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New Zealand Regional Cancer Networks Improved cancer control through increased regional collaboration Overview • • • • • • New Zealand and its people Cancer in New Zealand New Zealand Cancer Control Strategy Key Players Regional Networks Work priorities and programmes People in New Zealand • 4.27 million – 68% – 15% – 7% – 9% – 12% European Maori Pacific Peoples Asian Other Rural / Urban Population • 72% live in main urban areas • 5.5% live in rural areas • 1.6% live in remote rural areas Cancer in NZ • Second leading cause of death • 7,500 people die annually & expected to rise to 9000 by 2012 • 17,000 new registrations annually and expected to rise to 22,000 by 2011 • Top 3 for males: lung, bowel, prostate • Top 3 for females: breast, bowel, lung Inequalities - Maori • Age-sex-standardised incidence rates for cancers overall: Maori – 219/100,000 Non-Maori – 220.5/100,000 • Age-sex-standardised mortality rates for cancer overall: Maori – 117.5/100,000 Non-Maori – 66.3/100,000 Inequalities - Maori • Cancer registrations • Cancer deaths • Source: Hauora Maori Standards of Health IV – A Study for the Years 2000-2005 Maori Non-Maori Lung Prostate Female breast Colorectal Prostate Female breast Colorectal Melanoma Stomach Lung Maori Non-Maori Lung Lung Female breast Colorectal Colorectal Female breast Stomach Prostate Prostate Pancreas Haka = a traditional Māori challenge NZ Cancer Control Strategy • Started 1999 – NZ Cancer Control Trust • 2000 – NZ Health Strategy • 2001 – Improving Non-Surgical cancer Treatment Services in NZ & NZ Palliative Care Strategy • 2003 – NZ Cancer Control Strategy • 2005 – NZ Cancer Control Strategy Action Plan 2005-2010 Background • • • • Midland regional service planning commenced February 2004 Project Manager commenced late 2004 NZ CC Strategy Action Plan – March 2005 Cancer Control Projects – 2 for Midland 1. Midland Cancer Network Framework 2. Midland patient & parallel mapping for the major tumour groups • MCN formed October 2006 (CD & Overall purposes of the Strategy: Reduce the incidence and impact of cancer Reduce inequalities with respect to cancer NZ CC Strategy Goals 1. 2. 3. 4. 5. 6. Reduce the incidence of cancer through primary prevention Ensure effective screening and early detection Ensure effective diagnosis and treatment of cancer Improve the quality of life for those with cancer, their family and whanau through support, rehabilitation & palliative care Improve the delivery of services across the continuum of cancer control, through effective planning, co-ordination and integration of resources and activity, monitoring and evaluation Improve the effectiveness of cancer control in NZ through research and surveillance. Key Players • Ministry of Health • 21 District Health Boards – NZ Cancer Control Implementation Steering – NZ Cancer Treatment Working Party • • • • • • National Clinical Director, CCC PHARMAC,SPNIA 4 Regional Cancer Networks Primary Health Organisations Non-Government Organisations Consumers Regional Cancer Networks • established 2006/07 • Leadership, facilitation & co-ordination role • Continuum – primary prevention, screening & early detection, treatment, rehabilitation & support, palliative care, research & surveillance • Complex organisational & service delivery structures Regional Cancer Networks • • • • • • • Work across organisational boundaries Strong clinical and managerial leadership Involves patient & public Maori and Pacific participation/partnership Strengthen Primary involvement Quality assurance & clinical governance Deliver a set of comprehensive, integrated & best practice cancer services RCN Service Requirements • Investigate and address systemic causes of cancer inequalities • Develop patient pathways & improving the experience of care • Cancer data analysis capacity • Regional Strategic Cancer Control Plan • Tumour specific and service improvement MD work groups • Support service planning to maximise finite resources RCN Alignment with National Goals Two key work programmes: 1. Patient & service mapping 2. Reducing inequalities Work Streams: • Service improvement • Tumour groups RCN Management Team • Funding $550,000 pa – management infrastructure • Clinical Director (part time) • Manager • Service Improvement Facilitators – Patient and service mapping – Addressing inequalities • Administration support RCN Structure • • • • Each network slight structure differences All lead DHB and CEO All have a governance group All have work groups RCN Work Programme • • • • RCN Operating framework Regional Cancer Control Strategy Plans Service & Patient Mapping Development of patient management frameworks • Reducing inequalities • Establishment of AYA OHS • Palliative Care Primary Prevention Cancer Pathway Recognition Initial Diagnosis Determination of treatment Implementation of treatment Follow up program Recognition of recurrence Re treatment programme End of life care Addressing inequalities Supportive Care Confirmation of diagnosis Supportive Care Care Co-ordination Framework Multidisciplinary Meeting Framework Tumour Stream Steering Groups - Network Patient Journey Mapping Addressing Inequalities Potential cancer signs & symptoms, or abnormal results from a screening test of investigation Initial diagnosis & referral Determination of treatment Treatment Follow-up care Determination of plan & treatment for recurrence End-of life care Specialist Palliative Care Service Specifications Including End of Life Programme National Data Projects Screening Programmes PATIENT MANAGEMENT FRAMEWORK Guidelines e.g. Clinical, Supportive Care, GP Referral, Medical Imaging Network Focus National Focus New National Priorities • • • • • HPV programme Bowel Screening Programme Supportive Care Guidelines Information Systems project Specialist palliative care service specifications & gap / costing analysis • Other guidelines – suspected cancer in primary