS Scotland. Six reviews were
undertaken in 2014/15 with a further seven scheduled for 2015/16. The outcomes of
these reviews demonstrate high levels of compliance.
Planning is ongoing with the supplier for the regional e-prescribing system around future
upgrade of the system. It is planned that the migration to version 5.3.4 will take place in
July 2015. With the appointment of a data analyst, routine and ad hoc reporting
commenced and will be used to inform planned work around future service delivery
model(s) that will be taken forward in 2015/16.
The national Patient and Clinician Engagement process has been established with
clinical input to these meetings managed regionally. Good representation by WoS
clinicians has been achieved.
Managed entry of new drugs continues to be supported by the Regional Prescribing
Advisory Subgroup. Guidance issued to Area Drugs and Therapeutics Committees has
been accepted and implemented. An estimate and analysis of predicted costs of cancer
medicines for WoS NHS Boards for 2015/16 based on Forward Look has been prepared.
Comprehensive CMGs for all main tumour types have been maintained in conjunction
with regional/national MCNs.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
5
•
Acute Oncology: Significant work continues to be progressed by local NHS Boards.
All 4 WoS NHS Boards now participate in the national 24 hour telephone triage model in
conjunction with NHS 24. The BWoSCC participates during out of hours only, operating
its own internal system during working hours. An expert clinical group has been
established to oversee and manage clinical policies and protocols.
Regionally, Guidelines for Investigation, Diagnosis and Management of Metastatic
Malignancy of Undefined Primary Origin have been agreed. NHS Forth Valley is an early
implementer site.
Quality
WoSCAN continues to lead delivery of the national cancer QPI programme. The
development phase of the programme is now complete and national reporting of
performance has commenced. The focus is now moving to updating of the indicators that
have been developed, commencing with Breast QPIs in the latter part of 2015.
Reporting performance against national QPIs is a mandatory requirement for NHS Boards
and the Network will continue to work closely with NHS Boards to take this work forward.
QPIs are demonstrating that they drive quality improvement and efficiencies in care
provision. Annual comparative reports have been compiled for all of the main cancer types
and are publically available on the WoSCAN internet site www.woscan.scot.nhs.uk.
Transforming Care After Treatment
Four phase 1 bids were submitted and approved and work has been undertaken to develop
detailed project plans. These bids relate to breast cancer (x2 projects); urological cancer and
lung cancer follow up. In phase 2, 8 bids have been successful. These focus on bids
developed in conjunction with local authority and primary care partners and look at issues,
such as, employability, cancer care reviews, cognitive impairment, and the use of holistic
needs assessment.
A regional Learn and Share Event is planned for 23rd September 2015.
Cancer Managed Clinical Networks and Specialty Networks
MCNs play a significant part in Network activity and work alongside the Cancer Research
Network. Our MCNs (10 regional and 3 national) are the source of ‘expert’ clinical opinion
from which the Network draws its advice on a wide range of service issues including clinical
guidelines, treatment options and optimal service configuration. MCNs adopt an evidenced
based approach, adopting national guidance as their reference for determining quality
standards and pathways for cancer patients.
A wide range of developments have been initiated via regional and national MCNs during
2014/15. The main focus of these developments has been on improving access, quality and
the safe delivery of cancer care across the region. Some examples of the work undertaken
are noted below with others detailed within the body of this report:
•
Work to improve access to clinical trials is ongoing. In conjunction with the Scottish
Cancer Research Network clinical trials maps have been refreshed for haemato-oncology
to ensure ready access to current trial information for frontline staff.
•
Review and updating of regionally agreed consensus follow up guidelines has
commenced. During 2015/16 further work will be undertaken to ensure that innovative
models of stratified follow up care are fully implemented in practice.
•
Updating of service maps, setting out key points of service delivery and the
interconnections between them for all main cancers.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
6
•
A broad range of regional policies, guidelines and protocols have been reviewed and
updated. These underpin the effective, safe delivery of cancer care.
•
A programme of regional and national educational meetings has been delivered and has
contributed to continuing professional development while strengthening clinical
networking. Clinical engagement with the MCNs continues to be effectively maintained
despite increasing pressure on clinical time. These meetings also afford the opportunity
to review performance data, providing assurance about the quality of care delivered
across the region.
•
MCNs continue to actively participate in the National Cancer Quality Programme,
identifying areas of compliance with nationally agreed QPIs and areas where
improvement is required. All MCNs and are involved in driving forward service
improvements in conjunction with constituent NHS Boards.
•
Multidisciplinary team meeting reconfiguration (Regional Skin Cancer and Regional Head
and Neck Cancer) and review/refresh of operational policies.
Each MCN has a clear work plan in place and reports annually to the RCAG. Detailed activity
and audit reports for each MCN are publically available on the WoSCAN internet website.
Patient Experience and Involvement
National Patient Experience QPIs have been developed and implemented. Targeted activity
is being undertaken within each NHS Board to complement work already underway looking
at performance against cancer specific QPIs.
Patients and carers continue to play an important role in our regional work and their input is
welcome. Involvement in key regional work streams has been successfully achieved with a
number of active participants. Their input has been invaluable to shaping the delivery of the
work programme.
A national patient experience survey will be undertaken in the latter half of 2015/16, the
results of which will inform future work.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
7
2. Managed Clinical Networks
2.1 Breast Cancer
Clinical Lead
MCN Manager
Ms Iona Reid
Tom Kane
In 2013 approximately 2,313 new cases of breast cancer were captured by audit within the
West of Scotland (WoS). The Breast Cancer Managed Clinical Network (MCN) continues to
support and develop the clinical service for these patients and at present there are 8 breast
cancer multi-disciplinary team (MDT) meetings across the region, where a range of health
care professionals discuss the care of breast cancer patients.
Regional Clinical Audit
The MCN took part in a national audit meeting in February 2015, providing information to the
meeting on how the network is working to achieve the national cancer quality performance
indicators (QPIs). The 2013 regional clinical audit report was published in January 2015 and
is available on the West of Scotland Cancer Network (WoSCAN) internet website.
Regional Service
The high-level regional service map of breast cancer service provision was reviewed during
2014: the updated baseline position identifies the points at which services are delivered, the
service components available at each, and the connections between these points which
represent the referral pathways for access to specialist services.
Transforming Care After Treatment
Transforming Care After Treatment is a national programme, supported by Macmillan Cancer
Support. The MCN is working on 2 projects in different parts of the WoS; looking at reviewing
the information provided to general practitioners (GPs)/ patients after their treatment and
looking at a questionnaire for patients having follow up of their breast cancer. This work will
continue in 2015/16.
Detect Cancer Early
The MCN has performed a supporting role to this national programme. The Detect Cancer
Early Staging Data report published by the Scottish Government in 2014 indicated that there
was a 4.3% increase in the percentage of people diagnosed at an early stage of cancer
(stage 1) for breast, colorectal and lung cancer (combined).
Sentinel Node Biopsy
Following a national review of the management of the axilla following sentinel node biopsy in
breast cancer, the MCN has developed a clinical guidance document for use by doctors and
nurses in the WoS.
Recommended use of Mammograms after Pulmonary Thromboembolism
Following the publication of a document from the National Institute for Health and Care
Excellence in England, the MCN discussed the implications for patients in the WoS and
thereafter developed a clinical guidance document for use by doctors and nurses in the WoS.
Guideline Development and Review
Clinical management guidelines (CMGs) are important to ensure that patients are receiving
what is agreed by clinical experts to be the most up to date treatment. The CMG for breast
cancer has been updated.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
8
Immediate Breast Reconstruction
The MCN has been involved in a review of access to and uptake of immediate breast
reconstruction. Work is ongoing with the WoS Regional Planning Group.
Family History
MCN members contributed to the Familial History Breast Cancer Report (Healthcare
Improvement Scotland) which each of the NHS Boards in the WoS will take forward locally.
Education
The MCN continues to deliver education events which are well received by a large multidisciplinary audience. The event in November 2014 focussed on the Family History Report.
2015/16 Priorities
•
•
•
•
•
•
Review the service map;
Participate in the Transforming Care After Treatment projects in the WoS;
Review the Breast Cancer Follow Up Guidelines;
Contribute to the Regional Planning Group work on immediate breast reconstruction;
Support regional and national educational events; and
Support the delivery of the regional clinical audit work programme to ensure that the data
gathered is used effectively in order that care is provided safely and equitably across the
region.
2.2 Colorectal Cancer
Clinical Lead
Network Manager
Professor Paul Horgan
Kevin Campbell
Approximately 1,650 new cases of colorectal cancer present in the WoS each year and
around one third of these are rectal cancers requiring consideration for neo-adjuvant
oncology treatment. Colorectal cancer services in the WoS are organised around 7 local
MDTs.
The Colorectal Cancer MCN strives to deliver continuing quality improvement in clinical
treatment and care, demonstrated through: improved operational efficiency, clinical
effectiveness and patient outcomes. The MCN work plan for the year addressed the
following key areas.
Regional Clinical Audit
Service performance was reviewed against the national QPIs for colorectal cancer for the
first time this year. Results for WoS Boards were collated with those from other Scottish
Boards and presented at a national MCN event in Perth. Individual QPI results were
considered and reasons for non-compliance with indicated targets were discussed; a formal
report of the output from the process, including any specific actions, is being prepared. MCN
members contributed to the baseline review process for the QPIs and recommendations for
refinement of a number of the assessments has been produced.
Guideline Development and Review
A review of the regional CMG for colorectal cancer has been undertaken. The revised
guideline having been reviewed by the Regional Prescribing Advisory Subgroup is being
further revised to reflect recently issued guidance.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
9
Regional Service
The high-level regional service map of colorectal cancer service provision was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services.
Education
The MCN convened an education meeting in April 2014 focussed on the management of
early disease; bowel screening, diagnosis and staging, colonoscopy and polyp cancers.
Transforming Care After Treatment
The Advisory Board has been made aware of proposals being developed in support of the
Transforming Care After Treatment Programme. A further update on progress will be
provided through the MCN education programme.
Profiling of Interval Cancers
MCN clinical audit data contributed to work undertaken to try to describe the characteristics
of this patient group and identify the discriminators which determine their presentation.
Priorities for 2015/16
Objectives for 2015/16 are aligned with regional and national emphasis on improved quality
of care and effective and efficient systems of delivery. The MCN will complete the review of
the Colorectal Cancer CMG and will also review the regional guidance on management of
follow up. The MCN will contribute to the first national report of performance utilising the
QPIs. An education meeting is being planned for April, topics will include radical resection
and hyperthermic intraperitoneal chemotherapy for colorectal cancer peritoneal metastases,
the relationship between inflammation and cancer and transforming care after treatment.
2.3 Gynaecological Cancer
Clinical Lead
Network Manager
Dr Nadeem Siddiqui
Kevin Campbell
Approximately 840 new gynaecological cancers present each year in the WoS: 290 ovarian,
310 endometrial, 170 cervical and 70 vaginal/vulval. Provision of gynaecological cancer
services in the WoS is organised around a single regional MDT which meets weekly. This
meeting is supported by video-conferencing technologies to facilitate specialist input to the
discussion and planning of the treatment and care of all patients presenting across the
region.
The MCN strives to deliver continuing quality improvement in clinical treatment and care
demonstrated through improved operational efficiency, clinical effectiveness and patient
outcomes. The MCN work plan for the year addressed the following key areas.
Regional Clinical Audit
The MCN continues to use Quality Improvement Scotland Standards and regionally defined
key outcome measures to assess and compare service performance. National clinical audit
data sets for endometrial and cervical cancers have been developed, aligned to
measurement of the new national QPIs. The data sets were implemented on 1st October
2014.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
10
National Quality Performance Indicator Development
MCN members have this year participated in the development of national QPIs for the
management of both endometrial and cervical cancers; these were published in September
2014 and audit data collection commenced the following month.
Regional Service
The high-level regional service map of gynaecological cancer service provision was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services.
Guideline Development and Review
The regional guidelines for follow up management have been reviewed and a number of
revisions were made, which have the overall effect of reducing activity regionally. The
guidelines are now being finalised in preparation for presentation to the Regional Cancer
Clinical Leads Group.
Education
The first education event of the year, in May, focussed on local implementation of enhanced
recovery after surgery, with additional presentations on the epidemiology of gynaecological
cancer in the WoS and also pain management. The October event was utilised to facilitate
wide clinical engagement in the review of MCN follow up guidelines.
Transforming Care After Treatment
The Advisory Board has been made aware of proposals being developed in support of the
Transforming Care After Treatment Programme. A further update on progress will be
provided through the MCN education programme.
Implementation of the Regional Ovarian Cancer Service Model
The fifth consultant post has now been successfully filled; this reflects the commitment of the
agreed Regional Surgical Service Model for Ovarian Cancer. Additional theatre time
provision and reconfiguration of clinics is further required to maximise the benefits of this full
complement of personnel.
Priorities for 2015/16
Objectives for 2015/16 are aligned with regional and national emphasis on improved quality
of care and effective and efficient systems of delivery. Data will be available in this coming
year to facilitate assessment of services utilising the national QPIs for ovarian cancer; data
for endometrial and cervical will become available in 2016. The MCN will continue to promote
development and further refinement of local enhanced recover after surgery programmes
utilising opportunities to share learning and experience to support this. Following publication,
the MCN will work with local teams to support introduction of the revised regional follow up
guidelines.
2.4 Haemato-Oncology
Clinical Lead
Network Manager
Dr Mark Drummond
Heather Wotherspoon
The Haemato-oncology MCN continues to support and develop the clinical service for
patients with haematological cancer across the 5 NHS Boards in the WoS (NHS Ayrshire and
Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Greater Glasgow and Clyde
(NHSGGC) and NHS Lanarkshire). The effective management of haemato-oncology patients
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
11
throughout the region continues to rely on organised and effective MDTs which complement
the well established Regional Haemato-oncology MDT. Ongoing development and update of
CMGs and other clinical guidance continue to drive consistency of practice throughout the
region. The Haemato-oncology MCN has successfully progressed a number of priorities
identified in the 2014/15 work plan.
Regional Clinical Audit
A comprehensive clinical audit report assessing compliance with regional CMGs and
reporting performance in both lymphoma and acute leukaemia against key outcome
measures was issued to NHS Boards in November 2014. The results demonstrate that
patients with haematological malignancies in the WoS continue to receive a consistent high
standard of care.
Quality Performance Indicator Development for Lymphoma and Acute Leukaemia
Lymphoma and acute leukaemia QPIs were implemented in October 2013 and July 2014
respectively. The first audit report of lymphoma QPI data is scheduled for publication in
March 2015.
Regional Service Map
The high-level regional service map of haemato-oncology service provision was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services.
Multi-disciplinary Team Working
The 7 local MDTs held across the WoS continue to complement the function of the regional
haemato-oncology MDT. The MDT referral templates for the different haematological
malignancies have been updated to facilitate the regional MDT meetings and, where
applicable, have been aligned to the published QPIs.
Guideline Development and Review
The MCN continues to focus on the development and update of CMGs and clinical guidance
documents and this remains a core component of MCN activity. Twenty-one CMGs are
currently available covering all the major types of haematological malignancies. Two clinical
guidance documents are also available and a further 2 are under development.
Blood Cancer Diagnostics
The Molecular Diagnostics Subgroup, established in February 2014, continues to strive
towards improving the efficiency of the diagnostic process and streamline testing.
Strengthen and Support Haemato-oncology Clinical Trial Activity
The Haemato-oncology MCN Clinical Trials Subgroup, established in June 2013, continues
to strengthen and support haemato-oncology clinical trial activity across WoSCAN. Diseasespecific maps of open clinical trials in WoS are updated regularly and major forthcoming trials
and areas of priority are identified to facilitate early set-up of studies. Representatives from
paediatric haematology and the bone marrow transplant team have recently joined the
subgroup.
Collaborative Working
The MCN continues to work with the WoS Pharmacy Cancer Network to progress a number
of medicines governance actions. MCN members have also worked with the Regional
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
12
Systemic Anti-Cancer Therapy Executive Group to produce an amendment to the
Hydroxycarbamide Shared Care Protocol to include sun care advice.
2015/16 Priorities
The MCN is currently developing objectives for 2015/16. A number of objectives will be
carried over from this year as guideline and protocol development, blood cancer diagnostics,
clinical trial activity and clinical audit continue as priorities in the work plan.
2.5 Head and Neck Cancer
Clinical Lead
Network Manager
Mr Stuart Robertson
Heather Wotherspoon
The Head and Neck Cancer MCN continues to support and develop the clinical service for
approximately 600 head and neck cancer patients per annum across the 4 WoS NHS
Boards. The effective management of these patients continues to rely on coordinated
delivery of treatment and care that requires close collaboration of professions from a range of
specialties. During the course of this year, the Head and Neck Cancer MCN reprioritised its
work to focus on MDT reconfiguration. Whilst a number of objectives have been successfully
progressed, some have been carried over to next year’s work plan as a result of this shift in
focus.
Regional Clinical Audit
A comprehensive clinical audit report was issued to NHS Boards in February 2015 reporting
performance against 8 key outcome measures. The results demonstrate that patients with
head and neck cancer in the WoS continue to receive a consistent high standard of care.
Head and Neck Cancer Quality Performance Indicator Development
Head and neck cancer QPIs and associated dataset have been effective for patients
diagnosed from the 1st April 2014. A head and neck cancer training event and 9 month
dataset review took place in February 2015. The first report of the head and neck cancer
QPI data will be presented at a national education event in December 2015.
Regional Service Map
The high-level regional service map of head and neck cancer service provision was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services.
Guideline Development and Review
The Head and Neck Cancer Follow Up Consensus Guideline is currently being reviewed and
updated. The MCN propose to develop a follow up imaging guideline which will be closely
related to this work.
Human Papilloma Virus Testing
Establishment of human papilloma virus testing in oropharyngeal cancer patients has
become an important prognostic factor in the management and treatment of these patients.
As of 1 April 2014, molecular human papilloma virus typing of all oropharyngeal squamous
carcinomas diagnosed in Scotland has been performed at the Scottish Human Papilloma
Virus Reference Laboratory.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
13
Oral Rehabilitation Pathway
The regional pathway for oral screening of patients with a new diagnosis of head and neck
cancer prior to any treatment was endorsed at the Regional Cancer Clinical Leads Group
meeting in June 2014 and has been implemented in 3 of the 4 WoS Boards.
Audit on the Management of Malignant Salivary Gland Carcinomas
This retrospective audit is being undertaken with a view to developing a standardised
management approach. Data has been collected and is currently being analysed. Findings
will be presented within the next 4 - 6 months.
Optimal Treatment Pathway for the Management of Osteoradionecrosis
A short-life working group has recently been established to take this work forward and the
first meeting took place on 24th February 2015.
Implementation of Regional Multi-Disciplinary Team Meeting Proforma
The final version of the regional MDT meeting proforma has been circulated to the MDT
chairs and co-ordinators of the North Glasgow and Ayrshire MDT and the Lanarkshire and
Forth Valley MDT for local implementation.
Multi-disciplinary Team Configuration across the West of Scotland
The MCN has recently concluded a consultation period on MDT reconfiguration across WoS
to support delivery of the strategic plan for consolidation of diagnostic, allied health
professionals, nursing and surgical teams for head and neck cancer on the South Glasgow
hospital site in July 2015. The proposal to move to a 2 MDT option will be taken to the
Regional Cancer Advisory Group for final approval in March 2015.
Priorities for 2015/16
The MCN is currently developing objectives for 2015/16.
A number of objectives will be
carried over from this year but MDT reconfiguration is likely to remain a key focus of MCN
activity in the coming year.
2.6 Lung Cancer
Clinical Lead
Network Manager
John McPhelim
Tracey Cole
In 2014 approximately 2,700 new cases were captured by audit within the WoS (2,612 lung
cancers and 95 malignant pleural mesothelioma). The Lung Cancer MCN continues to
support the development of clinical services for patients. Currently there are 7 lung cancer
MDT meetings held each week across the region.
Regional Clinical Audit
Effective utilisation of audit data to support service improvement is a key objective of the
Lung Cancer MCN. During 2014, analysis of performance and quality was against the
national QPIs providing the opportunity for national, as well as regional comparison of
results. Overall performance in the WoS was satisfactory against these measures, however,
there remains room for improvement in some areas. The National Lung Cancer QPI report
will be published later this year by Information Services Division and will be available on their
website.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
14
Education
The MCN continues to support education events and provide an opportunity for members
from all specialties to engage with colleagues from across the region. The November 2014
event provided a varied programme, presentations were from nursing, oncology, and
radiology members of the MCN, and also a local authority partners. Also, the regional QPI
results were presented and discussed.
Malignant Pleural Mesothelioma
Following the launch of the monthly regional mesothelioma MDT meeting, work was
undertaken to review the referral pathway and documentation used when submitting patients
for discussion. A regional referral process and pro forma is now in place and has been
distributed across the region.
Regional Imaging Guideline
Work was initiated to refresh the Lung Cancer MCN Regional Imaging Guideline, this is being
finalised and will be issued as soon as possible.
Regional Follow Up Guidance
The Lung Cancer MCN Regional Follow Up Guidance was subject to planned review during
2014 and was deemed to be extant guidance. However whilst undertaking the review it was
agreed that further work should be carried out to look at the evidence available since the
guidance was launched to formally assess follow up activity and outcomes. The MCN will
progress this work in the 2015/16 work plan.
Regional Service Map
Work was undertaken to review the high-level map of lung cancer services in the WoS. The
updated baseline position describes the points of delivery, the service components available
at each point and the interconnections between these in regard to access to tertiary services.
Very minor modifications were made none of which had implications on service or resource.
Transforming Care After Treatment
On behalf of WoSCAN NHS Lanarkshire are participating in the first phase of the national
Transforming Care After Treatment Programme. The project is currently being implemented
in South Lanarkshire and will continue to be supported by the MCN in the coming year.
2015/16 Priorities
•
•
•
Assess lung cancer follow up activity and outcomes across the WoS.
To continue to support the implementation of the Transforming Care After Treatment
Programme bid in NHS Lanarkshire with a view to regional implementation in the future.
Addressing deficiencies in achievement of QPIs targets during 2013.
2.7 Skin Cancer
Clinical Lead
Network Manager
Dr Mark Darling
Tom Kane
In 2013 approximately 568 cases of malignant melanoma were captured by audit within the
WoS. The Skin Cancer MCN continues to support and develop the clinical service for these
patients and has made progress and delivered a number of key objectives.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
15
Guideline Development and Review
Development and updating of CMGs remains a core component of network activity. The
Squamous Cell Carcinoma CMG is currently being reviewed. The Malignant Melanoma CMG
is nearing completion.
Regional Follow Up Guidelines
The regional follow up guidelines for the 3 skin cancers were issued to the NHS Boards in
October 2011. A review has now commenced for squamous cell carcinoma and basal cell
carcinoma follow up. It is expected that new national guidance for malignant melanoma will
be published in 2015 and a review of malignant melanoma follow up will take place at that
point. Advisory Board members from across all WoS NHS Boards have confirmed that they
are broadly adhering to the current guidelines. The MCN is also working on an additional skin
cancer follow up guideline for patients who have had transplants.
Regional Service Map
The high-level regional service map of skin cancer service provision was reviewed during
2014, the updated baseline position identifies the points at which services are delivered, the
service components available at each and the connections between these points which
represent the referral pathways for access to specialist services.
Regional Skin Cancer Multi-Disciplinary Team Working
MDT meetings provide an opportunity for a range of specialities involved in the care of
patients with cancer to discuss the best treatment options. The MCN has been leading a
review of the configuration of the Regional Skin MDT. A range of measures have been
introduced which has enabled the Regional Skin MDT to work more effectively. This work is
ongoing.
Quality Performance Indicator Development
QPIs for malignant melanoma were developed by a national group, which has representation
by network members. The malignant melanoma QPIs were published in June 2014.
Following publication of the malignant melanoma QPIs, the Advisory Board have reviewed
and assessed their impact and agreed that QPIs will be a benchmark for future activity.
Transforming Care After Treatment
Transforming Care After Treatment is a national programme, supported by Macmillan Cancer
Support. The MCN is monitoring the Transforming Care After Treatment work in NHS Fife,
regarding their project to improve care for patients with skin cancer. The MCN will take
lessons learned in Fife into the WoS once the Transforming Care After Treatment work
completes.
Regional Clinical Audit
The 2013 clinical audit data report was published in September 2014 and is available on the
WoSCAN website. Action plans are being monitored through the Advisory Board.
2015/16 Priorities
•
•
•
•
•
Review the service map;
Support national educational events;
Continue to monitor the Transforming Care After Treatment work;
Review the CMGs and malignant melanoma follow up;
Support the delivery of the regional clinical audit work programme to ensure that the
data gathered is used effectively in order that care is provided safely and equitably
across the region; and
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
16
•
Support the continuing improvements in the Regional Skin MDT.
2.8 Upper Gastro-Intestinal Cancer
Clinical Lead
Deputy Clinical Lead
MCN Manager
Mr Matthew Forshaw (September 2014 onwards)
Mr Chris Shearer (March 2014 until August 2014)
Tracey Cole
The Upper Gastro-Intestingal (GI) Cancer MCN continues to support and develop the service
for patients with oesophago-gastric cancer, at present there are 4 upper GI cancer MDTs in
the region. The 2013 WoSCAN audit data indicates that, in total, there were 725 oesophagogastric cancer diagnoses in the region, 476 of which were oesophageal cases and 249
gastric cases.
Regional Clinical Audit
Effective utilisation of audit data to support service improvement is a key objective of the
Upper GI Cancer MCN. 2014 was the first year of analysis using the national QPIs which
provided the opportunity to analyse and present data with not only a regional, but a national,
comparison of results. Overall performance in the WoS was satisfactory against these
measures, however, there remains room for improvement in some areas. The National
Upper GI Cancer QPI report was published in February by Information Services Division and
can be found on the Information Services Division website.
Survival Analysis
In 2013 the WoS Cancer Surveillance Unit began examining hospital readmissions and
survival by NHS Board across the MCN. Initial analysis was carried out on the data of
patients diagnosed between January 2006 and December 2011, initial results showing that
data capture across the region was variable and demonstrated that unadjusted survival
across the WoS did not raise any concerns. The analysis was extended to include the data
of patients diagnosed during 2012, and to show the effects, if any, on survival of the following
factors - surgical volume, hospital of treatment, outcomes of oncological treatment, and
readmission rates. Final analysis of this data is currently being written up by the WoS
Cancer Surveillance Unit.
Regional Service Map
Work was undertaken to review the high-level map of upper GI cancer services in the WoS.
The updated baseline position describes the points of delivery, the service components
available at each point and the interconnections between these in regard to access to tertiary
services. Very minor modifications were made none of which had implications on service or
resource.
Early Disease Surveillance
Following on from the successful implementation in NHS Forth Valley of a surveillance
programme for patients with early disease, members of the MCN have been working
together with the long term aim of having a regional model for optimal management of these
patients.
A short life working group was formed with representation from all NHS Boards in the WoS.
The group drafted a proposed optimal surveillance model which was developed in line with
the British Society of Gastroenterologists Guidance published in November 2013. This
model is with local NHS Board Endoscopy Users Groups with a view to becoming an
eventual regional model. The MCN will continue to support this work.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
17
Education
WoSCAN hosted a very successful national event in Glasgow in October 2014. It was well
attended by professionals from the 3 regional cancer networks, and received extremely
favourable feedback. The morning session concentrated on the QPI analysis and the
national comparisons, with the afternoon providing an education and development session.
2015/16 Priorities
•
•
•
Working both regionally and nationally, address deficiencies in achievement of QPI
targets during 2013.
Re-evaluate the diagnostic pathways for oesophageal cancer throughout the WoS to
identify any potential variance that may exist and address QPI performance below
national targets.
Continuation of working towards establishing an optimal regional model of early disease
surveillance.
2.9 Urological Cancer
Clinical Lead
Network Manager
Mr Gren Oades
Tom Kane
In 2013 there were approximately 2,600 new urological cancers captured by audit within the
WoS. The incidence of urological cancers in Scotland is increasing and national figures
suggest that prostate cancer is the most common cancer in men. The Urological Cancers
MCN continues to support and develop the clinical service for these patients.
Regional Clinical Audit
The Clinical Audit Report demonstrates the key findings of the 2013 clinical audit and is part
of the process to ensure that areas where improvement can be made are taken forward. The
Clinical Audit Report is available on the WoSCAN internet site.
National Cancer Quality Performance Indicators
MCN members have been involved in the development of the QPIs. In the last year QPIs for
testicular cancer were published. The network members will work to ensure that the QPIs are
effectively implemented.
Enhanced Recovery After Surgery
Enhanced recovery after surgery is a way of ensuring that patients are well prepared for their
surgery and are able to go home quickly after surgery to recuperate. The enhanced recovery
after surgery pathway has been completed and circulated to support local implementation
within the NHS Boards in the WoS.
Regional Service Map
The high-level regional service map of urological cancers service provision was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services.
Transforming Care After Treatment
Transforming Care After Treatment is a national programme, supported by Macmillan Cancer
Support. The MCN is supporting a local development project group to further develop
community based prostate cancer care in NHS Forth Valley.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
18
Guideline Development and Review
CMGs are important to ensure that patients are receiving what is agreed by clinical experts
to be the most up to date treatment. The MCN has reviewed 2 CMGs for prostate cancer and
updated the kidney and the testicular CMGs. The Penile Cancer CMG review is nearing
completion. A new CMG has been created for kidney patients whose cancer has stayed
within the kidney itself (non metastatic). The MCN is currently working to complete an
additional CMG for patients with prostate cancer who have issues with their bone health.
Developments in Prostate Surgery
The MCN is supporting the regional review of how patients who require prostate cancer
surgery are treated and how they may be treated in future. This work will continue into
2015/16.
Education
The MCN continues to deliver an annual education event which is well received by a large
multi-disciplinary audience.
2015/16 Priorities
•
•
•
•
•
•
•
Review the service map.
Continue with the review of CMGs.
Review the follow up regional guidelines for bladder and prostate cancers.
Support the annual regional educational event.
Continue to support the Transforming Care After Treatment development project in NHS
Forth Valley.
Review current surgical practice for prostate cancer.
Support the delivery of the regional clinical audit work programme to ensure that the data
gathered is used effectively in order that care is provided safely and equitably across the
region.
2.10 National – HepatoPancreatoBiliary
National Clinical Lead
Regional Clinical Lead
National MCN Manager
Prof Steve Wigmore
Mr Euan Dickson
Lindsay Campbell
Clinical Audit
The 2013 clinical audit was analysed and presented at the 23rd January 2015
HepatoPancreatoBiliary (HPB) Education Event in Glasgow and the audit report was
published 18th March 2015. The 4 NHS Board actions identified from the 2012 clinical audit
were completed while the 2 MCN actions are in progress and now include the 2013 results.
Guideline Development and Review
The Scottish CMG for cancer of the gallbladder/biliary tree is completing its review with
implementation expected April 2015 while the guideline for hepatocellular carcinoma is in
review.
The review of the Glasgow MDT operational policy is in progress with
implementation expected April 2015 while the review of the follow up guideline is in progress.
National Education Events
The MCN held its successful education event in Glasgow on 23rd January 2015. The second
surgical mortality and morbidity review was held on 25th March 2015 in Edinburgh.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
19
Enhanced Recovery After Surgery
An Enhanced Recovery After Surgery Pathway for the Surgical Management of Patients with
Pancreatic Cancer is being extended to Dundee, Aberdeen and Inverness. An Enhanced
Recovery After Surgery Pathway for liver cancer is developing in Edinburgh.
Transforming Care After Treatment
Dr Angela Edgar and Dr Jeff White are the co-leads for a national phase 2 project to develop
end of treatment summaries for teenagers and young adults with cancer. Sandra White
presented an update on the national programme at the education event in Glasgow.
Multi-Disciplinary Team Working
The MCN will continue to optimise effectiveness and efficiency of MDT review meetings by
continuing improvements identified in 2013/14. The Glasgow MDT has improved with
hepatocellular carcinoma (liver cancer) patients managed on Wednesday mornings and
pancreatic/biliary cancer patients managed on Thursday mornings. The Aberdeen, Dundee
and Inverness MDTs meet weekly and the North of Scotland MDT meet monthly. The
Edinburgh MDT has improved real time communication through the TrakCare application.
National Service Map
The high-level service map of HPB cancers service provision in the WoS was reviewed
during 2014, the updated baseline position identifies the points at which services are
delivered, the service components available at each and the connections between these
points which represent the referral pathways for access to specialist services. This work is
being expanded to the North and South East of Scotland. Selective internal radiation therapy
is available from the Edinburgh centre and the MCN website describes how to refer patients.
Patient Pathway
Building on the achievements of 2013/14, the MCN continue to develop and implement an
HPB cancers patient pathway in each Board: NHS Ayrshire and Arran, NHS Forth Valley and
NHS Lanarkshire are developing pathways based on the NHSGGC Pathway.
Ongoing Work
•
•
•
Guidelines: The Scottish Referral Guidelines for Suspected Cancer were reviewed
through the National Detect Cancer Early Programme and published in August 2014,
recommending GPs have direct access to computed tomography as well as X-Ray and
ultrasound.
Acute Oncology: The Inverness oncologist has retired and the Aberdeen oncologists are
covering until a permanent replacement is in post.
Clinical Trials: 3% of patients participated in clinical trials during 2013/14 (7%, 7%, 5%
and 6% in previous years) and work continues to expand the number of and participation
in HPB clinical trials across Scotland.
2015/16 Objectives
Support of the HPB clinical audit programme, guideline development and review, support of
the Enhanced Recovery After Surgery Programme, support of the Transforming Care After
Treatment Programme, national education events and service maps are core objectives
which will be taken forward in 2015/16 for the Scottish HPB Cancer MCN.
In addition, the Scottish HPB Cancer MCN will continue to support MDT meetings and the
development/review of the NHS Board-level HPB cancer patient pathways.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
20
2.11 National – Sarcoma
National Clinical Lead
Regional Clinical Lead
National MCN Manager
Dr Jeff White
Dr David Ritchie
Lindsay Campbell
National Cancer Quality Performance Indicators
Sarcoma QPIs were implemented on 1st April 2014, reviewed after 9 months of data capture
and the first year’s performance is planned to be reported on 18th December 2015.
Guideline Development and Review
The Scottish Sarcoma MDT Operational Policy was updated in September 2014.
guidelines for pathology and follow up are being reviewed.
The
National Education Events
The MCN held 3 successful education days in Dundee, Glasgow and Edinburgh, along with
members participating in the British Sarcoma Group conference in Nottingham.
Transforming Care After Treatment
Dr Angela Edgar and Dr Jeff White are the co-leads for a national phase 2 project to develop
end of treatment summaries for teenagers and young adults with cancer. Sandra White
presented an update on the national programme at the education day in Glasgow.
Enhanced Recovery After Surgery
The Enhanced Recovery After Major Sarcoma Surgery Pathway is being developed in
Glasgow.
Multi-Disciplinary Team Working
The Scottish Sarcoma MDT meeting continues to improve with the 5 centres supporting each
other to sustain services. The coordination of the meeting is being piloted using a Glasgowbased electronic application. Analysis of the meetings during 2013 is in progress.
National Service Map
The high-level service map of sarcoma service provision in the WoS was reviewed during
2014, the updated baseline position identifies the points at which services are delivered, the
service components available at each and the connections between these points which
represent the referral pathways for access to specialist services. This work is being
expanded to the North and South East of Scotland.
Patient Pathway
Building on the achievements of 2013/14, the MCN continue to develop and implement a
sarcoma patient pathway in each Board: NHS Dumfries and Galloway implemented in July
2014; NHSGGC pathway is being developed based on electronic referrals (and includes the
Regional Musculoskeletal Oncology Diagnostic Pathway); NHS Ayrshire and Arran and NHS
Lanarkshire will develop pathways based on the NHSGGC pathway.
Positron Emission Tomography/Computed Tomography
The sarcoma guideline is being reviewed by the Positron Emission Tomography Short Life
Working Group.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
21
Ongoing Work
•
Cancer Waiting Times: An audit of performance against waiting times for patients with
primary sarcoma was undertaken by the 14 NHS Boards during 2014.
•
Clinical Trials: 15% of patients participated in clinical trials during 2013/14 (22%, 14%,
16% and 17% in previous years) and the Edinburgh centre lead is working with the Chief
Scientist Office to streamline approvals for all 5 centres.
•
Scottish Bone Tumour Registry: The sarcoma radiologists continue to utilise the Registry
to raise awareness among their NHS Board colleagues to support early detection and
NHS Board-level patient pathways. The Registry is aligned with the bio banks in the 5
centres to receive tissue and blood for future research.
•
Sarcoma Awareness Week: During the Sarcoma Awareness Week (June 2014) medical
students and foundation year doctors from across the United Kingdom were invited to
take part in an online educational module. One of the winners spent a week in the
Beatson West of Scotland Cancer Centre where they undertook an audit of WoS patients
with skin sarcoma that is supporting the development of clinical management guidelines.
•
Early Detection: The Bone Cancer Research Trust and the Royal College of General
Practitioners developed online training for bone cancers while Sarcoma UK and the
Royal College of General Practitioners are developing online training for soft tissue
sarcomas.
•
Guidelines: The Scottish Referral Guidelines for Suspected Cancer were reviewed
through the National Detect Cancer Early Programme and published in August 2014,
recommending GPs have direct access to computed tomography as well as X-Ray and
ultrasound.
•
Patient Experience: A survey of Scottish sarcoma patients was taken during March 2015
and is being analysed by Public Health England to compare with English and Welsh
sarcoma patient experience.
2015/16 Objectives
Support of the sarcoma clinical audit programme, guideline development and review, support
of the Enhanced Recovery After Surgery Programme, support of the Transforming Care After
Treatment Programme, national education events and service maps are core objectives
which will be taken forward in 2015/16 for the Scottish Sarcoma MCN.
The MCN will also continue the support of the MDT meetings and 5 centres, complete the
NHS Board-level sarcoma patient pathways, complete the audit of performance against
national waiting time standards and compare the patience experience survey.
2.12 National – Adult Neuro-Oncology
National Clinical Lead
Regional Clinical Lead
National MCN Manager
Dr Avinash Kanodia
Mr Jerome St George and Dr Allan James
Lindsay Campbell
National Cancer Quality Performance Indicators
The Brain/Central Nervous System Cancer QPIs were implemented on 1st January 2014,
reviewed after 9 months of data capture and the first year’s performance is planned to be
reported on 10th August 2015.
Guideline Development and Review
The Scottish guidelines for tumour related epilepsy management, epilepsy treatment and
genetics were updated in December 2014. The WoS MDT operational policy review is being
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
22
completed and expected to be published in April 2015. The guidelines for radiology are
being retired (as they are included in the CMG) and the guidelines for follow up are being
reviewed.
National Education Events
The MCN held its successful national meeting in Aberdeen on 31st October 2014.
Enhanced Recovery after Surgery
The patient diary component of an Enhanced Recovery After Surgery Pathway is being
tested in Glasgow for the surgical management of brain tumour patients.
Transforming Care After Treatment
Dr Angela Edgar and Dr Jeff White are the co-leads for a national phase 2 project to develop
end of treatment summaries for teenagers and young adults with cancer. The North of
Scotland Clinical Lead is planned to give an update on the national programme at the
national meeting in Inverness on 9th November 2015.
Multi-Disciplinary Team Working
The MCN will continue to optimise the effectiveness and efficiency of MDT review meetings
by continuing improvements identified in 2013/14. The Aberdeen and Inverness weekly
meeting is back to Thursdays while Aberdeen, Inverness and Edinburgh have monthly
meetings on Wednesdays.
National Service Map
The high-level service map of brain/central nervous system tumours service provision in the
WoS was reviewed during 2014, the updated baseline position identifies the points at which
services are delivered, the service components available at each and the connections
between these points which represent the referral pathways for access to specialist services.
This work is being expanded to the North and South East of Scotland.
Patient Pathway
Building on the achievements of 2013/14, the MCN continue to develop and implement a
brain/central nervous system tumours patient pathway in each Board: the NHS Forth Valley
pathway was reviewed after 3 years of operation; the NHSGGC pathway was implemented in
June 2014; NHS Ayrshire and Arran and NHS Lanarkshire will develop pathways based on
the NHSGGC pathway.
Ongoing Work
•
•
•
•
Supportive and Psychological Care: The Supportive and Psychological Care Subgroup
meet with the 3 brain/central nervous system charities in Scotland every 4 months to
improve joint working and collaborate on research.
Research: Professor Anthony Chalmers continues to Chair an annual research meeting
between the Scottish Adult Neuro-Oncology MCN and the Scottish Imaging Network.
GP Education: The 8 education videos for GP and optometrists on headache and
papilloedema are being offered to the Royal College of General Practitioners for online
training to raise awareness and promote early detection.
Guidelines: The Scottish Referral Guidelines for Suspected Cancer were reviewed
through the National Detect Cancer Early Programme and published in August 2014,
recommending GP have direct access to computed tomography as well as X-Ray and
ultrasound.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
23
•
Clinical Trials: 43% of brain/central nervous system tumour patients participated in
clinical trials in 2013/14 (33%, 22%, 5% and 8% in previous years).
2015/16 Objectives
Support of the adult neuro-oncology clinical audit programme, guideline development and
review, support of the Enhanced Recovery After Surgery Programme, support of the
Transforming Care After Treatment Programme, national education events and service maps
are core objectives which will be taken forward in 2015/16 for the Scottish Adult NeuroOncology MCN.
The Scottish Adult Neuro-Oncology MCN will also continue the support of the MDT meetings
and complete the NHS Board-level Brain/Central Nervous System Tumour Patient Pathways.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
24
3. Clinical Audit
The well established audit and clinical governance process for the West of Scotland Cancer
Network (WoSCAN) enables the assessment and comparison of performance and quality of
cancer services delivered across the region, aiming to systematically drive service
improvement and improve outcomes for cancer patients. The alignment of the regional
governance process with the national framework for the mandatory reporting of quality
performance indicators (QPIs) ensures timely reporting of regional analysis and requires
NHS Boards to develop local action/ improvement plans in response to areas of variance
highlighted through audit.
Data quality and completeness is excellent across the region facilitating outcome focussed
comparative analysis for 1 national and 9 regional cancer managed clinical networks (MCNs)
during 2014/15. MCN annual audit reports have been published for all tumour groups and
regional data has been submitted to Information Services Division for inclusion in national
reports for upper gastro-intestinal, lung and colorectal cancers. West of Scotland NHS
Boards have returned action/improvement plans in response to recommendations set out
within the reports and progress against these plans has been monitored by MCN advisory
boards and is documented within MCN activity reports.
WoSCAN continues to host eCASE (Electronic Cancer Audit Support Environment), a secure
web based database used to record cancer audit data for all tumour specific regional and
national cancer MCNs. Further developments during 2014/15 have facilitated the reporting
of QPI data via SQL Server Reporting Services. Standard reports have been created within
SQL Server Reporting Services to enable consistent and comparable measurement against
national QPIs. Additional functionality exists to enable ad hoc reports to be built by local
users to meet local reporting requirements.
2015/16 Priorities
Delivery of the regional clinical audit work programme and input to the national QPI reporting
programme remains a priority for the WoSCAN Information Team during 2015/16.
The regional analysis, reporting and action plan schedule for 2015/16 has recently
commenced. This year will see the reporting of performance against QPIs for 18 cancer
types, including sarcoma and brain/central nervous system cancer for the first time, with
Information Services Division scheduled to publish national reports for melanoma, head and
neck and urological cancer QPIs.
Additional priorities for 2015/16 are detailed below:
• Continue to support the regional implementation of cancer QPIs.
• Contribute to the national baseline review process for QPIs to ensure indicators continue
to drive quality improvement.
• Work with clinical and audit leads to assure compliance with national and regional
governance frameworks as detailed in Chief Executive Letter 06 (2012).
• Optimise the use of resources through the targeted collection and reporting of information
and the continued development of eCASE standard and ad hoc reporting via SQL Server
Reporting Services.
• Maximise the use of multiple sources of information to drive service quality and
improvement, assist capacity planning and assist in the identification of future priorities
(e.g. Chemotherapy Electronic Prescribing and Administration System, ARIA (electronic
radiotherapy information system) and Acute Cancer Deaths & Mental Health).
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
25
4. West of Scotland Pharmacy Cancer Network
Chair
Mary Maclean
The West of Scotland Pharmacy Cancer Network (WoSPCN) facilitates a co-ordinated and
collaborative approach to the planning and delivery of pharmaceutical care to cancer patients
across the west of Scotland. Members of the group also contribute to a range of multiprofessional groups at regional and national level and support the Managed Clinical
Networks (MCNs) and the Regional Cancer Advisory Group Prescribing Advisory Subgroup
(RPASG) to promote an equitable approach to the safe, clinical and cost effective use of
cancer medicines.
The main focus of the WoSPCN in 2014/15, in line with network strategy, was to support the
safe and effective use of systemic anti-cancer therapy (SACT).
Chemotherapy Electronic Prescribing and Administration System
Supporting and maintaining the Chemotherapy Electronic Prescribing and Administration
System (CEPAS) continued to be the key priority area. Local and regional resource
commitment was made to ensure the necessary clinical and pharmacy activities were
delivered to maintain ‘business as usual’ in the 4 WoS NHS Boards. The new regional senior
information analyst, appointed to develop and provide reports from ChemoCare®, is now well
established within the regional CEPAS team. Key activities over the year included:
• Ongoing maintenance of the regimen library in ChemoCare® including all SACT clinical
trials.
• Clinical support for implementation of the system at the Lorn & Islands Hospital in Oban
and Mid Argyll Community Hospital in Lochgilphead.
• Preparation for the next version including clinical test plans, a review of new functionality
and its impact on current local processes, regional configuration requirements and a
training strategy for implementation.
• Development and implementation of the governance framework and request process for
reports from ChemoCare®.
• Determined NHS Board reporting requirements and agreed priorities for routine standard
reports.
• A number of reports delivered in response to requests including SACT 30-day mortality
reports which are now routinely provided to all NHS Boards.
Regional Extravasation Guidelines
An extensive review and update of the regional extravasation guidelines, working with the
Cancer Nursing Forum, was completed. The final draft is currently out for wider consultation
with a view to final publication early summer 2015.
Chief Executive Letter (CEL) 30 (2012) Guidance for the Safe Delivery of SACT
WoSPCN members supported the regional audit programme by leading or participating in
audit teams assessing compliance with CEL 30 (2012) Guidance for the Safe Delivery of
SACT.
Access to New Cancer Medicines
The group continued to support consistent and equitable regional implementation of national
guidance on new treatments including:
• Delivering regular horizon scanning reports on new cancer medicines developments to
NHS Boards.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
26
• Preparation of SACT protocols to support implementation of Scottish Medicines
Consortium (SMC)/Healthcare Improvement Scotland advice.
• Continued to support local Board Individual Patient Treatment Request (IPTR) processes
through shared regional working on cancer medicine evidence briefings for IPTR panels.
2015/16 Priorities
• Ongoing clinical support for CEPAS including:
−
Testing and implementation of the next version of the software.
−
Operational support for clinical maintenance through collaborative working with NHS
Board lead cancer pharmacists, accountable pharmacists and clinical trial
pharmacists.
−
Using reports from ChemoCare® to develop a regional process to support regional
monitoring of cancer medicines utilisation.
−
Undertake a review of the current clinical support model, propose and test a new
service model to inform recommendations to the CEPAS Executive Group on a more
responsive and sustainable service.
• Support Board compliance with CEL 30 (2012) Guidance for the safe delivery of SACT
through:
−
Ongoing review, updates and development of regional SACT protocols and
supportive treatment guidelines.
−
Participation in the regional/national audit visits scheduled.
• Support timely access to new cancer medicines through:
−
Support to the MCNs and RPASG in response to cancer medicines advice accepted
by SMC.
−
Continue to deliver regular horizon scanning reports on new cancer medicines
developments to NHS Boards.
−
Support local Board IPTR processes through continued shared regional working on
cancer medicine evidence briefings for panels.
• Finalise the revised and updated extravasation guidelines, publish and support local
implementation.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
27
5. West of Scotland Cancer Nurses Group
Chair
Vice Chair
Mhairi Simpson
Sandra Campbell
Lead Nurses
Each Managed Clinical Network (MCN) has a lead nurse(s) who are members of the MCN
Advisory Boards and West of Scotland (WoS) Cancer Nurses Group. The group has met less
frequently during 2014/15 for a range of reasons; however the aim for 2015/16 is to schedule
meetings to coincide with Regional Cancer Clinical Leads Group meetings.
West of Scotland Cancer Network Extravasation Guidelines
These guidelines have been revised, a process involving WoS NHS Board nurses, and are
currently out for consultation with the WoS Cancer Nurses Group.
Acute Oncology
All 4 WoS NHS Boards are now involved in the National Cancer Treatment Helpline. The
Beatson WoS Cancer Centre has its own cancer treatment helpline (8am to 8pm, 7 days a
week) for all WoS patients being treated there which is working well (overnight only with the
National Cancer Treatment Helpline). Local models for acute oncology are currently being
developed across WoS NHS Boards including acute and primary care services.
Living with and Beyond Cancer / Transforming Care After Treatment
Members of the group are involved in both Phase 1 and Phase 2 projects. Projects involve
both cancer and generalist nurses in acute and primary care settings. In addition nurses are
involved in working with local authority and third sector colleagues to take the Transforming
Care After Treatment agenda forward. WoS NHS Boards are also developing local
approaches to delivering the Living With and Beyond Cancer agenda in addition to
Transforming Care After Treatment projects. Living With and Beyond Cancer was the focus
of the Sharing Practice Event 2014.
Sharing Practice Event 2014
This annual event was held in September and focused upon Living With and Beyond Cancer.
Topics included: acute oncology; end of treatment summaries; health and wellbeing events;
health and social care; transforming care after treatment; and end of life care. The
presentations generated discussion and debate resulting in the cancer nurses learning and
sharing across NHS Boards and tumour groups. A further event is scheduled for September
2015.
Chief Executive Letter 30 (2012) [Revised] Guidance for the Safe Delivery of Systemic
Anti-Cancer Therapy
Peer reviews have commenced and directly involve nurses from across the 4 WoS NHS
Boards. Nurses are involved in the preparation and review process at Board level in addition
to acting as peer reviewers.
6. Regional Systemic Anti-Cancer Therapy Executive Steering Group
Chair
Gail Caldwell
The Regional Systemic Anti-Cancer Therapy Executive Steering Group (RSESG) was
established in late 2012. The RSESG provides leadership and overarching governance for
systemic anti-cancer therapy services (SACT) in the West of Scotland (WoS). Membership
is multi-professional and includes the lead SACT clinicians from each of the constituent NHS
Boards. Work progressed during 2014/15 by the RSESG includes:
Chief Executive Letter 30 (2012) Implementation and Compliance
Chief Executive Letter 30 (2012) ‘[Revised] Guidance for the Safe Delivery of Systemic AntiCancer Therapy’, was published by the Scottish Government in July 2012. A governance
framework and audit tool was published by Healthcare Improvement Scotland, and a 3-year
programme of peer review audits began. There have been 7 audits undertaken to date in the
WoS, a further 5 will be carried out this year, and the remaining 4 will be completed in 2016.
There is a robust governance process surrounding the audits. Audit teams are multidisciplinary (an oncologist or haematologist, a nurse, and a pharmacist) and where possible
representation is spread across the 3 remaining WoS NHS Boards than those being audited.
Following each audit a full report is submitted to the RSESG secretariat for review and
distribution to appropriate NHS Board personnel (medical director, local SACT group,
director of pharmacy, nursing director, service manager, lead pharmacist, lead nurse), and
action plans are developed.
To date there have been no areas of concern uncovered only minor findings which seem to
be common across units. Audits will also be undertaken in the independent healthcare
setting, these will be led by Healthcare Improvement Scotland. Volunteers from the WoS will
assist with this process.
Systemic Anti-Cancer Therapy Future Delivery Models
Due to increasing cancer incidence and the introduction of novel diagnostic, and treatment,
technologies, there is a year on year increase in the demand for SACT by approximately 8%.
It is therefore recognised that there is a requirement to identify and establish alternative
models of service delivery for SACT. A successful workshop that had the backing of the 4
WoS NHS Boards was held on 5th February 2015 to initiate and plan the work required. It
was unanimously agreed that there is value in progressing work to address the future
delivery of SACT services at a regional level. It is proposed that a regional project is
undertaken over 18 - 24 months focussing on optimising current workforce, pathway
development, and treatment delivery. The Regional Planning Group will consider this
proposal in May 2015.
West of Scotland Extravasation Guidelines
The West of Scotland Cancer Network Extravasation Guidelines are undergoing full review
and revised guidelines will be published in due course. Whilst the review of the guideline is
being progressed, the group will continue to coordinate on-going maintenance and
development of drug monographs to ensure the most up to date advice is available.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
29
7. West of Scotland Primary Care Cancer Network
Clinical Lead
Network Management
Dr Rosalie Dunn
Margaret Welsh
The Primary Care Cancer Network has a pivotal role in the interface between primary and
secondary care. The steering group continues to meet twice a year; membership includes a
lead cancer general practitioner (GP) from NHS Ayrshire and Arran, NHS Forth Valley, NHS
Greater Glasgow and Clyde, NHS Lanarkshire and a range of other healthcare professionals
who work in the primary care setting and patient/carer representation. The Network
successfully made progress with number of priorities identified in the 2014/15 work plan,
some of which were aligned to national programmes of work.
Detect Cancer Early: Scottish Referral Guidelines
Network members have been active in the review of the Scottish Primary Care Cancer
Guidelines and the updated, published guidelines should help to identify those patients who
are most likely to have cancer and who therefore require urgent assessment by a specialist.
Equally, it is intended that the guidelines will help to identify patients who are unlikely to have
cancer and who may appropriately be observed in a primary care setting or who may require
non-urgent referral to a hospital.
National Bowel Screening Quality Outcomes Framework Initiative
Further detect cancer early work ongoing is around the delivery a 4.1% reduction in the
number of patients who do not participate in the national bowel screening programme.
Regionally a preliminary analysis of data has been undertaken in an attempt to link general
practice action plans and to determine which actions, if any, appear to promote increased
engagement. Locally, practices identified as making slow progress have been contacted and
asked to review their action plans in preparation for the submission of improvement detail at
the end of year 2 of this national workstream.
Transforming Care After Treatment
The 4 lead cancer GPs have been actively involved in local project steering groups and the
completion of the partnership applications for access to and release of funding to support
testing of new models of care for patients diagnosed with breast, lung and prostate cancer. In
December 2014 Dr Dunn had an Expression of Interest approved for a local development
project looking at the role of the practice nurse in the delivery of cancer care reviews.
Health Promoting Health Service
For many patients a diagnosis of cancer can provide motivation to improve their lifestyle to
optimise their survival and quality of life; thereby providing an opportunity for a teachable
moment. Work continued from last year looking at increasing access to health improvement
programmes and consideration now to be given to a plan for implementation and the training
required to support primary care teams to deliver health improvement opportunities to cancer
patients.
Psychosocial Support of Patients with Cancer
Members of the Psychosocial Reference Group, a subgroup of the Network, have been
actively involved in supporting transforming care after treatment local development projects.
Looking ahead to 2015/16, the chair of this subgroup is already working closely with the
regional TCAT clinical lead.
Primary Care Referrals and Performance Status
The steering group clinical members highlighted that functional ability and co-morbidities can
be hidden by patients when they attend secondary care for diagnostic investigations. Wide
clinical engagement was undertaken and a consensus was reached on the potential benefit
for patients and secondary care colleagues if this information was available at the point of
referral.
On behalf of the Network and the Regional Cancer Clinical Leads Group, a letter was issued
to the 4 lead cancer GPs to ask for discussions to be progressed locally with the relevant
staff and to take forward the implementation of inclusion of patient performance status in the
SCI Gateway referral template and it was noted to be timely because of the changes to
referral templates resulting from the revision of the Scottish Referral Guidelines.
Referrals for Family History Related Genetic Testing
Work was initiated by the Network in collaboration with the Regional Cancer Genetics
Service to explore how to reduce the number of unsuitable referrals coming forward to that
service. Consideration was given to what could help improve the quality of referrals and it
was agreed that the family history questionnaire would be shared with primary care
colleagues and could be completed and then accompany the referral. Consequently, the
periodic review of the primary care referral guidance document was brought forward to
include this change and the updated guidance has now been shared with primary care
colleagues across the region.
2015/16 Priorities
The Network is developing work plan objectives for 2015/16 and recognises that a number of
the work streams noted above will carry over for completion in the coming year.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
31
8. Scottish Cancer Research Network
Lead Clinician
Dr David Dunlop
Research Network Manager Chloë Cowan (until August 2014)
Post vacant at time of report
www.scrn.org.uk
Research Network Manager
As a result of promotion Chloë Cowan, Research Network Manager, left the Network in
August 2014. Due to re-structuring of this post, this position has not yet been replaced.
Karen Bell, Scottish Cancer Research Network (SCRN) Senior Research Nurse, is currently
taking forward and managing responsibilities of the Research Network Manager post.
Progress on National Infrastructure Changes
Following the review of NHS Research Scotland, as identified in the previous year’s report,
NHS Research Scotland has undergone restructuring and the Central Management Team
based at the Golden Jubilee National Hospital is now established. All Topic Research
Network and Speciality Group reporting will now be by means of this route and to facilitate
this, NHS Research Scotland Central Management Team have recently appointed a Network
Support Manager who will enable consistent handling of study metrics.
Quality Performance Indicators
This was the first year of reporting on national cancer Quality Performance Indicators (QPIs)
– “The Clinical Trials Access QPI”. Whilst the data for this QPI was being collated, issues
were identified in the way that this QPI was being reported. Following discussions between
the SCRN research network managers and cancer audit/information managers from each of
the cancer networks, amendments to the reporting guidelines have been proposed which will
be reviewed by the National Cancer Quality Steering Group in July 2015.
Radiotherapy Clinical Trials
Radiotherapy clinical trials continue to progress under the auspices of the chair of clinical
oncology and SCRN-W clinical trial radiographer. The clinical trial radiographer post has
been integral in successful opening of multi-site radiotherapy trials across the west of
Scotland ensuring all radiotherapy quality assurance processes have been addressed and
implemented to ensure safe delivery of trials. This was demonstrated in the last year with the
opening of the POSNOC trial which is aimed at finding out if treatment to the axillary lymph
nodes is necessary in early stage breast cancer.
The Beatson West of Scotland Cancer Centre will shortly be opening the SABR-COMET trial
for which we are the only UK site. SABR-COMET will address an area of unmet need in a
group of patients with oligometastatic tumours who would not normally be treated with this
technique and will initially open to patients with lung and brain metastases. The study has
been adopted by the Chief Scientists Office and will be led by a clinical oncologist NHS
Research Scotland fellow. It is vital that we successfully deliver this trial in order that we are
first in line in being chosen as a site for a PHASE III trial if this ensues.
Professor Anthony Chalmers is the Chief Investigator for PARADIGM trial which is a “lead-in”
dose escalation trial followed by a randomised phase II trial for patients with newly diagnosed
glioblastoma. The Phase II part of this study is a double blind trial of radiotherapy plus
placebo versus radiotherapy plus Olaparib. This study is sponsored by NHS Greater
Glasgow and Clyde and is a national multicentre study.
In order to promote radiotherapy clinical trials across Scotland, the SCRN–W is in preliminary
discussions with NHS Research Scotland Central Management Team Communications
Manager regarding the use of NHS Research Scotland website for the purpose of promoting
radiotherapy trials across Scotland.
EDGE™ – Clinical Research Management Software
The process of data migration and associated data validation is almost complete within the
Beatson West of Scotland Cancer Centre and across all Network sites. In order for the
system to go live which is planned for the end of June, concurrent training sessions for all
staff are taking place are at the time of this report. Initially, EDGE ™ will be used for specific
patient and trial management with more wide-ranging aspects being taken forward following
this.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
33
9. West of Scotland NHS Boards
9.1 NHS Ayrshire and Arran
Health Improvement and Cancer Prevention
A proportion of the Detect Cancer Early funding in NHS Ayrshire and Arran has been used to
undertake targeted work aimed at detecting breast, bowel and lung cancer at an earlier
stage. The Public Health Department used local intelligence to establish which population
groups were most likely to develop these cancers, and most at risk of late presentation. This
included using data on breast and bowel screening uptake and smoking prevalence data. A
key aim of the local programme was to reduce the inequalities gap that exists in terms of
stage at which cancer is diagnosed. The Detect Cancer Early funding was used to increase
capacity within the department to provide brief interventions with local target groups aimed
at:
•
Raising awareness of signs and symptoms of cancer.
•
Encouraging the public to see their General Practitioner (GP) if they were concerned
about possible cancer-related symptoms.
•
Empowering people to be screened for cancer when invited.
The Public Health Team has provided brief interventions and advice to several thousand
people within the target groups, in a range of venues including: football stadia, supermarkets
and bingo halls. The feedback received from the public had been extremely positive.
The Public Health Team has also been working closely with pharmacies and GP practices
based in areas of high socioeconomic deprivation, to ensure front-line staff are supporting
the campaign messages and providing advice and information to patients where appropriate.
Imaging and Diagnostics
The imaging and diagnostic services have been under significant capacity pressures due to
staff vacancies and increasing demand.
Treatment
Surgical Services
Enhanced Recovery is now embedded in the surgical wards.
Colorectal clinical nurse specialists are piloting telephone reviews with patients in place of
surgical follow up clinic.
Specialist Oncology Services
A review of chemotherapy services is in progress and is expected to be concluded in
September 2015 with a recommendation made to the Board regarding future service delivery
in NHS Ayrshire and Arran.
Changes have been made to chemotherapy delivery process with 2 step approach
introduced for breast and colorectal patients. This enables more efficient scheduling and
avoids patients experiencing the long waits between clinic review and receiving their
chemotherapy treatment.
Telephone reviews being piloted within haematology services by consultant haematologist.
Acute oncology is embedded in both acute sites and is working well. Continued education
with staff and awareness raising as well as ongoing programme with new Foundation Year
doctor 1 intakes.
Paracetamol guidelines are confirmed and currently awaiting for these to be ratified and used
by NHS 24 to ensure consistency nationally.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
34
Vomiting and Nausea pathway is currently in draft.
Continued audit of outcomes.
Living with Cancer, including Patient and Public Involvement
Macmillan Cancer Information and Support Service Project - Progress to Date
The Macmillan Cancer Information and Support Service is now available throughout
Ayrshire. The library service in Saltcoats was launched in 2012 with Boots Store Ayr
following in September 2013 and Boots Store Irvine in September 2014. The services have
dealt with over 2,047 enquiries and many people who have been struggling to find the
appropriate help have been assisted in finding the information and support they required.
This can vary from providing a simple leaflet to someone dropping in for a chat or spending
time with people/families needing support in coming to terms with living with a cancer
diagnosis.
• Boots (Ayr): People living with cancer in South Ayrshire can now get quick and easily
access information and support on cancer services, following the opening of a Macmillan
Cancer Information and Support Service situated in the Ayr Boots Store. We have strived
to implement innovative project outcomes to address health inequalities faced by people
affected by cancer in their local communities. This enterprising initiative has involved
collaborative working between all key partners to develop the first static Macmillan
Information Service to be sited in a Boots store in the United Kingdom. It is hoped that this
model of delivery will significantly increase access to information and support.
• Boots (Irvine): This service allows people living in Irvine and the surrounding area to
access quick information and support to help them cope with their diagnosis of cancer.
The service was launched in September 2014 and has provided support to a number of
service users and their families; links within the local community have proved beneficial in
assisting clients with a number of issues e.g. housing, counselling and finance.
• Saltcoats Service: This service is in the process of major transition towards sustainability.
Meetings are held regularly with Macmillan, North Ayrshire and NHS Ayrshire and Arran.
The service falls under the Macmillan In-direct Volunteering Team who supply support to
the lead volunteer should the need arise.
• Volunteers Strategy: Fully trained and supervised volunteers are essential to ensure that
people affected by cancer receive comprehensive, accurate, timely information and
support throughout the care pathway. We now have a total of 40 volunteers, all have been
recruited and trained in line with NHS Ayrshire and Arran’s governance policy. This year
will see the selection and training of champion volunteers for the 2 Boots drop-in services.
These volunteers will assist in managing present service volunteers and also be engaged
in promoting services within the community. The plan is to identify and train champion
volunteers who will continue to take the service forward when Macmillan funding ceases
in 2015 the Macmillan Direct Volunteering team will provide support to the champion
volunteers.
• Isle of Arran: A full scoping exercise has been undertaken in the summer of 2013, over
100 questionnaires were returned, and a full gap analysis and report was completed and
distributed to the Arran Steering Group. The decision was taken to have an unmanned
Macmillan Information Point within Brodick Library, with a volunteer from the Saltcoats
Library service responsible for liaising with the library staff in Brodick to stock relevant up
to date information.
• Funding for the Macmillan Cancer Information and Support Service has been extended
until Jan 2016.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
35
Improving Quality of Cancer Care for Patients
The cancer treatment helpline is embedded locally within clinical practice. There is
continuous input into the expert practice group of cancer treatment helpline to support further
development/improvement of service.
End of treatment summaries have been piloted and embedded into head and neck cancer by
clinical nurse specialists and feedback from receiving GPs has been obtained to inform
future practice.
Funding has been sought and approved from the 3 Joint Integrated Boards in Ayrshire to
develop and deliver a Multi-morbidity Rehabilitation Programme. This will allow people with a
diagnosis of cancer to access a tiered rehabilitation programme from summer 2015.
The Macmillan Nutrition Project is ongoing in terms of delivery and evaluation. This project
aims to develop a tiered approach to nutritional care so that those accessing cancer services
will have easier access to high quality and equitable nutrition services, and that this will
ultimately lead to improved outcomes. As a result of the project Macmillan Dietetic Assistant
Practitioners are now onsite at University Hospital Crosshouse 4 days/week, offering proactive nutritional advice to people undergoing chemotherapy. A community weight
management group programme has also been developed specifically for people with a
cancer diagnosis; and a self-referral pathway has been developed and trialled. As a result of
this new development, people with a diagnosis of cancer now have direct access to dietetic
services across Ayrshire and Arran.
Transforming Care After Treatment
NHS Ayrshire and Arran’s Phase 1 Transforming Care After Treatment Project commenced
in November 2015. The aim of the project is to: provide a streamlined, effective, efficient, and
person-centred service through the delivery of complete packages of care; and ultimately,
improve cancer outcomes and quality of life, and promote ongoing health and well-being.
This will be achieved through the following objectives:
• Pilot a new model of care within breast cancer services, and latterly colorectal cancer
services, across Ayrshire and Arran. The model will strengthen local and national
cross sector partnerships through the adoption of a co-production model.
• Create and promote a map of services which facilitates easy navigation of services by
patients and clinicians.
• Introduce and embed an end of treatment summary, holistic needs assessment
(HNA)/electronic HNA (eHNA) with associated care plan, and promote brief
interventions which lead to improvements in health and well-being. This development
will facilitate a shift from the existing medical model of care, to a holistic, personcentred model. The eHNA will be offered to patients at a minimum of 3 time points –
diagnosis, end of treatment, and 6-8 weeks post treatment.
• A new Health and Well-Being Clinic will be developed within a primary care setting for
those who are 6-8weeks post-discharge from active cancer follow up within
secondary care. These clinics will provide an opportunity to administer the
HNA/eHNA and create a care plan which meets the patient’s on-going needs. The
service map and tiered services will allow the care plan to be achieved and should
reduce the risk of unmet need amongst cancer survivors.
• Develop existing services and limit/fill gaps by introducing new models of care,
improving skill mix and creating tiered services which directly relate to identified
needs e.g. by creating local authority and dietetic led rehabilitation classes for those
who have completed active anti-cancer therapies and have low levels of need; and
continuing to offer higher level rehabilitation classes (delivered mainly by healthcare
services but in partnership with local authorities and voluntary agencies) for those still
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
36
•
undergoing active anti-cancer treatments and those who have completed active anticancer treatment but are identified as having high levels of need .
Share progress and learning locally and nationally to enable spread and challenge
cultural thinking.
To date there are 3 clinics running with 1 clinic in each locality area. A local evaluation
strategy has been developed and this feeds in to the national Transforming Care After
Treatment Evaluation Strategy. A local patient and carer panel is informing the Transforming
Care After Treatment process.
The Phase 2 Transforming Care After Treatment project is being led by local authority staff.
The aim of this project is to initially support survivors of breast cancer followed by colorectal
survivors to build the confidence and skills necessary to enable a return to employment or to
pursue business opportunities through integrated employability support.
It will also aim to change attitudes and behaviours at 3 different levels:
• Patients;
• Health and wellbeing practitioner and other partnership staff; and
• Employers including linking to human resource departments of major employers.
There will be 3 areas of focus for this project:
• Business awareness: developing more positive and supportive relationships with
survivors of cancer;
• Returning to work: positive assistance to support individuals to remain with an existing
employer; and
• Securing work: tailored support to help individuals return to the labour market and secure
employment.
Activities will include:
• Staff employability awareness;
• Comprehensive information provision;
• Impartial and confidential money advice;
• Developing business awareness and buy-in;
• Focus groups to identify local issues and opportunities;
• Personal and interpersonal skills development;
• Consideration of opportunities for self-employment and starting a business;
• Employability development;
• Access to the employability pipeline; and
• Moving into the labour market and into employment.
Delivery
eHealth
GP referral proformas have been updated to reflect new Scottish Referral Guidelines for
suspected cancer.
Electronic Holistic Needs Assessment: NHS Ayrshire and Arran’s eHNA pilot (which is a
distinct project but interlinks with the Transforming Care After Treatment project) went live in
breast cancer services on the 1st of September 2014. To date 150 eHNAs have been
completed with 146 subsequent care plans created (conversion rate 97%). On average there
are 5 concerns and 1 information need per assessment. The top 3 concerns are:
• Tired/exhausted or fatigued;
• Hot flushes/sweating; and
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
37
• Sleep problems/nightmares.
The majority of concerns are dealt with through discussions and advice, with ‘Information
given’ following closely behind. The top 3 information needs are:
• Exercise and activity;
• Diet and nutrition; and
• Complementary therapies.
Workforce
There are significant workforce pressures as a result of unfilled vacancies and increasing
demand. A bid for funding from Macmillan Cancer Support is being progressed for 4 clinical
nurse specialist posts within services which are under particular capacity pressures (lung
cancer, upper gastro-intestinal cancer, haemato-oncology, gynae-oncology). Additional
workforce requirements identified within oncology wards/day units within NHS Ayrshire and
Arran and being taken forward through usual funding processes.
9.2 NHS Forth Valley
Health Improvement and Cancer Prevention
Detect Cancer Early continued to be the focus of cancer health improvement and prevention
in Forth Valley including healthy workplace initiatives along with media releases to local
newspapers and radio stations and placing promotional literature in key locations. GP
practices have developed action plans to encourage patients to take up the option of bowel
screening and symptoms to be aware of between cycles.
Diagnostics
NHS Forth Valley is participating in the relevant regional work streams including participation
in the national audit of positron emission therapy/computed tomography utilisation,
discussions around the regional service model for the provision of radiofrequency ablation
and other forms of ablation therapy and has been inputting to the on-going development and
subsequent implementation of a national service framework for molecular testing.
The laboratory service has successfully implemented use of the imaging technologies for
Liquid Based Cervical Cytology screening as part of the National Managed Service
Agreement with Hologic for Cervical Cytology. This has improved efficiency of screening
although the small screening staff cohort remains a challenge given the expected but as yet
unobserved reduction in sample numbers.
The planned national changes to screening ages are expected to lead to a reduction in
cervical cytology samples from around 22,000 per annum to approx 19,000. The business
case relating to the implementation or practicalities of the use of high risk Human Papilloma
Virus testing as the primary screening modality for cervical cancer has been put forward with
the potential to dramatically alter this service delivery model. This will require workforce
planning.
The continuing increased demand for histological diagnosis is an ongoing challenge. The
introduction of national screening programmes and local initiatives to cope with demand have
placed additional pressures on this service. There has been an observable impact on
turnaround times and this is likely to continue if service needs are not addressed.
Radiology
Diagnostics continued to experience higher levels of demand as a result of the Detect
Cancer Early Programme. This is reported back through the NHS Forth Valley Detect
Cancer Early Steering Group.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
38
Computed tomography colonography is only available on an ad-hoc basis and is not
available as part of the Bowel Screening pathway. Work is ongoing to take forward a
business case.
There is a general increase in activity for radiology as a result of cancer trials.
Endoscopy
Endoscopy demand continues to be a significant pressure. Additional sessions in the
evening and at week-ends are in place along with additional capacity from the Golden
Jubilee Hospital and the arrangement with NHS Fife to meet demand.
Treatment
Surgical Services
• Breast Reconstruction: An oncoplastic breast surgeon commenced in post in September
2014. Less complex reconstruction cases are now being undertaken locally in NHS
Forth Valley.
•
Micro-vascular cases continue to be undertaken in Glasgow. A governance framework
between NHS Forth Valley and NHS Greater Glasgow and Clyde for the delivery of the
service locally and regionally is in place.
Patients can now be offered an appropriate range of options. As the new service is
implemented, it is being kept under review to assess the impact on all areas involved in
pathway to identify training or resource needs.
•
Minimally invasive Prostatectomy: A regional clinical management guideline (CMG) has
been developed. NHS Forth Valley is working with colleagues to take this forward.
Specialist Oncology Services
The Cancer Treatment Helpline NHS 24 phone triage model rolled out during 2013/14 has
been embedded. The pathway is audited and reviewed to take forward issues identified.
Construction of the radiotherapy satellite centre is underway at Monklands Hospital. Patients
from NHS Forth Valley will be referred to the Lanarkshire Beatson in phase 2 of the project.
An electronic portal link to Lanarkshire is a pre-requisite which NHS Forth Valley eHealth will
take forward.
Cancer medicines: NHS Forth Valley participates in the relevant groups. The Cancer Team
meet regularly with the Clinical Director and General Manager from the Beatson West of
Scotland Cancer Centre (BWoSCC).
Cancer of Unknown Primary: NHS Forth Valley is taking forward with the BWoSCC a
pathway for the investigation, diagnosis and management of malignancy of undefined
primary origin to support and develop local/regional service model.
The Systemic Anti-Cancer Treatment (SACT) Chief Executive Letter (CEL) (30) 2012 audit of
NHS Forth Valley showed very high compliance. The recommendation for the clinical lead to
have a job description for the role as NHS Forth Valley SACT Lead has been actioned.
Other
Psychosocial Oncology: NHS Forth Valley has established a programme of advanced clinical
communication training for senior medical and nursing staff, provided in accordance with the
evidence-based Effective Communication for Healthcare (EC4H) model devised by NHS
Lothian. A commitment to ensuring that senior staff participate has been given by the
associate medical directors.
Psychosocial support for patients/carers who are living with or surviving cancer is available
according to a tiered model of care as advocated by the National Institute for Health and
Care Excellence (2004). However, a rise in the number of referrals to clinical psychology for
patients / carers with lower levels of psychological distress has resulted longer waiting times
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
39
for level 3 and 4 patients. A review of this is being taken forward as part of the wider Clinical
Services Review for Cancer Services. The consultant clinical psychologist has provided
training to clinical nurse specialists in the use of the Concerns Checklist tool the aim of which
is to have a consistent process for screening for distress and managing holistic needs.
Living with Cancer, including Patient & Public Involvement
Transforming Care After Treatment
NHS Forth Valley has completed a prostate cancer follow up pilot on behalf of the region. As
part of the Transforming Care After Treatment Programme, NHS Forth Valley are taking
forward Transforming Care After Treatment for prostate cancer as part of Phase 1. This will
include using an end of treatment summary and HNA for prostate cancer patients.
Macmillan One to One Project
NHS Forth Valley is the only Scottish Health Board to have secured funding from Macmillan
Cancer Support for an innovative project to support patients once they have been discharged
from active cancer treatment. A team of district nurses and support staff assess individual
patients’ needs and perform a HNA with the patient using the Concerns Checklist and agree
a care plan which, if necessary, involves signposting patients to the most appropriate service
or resolving issues by liaising with service providers themselves.
Improving Quality of Cancer Care for Patients
Pathways, Protocols and Referral Guidance
Regular review of the cancer pathways for each tumour site is frequently undertaken
ensuring that resources are allocated appropriately, patient care is safe and effective and
waiting times are maintained.
Regional and local protocols are used to provide safe and consistent care to patients and to
respond to new medicines, changes in technology and relevant guidelines. Mechanisms to
review protocols on a regular basis are in place.
In order to ensure that patients with a potential diagnosis of cancer or those patients with a
previous diagnosis of cancer are referred to the most appropriate clinician and can be seen
and treated expeditiously, referral guidelines for primary care must be reviewed regularly, be
familiar to referrers and readily accessible. The lead cancer GP plays an important role in
the development and review of referral guidelines ensuring that referrers are aware of these
and are referring patients appropriately.
Quality Performance Indicators
The continuous agenda of improving the quality of care provided to cancer patients in Forth
Valley is the cornerstone of our cancer strategy. Better Cancer Care states that a wide
ranging approach to quality improvement is required to ensure that services improve
performance across all dimensions of quality. In tandem with national developments in
quality improvement NHS Forth Valley cancer services continue to review local data and
work with individual teams where required to action any required changes. The introduction
of national quality performance indicators (QPIs) allows local services to benchmark and
allows individual teams the opportunity to present a standardised data set to the Clinical
Governance Group and to the Forth Valley Cancer Advisory Group, identifying areas of good
practice and where further quality improvement work may be required. Implementation of
QPIs and associated data collection has progressed in NHS Forth Valley to the agreed
timescale.
Prisons
NHS Forth Valley has 3 prisons with a total population of approximately 1,500 inmates.
Approximately 750 of these prisoners are housed in Glenochil Prison, which has an
increasing ageing population and consequently some prisoners may die whilst in custody. In
response to the changing needs of the prison population with regards to cancer and end of
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
40
life care, there are established links with appropriate staff in the local prisons. Pathways for
prisoners with a suspected cancer and end of life care needs have been developed through
collaborative working between the Scottish Prison Service and the cancer teams in NHS
Forth Valley. Whilst there have been improvements, progress has been slow. On-going
collaboration is required to build relationships and improve the quality of care from the
prisoner/patient perspective. There is a need to raise awareness of the value of advance/
anticipatory care planning and adopt a new model that will reduce the risk of inappropriate
admission. There is also a need to raise awareness of the compassionate release process.
Maggie’s Centre
NHS Forth Valley in conjunction with and supported by the Patient and Public Involvement
Group, undertook a detailed study of the most appropriate model of cancer support and
information, and concluded that this could be best provided by a Maggie’s Centre. Maggie’s
have agreed to build a centre in the grounds of Forth Valley Royal Hospital and this is due to
open in 2015.
Delivery
eHealth
Order comms for laboratories and imaging requests has continued to be rolled out in NHS
Forth Valley during 2014.
Cancer Audit Tracking System - CATS. The system has been developed linking to systems
across the hospital for more efficient and effective tracking and management of patients.
Plans for management of multi-disciplinary team (MDT) meeting information will be taken
forward in 2014/15, including the treatment summary.
Workforce
NHS Forth Valley’s Clinical Services Review, Shaping Services for the Future is underway.
A key element of the review is a workforce that is fit for the future.
We continue to work closely with partners at the BWoSCC around demand for oncology
services.
9.3 NHS Greater Glasgow and Clyde
Health Improvement and Cancer Prevention
Cancer is the second most common cause of death among our residents. The number of
cancers is predicted to continue to increase. The NHS Greater Glasgow and Clyde
(NHSGGC) Cancer Health Improvement Strategy aims to reduce the prevalence of risk
factors among our residents and staff, and sets out the strategic vision, mission and
objectives of NHSGGC which builds on work already in place, with a focus on efforts to
reduce risk factors, based on available evidence. Cancer health improvement work includes
prevention, early detection, screening and rehabilitation.
Prevention
In March 2014 the Cancer Research UK Primary Care Engagement Programme was
launched in partnership with NHSGGC. A primary care engagement facilitator manager and
2 primary care engagement facilitators were appointed to post. The aim of the programme is
to support practices to support in depth discussions on cancer outcomes using a range of
tools including:
•
•
•
•
•
Production of an evidence based action plan;
Supporting engagement;
Safety netting;
Significant event analysis/audit;
Sharing best practice; and
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
41
•
Training for all practice staff.
To date more than 50% of primary care practices in NHSGGC have engaged in a face to
face visit with the programme.
Initial support given to practices was in relating to the
General Medical Services Bowel Screening Contract which aimed to see a reduction in nonresponder rates to bowel screening. 33% of Practices had seen more than a 5% drop in non
responders as a % of the eligible population based on MOBIUS data. Whilst the initial focus
had been on bowel screening due to the General Medical Services Contract; practices have
now identified and explored other areas of Cancer prevention, screening and early detection
which they have requested support with.
Staff Health - Facilities
A range of activities have been undertaken with staff within the Facilitates Directorate on
prevention and earlier detection of cancer. This has included: breast cancer awareness
month in October 2014 short sessions were delivered to facilities staff in Gartnavel Royal
Hospital, Leverndale, Laundry and Cowlairs, emphasising the importance of early detection
of changes in the breasts and attendance at mammography screening. Information leaflets
were distributed across these sites and also to Dykebar, Parkhead and Stobhill. In addition,
health events were delivered in Hillington for laundry staff and telecom operators in
September where a representative from cancer services was present. Further events have
taken place at Royal Alexandra Hospital in January and Inverclyde Royal Hospital in
February. The events attracted 100 employees mainly from the facilities departments.
Further events are planned at Glasgow Royal Infirmary in April and a future date will be
secured at Vale of Leven in May 2015. Detect cancer early awareness raising activities have
been developed over the past year with staff. This has included articles in Staff News, on
Staffnet and via wage slips. The Occupational Health Service for NHSGGC continues to
promote the Detect Cancer Early Campaign and materials with staff groups. A Health
Improvement eModule has been developed and is about to go onto the Learn Pro Test Site
together with a module on Staff Health within the Management Induction Training Course.
This will continue to support the key cancer prevention messages.
Smoking
In 2014/15, 1,647 inpatients were referred to the Smokefree Hospital Service of whom 1,249
made a quit attempt and 366 were successful at 4 weeks (as of 2nd April 2015). 89 staff
members used the Smokefree Hospital Service and 42 were successful at 4 weeks (as of 2nd
April 2015).
Early Detection
The Cancer and Health Improvement Working Team for NHSGGC have worked with key
partners in priority communities to increase the number of cancers that are detected at an
earlier stage. This has complimented the Scottish Government’s Detect Cancer Early Social
Marketing Campaign with local interventions, including cancer awareness workshops,
education events and health fayres for breast, bowel and lung cancers. Local activity to
support the NHSGGC cervical screening campaign, including education events at places of
further education and a “vox pox” event at the Forge Shopping Centre which was supported
by Radio Clyde.
In addition a public health pharmacy campaign where pharmacists use prescription bags with
different cancer detection and screening messages for identified populations. An evaluation
of the effectiveness of this intervention is currently underway.
Screening
The Detect Cancer Early Campaign has targeted both bowel and breast screening within the
national social marketing campaign. Activity has included projects targeting increased uptake
of cancer screening in new invitees to the programme and with non-responders.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
42
Bowel Screening Telephone Engagement Project
April 2014 saw the launch of a telephone engagement project to increase the uptake of nonresponders to the bowel screening programme. This is a pilot project being tested across 39
GP practices. To date 940 non-responders to the bowel screening programme have
received a telephone call to encourage them to complete the bowel screening test. Results
from this pilot programme will be published in 2015.
Breast Screening Text or Telephone Engagement Project
A project was undertaken to improve engagement and uptake of breast screening invitations
within 10 GP practices. These practices with low uptake were identified from the previous
breast screening round. The breast screening service was testing a range of engagement
methodologies to improve uptake. The service contacted 400 women, either by telephone or
text, to remind them of their scheduled breast screening appointment with contact details
should they need to cancel and/or rearrange their appointment. A full report on the
outcomes of the engagement methodology pilot will be available in 2015.
Teachable Moments
The West of Scotland Primary Care Cancer Network established a working group to examine
current practice within general practices with cancer patients around teachable moments. A
survey has been completed across all West of Scotland Board areas. The findings from the
survey will be used to inform training and implementation of a small test of change pilot in
2015.
Imaging and Diagnostics
Imaging
• Bowel Screening: Imaging is one of the key components to the Bowel Screening
Programme. Initially computed tomography colonoscopy was limited within the pathway
however referrals for this type of procedure have increased to the extent that barium
enema procedures are rarely undertaken. NHSGGC Imaging Departments now run
accredited computed tomography colonography courses to enable radiographers to
undertaken these procedures in order to meet the increasing demand. Computed
tomography colonography requires more procedure, scanning and reporting time which
has a knock on effect to productivity.
•
Breast Screening: The introduction of magnetic resonance imaging for family history
screening testing has been introduced in a controlled environment providing early results
to patients.
There is an expectation that this will increase year on year. The
symptomatic breast service within Imaging has seen an increase in referrals to one-stop
services for patients and this has resulted in Imaging, Surgery and Anaestethics
Departments collaborating in a Rapid Improvement Event. This collaboration is ongoing
as the services are redesigned and relocated to Gartnavel General Hospital within a
LEAN framework methodology.
•
Ear Nose and Throat: Fine Needle Aspiration – Thyroid: There is an increasing demand
for one-stop ultrasound services in the provision of fine needle aspiration thereby
reducing the need for patients to return for a further appointment for a biopsy to be
performed.
This requires specialist radiologist and sonographer expertise which at
present is limited. Sonographer training is ongoing to enable sonographers to carry out
these procedures. We are one of a small number of NHS Boards who facilitate
radiographic up-skilling for this procedure.
•
Cancer 31/62 Day Targets: With the introduction of a TrakCare and Clinical Radiology
Information System interface, key questions on the electronic referral now identify
patients on the 62-day pathway at a much earlier stage. With more patients identified at
the point of referral, this should contribute to an overall improvement in both performance
and outcomes for patients. However, in order to sustain a turnaround to scan within 14
days, a re-profiling of appointment templates will be required involving a displacement of
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
43
non-cancer scans. Current evening and weekend working sustains out-patient access
targets. Diagnostics and in particular Imaging Department are reaching an “on demand
service delivery model” in relation to imaging for unscheduled, scheduled and cancer
imaging.
•
Radio Frequency Ablation: Radio frequency ablation is provided for a selected group of
patients identified by surgeons and radiologists, where surgery is not suitable for the
patient and the tumour treatment. NHSGGC now has West of Scotland (WoS) support
and funding to provide this service for the whole region from 1st April 2015. Discussions
are ongoing with Surgical and Anaesthetic Directorate in relation to required staffing
recruitment to support this service.
Laboratory Medicine
• General: The laboratory facility on the Southern General Hospital site has been fully
operational for almost 3 years now and we are well placed to support the new hospital,
which will be fully operational by June 2015. Histopathology, cytology and genetics
laboratory services are well placed, having been centralised, complemented by
substantial haematology, biochemistry and microbiology laboratories. Genetics clinics
are provided on site within a purpose built clinic area. Genetics are beginning to see the
benefit of next generation sequencing technology and we are now working towards
‘mainstreaming’ as the genetic component of disease is routinely moving to the forefront
of many patient pathways of care. Molecular pathology, molecular haematology and
molecular genetics have been integrated into a single new National Services Division
funded Molecular Diagnostics Service managed within genetics as ‘stratified medicine’ /
’personalised medicine’ becomes a reality for increasing numbers of patients.
•
Molecular Diagnostics: The national Molecular Pathology Evaluation Panel and Steering
Groups continue to produce improved paperwork and procedures for the evaluation and
introduction of new tests. The trend of increase in demand for testing continues. One of
the drivers behind placing molecular diagnostics within medical genetics was to release
the potential under capacity of equipment (which is already supplied to medical genetics
from central National Services Division funding) and this has been happening on a
practical level to rationalise and combine like activities, the most relevant example being
the development of a single ‘Did Not Attend’ extraction facility for the whole department.
The service has also benefited from new equipment purchases. The involvement of staff
in MDT meetings remains a strength of the service and it is intended to build on these as
a means of improving the patient care pathway. Various changes, along with greater
desire for testing with the ‘Angelina Jolie’ effect and potential for more targeted
chemotherapy, have continued to have a very significant impact on demand for tests.
This, coupled with pressure for more rapid / streamlined testing is likely to grow as the
impact of knowledge of BRCA status on clinical management becomes more certain.
Breast cancer testing has all been done in Glasgow since 2012 and includes BRCA1
and BRCA2, and PTEN, p53, RAD51C/D where indicated.
•
Haemato-Oncology Laboratory Gartnavel General Hospital; Diagnostic Flow Cytometry
and Stem Cell processing for Bone Marrow Transport: The workload for this laboratory
section continues to increase. A Regional Flow Cytometer Service is established in
Glasgow (Gartnavel General Hospital Haematology Laboratory) providing a service to
NHSGGC, NHS Forth Valley, NHS Ayrshire and Arran and NHS Dumfries and Galloway,
with a smaller service in NHS Lanarkshire (Monklands Hospital). This technique allows
for rapid diagnosis, investigation and management of many haematological cancers,
with results available within 24 hours of patient sampling. Workload continues to
increase year-on-year. For example, requests for acute leukaemia analysis have
increased by 80% over the past 5 years. All results are reported by a consultant
haematologist. Stem cell processing continues to expand to accommodate all regional
patients undergoing autologous stem cell transplantation and for all Scottish patients
undergoing allogeneic stem cell transplantation and donor lymphocyte infusions.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
44
•
Clinical Genetics: The main development in the Cancer Genetics Service over the past
year or so has been a reduction in the threshold for offering BRCA testing to families
with breast and / or ovarian cancer which was agreed in line with Scottish Intercollegiate
Guideline Network Guideline 135 and National Institute for Health and Care Excellence
Clinical Guideline 164. The testing was also extended to unaffected individuals in some
families following the update of the National Institute for Health and Care Excellence
Familial Breast Cancer Guidance in June 2013. Partly as a result of this, but also as a
consequence of increased media interest in genetic testing for breast cancer after
celebrities have revealed their own BRCA status, there has been a marked increase in
referrals to the service which were up 26% on the previous year. Members of the service
have worked closely with the Breast Cancer Managed Clinical Network (MCN) Family
History Subgroup, and with Healthcare Improvement Scotland, to agree the
implementation of the National Institute for Health and Care Excellence Familial Breast
Cancer Guidance 164 for Scotland.
•
Genetics Staffing: Staff have continued to be seconded from molecular genetics and
cytogenetics into molecular pathology to meet service need, facilitate cross training and
achieve better integration into the new Molecular Diagnostics Service.
Achievements:
- Further improvement in failure to attend rates and cancellations.
- New database now implemented and running live.
- Continuing interaction with the WoS Breast Cancer MCN, via the Family History
Subgroup. Ongoing discussions re implementation of National Institute for Health
and Care Excellence update on Familial Cancer: focusing on genetic testing
guidance, offer of tamoxifen as risk reduction measure, and some changes to
screening regime.
- Participation in a number of multicentre studies: EMBRACE epidemiology of BRCA1 /
2 families; BRCA3 attempting to identify new breast cancer genes; IMPACT prostate
screening for men with BRCA1/2 mutations. The WoS service was in the top 5 UK
recruitment centres for these 3 studies, and continue to look for other studies as
appropriate.
- Development of Scottish Clinical Genetics Forum, with Cancer Genetics Subgroup to
look at ongoing updating of clinical guidelines and protocols. Possibility of developing
a Cancer Genetics Managed Service Network to facilitate changes to protocols.
•
•
Challenges:
- Waiting times: referrals up 26% on last year. Triaging of referrals useful to cut down
on patients needing to be seen in the clinic, (though confuses waiting times).
- Pressures on referrals partly reflects increased awareness of genetic testing, with
many referrals not eligible for testing (these are largely dealt with by letter but quite a
big workload in doing so). Recent discussions with WoS Primary Care Cancer
Network to look at ways to address this: reviewing the referral guidance for GPs
earlier than previously planned; enabling family history questionnaire link to be added
to Scottish Care Information Gateway to accompany referral.
- Pressures on laboratories as more patients now eligible for testing and desire for
quicker result with possibility of impact on management (though guidelines not yet
supporting rapid testing).
- Data input / database: challenges of previous database with limited ability to extract
meaningful data, should be resolved with the new database now running live (but will
mean comparison data not available at first).
- Progress now being made in accessing our paperless systems from other Health
Board areas when doing satellite clinics, and accessing paperless records on these
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
45
patients if in another Health Board’s Scottish Care Information store (and allowing
access to our paperless records to other Health Board areas, i.e. other portals.)
•
Pathology: The continued involvement of staff in MDT meetings remains a strength of
the service and these are being built on and extended to other patient groups as well as
discussions regarding the refinement of patient pathways.
•
62/31 Day Pathway: Significant pressure is placed on pathology to manage a 7-day
turnaround time for those patients referred as “urgent suspicion of malignancy” and on
the 62-day pathway. The number of patients on this pathway continues to increase.
Many of these patients are discussed at MDT meetings ahead of the 7-days adding
pressure to the pathology turnaround time. Turnaround times for specimens are critically
monitored to ensure targets can be met. Monthly key performance indicators confirm that
the pathology service has a high success rate in reporting ‘suspicion of cancer’ cases
within the 7-day target.
•
Detecting Cancer Early: The success of the Detect Cancer Early advertising Campaign
for breast cancer has seen a significant increase in breast specimens received by
pathology. The Bowel Screening Programme and Detect Cancer Early Campaign for
bowel cancer has significantly increased the number of specimens from endoscopy
clinics. The number of specimens received by pathology from the original screening
programme far exceeded the number originally anticipated on the sample numbers.
•
Consultant Staffing: At the time of the move to the single integrated Pathology
Department there was a significant shortfall in consultant pathologist sessions which has
now been addressed. This has helped improve the turnaround time within pathology.
•
Teleconferencing: Increased use of teleconferencing has been made following the
integration of the Pathology Department on the South Glasgow Hospital site to link
consultant pathologists to MDT meetings. Teleconferencing is now used to link to the
Clyde lung, urology and colorectal MDT meeting. This has produced saving in consultant
time. Teleconferencing is now available for MDT meeting currently held at Glasgow
Royal Infirmary.
•
Cervical Cytology: Image assisted screening allows primary screeners to screen
additional cervical smears. Introduction of this technology significantly reduced the
backlog of cervical smears within the laboratory and has progressively reduced the
turnaround time -most recently 10 days (January 2015). In line with the rest of Scotland,
the Cervical Cytology Department changed its referral practice for mild dyskaryosis from
1st December 2012. Mild dyskaryotic smears are now repeated and patients only
referred to colposcopy if the abnormality persists. This has resulted in a decrease in the
number of women referred to colposcopy.
Treatment
Surgical Services
• Re-organisation of Services with Opening of New South Glasgow University Hospital:
Throughout 2014/2015 the Directorate was involved in the organisational and preimplementation steps related to the re-structuring of surgical services across NHSGGC
in relation to the planned opening of the New South Glasgow University Hospital.
•
Outpatient Services: The Directorate continues to work flexibly to meet the demands of
the increase in referrals received. Within breast services, a number of lower risk
outpatient clinics have been introduced to maximise effective use of surgical and
diagnostic resources. Within General Surgery and Ear Nose and Throat, additional
clinics were run throughout the year to meet demand on services.
•
Diagnostic Procedures within the Surgical Directorate: The Endoscopy Service continues
to work flexibly to meet demand for colonoscopies and upper gastrointestinal
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
46
endoscopies, including running additional sessions across sites throughout 2014/2015.
The final training was completed for a nurse endoscopist and we continue to try to recruit
to further training or substantive nurse endoscopist posts. An additional session for
endoscopic ultrasound has been introduced and a further clinician is now trained to
undertake this procedure.
The Ear, Nose and Throat Service continues to work flexibly to strive to meet demand for
ear, nose and throat diagnostic scopes with additional sessions being run where
possible. Short-term contracts have been agreed with recently retired consultants to
maintain service provision given the challenge of recruiting head and neck consultants
nationally.
The Urology Service has witnessed a continual increase in demand for diagnostic
procedures such as flexible cystosocpy and trans-rectal ultrasound and biopsy. Ongoing
additional flexible cystoscopy sessions were undertaken to help meet this increased
demand. The nurse-led trans-rectal ultrasound and biopsy service, which was introduced
in 2013, continued throughout 2014/2015. An additional nurse specialist has now
commenced training in this procedure.
As part of the re-organisation of rrology services with the opening of the New South
Glasgow University Hospital in 2015, a diagnostic hub has been modelled for Glasgow
Royal Infirmary to allow for additional flexible cystoscopy and trans-rectal ultrasound and
biopsy capacity. The diagnostic hub is planned to be operational by July 2015.
NHSGGC continue to carry out prostate template biopsies for patients from across the
region. However there is increasing pressure on this service as it is a service delivered
by only 1 consultant and the number of referrals is increasing.
•
MDT Meetings: Ongoing review of processes and documentation relating to the cancer
MDT meetings across Surgical Services undertaken. Identification of additional data
items for inclusion in MDT referral forms and updated MDT outcome forms progressed
with MDTs and IT and planned implementation in 2015.
•
Treatment: As part of the re-organisation of Surgical Services with the opening of the
New South Glasgow University Hospital in 2015, the review of provision of oncological
surgical procedures was undertaken. Throughout 2014/15 planning and preimplementation steps were carried out for the relocation of complex urological surgery
and head and neck surgery to the New South Glasgow University Hospital.
•
•
The Laparoscopic Prostatectomy Service, introduced in December 2013, continued
throughout 2014/15. Throughout 2014/15 NHSGGC also contributed to the ongoing
discussions/planning regarding the introduction of a robotic prostatectomy service in
Scotland.
Quality Performance Indicators/ Cancer Audit: The Surgical Directorate continues to
contribute to the data collection, reporting and analyses of quality performance
indicators/ cancer audit data and identify and implement actions arising from the data.
Cancer Waiting Times: A Rapid Improvement Event was held for breast services and a
number of actions were identified and either implemented or were being progressed in
2014/15. The directorate continues to monitor and report on patients on cancer/
suspected cancer patient pathways in real-time and provide retrospective monthly and
quarterly data submissions to Information Services Division. The directorate also
participates in national consultations regarding review and development of National
Cancer Waiting Times Standards and reporting, and also quality assurance exercises.
As regards performance against the 62-day and 31-day standards, the Surgical
Directorate strives to meet these targets. This is becoming increasingly challenging in
part due to the increase in number of referrals to services and the increase in the
number of investigations now standard on pathways.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
47
Specialist Oncology Services
• Radiotherapy: In 2011/12, NHSGGC outlined proposals to utilise the Scottish
Government Radiotherapy Modernisation Funding to address the capacity issues facing
the BWoSCC. Work has continued in the last 12 months on the building of the
Lanarkshire Beatson, the Radiotherapy Satellite Centre based at Monklands Hospital in
Airdrie. This major capital build remains on target to be operational from November
2015, and work is ongoing to address the transfer of existing staff wishing to move and
recruit new staff members across radiotherapy physics, therapy radiography, nursing,
medical and administration staff groups. NHSGGC continues to progress the plans for
this unit in partnership with NHS Lanarkshire around the operational management of the
satellite centre.
2014/15 has seen the continued utilisation of the extended working day across the
department to meet the demands on capacity and slot availability in advance of the
satellite centre opening in November. There have been advancements also in the
booking/planning software used within radiotherapy, ARIA (electronic radiotherapy
information system), which was upgraded in February 2015. This software update has
noticeable benefits in a move towards paper-lite working within the department, the
rationale and implementation of which is currently being considered.
The further development of advanced techniques is evidenced by the recent National
Cancer Services Analysis Team Report to NHS Scotland that 57% of radical patients in
the WoS are now treated by intensity modulated radiotherapy. This is routine for all
prostate, head & neck and brain patients, with around 50% of lung, oesophagus and
colorectal patients also being suitable for treatment in this manner. This technique
allows a high dose to be delivered to the tumour, while significantly sparing the
surrounding normal tissue, thus relieving the patients of both acute and long term side
effects. This method can also be delivered more quickly than previous treatments
allowing increased throughput of patients. In addition, all patients receive some form of
image guided radiotherapy, allowing radiographers to ensure that the planned treatment
is delivered precisely throughout the treatment course.
In addition to intensity modulated radiotherapy, the BWoSCC has introduced stereotactic
ablative body radiotherapy techniques for the treatment of lung and prostate tumours, a
radical new approach to the management of these diseases. Lung stereotactic ablative
body radiotherapy is used in the treatment of small lung tumours in patients not suitable
for surgery. Individual patient clinical planning is more complex, however the patient
only attends for 5 treatments instead of the more normal 20-25 fractions. 91 patients
were treated by this technique 2014/15, with outcomes of 96.7% local control at 2 years
survival, and these are patients who would not have been eligible for any form of radical
treatment prior to the introduction of stereotactic ablative body radiotherapy.
Work has been progressed nationally around subsequent waits for radiotherapy
treatment, with NHSGGC inputting to the Scottish Government working group around
definitions and means of recording data. It is expected that this workstream will continue
to develop in 2015/16.
•
Chemotherapy Provision: The year on year demand for SACT across the WoS remains
high, by approximately 8%, due to increasing cancer incidence and the introduction of
new, effective anti-cancer medicines. These new medicines are often less toxic and as
such are increasingly offered to less fit or older patients who may not previously have
received any treatment. Increasing cancer survival rates, coupled with an increasing
cancer incidence, mean that prevalence is increasing. This results in many patients
having additional lines of treatment which may previously not have been considered /
delivered.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
48
The Macmillan Day Case Unit within the BWoSCC remains busy, with the most recent
service expansion in April 2013 of 11 day case stations to facilitate the delivery of day
case cisplatin based regimens and the year on year demand. Overall there is a 48 day
case station being fully utilised between the hours of Monday to Friday 8am-8pm within
the BWoSCC for the provision of SACT and supportive therapies. The model of
provision is either a same day treatment approach or a two tier appointment approach,
which is dependent on treatment regimen, clinic provision and patient demographics.
Collaborative working is ongoing to review day case treatment delivery to consider and
explore efficient patient pathways, ensuring patients’ treatment is scheduled prescribed
and delivered in a timely and efficient manner.
•
Acute Oncology Assessment Unit: The Acute Oncology Assessment Unit has been
operational since 7th October 2013 and is now fully established with access for patients
from all over Glasgow City, experiencing treatment toxicities. It also provides a service to
patients attending for day case treatments or attending the outpatient department who
are unwell requiring urgent assessment, treatment, or direct admission.
Direct patient access has been improved considerably, if following phone assessment
they require to be seen. Acute Oncology Assessment Unit referrals also come via a
clinician if they have a patient who presents unwell to the clinic or
radiotherapy/chemotherapy treatment area, or if they become unwell during day case
treatment.
All emergency admissions to the BWoSCC are also channelled through the unit for
urgent assessment and immediate management, prior to being admitted to an inpatient
ward.
Recent evaluation has shown that the unit is effectively meeting patient and service
need. Patient experience work showed high levels of satisfaction and positive
experiences for patients attending the unit. There are currently around 20-36 patients
per 5 day week attending the unit (average of 27.25 per week).
•
BWoSCC Cancer Treatment Helpline: The Beatson Cancer Treatment Helpline went live
on 3rd March 2014 and is a 7 day service, managing approximately 400 calls per month
(average of 13 calls per day). All patients phoning the helpline receive a structured
phone assessment by a nurse practitioner, using a validated assessment tool (UK
National Oncology Nursing Society), and are then seen in Acute Oncology Assessment
Unit or arrangements made for them to be reviewed at their local hospital/GP if they
require more than telephone advice. This is proving to be a well used service with
patients phoning for advice about treatment toxicities, including oncological emergencies
such as sepsis, which can then be promptly managed. Communication is made with
primary care, emergency departments and oncologists via telephone, email and via the
log sheets that are completed for every patient who calls. If required, a patient will
receive a call back the following day. The Beatson Cancer Treatment Helpline is staffed
by the Acute Oncology Assessment Unit nurse practitioners 8am-8pm, 7 days a week.
Overnight calls (approx 2 per night) are taken by the National Cancer Treatment Helpline
(operated by NHS24) and reviewed by the BWoSCC nurse practitioners the following
day, carrying out follow up calls to patients, with referral to oncology clinicians, as
appropriate.
Specialist Oncology Services Ongoing and Future Priorities
• High Acuity Unit: With the migration of inpatient services to the South Glasgow
University Hospital from Gartnavel General Hospital, significant work was undertaken in
2014/15 to benchmark the impact the reconfiguration would have on the BWoSCC.
Short life working groups were set up focusing on specific areas such as medical,
surgical and diagnostic services to understand the changes being made and the
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
49
provision remaining on site. These working groups concluded in December 2014 and
provided clear direction for the Cancer Centre.
On 29th May 2015 the High Dependency Unit at Gartnavel General Hospital closed and
transferred to the South Glasgow University Hospital. On the same day the BWoSCC
opened a 4 bedded High Acuity Unit within an oncology ward. This service is staffed by
critical care nursing staff 24/7, working with oncology and haematology nurses to share
skills and competencies.
Patient care is led by consultant oncologists and
haematologists with support from anaesthetists at Gartnavel General Hospital during
working hours or resident on-call out of hours. Patients who require more than Level 1
care or invasive monitoring are transferred to the South Glasgow University Hospital
High Dependency Unit or Intensive Care Unit as appropriate. The focus is on early
recognition and patient transfer (where appropriate), although where necessary, prior to
transfer, the High Acuity Unit can deliver level 2 and 3 care. Input across a number of
clinical areas will be required in 2015/16 to develop the model further to meet the
demands of the service.
•
Front Door Oncology Support: The development of front door oncology support remains
high on the agenda also. Having developed and implemented the Acute Oncology
Assessment Unit successfully, the input of oncologists at the front door of Acute Medical
Receiving Units is vital to ensure earlier intervention by oncologists to allow the
combined approach to the management of oncology patients the non-oncology setting.
Work will be undertaken with colleagues across NHSGGC in the coming year to develop
a suitable model.
Research Developments in Clinical Oncology 2014/15
Clinical oncology research activity revolves around the multidisciplinary Radiotherapy
Research Group, which meets monthly to discuss ongoing, new and potential projects that
involve radiotherapy. Research activity focuses on three scientific themes: (i) radiotherapydrug combinations led by Professor Anthony Chalmers, (ii) image-guided, adaptive
radiotherapy led by Stefano Schipani and Claire Paterson, and (iii) advanced technical
radiotherapy led by Stephen Harrow. The team prioritises research in cancers of unmet need
that are common in the WoS, specifically lung cancer (including mesothelioma) and cancers
of the head and neck, brain, pancreas and prostate. Key achievements in 2014/15 include:
• Completion and publication of the SYSTEMS trial, which is the largest ever prospective
study of palliative radiotherapy for malignant mesothelioma. The study demonstrated that
approximately 35% of patients derive clinically meaningful pain relief from standard, low
dose palliative radiotherapy (MacLeod N et al, J Thoracic Oncology 2015).
•
Full funding of SYSTEMS-2, which will be the first ever randomised study of radiotherapy
dose escalation in mesothelioma.
•
Successful funding of three novel phase I/II studies testing the PARP inhibitor olaparib in
combination with radiotherapy in the treatment of brain tumours (PARADIGM,
PARADIGM-2) and pancreatic cancer (PIONEER), of which PARADIGM has opened.
•
Funding and execution of PRO-SABR, a phase II feasibility study of stereotactic ablative
radiotherapy in prostate cancer.
Prof Chalmers also runs a research laboratory at the Wolfson Wohl Cancer Research Centre
(University of Glasgow) that is a leading UK and internationally competitive centre for preclinical evaluation of radiotherapy-drug combinations.
Living with Cancer, including Patient & Public Involvement
NHSGGC Health Improvement Teams support a number of programmes of work with the
aim to support people receiving treatment for cancer and living with a cancer. A range of
services have been put into place with clear referral pathways.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
50
Evidence demonstrates that people with a diagnosis of cancer experience an impact on
finances and managing day to day costs of living with a long term condition such as cancer.
Financial support is available to all patients with a cancer diagnosis in NHSGGC. Macmillan
Cancer Support offer assistance with budgeting, benefits reviews and managing debt in all
our acute hospitals and can also visit patients at home. A clear referral pathway is in place
to support staff to refer patients with a diagnosis of cancer to the service. In the period from
2014/15, 1,111 patients with a cancer diagnosis have been referred to the money advice
service. This has resulted in financial gains of £1,616,239.17.
Move More is a 12-week physical activity programme funded by Macmillan Cancer Support
and delivered in partnership with Glasgow Life. It is a free programme for people with a
diagnosis of cancer or living with cancer. Exercise helps to combat the tiredness associated
with late cancer treatment, supports recovery, increased functionality and increases self
esteem and reduces anxiety. Further funding was secured with NHS investment to support
the developments from year 2 of the pilot to bed down which included the expansion of the
programme from Move More exercise class programme to include walking and Chi Gung
within the menu of activities on offer.
Over the past 12 months the Move More programme has received 186 enquiries of which
73% where female and 27% male. The Move More programme in 2014/15 delivered:
•
126 gentle movement sessions;
•
416 circuit class sessions; and
•
108 walking sessions.
Referrals to the service have come from a range of services including the NHS. A pathway
will be developed in 2015/16 to improve referrals from NHS services into the Move More
programme.
Improving the Cancer Journey is a partnership programme with Glasgow City Council,
Macmillan Cancer Support and NHSGGC. The programme was launched in February 2014
as a pilot initially with 5 cancer groups and expanded to all cancers in Summer 2014. To
date more than 200 people have attended for a HNA. The assessments have identified a
range of issues for people with a cancer diagnosis living within Glasgow City including
money worries, treatment concerns, physical activity, work and employment issues. For
each area of the HNA there is a referral pathway in place including back to clinical nurse
specialists where there are specific issues related to treatment or symptoms.
The Vocational Rehabilitation Service has supported 99 patients with a diagnosis of cancer
to remain in work or return to work. An independent evaluation of the service undertaken by
the University of Glasgow was published in November 2014 which demonstrated that the
service was associated with a range of outcomes including improvements in health.
Engagement with the service also demonstrated an increase in the number of clients in work
and a reduction in the number of clients off work sick. These work outcomes were sustained
at 6 months after discharge from the service. The service works effectively with clients with
complex needs who faced barriers in returning to work following a cancer diagnosis including
those living in deprived areas and with lower incomes. The evaluation recommended
continuation of the service. The service was funded as a pilot and an options appraisal paper
is currently being prepared to consider the future shape, reach and funding of the
programme.
Work has been undertaken to develop a small test of change pilot using a HNA tool within
the Haemato-Oncology Unit at Inverclyde Royal Hospital. Tailored training has been
delivered to staff. The training will support staff to undertake a HNA with each of their
patients to address any underlying worries and concerns they may have. Referral pathways
have been established with local services to support referrals on a range of issues, e.g.
money advice. The HNA will be implemented in 2015/16.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
51
NHSGGC in partnership with Glasgow Life and Macmillan Cancer Support have established
an information and support service staffed by trained Macmillan cancer volunteers in
Glasgow City libraries. The service is available in 31 libraries across the Glasgow City. The
service is supported by 128 volunteers who have had 6,114 contacts over the past year and
have supported enquiries through distribution of 18,000 leaflets on cancer to those who have
accessed the library service. Capital builds at Drumchapel and Royston are due to be
completed in June 2015 with further builds being completed at Castlemilk and Partick by
September 2015. Outreach sessions have been planned for Stobhill and Victoria Hospitals,
Health Centres, Boots and community venues.
A Patient Experience Project has been undertaken within the Acute Oncology Assessment
Unit. The project has captured patient experience of the Beatson Cancer Treatment Helpline
and the Acute Oncology Assessment Unit. The aim is to understand the experience of
patients using these services.
A survey has been undertaken and analysis of findings is
currently underway.
The Patient Information Centres at the Victoria and Stobhill Ambulatory Care Hospitals have
service level agreements in place with organisations which support patients with a diagnosis
of cancer. These include Macmillan financial inclusion, Hairmony, Breast Cancer Care,
Carers. A new patient information centre will open within the South Glasgow University
Hospital in summer 2015.
The Moving Forward Course aims to provide information, support and professional guidance
on how to cope with and adjust to life after treatment for breast cancer. Topics covered
include: healthy eating, exercise, managing menopausal symptoms, lymphoedema, cancer
fatigue, intimacy and relationships. It also provides support to adjust and adapt following a
diagnosis of breast cancer. 3 Moving Forward Courses were delivered across NHSGGC
during 2014/15 in partnership with Breast Cancer Care. A total of 27 participants attended
the courses.
Improving Quality of Cancer Care for Patients
In 2014/2015, NHSGGC completed an overall review of the Board’s performance against
cancer QPIs/standards/key outcome measures for patients diagnosed in 2012. As a Board,
across all criteria, NHSGGC is meeting 59% (65/111) of the criteria at the target level. On
the basis of 2012 data, the Board overall has committed to 41 actions; the theme of the
actions is as follows:
•
MDT meetings (cases discussed, membership, documentation) (6 actions);
•
Staging data (completeness and recording) (9 actions);
•
Review of cases not meeting standard/ criteria or cases not recorded (15 actions);
•
Monitoring/benchmark (3 actions);
•
Data collection/recording (5 actions);
•
Referral criteria, pathway and protocols and pathways (2 actions); and
•
Diagnostic pathways (1 action).
This was the first high level review of this type, and NHSGGC intends to carry out this high
level analysis on an annual basis from now on, as a means of reviewing care overall within
cancer services, and identifying key areas for action.
Key Areas of Progress
At final Performance Summary Report, Boards are asked to confirm the accuracy of the audit
data and provide a commentary on the analysis. NHSGGC has completed this process for
2012 data. As the data is reported retrospectively, there may be times when the service has
changed since the period of the report, or action may not be appropriate, and this
commentary provides an opportunity to highlight this to the West of Scotland Cancer Network
(WoSCAN) as well as to provide an explanation for audit results, where required.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
52
NHSGGC has submitted all required action plans for 2012 data to WoSCAN within the set
timelines. The action plans have recommended 41 actions for the Board overall; which are
being progressed locally, and monitored via WoSCAN.
NHSGGC has implemented cancer QPI datasets for the following cancers, in line with the
national timeline: renal, prostate, breast, hepatopancreatobiliary, upper gastro-intestinal,
colorectal, lung, ovarian, lymphoma, brain/central nervous system, sarcoma, bladder, head
and neck, acute leukaemia, melanoma, cervix and endometrial, and testicular.
One month following publication of the QPI dataset, the cancer audit support staff has
undertaken a gap analysis of the dataset, to identify any potential implications on audit
systems or processes. Where appropriate, action has been taken forward at a local service
level to address any implications, which usually involves a change or addition to existing data
collection processes or systems. It should be noted however, that it can be some time
before the changes are embedded in practice, and this may result in issues with data quality
and completeness in the short term.
Key Ongoing Work
Following implementation of the Cancer QPIs, a number of higher level issues have been
identified, which have wider implications, and these have been escalated to the Cancer
Monthly Management Information Group or WoSCAN for further consideration. These
include:
•
Access to data on patients diagnosed in the private sector;
•
Access to data on patients diagnosed through screening;
•
SMR01 data, which is not directly comparable to audit data, which may create
difficulties in reporting;
•
Collection of follow up and recurrence data (this can include 1 year post treatment data,
or follow up for 10 years post diagnosis);
•
Access to data on clinical trials; and
•
Patients whose pathway takes them out with NHSGGC for part of their treatment, and
the availability of audit data across Boards.
Further review is required to assess the impact of the change in datasets; and to determine
whether the reduction in data collection requirements will assist the Board to meet the
requirement to audit those cancers not currently reported and the generic QPI datasets.
For generic QPIs, further discussion is required to agree responsibility and organisational
arrangements for the collection of the patient experience dataset.
9.4 NHS Lanarkshire
Health Improvement and Cancer Prevention
NHS Lanarkshire’s Health Improvement Staff have a wide range of interventions in place to
address these objectives. As well as general health improvement work there are also
targeted actions in relation to cancer prevention, awareness and screening uptake. Each
individual unit in Lanarkshire is on schedule to deliver on every objective.
Imaging and Diagnostics
Digital mammography is available on all 3 acute hospital sites in Lanarkshire. Work
continues within the radiology departments to highlight suspicious findings urgently to the
relevant clinician.
Treatment
Surgical Services
Work continues to develop an effective enhanced recovery service for all tumour types.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
53
Systemic Anti-Cancer Therapy Treatment Services
NHS Lanarkshire SACT Group was established in January 2013. The Group reports directly
to the NHS Lanarkshire Cancer Divisional Management Team and liaises with the NHS
Lanarkshire Cancer Strategy Group.
• The Group will produce an annual report for NHS Lanarkshire and the Regional SACT
Executive Steering Group.
• The Group now meets 2-monthly with video-conferencing available to maximise
attendance.
• The current work programme of the group involves: 1) examining the local implications of
implementing the CEL 30 (2012) and, 2) ensuring NHS Lanarkshire are ready for peerreviewed audits of CEL 30 (2012) which commence in June 2014.
Issues highlighted as requiring particular action are:
•
•
•
•
Education and training of staff (especially medical staff at non-Consultant Grade e.g.
Specialty Doctors/ Staff Grade Doctors). National group organised by NHS Education
Scotland have developed an Education and Training Framework document, now
published, and are following up on this with a Competency Assessment Training
Programme for staff in Scotland. This will allow NHS Lanarkshire to address deficiencies
in staff training.
Risk Management: The Group is working on the 30-day mortality data for patients who
have received SACT. Relevant tumour groups are progressing this.
Clinical Incidents: Incidents related to SACT continue to be recorded and reviewed and
learning shared.
Acute Oncology Developments: Nurse Specialist is in post to assist with this initiative to
improve the care of patients with acute oncological problems.
Specialist Oncology Services
Partnership work continues with the BWoSCC to deliver local and regional services.
Other
As part of service improvement and patient experience, NHS Lanarkshire Cancer Services
launched an innovative model for cancer patients. A 3-month pilot, commenced January
2014 until mid-April 2014 on all 3 NHS Lanarkshire acute sites Monday-Friday, with the
addition of weekend cover at Hairmyres Hospital. The overall aim is to reduce non-elective
inpatient length of stay and avoid unnecessary admission for cancer patients, support clinical
decision making, admission avoidance and discharge planning in the emergency
department, receiving units and inpatient areas. The Cancer Assessment and Support Team
will provide specialist cancer nursing care for patients with oncology and haematological
emergencies. This means that patients will have access to more appropriate and timely care
by healthcare professionals who are familiar with their condition and specific needs. Most
importantly, the team will facilitate effective communication between oncology and medical
teams enabling a collaborative working approach. It is anticipated by testing this reactive,
collaborative model, will support a sustainable acute oncology pathway to ensure that
patient’s unplanned toxicities are assessed and managed in a timely manner by the right
person at the right time, receiving the right management and onward referral.
New Development: Nurse Led Peripherally Inserted Central Catheter Lines Clinics at
Monklands and Wishaw Hospital sites (1 session per week on each hospital site).
Saturday Blood Transfusion Clinic at Wishaw General Hospital: A pilot is running over a 12week period in an effort to alleviate congestion and enable improved access for SACT
delivery. An evaluation of the service will be completed at the end of pilot.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
54
Living with Cancer, including Patient and Public Involvement
New models of care have been developed with third sector partners, for example:
Headstrong and Moving Forward with Breast Cancer Care.
NHS Lanarkshire is a member of the Macmillan Lanarkshire Financial Information Service
with North Lanarkshire Council, South Lanarkshire Council, Department of Work and
Pensions and Macmillan Cancer Support.
Work is ongoing with regards to implementing Patient Reported Outcome Measures within
cancer care in acute services.
Collaborative working continues with local third sector services, including: Maggie’s, Haven,
Kilbryde, Lanarkshire Cancer Care Trust and national charities.
Regional guidance has been developed by tumour specific MCNs to inform the follow up
pathways of cancer patients.
The national Transforming Care After Treatment Programme has provided NHS Lanarkshire
with a funding opportunity, via WoSCAN, to support a project in lung cancer at the end of
treatment, incorporating end of treatment summaries; e-Patient Reported Outcome
Measures; stratified follow up; and collaborative working with local authority and third sector
services.
Improving Quality of Cancer Care for Patients
•
•
•
•
•
•
•
Project Initiation Document signed off October 2013 by the Cancer Strategy
Improvement and Implementation Group.
Between October – December 2013 a large scoping exercise took place which involved:
Hosting a series of staff engagement events for all 9 tumour groups to review current
ways of working and identify areas for improvement;
Undertaken a mapping exercise of cancer support services in Lanarkshire to identify the
range of services that are available, as well as identify gaps; and
‘Horizon Scanning’ work undertaken to identify and learn from different models of cancer
care across the UK.
In January – February 2014, 4 patients and carer events were hosted to learn from their
experience of cancer services and support services, in order to shape current and future
service delivery.
Work is progressing to develop a cancer information web based resource.
Delivery
eHealth
Work is currently being undertaken regarding electronic MDT running.
Workforce
The workforce of NHS Lanarkshire continues to be reviewed to ensure that our current
workforce is future ready.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
55
10. Conclusion
This report reflects the diverse and significant amount of work that has been undertaken
locally and regionally over the past year to further develop and improve cancer care in the
West of Scotland. It highlights key achievements, work in progress and identifies some of the
many challenges that we currently face.
Working in an increasingly challenging financial environment, our task is to continue to
strengthen our collaboration and keep a strong, clear focus on reducing inequalities and
reducing cancer incidence, its burden and impact, and mortality. Through strong
partnerships, we will continue to benefit from the active work of committed clinicians,
patients, carers, staff and partners.
Mr Robert Calderwood
Chair, Regional Cancer Advisory Group
Chief Executive, NHS Greater Glasgow and Clyde
Dr Hilary Dobson
Regional Lead Cancer Clinician
Clinical Director, West of Scotland Breast Screening, NHS Greater Glasgow and Clyde
Evelyn Thomson
Regional Manager (Cancer), West of Scotland Cancer Network
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
56
Glossary of Acronyms
BWoSCC
CEL
CEPAS
CMG/CMGs
eCASE
GI
GP/GPs
HNA/eHNA
HPB
IPTR
MCN/MCNs
MDT/MDTs
NHSGGC
QPI/QPIs
RCAG
RPASG
RSESG
SACT
SCRN
WoS
WoSCAN
WoSPCN
Beatson West of Scotland Cancer Centre
Chief Executive Letter
Chemotherapy Electronic Prescribing and Administration System
Clinical Management Guideline/s
Electronic Cancer Audit Support Environment
Gastro-Intestinal
General Practitioner/s
Holistic Needs Assessment/electronic Holistic Needs Assessment
HepatoPancreatoBiliary
Individual Patient Treatment Requests
Managed Clinical Network/s
Multi-Disciplinary Team/s
NHS Greater Glasgow and Clyde
Quality Performance Indicator/s
Regional Cancer Advisory Group
RCAG Prescribing Advisory Subgroup
Regional Systemic Anti-Cancer Therapy Executive Steering Group
Systemic Anti-Cancer Therapy
Scottish Cancer Research Network
West of Scotland
West of Scotland Cancer Network
West of Scotland Pharmacy Cancer Network
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
57
APPENDIX I – Consolidated Regional Work Plan 2014/15: End Year Position
This high level plan sets out WoSCAN’s programme of work for 2014/15. This work programme is aligned to national priorities and those being
progressed by West of Scotland (WoS) NHS Boards. It aims to consolidate and build on work previously undertaken or ongoing, and to drive forward
continuous improvements in care, outcomes and patient experience.
To inform this plan a regional workshop was held on the 6th February 2014 to review and consider the emerging national and regional priorities
identified by the West of Scotland Cancer Network (WoSCAN), its constituent Managed Clinical Networks (MCNs)/regional groups and NHS Boards.
A total of 48 people attended, including clinical leads, the regional cancer network, regional planning group, NHS Board cancer service and planning
managers, the Scottish Government Health Department (SGHD) and third sector partner organisations. All WoS Boards participated in the workshop.
Regional priorities, which reflect the key elements of the national cancer strategy (Better Cancer Care, 2008), are aligned with the Healthcare Quality
Strategy for NHSScotland, and underpinned by the need to improve efficiency and productivity within cancer care, were agreed in the workshop and
are incorporated within this plan.
1. Objectives to be carried forward from 2013/14 work plans
Regional work plan
Determine the optimal regional service model for immediate breast reconstruction that will enable the agreed regional clinical pathway to be
implemented equitably across the WoS.
2. Overarching regional priorities 2014/15

Detect cancer early, referral and access, including:
o
Support national awareness campaigns and work with NHS Boards to manage demand, sharing learning across sites.
o
Input to national review of referral guidelines for oesophagogastric, hepatobiliary, urological and skin cancers and support local
implementation once agreed.
o
Work with NHS Boards to maintain performance against national access standards.
-

Review sarcoma waiting times performance via the National MCN and work with NHS Boards to redesign care pathways where
required.
Diagnostics, including:
o
Review the findings of the national audit of Positron Emission Therapy/Computed Tomography (PET/CT) utilisation and take forward
any regional recommendations.
o
Determine the requirements to sustain a regional service model for the delivery of percutaneous tumour ablation and, if required,
develop business case to support further development/sustainability.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 58 of 82
o



Input to the work of the national molecular pathology group to define diagnostic algorithms and pathways.
Specialist Oncology Services, including:
o
Development of a full business case to support the development of a satellite radiotherapy facility in the region, including optimising the
utilisation of current capacity and agreement of a change plan that will underpin the planned service development. Work being led by
Janette Fraser, Director of Regional Planning who chairs the regional Project Board.
o
Participate in the national short life working group (SLWG) to determine the need for nationally agreed pathways for clinical
management of patients with rare cancers. Support the North of Scotland Cancer Network to establish more sustainable models of
care and agree contingency plans.
o
Develop and embed the regional reporting model for systemic anti-cancer therapy.
o
Implement chemotherapy electronic prescribing and administrations system (CEPAS) in Oban and Lochgilphead.
o
Acute oncology: assess the learning from the evaluation of 24 hour telephone triage pilots and determine support required to support
wider roll out; and progress implementation of a model of care to support the management of malignancy of undefined primary origin.
o
Assess and assure compliance with CEL 30 (2012): Guidance for the Safe Delivery of Systemic Anti-Cancer Therapy, progressing a
regional programme of peer review and supporting the development of action plans to address any issues that may be identified.
o
Via the Regional Prescribing Advisory Subgroup provide advice to Area Drugs and Therapeutics Committees (ADTCs) and forward
planning information timeously to NHS Boards regarding cancer medicines.
Surgical Oncology, including:
o
Initiate and progress work to determine how the shift from open radical prostatectomy to laparoscopic radical prostatectomy will be
supported. Regional SLWG to be chaired by Dr Iain Wallace, Medical Director NHS Lanarkshire.
o
Complete work to define and agree the future service delivery model for radical oesophagogastric surgery. SLWG chaired by Dr Hilary
Dobson, Regional Lead Cancer Clinician.
o
Complete work to define optimal enhanced recovery after surgery (ERAS) pathways for cancer patients.
o
Review outcome data to assure the quality of care provided, particularly in those areas where lower volume surgery is undertaken.
Transforming Care after Treatment (TCAT), including:
o
Work with NHS Boards to develop and test new models of care after treatment, facilitating the sharing of practice across the region and
nationally and optimising the use of available resources and capacity. Progress successful bids in relation to breast cancer in Ayrshire
& Arran and Greater Glasgow and Clyde; prostate cancer in Forth Valley; and lung cancer in Lanarkshire, ensuring robust evaluation is
in place from the outset.
o
Develop bids for consideration in Phase 2 (Aug-Oct 2014).
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 59 of 82


Quality, including:
o
Continue to lead the national cancer quality programme, completing the development and implementation of national Quality
Performance Indicators (QPIs) for all main cancer types and patient experience.
o
Develop standard QPI reports that will enable timely local reporting of data in line with nationally agreed measurability criteria.
o
Assess performance against nationally agreed QPIs and publish reports in line with agreed regional and national reporting schedules.
o
Assure that improvement plans are in place to progress any actions identified.
o
Support NHS Boards to implement patient experience QPIs, sharing learning across WoS Boards.
eHealth, including:
o
Review requirements to better support regional and national multidisciplinary team (MDT) meetings.
o
Develop business case to support the upgrade of chemotherapy electronic prescribing and administrations system (CEPAS).
o
Further develop electronic cancer audit system (eCase) to support data capture and reporting of nationally agreed QPIs.
2.1 Overarching regional priorities that will be integral to individual MCN work plans

Quality assurance and improvement
o
Maximise the use of clinical and service information to inform and drive pathway review and service improvement.
-
o

Maximise the use of established MCN educational events/clinical fora to promote best practice and drive improvement in care delivery.
Clinical guidelines
o

Clinical audit: assess performance against nationally agreed QPIs, work with NHS Boards to improve data capture, produce
regional comparative performance reports, work with NHS Boards to agree local action plans and ensure that regional actions
are progressed.
Develop, update and support implementation of agreed clinical management guidelines. 15 are due for review in 2014/15.
Transforming Care after Treatment
o
Support the implementation of regional follow up guidance in practice e.g. end of treatment summaries, testing out new follow up models
for delivery etc.
o
Review and update follow up guidelines for Lymphoma. Initiate reviews for Bladder, Gynaecology, Head & Neck and Bladder, Renal and
Skin.
o
2.2 Regional priorities that will be progressed by individual MCNs and other established regional groups/networks
(Full detail contained within individual work plans that can be sourced via WoSCAN website www.woscan.scot.nhs.uk).
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 60 of 82
3.
Regional Work Plan 2014/15
Progress Status
BLUE
GREEN
AMBER
RED
Description
Completed – objective achieved.
On track to be completed within timescales.
Some delay, but expected to be completed (e.g. will be complete within 1-2 months of original timescale).
No progress or major delay in implementation (e.g. delay of 3 months or more).
Table 1: Regional Level
3.1 DETECT CANCER EARLY
3.2 REFERRAL & ACCESS
3.3 DIAGNOSTICS
3.1 Detect Cancer Early (DCE)

WoSCAN predominantly plays a supportive role in cancer prevention and early detection, with most actions relating to these being delivered through primary
prevention plans developed nationally and operationalised locally. Early work to explore how cancer MCNs could support and promote the implementation of CEL 01
(2012) Health Promoting Health Service was undertaken in 2013/14. This will be progressed in 2014/15.

During 2013/14, under the auspices of the Scottish Cancer Taskforce, a national programme of work to take forward generic and tailored approaches to raising
awareness of cancer symptoms amongst the public to encourage early presentation was progressed, focussing on breast, colorectal and lung cancers. This will
continue in 2014/15 with the programme being tailored to focus on breast screening and potentially other cancers, such as, melanoma, head & neck and
gynaecological cancers that were prioritised in 2013. Non-recurring and recurring national funding has been provided to Boards to support managing the impact of the
th
Detect Cancer Early Programme, particularly on diagnostic and symptomatic services. Year 1 baseline data (i.e. combined 2011/12 data) was published on the 25
February 2014 and quarter 4 2013 data due for submission to the Health Department in May 2014.

Work was initiated in 2013/14 to explore the feasibility of working towards an agreed model of early disease surveillance across the regional for high grade dysplasia
and early disease. This work will continue and be completed in 2014/15.

National screening programmes continue to be centrally funded and coordinated and delivered through local NHS Board screening services. This includes compliance
with Healthcare Improvement Scotland standards for breast, colorectal and cervical screening.
3.2 Referral and Access

Significant work continues to be undertaken by West of Scotland NHS Boards to maintain compliance with cancer access standards, with work being undertaken to
assure compliance in those cancers not nationally reported. Neurological cancers were reviewed in 2013/14 and sarcoma will be reviewed in 2014/15.

A national review of cancer referral guidelines was initiated in late 2012, with a move to symptom based referral guidelines. Revised guidelines for breast, colorectal
and lung cancers have been published by Healthcare Improvement Scotland. Revised referral guidelines for oesophagogastric, hepatobiliary, urological and skin
cancers will be published in April 2014.
3.3 Diagnostics

Genetics services continue to be coordinated nationally via 4 centres of which Glasgow is one.

A national molecular pathology group has been established to oversee the implementation of new molecular tests. WoSCAN is inputting to this work.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 61 of 82

A national audit led by the West of Scotland Cancer Surveillance Unit took place in 2013 to assess compliance with national PET-CT protocols across NHS Scotland.
The WoS will review the output of this work in 2014 and agree any regional actions required.

A review of percutaneous tumour ablation services has been initiated, which will determine future service requirements. This work will be progressed in 2014/15.
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
Issue
Actions
Lead
Due
Outcome
Updated Position
Detect cancer
early
Assess the impact of national and local awareness
campaigns on early detection and service provision,
ensuring that local intelligence is shared across NHS
Boards.
Cancer
Managers
Ongoing

Shared intelligence and
learning across NHS
Boards.
Standing agenda item
national Cancer Managers
Forum.
Review baseline and performance data to inform future
action that is required to support delivery of HEAT
target.
Cancer
Managers
June 14

Local/regional action
plan(s).
Board trajectories in place
and ongoing performance
monitoring against this.
Monitor the impact of the DCE Programme on delivery
of cancer access standards, initiating regional action
where required to support local NHS Boards to
continue to deliver against standards.
Cancer
Managers
Ongoing

Continued delivery of
cancer access
standards.
Standing agenda item
national Cancer Managers
Forum. WoSCAN inter
hospital transfer policy being
reviewed & updated.
Complete work to determine the feasibility of working
towards an agreed model of early surveillance across
the region for high grade dysplasia and early disease.
MCN Clin
Lead/MCN
Man (TC)
Mar 15

Planned extension of a
structured surveillance
programme.
Prospective audit to be
undertaken in NHSGGC to
determine current practice.
GREEN
Health
improvement
CEL 01 (2012)
Support primary care teams to deliver health
improvement opportunities, supporting implementation
of CEL 01 (2012), and agree areas where further
targeted regional work should be considered.
PCCN
Mar 2015

Teams better equipped
to deliver interventions.
Targeted activity scoped
and defined.
Meeting x2 held to review
results of the regional survey
on “the use teachable
moments in practice”. NHS
Board information shared with
Health Improvement
colleagues.
Presentation on this work
delivered at annual regional
cancer planning workshop.
Draft recommendation paper
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 62 of 82
reviewed by 4 Board Lead
Cancer GPs and discussed at
February Steering Group.
Planning for implementation
of recommendations to be
defined as a 15/16 work plan
objective and SLWG to be
reconvened.
GREEN
Familial breast
cancer
Input to national SLWG to determine which
recommendations, contained in NICE 164 Familial
Breast Cancer 2013, should be prioritised for
implementation in Scotland.


Breast MCN
Clin
Lead/Man
Review implications of recommendations for WoS
NHS Boards.
Work with NHS Boards to progress implementation
of recommendations.
Referral
guidelines
Ensure active network participation in the development
of revised national guidance for oesophagogastric,
hepatobiliary, urological and skin cancers and support
local implementation of this revised guidance via
MCNs.
RMC
Relevant
MCN Clin
Leads/Man
Access
Continue to monitor compliance with access standards
across the region, identifying areas where specific
regional action may be required to support local NHS
Board delivery.
 Highlight concern nationally regarding the impact
of unscheduled care on the front door accident and
emergency services and further downstream on
elective capacity for cancer patients.
Horizon scan and define molecular testing
requirements to inform future service planning.
Cancer
Managers
Molecular testing
Ongoing
Clear assessment of the
implications of
recommendations for
WoS NHS Boards.
Supported
implementation of
recommendations across
the region.
Discussion at last Breast
Cancer MCN Advisory Board
meeting, NHS Boards taking
forward. No actions defined
for MCN.
BLUE
tbc
(dependant
on
completion
of national
work)
In line with
national
work prog.


Design and
implementation of
revised national referral
guidelines. Optimal
referral pathways.
All revised guidelines now
published and NHS Boards to
make adjustments to SCI
Gateway in support of
implementation.
BLUE
Ongoing

Initiation of collaborative
cross Board working to
support local delivery of
access standards.
(Cross reference Detect
Cancer Early)
Refresh of inter hospital
transfer policy initiated.
Forward look information
available to inform
service planning.
Horizon scanning was
completed by each of the
Networks and there are
developments in acute
leukaemia, familial breast
RLCC
April 14
RMC/MCN
Clin Leads/
Man
Ongoing
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15


GREEN
Page 63 of 82
cancer and advanced
melanoma. MCNs will
continue with twice a year
horizon scanning of emerging
practice across the full patient
pathway and not just on
diagnostics.
GREEN
Percutaneous
ablation therapy
Input to national work to define/agree sustainable
service models for future testing.
Support the introduction of new tests across the
region, ensuring equity of access.
RA
Define and agree future service model for the provision
of percutaneous ablation therapies, ensuring
sustainability of any service that is
established/delivered.
RMC/AMacL
(GGC)


Aug 14

Agreed model for service
provision.
Supports timely and
efficient introduction into
practice.
Costed proposal for the
delivery of an agreed
regional/national service
model.
National process established
and framework to support
introduction of new test in
place.
Funding to support regional
service model agreed,
excluding lung which has to
be progressed as a potential
national service by NHSGGC.
BLUE
PET/CT
Review national audit of PET/CT utilisation findings
and agree any specific regional action that is required.
RMC/AMacL
(GGC)
Aug 14
Dec 14
Mar 15

Regional action plan (if
required).
WoS Cancer Surveillance
Unit findings submitted to
Scottish Government June
2014.
GREEN
SPECIALIST ONCOLOGY SERVICES
3.4 RADIOTHERAPY
3.5 SYSTEMIC ANTI-CANCER THERAPY
3.6 ACUTE ONCOLOGY
3.4 Radiotherapy
Work is ongoing in a number of areas, including for example:

Extensive work has been undertaken within the Beatson West of Scotland (BWoSCC) Cancer Centre to deliver access standards and manage capacity efficiently.
Work will continue in to 2014/15 and beyond.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 64 of 82
th

As part of a medium term capacity plan that has been developed by the BWoSCC a 12 linear accelerator will become operational in Spring 2014. This will remain in
place until the opening of the new satellite facility in Lanarkshire in the latter half of 2015/16.

The full business case for the development of a satellite radiotherapy facility in the WoS has been completed and submitted for approval by WoS NHS Boards and the
Health Department.

WoSCAN, through the Clinical Lead for Radiotherapy in the BWoSCC, have continued to participate in the Scottish Radiotherapy Programme Board.

WoSCAN, through the Director of Regional Planning, General Manager and Clinical Director for the BWoSCC have inputted to the national SLWG looking at the
future sustainability of radiotherapy services across NHS Scotland.
3.5 Systemic Anti-Cancer Therapy
Work is ongoing in a number of areas, including for example:

WoSCAN has initiated a rolling programme of work to assess compliance with this CEL 30 (2012). This will involve an external peer review of services, building on
work previously undertaken in the WoS. A self assessment of the implications of the new CEL for WoS Boards was undertaken in 2013/14 and a workplan developed
to address gaps identified.

Horizon scanning information was issued to NHS Boards in December 2013 to inform forward planning for 2014/15. This is kept under regular review.

A significant unknown at this stage is the impact of the imminent change to Scottish Medicines Consortium (SMC) process in response to the New Medicines Review.
Roles/responsibilities in the revised process(es) introduced will require to be determined and clearly defined.

Electronic prescribing has been embedded in practice across the four WoS NHS Boards. Work is ongoing to transition fully to business as usual and maximise
benefits realisation. Work will be undertaken in 2014/15 to implement the system in Oban and Lochgilphead, embed the regional reporting model in practice and
prepare the business case to support system upgrade (cross reference section 3.10).

Systemic anti-cancer therapy protocols and associated clinical management guidelines have been kept under review and developed/updated when required.
3.6 Acute Oncology
Work is ongoing in a number of areas, including for example:

Participation in pilot national 24 hour telephone triage model in conjunction with NHS24 (NHS Ayrshire & Arran is the pilot site). This will be extended to other WoS
NHS Boards in 2014 (February 2014 NHS Forth Valley and April 2014 NHS Lanarkshire).

The Beatson West of Scotland Cancer Centre Acute Assessment Unit opened on the 7 October 2013, having agreed a phased approach designed to assess and
determine the infrastructure, bed model, and specialist clinical skills were in place to deal with the complex medical needs of the patient, particularly as there is no
accident and emergency unit on site for back up support.

A regional guideline for the investigation, diagnosis and management of metastatic malignancy of undefined primary origin has been developed and agreed.
Implementation of this guidance will be taken forward in 2014/15.
th
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 65 of 82
Issue
Radiotherapy
capacity planning
and demand
management
Actions
th
Establish running of 12 linear accelerator.
Lead
Due
Outcome
Updated Position
DD/GJ
BWoSCC
May 2014

Increased capacity.
12 Linac operational
April 14

Maintain increased
capacity.
Discontinued at present due to
above being established.
Potential to reintroduce should
demand necessitate this.
Routine data submission in
place. Activity regularly
benchmarked with other
centres across the UK.
Continuation of extended working day model.
Continue to regularly review activity data and
participate in NATCANSAT audit.
RCAG
Ongoing

Maximise use of
available capacity.
Benchmarking
performance with other
UK Centres.
Continue to support the NHS Greater Glasgow and
Clyde Acute Operating Division in driving forward
redesign in radiotherapy.
RPD/
BWoSCC
DD/GJ
Ongoing

Progress made with
agreed developments
in a timely manner.

Clear pathways in
place with robust
contingency plans
agreed between
Cancer Centres.
Work ongoing. Gary Jenkins
and Janette Fraser
representing the WoS.
Contingency plans in
place/agreed with North of
Scotland Cancer Network
require to be regularly
reviewed.
GREEN

Full business case for
satellite facility.
Full business case approved.
Input to the national SLWG set up to review current
pathways for radiotherapy and future service delivery
models, ensuring safe, sustainable pathways are in
place and robust contingency plans are agreed
between Cancer Centres.

Assess impact of changes in other regions for
West of Scotland services, taking account of
impact for other cancer services (e.g. surgery).
Full business
case (FBC) for
satellite facility
Cancer
medicines
th
Complete development of the full business case for
satellite facility, ensuring effective input from all
Boards.

Submit FBC to Lanarkshire Health Board.

Submit FBC to Health Department
RPD
Feb 14
Pending approval, move to next phase of Project Plan.
RPD
tbc
Refresh change plan to support transition from existing
service model to proposed new service model.
JB (GGC)
April 14
Horizon scanning for new cancer medicine
developments including identification of opportunities
RCCP/
RPASG
GREEN
BLUE
Feb 14
March 14
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Building work commenced.

Clearly defined change
plan.
Recently refreshed.
GREEN
Latest horizon scanning report
issued to Directors of Finance.
Page 66 of 82
to generate savings and/or improve efficiency.



Continue to:
Advise NHS Boards on the implementation of
Scottish Medicines Consortium and National
Institute for Clinical Excellence (NICE)/Healthcare
Improvement Scotland (HIS) guidance on new
cancer medicines.
Peer review regional proposals not subject to
national guidance to NHS Boards.
Prepare SACT protocols to support implementation of
SMC/NHS HIS advice. Update existing systemic anticancer therapy protocols, which are due for review and
in response to new safety information.
Assess impact of imminent change to SMC process in
response to the New Medicines Review and define
‘new’ role/responsibilities.

GREEN
Update 2014/15 report regularly to facilitate in
year reviews of projections.
Issue regular horizon scanning reports to Boards
to assist with local service planning.
Produce report for 2015/16.
Ongoing
Detailed regional
analysis of SMC
Forward Look and
other cancer
developments
circulated in confidence
to NHS Board

Guidance issued to
ADTCs.
Quarterly
Dec 14
RPASG
Ongoing
Guidance continues to be
issued to ADTCs.
GREEN
RCCP
Ongoing


RPASG
Ongoing
Guidance issued to
ADTCs.
Updated protocols
issued.

Defined regional
process implemented
to support process.

Suite of reports
available from CEPAS.
Work in progress.
GREEN
tbc
Support Boards to implement and deliver the new
Peer Approved Clinical System (PACS) process.
Define CEPAS reports required to support Boards and
MCNs to better understand cancer medicines
utilisation, monitor uptake of new cancer medicines,
refine horizon scanning predictions, support pharmacoepidemiological studies and better understand patient
outcomes.

RPASG
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
tbc
dependant
on
reporting
model
being
agreed
Suite of national reports
defined. Submitted to Scottish
Cancer Taskforce in Feb 2015
where reports were ratified.
SLWG disbanded.
BLUE
Page 67 of 82
Clinical
management
guidelines
(CMGs)
Safe
administration of
systemic anticancer
treatments
(SACT)
Maintain the prescribing guidelines section of the
WoSCAN intranet site.
RPASG
Complete review and update of extravasation regional
guidelines.
RPASG
Review and update relevant CMGs in line with
timescales agreed and regional governance process.

15 CMGs scheduled for review and updating in
2014/15.
MCN Man/
Clin Leads
Reg SACT
Exec Grp







MH (FV)
JM (Lan)
PMcL (A&A)
DD (GGC)
DD (GGC)
JM (Lan)
DD(GGC)
Participate in Healthcare Improvement Scotland
scrutiny process.
Acute oncology
Mar 15


Readily accessible
regional prescribing
guidance.
Site maintained.
Revised regional
guideline.
Review ongoing.
GREEN
GREEN
Initiate regional peer review process for assuring
compliance with CEL 30 (2012).
Forth Valley Royal Hospital
Wishaw General Hospital
Ayr Hospital
Southern General Hospital
Royal Alexandra Hospital
Monklands District General Hospital
Glasgow Royal Infirmary
Ongoing
In line with
agreed
governance
process/
timeline.

Clinical management
guidelines in development or
review are following the
standard operating procedure.
GREEN

Reports of compliance
with CEL 30 (2012) for
each site delivering
SACT.

Assurance of
performance across
region.

All sites utilising
national out of hours
telephone triage
service
Implemented. BWoSCC now
utilising for out of hours calls.
Regional input to national
Expert Group being refreshed.

Minimise duplication of
effort.
Ongoing via national group.
Regional guideline
implemented in pilot
Initial draft data analysis report
to support service planning
Mar 14
May 14
Aug 14
Sept 14
Oct 14
Jan 15
Mar 15
tbc
CMGs reviewed and
updated to reflect
current evidence based
practice.
Audits complete at
Forth Valley Royal, Wishaw
General, Ayr, Southern
General and Royal Alexandra.
Scheduled for Monklands March 2015. Pack sent to
Glasgow Royal Infirmary as 3month trigger - 15/12/14.
No significant issues identified.
Pack sent to Yorkhill as 3
month trigger - 24/02/15.
GREEN
Out of hours services and access to specialist advice
and care:


Take forward roll out of national ‘Out of Hours’
Telephone Triage Service.

NHS Forth Valley

NHS Lanarkshire
MH (FV)
JM/MS (Lan)
Feb 14
April 14
Share learning across sites/region, ensuring
alignment of patient information across the region.
Reg SACT
Exec Grp
Ongoing
Board cancer
Management of cancer of undefined primary origin:
leads/
 Implement agreed regional guidance. Pilot in NHS
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Mar 15

BLUE
Page 68 of 82
GCC and NHS Forth Valley initially.
managers
sites and evaluated to
inform wider roll out.
developed in conjunction with
WoS Cancer Surveillance Unit.
Local NHS Forth Valley Team
working with BWoSCC to
progress implementation of
Cancer of Unknown Primary
team.
3.7 SURGICAL ONCOLOGY
Work is ongoing in a number of areas, including for example:

A number of exemplar pathways to support implementation of enhanced recovery after surgery (ERAS) have been developed to support Boards progress
implementation of ERAS locally. This work will be completed in 2014/15.

A clinical pathway to assure quality and equity of service provision has been devised for immediate breast reconstruction. Work will be progressed in 2014/15 to agree
how this is taken forward and implemented.

A health technology assessment relating to the use of robotic surgery for radical prostatectomy was undertaken and reported in 2013. Having been considered by the
national planning forum 2 key recommendations have been made: 1) NHS Scotland should support a research proposal that would test the clinical and costeffectiveness of robotic surgery for prostate cancer and perhaps other conditions that may benefit from robotic surgery 2) Boards to plan to move from open radical
prostatectomy to laparoscopic radical prostatectomy. A regional group has been set up to progress recommendation 2. This will significantly impact future service
delivery models in the WoS.

A review of radical oesophagogastric surgery was initiated in 2013/14. This has involved a review of activity data, future demand, outcomes and clinical pathways.
This work will be completed in 2014/15.
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
Issue
Actions
Lead
Enhanced
recovery (ER)
Complete development of exemplar pathways for the
surgical management of defined cancers:

Urological

Sarcoma
MCN Man
(KC) +
relevant
MCN Man/
Clin Leads
Due
Dec 14
Mar 15
Outcome
Updated Position

Final version of the exemplar
for Urology was presented to
the RCCLG in December and
endorsed, with minor
amendment, for wide
circulation to encourage and
support local implementation.
Clearly defined
exemplar pathways.
GREEN
A proposal for the work on
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 69 of 82
ERAS for sarcoma (bone
tumours) has been circulated
for wider regional (WoS)
engagement.
Production of an ERAS
pathway will be an objective
for the 2015/16 work plan.
GREEN
Pancreatic cancer pathway in
Dundee in progress.
Aberdeen and Inverness now
included.
GREEN
Radical
oesophagogastric
surgery
Finalise agreed regional service model for the
management of those patients requiring to undergo
radical oesophagogastric surgery, taking account of
current activity, future demand, service sustainability
and clinical outcomes.
RMC/ RLCC
June 14

Clearly defined regional
service model.
Final paper with
recommendations went to
June 2014 RCAG. Retain 3
surgical resection centres at
present. Recommendations
accepted. To be kept under
review.
BLUE
Immediate breast
reconstruction
Determine the optimal regional service model that will
enable the agreed regional clinical pathway to be
implemented equitably across the WoS.
RPD/
RMC
Dec 14

Clearly defined and
agreed optimal regional
service model.
Appropriate access to
specialist plastic
surgery input across
the region.
Optimal use of
specialist resource.
Clinical case for change
presented to April Regional
Planning Group. Discussions
ongoing with Boards. Further
information sought via Chief
Executives. Detailed template
for review sent to Boards for
completion by mid January.
Thereafter for discussion at
next Regional Planning Group
meeting in March 2015.


RED
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 70 of 82
Radical
prostatectomy
Determine the optimal service model for the future
provision of laparoscopic radical prostatectomy.
RPD/
RMC
Determine transition plan to move to laparoscopic
radical prostatectomy from open procedures.
Volume/outcome
Review regional performance, particularly in relation to:

Oesophagogastric cancer

Prostate cancer
RLCC/IM
Consider potential implications for the sustainability of
other low volume / increasingly specialist services.
RPD/
RMC
RLCC
Oct 14

Clearly defined and
agreed optimal service
model.
Mar 15

Agreed transition plan.
In line with
audit
reporting
schedule

Assurance of quality of
care provision.
Mar 15

Agreement in principle to move
forward to robotic surgery.
Business case being
developed for submission to
next Regional Planning Group
meeting.
GREEN
OG – outcomes in line with
other centres.
GREEN
Clear understanding of
future priority areas to
be reviewed.
Prostate – being reviewed as
part of work ongoing around
minimally invasive radical
prostatectomy.
GREEN
3.8 TRANSFORMING CARE AFTER TREATMENT

Significant work is ongoing at a local level in relation to support for patients/carers living with and/or surviving cancer, which individual members of the network input
to.

During 2012/13, a national programme of work around transforming care after treatment (TCAT) was initiated. This programme is underpinned by non-recurring
funding (£5 million over 5 years) from Macmillan Cancer Support. Phase 1 bids have been submitted and approved and work is now underway to develop detailed
project plans. 4 bids from the WoS were successful in securing funding. A call for phase 2 bids will take place in summer 2014. Sandra White (Nurse Consultant, NHS
Ayrshire & Arran) has been appointed as the regional clinical lead for TCAT.

In conjunction with, work is being undertaken to provide accessible tailored information to patients. Network members are actively contributing to development of the
content for this tool.
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
Issue
Actions
Lead
Due
Outcome/Deliverables
Updated Position
Transforming
care after
treatment
Input to the work of the national programme board.
RLCC/
RMC
Ongoing

RLCC and RMC are members
of the National TCAT
Programme Board.
Develop, agree and progress project plans for successful
phase 1 bids, ensuring appropriate regional input via
SW/NSM
Ongoing
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Regional input to
national programme.
GREEN
Page 71 of 82
WoSCAN and relevant MCNs:

NHS Ayrshire & Arran (Breast)

NHS Forth Valley (Prostate)

NHS Greater Glasgow and Clyde (Breast)

NHS Lanarkshire (Lung)
SW (AA)
ST/SC (FV)
DH/RC
(GGC)
MS/JMcP
(Lan)
Mar 15
Mar 15
Mar 15


Mar 15

Undertake a baseline assessment of use of holistic needs
assessment across WoS NHS Boards.
WoSCNG
Dec 14
c/f

Develop and agree the regional action plan.
SW/NSM
May 14

Building on the work completed to date, progress the
agreed regional action plan during 14/15 with focus on:

Local Authority engagement.

Communication.

Education.

Change management.

Risk management.
Manage submission of Phase 2 bids.

Support development of bids.

Plan for wider roll out of phase 1 bids should projects
demonstrate success.
SW/NSM
RMC
SW
SW/NSM
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Mar 15
Aug 14
Mar-July 14
Mar 15


Clearly articulated
project plans.
Scope for shared
learning across projects
optimised.
Roll out plans should
pilots demonstrate
success.
Baseline assessment to
inform future work.
NHS Ayrshire & Arran/NHS
Forth Valley/NHSGGC/NHS
Lanarkshire have completed
and secured funding and
progressing with project
development.
Regional action plan
presented to and
endorsed by the
regional TCAT
implementation
steering group (ISG).
Regional action plan
endorsed by ISG and RCAG.
Foundations laid for
transformative change
in clinical practice with
a shift away from
traditional models of
care to more person
centred models that
focus on recovery and
health and well being.
July 18th local authority
engagement event postponed.
Alternative approach achieved
with a round of visits to
potential bidders for Phase 2.
Regional portfolio of
bids that embrace the
ethos of the national
programme. Shared
learning.
Approach and communication
agreed and emails sent out
June 27th. Deadline for
submissions September 30th
achieved for 7 EoIs with 2
submitted for October 8th.
GREEN
Awareness that Health Needs
Assessment being used and
some early thinking around
how best to establish a
regional baseline position and
assess utilisation and
effectiveness.
GREEN
BLUE
BLUE
Page 72 of 82
Outcome for WoSCAN of
national programme board
prioritisation is 7 successful
EoIs and one declined.
BLUE
Another EoI being further
strengthened for resubmission
to March meeting of national
programme board.
GREEN
Planning for wider roll out not
undertaken in 14/15 and will
be re-scoped for phase 3.
Follow up
Review and update regional follow up guidelines:

Lymphoma
Relevant
MCN
Man/Clin
Leads

Dec 14
Revised regional
consensus guidelines
published.
Clinical guidance documents in
development or review are
following the standard
operating procedure.
Lymphoma guideline review
complete and endorsed by the
Regional Cancer Clinical
Leads Group (RCCLG) 1st
October 2014 and formally
issued on November 19th.
BLUE
Initiate review of follow up guidance for:
Renal
Lung
Skin
Gynaecological malignancies
Head & Neck
Bladder
Oct 14
Oct 14
Oct 14
Dec 14
Dec 14
Feb 15

Reviews initiated.
Reviews completed for Lung,
Skin and Renal with
presentation to March meeting
of RCCLG and anticipate
approval for formal issue to
NHS Boards.
BLUE
Develop follow up guidance for patients with acute
leukaemia, treated with curative intent.
Mar 15

Regional guideline.
Initiated July 2014 and is
progressing to agreed timeline.






GREEN
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 73 of 82
Develop risk stratified follow up guidelines for the
management of post transplant patients at risk of
developing skin cancer.
Information
In conjunction with national tailored information project
promote the use of quality assured patient information in
practice.
RMC
Mar 15

Risk stratified follow up
guideline.
A discussion paper on follow
up guidelines for the
management of post transplant
patients at risk of developing
skin cancer was discussed at
the October 2014 Skin Cancer
MCN Advisory Board meeting.
Work is ongoing, with further
discussion planned for March
2015 meeting.
GREEN
Ongoing

Single source of quality
assure patient/public
information that is
readily accessible
across the region.
Early scoping by new NHS 24
lead supported by regional and
national MCN Managers.
NSM attended September
meeting and follow up meeting
held to further explore and
agree how the regional cancer
network will support this
refreshed project which is the
further development of the
personalisation tool – Info For
Me. National programme
vision statement and business
plan agreed.
GREEN
3.9 QUALITY
 All aspects of WoSCAN’s work plan are aligned with the dimensions of quality set out in the national quality strategy.

WoSCAN continues to lead on the national cancer quality programme. Quality performance indicators (QPIs) development for all main cancers will be completed by
October 2014. In line with CEL 06 (2012) reporting against QPIs for some cancers commenced in 2013/14. This will continue in 2014/15 with development of
Information Services Division’s (ISD) interactive dashboard and Healthcare Improvement Scotland’s assurance process.

In line with CEL 06 (2012) and regional governance processes NHS Boards will be required to submit data for analysis and develop action plans in response to
publication of QPI performance data.
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 74 of 82
Issue
Development of
National QPIs
Clinical audit
Actions
Lead the development of national QPIs for all main
cancers:
 Convene development groups and manage
development of tumour specific QPIs.
 Oversee and manage engagement process.
 Liaise with ISD and support development of datasets
and measurability documentation.
 Plan and oversee implementation of QPIs, assuring
development of information technology (IT)
databases to support data collection.
 Work with Information Services Division to undertake
post implementation review of datasets.
Lead
RMC/PM
(IS)
Optimise the use of available resource regionally &
locally:
 Further streamline data collection & local reporting.
 Further streamline regional reporting.
 Further develop eCase reporting functionality and
standard reports.
IM
Due
In line with
timelines
set out in
agreed
national
work
programme
Outcome/Deliverables
 Small sets of nationally
agreed QPIs, with
national datasets and
measurability criteria
developed and
successfully
implemented.
In line with
agreed
programme


Annual assessment of
service quality, patient
outcomes and
performance. Regional
comparative reporting.
Agreed action plans to
address areas where
performance requires
to be improved.
Improve efficiency and
optimise resource
utilisation.
QPI Development complete
with QPIs for all main cancer
st
types implemented as of 1
October 2014.
Schedule for 9 month review
of datasets and baseline
review of QPIs, following first
year of reporting, progressing
according to agreed
timescales.
GREEN
Data analysed and reported in
line with 2014/15 schedule.
Work underway to develop
QPI reports in line with ISD
measurability and develop
additional reports for
regional/national use.
A number of reports require to
be updated as a result of ISD
documentation updates.
GREEN
MCN audit reports issued to the service in line with
agreed timetable for reporting and agreed Network
Governance Framework, ensuring that any action that
requires to be taken is undertaken timeously.
IM
Participate in Healthcare Improvement Scotland’s
assurance programme.
Relevant
MCNs
Agree and progress 2014/15 programme of work with
DM/ IM/
West of Scotland Cancer Surveillance Unit.
MCN Clin
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Ongoing

In line with
national
prog.

May 14

Quality assurance and
improvement reports
issued to service to
inform service
provision and redesign.
Audit reports published and
issued to the service.
Service quality
assurance.
Meeting scheduled for 13
April.
GREEN
th
GREEN
Maximum use made of
data available to inform
Plan agreed. Work
progressing.
Page 75 of 82




Patient
Experience
Regional/national
guidelines
Oesophagogastric
Radical prostatectomy
Colorectal (interval cancer)
Gynae- oncology
Support NHS Boards to implement national patient
experience QPIs.
 Share models of good practice.
 Participate in Healthcare Improvement Scotland
assurance programme.
Review and revise regional guidelines and protocols in
line with agreed timescales/processes.
Develop an optimal treatment pathway for the
management of osteoradionecrosis following
radiotherapy to head and neck.
Multidisciplinary
Team (MDT)
Meetings
Formalise the management of patients with malignant
pleural mesothelioma.
 Staging tool agreed.
 Agree key outcome measures to support data
analysis.
Leads
and drive service
improvement.

WoSCNG
NHS Boards
Ongoing
tbc

MCN Man/
Clin Leads
MCN Man
(HW)/ MCN
Clin Lead
(SR)
MCN Man
(TC)/MCN
Clin Lead
(JM)
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
In line with
regional
review
dates
Mar 15
Mar 15




BLUE
Supported
implementation of
patient experience
QPIs.
Assurance that patient
experience is being
used to inform/drive
service improvement.
Responsibility sits with NHS
Boards who are currently
looking at approaches.
Governance/reporting still to
be finalised with Healthcare
Improvement Scotland.
Regional/national
guidelines reviewed
and updated to reflect
current best practice,
including discontinuing
some aspects of
current practice, where
appropriate.
Clinical guidance documents
in development or review are
following the standard
operating procedure.
Agreed pathways.
Clinical Lead identified to
progress this work. Short life
working group to meet Feb
2015 to take this forward.
MDT functioning
formalised.
Agreed key outcome
measures to enable
comparative reporting
of performance.
GREEN
GREEN
GREEN
Monthly Mesothelioma MDT
meeting running successfully
and revised standard
documentation in use.
Reminders issued regarding
appropriate recording of
staging for mesothelioma
patients. New outcome
measures under development
- anticipated will be finalised
and reported on for patients
diagnosed in
GREEN
2014.
Page 76 of 82
National and
regional
education
programmes
Review and strengthen function of the regional skin
cancer MDT.
MCN Man
(TK)/MCN
Clin Lead
Mar 15

Formal review of skin
cancer MDT and action
plan to enhance
function
agreed/implemented in
conjunction with NHS
Boards.
Discussed at December
Regional Cancer Advisory
Group (RCAG). Good
progress being made. A MDT
Coordinator has been
appointed. The MDT Chair
has resigned and a new chair
appointed. Work to make
better use of video
conferencing is providing
results to make more effective
use of the MDT. Timing of
meeting to change. Work
ongoing to review the
operational policy and to
develop a palliative care
referral pathway
.
GREEN
Host national meeting for Oesophagogastric Cancer.
IM/MCN Man
(TC)/Clin
Lead
Oct 14

Successful meeting
where nationally
agreed QPIs are
reported for the first
time.
Programme finalised with
input from external speakers.
Event held on 24th October
2014.
BLUE
Contribute with programme development for national
colorectal cancer meeting and national breast cancer
meeting.
MCN Man
(KC/TK)/ Clin
Leads
Jan 15 (C)
Nov 14 (B)
Feb 15 (B)

Tripartite agreement of
national programme
across Networks.
South East of Scotland
Cancer Network leading on
National Breast Meeting.
North of Scotland Cancer
Network hosting Colorectal
Cancer meeting; some input
to programme provided.
BLUE
Host regional tumour specific education events for
national and regional MCNs.
MCN Man/
Clin Leads
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Ongoing in
line with
agreed
prog.

Successful education
programme across a
wide variety of topics
with participation from
multiprofessional
groups.
2014 schedule completed and
evaluations are positive.
BLUE
2015 underway with 2 events
in January.
GREEN
Page 77 of 82
Host regional sharing practice event.
WoSCNG
Oct 14

Successful education
programme with
nursing input from
variety of areas/
specialties/Boards.
Event held in September.
BLUE
3.10 DELIVERY
Regional & national working
 Delivery of this work plan and realisation of the benefits for patients is highly dependent on effective regional and national working. During 2014/15 regional processes
will be kept under review and further developed where necessary.
eHealth

The regional cancer eHealth programme of work was refreshed in 2013/14. This will be taken forward in conjunction with eHealth Leads to ensure close alignment
with other local, regional and national developments. Work will focus on support for regional and national MDTs, cancer audit, electronic prescribing and supporting
the national TCAT programme.
Workforce
 Recognising that many of the workforce issues that impact cancer are generic, these are predominantly being addressed by other groups. WoSCAN will continue to
undertake targeted work where appropriate.

New appointments to some MCN Clinical Leads were made during 2013/14. (i.e. breast, neuro, haemato-oncology, and transforming care after treatment). Further
new appointments will be made in 2014/15 (i.e. upper gastrointestinal, hepatobiliary and skin).
Specific activities that will be taken forward regionally via the Network and its constituent MCNs and Regional Groups, in conjunction with WoS Boards in 2014/15 are
detailed below.
Issue
RCAG Terms of
reference
Actions
 Review RCAG terms of reference and
membership.
CEPAS
(Chemotherapy
electronic
prescribing &
administration)
Complete transition to business as usual function.
 Define and agree regional reporting model.
Lead
RMC
Due
Oct 14
Outcome/Deliverables
 Refreshed terms of
reference.
CEPAS IM
Aug. 14
Mar. 15

Reporting model
agreed and
implemented.
Terms of reference reviewed &
ratified at October 2014 RCAG
meeting.
BLUE
The “CEPAS Access and Data
Sharing Agreement” and
“CEPAS Information Request
Approval Process” documents
have been published on the
ChemoCare Report page of
the WoSCAN intranet website.
BLUE
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 78 of 82

Issue standard reports and evaluate usefulness of
these reports.

In conjunction with Boards take forward
TrakCare/CEPAS interface.
Reports to be developed have
been identified and
development priorities set.
Development of required
reports is in progress. 22 Adhoc report requests have also
been received over the last 9
months.
BLUE
JF (GGC)
Oct. 14
Dec. 14
Mar. 15
Apr. 15

Interface requirements
developed and
implemented.
Due to oversight, the
TrakCare/ ChemoCare
Interface specification paper
was not submitted to the
January 2015 TrakCare
Change Advisory Group (CAG)
meeting. At the March 2015
CAG meeting there was
agreement in principle. It is
anticipated that proposed
development timescales and
costs will be a substantive item
for discussion at the next
rd
CEPAS Executive (23 April).
RED
th

Implement CEPAS in Oban and Lochgilphead.
eHealth Prog
Man
Dec 14

System live in Oban
and Lochgilphead.
Oban went live 27 August
2014. Lochgilphead went live
th
29 October 2014.
BLUE

Scope the implications of future system upgrades
to inform way forward.
eHealth Prog
Man
Dec 14

Clear understanding of
future business
requirements and
implications of planned
system developments.
Business Case for
implementation of v5.3.4 was
supported by the CEPAS
Executive 26/06/14 and ratified
by the Regional Cancer
Advisory Group 29/08/14.
Timescales for potential move
to v6 are likely to be 1-2 years.
BLUE
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 79 of 82
eCASE
(System that
supports clinical
audit)
Progress agreed development plan.
 Align with national QPI development programme to
ensure regional capability to report against
nationally agreed QPIs that will be a mandatory
requirement for NHS Boards.
eHealth Prog
Man/IM
In line with
agreed
project plan

Sustainable national
system to underpin
clinical audit.
Re-planning of the eCASE QPI
development timescales is in
progress due to slippage.
Priorities for QPI development
and QPI revisions are being
assessed in alignment with the
audit reporting requirements.
AMBER

Transition to business as usual function.
- Take forward discussion with National
Service Scotland.
RW/RMC
Mar 15

Agreement on future
hosting arrangements.
Original planned follow up
meeting with National Service
Scotland was postponed due
to delay in receiving
clarification/ information from
Human Resources
Department. Meeting now
th
scheduled for 10 March 2015.
GREEN
Oct 14
-

Review support model and Service Level
Agreement.
Service level
agreement
reviewed/updated.
eHealth Prog
Man/ MCN
Man (KC)
Jun. 14
Dec. 14
Apr. 15

Server upgraded to
support system.
Scope requirements for regional and national MDT
eHealth Prog
meetings and determine how current support can be
Man
enhanced to meet identified needs, using sarcoma,
haemato-oncology and gynaecology MDTs as
exemplars.
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Jun. 14
Dec. 14
TBD

Report detailing how
current arrangements
can be optimised to
support clinical MDT
meetings.

Multidisciplinary
Team (MDT)
meetings
Upgrade version of current server.
Service Level Agreement for
FY 2014/ 15 has been issued
to Regional Cancer Leads.
BLUE
Next steps for upgrade
identified as follows:
1) Review/ assess other
outstanding issues
2) Resolve Core issue that
prevented upgrade
3) Dry/ Test Run of upgrade
(target date 11 March ‘15)
4) Upgrade (target date 2224 April ‘15 assuming task
3 OK)
GREEN
The WoS eHealth Leads,
utilising funding from the
Scottish Government, are
recruiting resource to
undertake a piece of work to:
Page 80 of 82
“inform the development of a
systems architecture to
support regional information
sharing, workflow and
collaboration”.
The deliverable from this piece
of work will be a report which
sets out:
”A future systems blueprint
and architecture for regional
information sharing and
workflow and evaluated
options for the design and
delivery of that blueprint
utilising the regional Cancer
MDT requirements as a test
case”.
It is anticipated that this piece
of work will take 3 months with
a target start date of April ’15.
AMBER
Cancer eHealth
Forum
Establish a regional forum that will, in time, inform
development of a refreshed regional cancer eHealth
plan.
eHealth Prog
Man
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Jun 14

Established regional
forum populated with
local eHealth ‘leads’ for
cancer across the
region.
A meeting of the eHealth
Engagement Group took place
th
on the 20 January. The
meeting was attended by
David Dougan (WOS eHealth
Programme Manger), Andrew
Hardy (NHS Ayrshire & Arran),
John Wells (NHS Forth
Valley). Apologies received
from Joanne Freel (NHSGGC)
and Liz McCulloch (NHS
Lanarkshire). Next meeting is
planned to take place in April
2015.
BLUE
Page 81 of 82
Lead Abbreviations
AMacL GGC
BWoSCC DD/GJ
DD (GGC)
DH (GGC)
DM (WoSCSU)
eHealth Prog
Man
GGC
IM
JB (GGC)
JF (GGC)
Aileen MacLennan Greater Glasgow and
Clyde
Beatson West of Scotland Cancer Centre –
David Dunlop/Gary Jenkins
David Dunlop (Greater Glasgow and Clyde)
Douglas Hansell (Greater Glasgow and
Clyde)
David Morrison (West of Scotland Cancer
Surveillance Unit)
eHealth Programme Manager
Greater Glasgow and Clyde
Information Manager
Jonathan Best (Greater Glasgow and Clyde)
Joanne Freel (Greater Glasgow and Clyde)
JM (Lan)
JMcP (Lan)
MCN Clin Lead
MCN Clin Lead (JM)
MCN Clin Lead (SR)
MCN Man
MCN Man (HW)
MCN Man (KC)
MCN Man (TC)
MCN Man (TK)
MH (FV)
MS (Lan)
NSM
PCCN
PM(IS)
PM (KC)
John Murphy (Lanarkshire)
John McPhelim (Lanarkshire)
MCN Clinical Lead
MCN Clinical Lead (John McPhelim)
MCN Clinical Lead (Stuart Robertson)
MCN Manager
MCN Manager (Heather Wotherspoon)
MCN Manager (Kevin Campbell)
MCN Manager (Tracey Cole)
MCN Manager (Tom Kane)
Mhairi Hughes Forth Valley
Mhairi Simpson Lanarkshire
Network Service Manager
Primary Care Cancer Network
Project Manager (Iona Scott)
Project Manager (Kevin Campbell)
PM (A&A)
RA
RCAG
RCCP
Reg SACT
Exec Grp
RPASG
RPD
RLCC
RMC
RC (GGC)
SC (FV)
ST (FV)
SW
WoSCNG
Peter Maclean (Ayrshire & Arran)
Ruth Adamson
Regional Cancer Advisory Group
Regional Cancer Care Pharmacist
Regional Systemic Anti-Cancer Therapy Executive
Group
Regional Prescribing Advisory Subgroup
Regional Planning Director
Regional Lead Cancer Clinician
Regional Manager (Cancer)
Russell Coulthard (Greater Glasgow and Clyde)
Sandra Campbell (Forth Valley)
Seamus Teahan (Forth Valley)
Sandra White Clinical Lead Transforming Care after
Treatment
West of Scotland Cancer Nurses Group
Work Plan prepared by Evelyn Thomson, Regional Manager (Cancer), West of Scotland Cancer Network
West of Scotland Cancer Network
Final – Published WoSCAN Year End Report and Work Plan 2014/15 v1.0 23/07/15
Page 82 of 82