Scottish Government

CANCER IN SCOTLAND SUSTAINING CHANGE

06 MAKING IT HAPPEN

Cancer Investment

What we said we would do:

• The Scottish Executive will make the necessary investments.

What has been achieved:

• Additional investment of 60 million was initially ring fenced for 3 years to secure more equitable and faster access to quality assured services by meeting waiting time targets and CSBS standards, increase patient involvement and participation in clinical trials, and secure real and lasting health improvements.

• Responsibility to decide on how and where to invest the money is vested in regional cancer networks. This has developed new relationships and ways of working across multidisciplinary teams and operational management and has led to enhanced understanding of patient needs and service provision.

• Principles of devolved responsibility for investment choice have been coupled with accountability and transparency in monitoring the effects. Regular updates are publicly available on www.cancerinscotland.scot.nhs.uk .

• This programme of focused investment is linked to reform and modernisation of services which will transform the way cancer services are delivered in Scotland.

Regional Cancer Advisory Groups (RCAGs)

What we said we would do:

• Establish three Regional Cancer Advisory Groups (RCAGs) and provide guidance on the structure and function of RCAGs and their respective tumour specific MCNs.

• The cornerstones of the new planning process for cancer services will be the MCNs working through the RCAGs.

What has been achieved:

• Guidance issued to NHSS to support RCAGs development with three RCAGs now well established in South East, West and North of Scotland. Working details of these structures and their investment and monitoring are available on
  www.scan.scot.nhs.uk
  www.show.scot.nhs.uk/woscan
  www.noscan.hw.ac.uk
  www.cancerinscotland.scot.nhs.uk

Patient Involvement

At the heart of the Scottish Executive's vision in Partnership for Care is a patient-focused culture of care, which is developed by a new partnership between patients, staff and Government. At a Scottish Parliament debate on Patient Focus and Public Involvement in June 2003 the Minister for Health and Community Care reiterated his aspiration to develop systems of care that reflect the needs concerns and experience of patients. He also reaffirmed that for this to happen patients must be engaged in a more serious and systematic way than at any point in the past.

What has been achieved:

• Patient Focus and Public Involvement (PFPI) was published in December 2001 and sets out a framework aimed at achieving a service where people are respected, treated as individuals and involved in their own care; where individuals, groups and communities are involved in improving the quality of care, in influencing priorities and in planning services and a service that is designed for and involving users. This is supported by an investment of 14 million over 3 years.

• An Involving People Team has been established to support strategic implementation of PFPI in the Scottish Executive Health Department and NHSScotland.

• Development of performance indicators for the Performance Assessment Framework (Involving People) and guidance to NHS Boards in December 2003.

• All NHS Boards now have in place a Designated Director responsible for providing strategic leadership for continued development and implementation of PFPI.

Cancer Specific

• Patient Involvement Workers are now in post in the North and South East of Scotland and soon to be appointed in the West of Scotland. Their remit is to involve patients in the design and delivery of cancer services in their region.

• The Scottish Cancer Group Quality Improvement Sub-Group commissioned and funded work by the University of Stirling to undertake a review of literature on the needs of patients with cancer and how patients can be involved more effectively as well as gaining patients' views on how best to ensure patient experiences can influence the development of cancer services. The report of that work was considered in August 2003 when it was agreed to set up a national cancer patient involvement workshop with a view to agreeing on the priority areas to be addressed and how these might be taken forward. This workshop is being held on 13 May 2004 and will involve a variety of stakeholders from across Scotland.

Voluntary Organisations

• The Scottish Cancer Coalition (SCC) which brings together a variety of cancer specific voluntary organisations launched their manifesto in September 2003. This the first time all the major cancer charities in Scotland have come together to celebrate the strength and diversity of the voluntary sector. Their manifesto include Calls for Action that highlight the agreement on priorities from all members of the SCC covering prevention, equity of access, education, patient/public involvement and research.

Managing Implementation

The approach taken by and mechanisms supporting implementation of Cancer in Scotland have delivered tangible improvements for patients and fundamental changes in the way that NHSS is working.

What has been achieved:

• Lead Clinician for Cancer Services and Chairman of Scottish Cancer Group providing leadership and direction for the modernisation and change agenda.

• Implementation Manager working directly to support networks with monitoring and development of targeted work to drive and support implementation.

• Implementation Framework provides clarity of purpose with 6-monthly monitoring reports from RCAGs on delivery of service change and improvements for patients.

• Annual Cancer Open Forum has been a significant success. Each year since 2001 more than 450 people drawn from across NHSS, voluntary sector, patients and public have attended. Feedback year on year has shown that delegates have welcomed the opportunity to share ideas and information and explore together areas of good practice.

• Networks development programme established with tumour specific workshops for breast, colorectal, gynaecological, lung and prostate cancers. A list of past and future workshops is included at Appendix 1 and summaries of past workshops are available on www.cancerinscotland.scot.nhs.uk .

Scottish Cancer Group

What we have done:

• The Scottish Cancer Group (SCG) chaired by the Lead Clinician was restructured to include more patients, the voluntary sector and others drawn from across the three regional networks. It is a forum to bring together a range of people with expertise and/or specific interest in the delivery of cancer services with all members having a clear remit to act as channels for communication and ideas and views from across the country.

• Standing agenda items have focused on regional investment plans, 6-monthly monitoring reports and the work of targeted sub-groups. The Group has also considered:

- NOF cancer programme proposals
- PFPI developments
- Communication skills
- SIGN Guidelines
- SMC recommendations
- Reports commissioned by the previous Scottish Cancer Group but considered by the current group such as "Tobacco and Alcohol in Ethnic Minority Groups: The Measurement Challenge" and "Why do affluent cancer patients have better survival than deprived? - Comparison of baseline characteristics and subsequent patterns of recurrence.

• Targeted sub-groups include:
  Referral Guidance
  Patient Information
  PET
  Radiotherapy Activity Planning
  Nursing, Cancer IM&T/eHealth
  Quality Improvement
  Genetics

• These groups have considered, developed and reported on a variety of issues all of which have now been or are currently being implemented and for which information is provided throughout this report.

• Minutes of Scottish Cancer Group and all sub-groups are published on www.cancerinscotland.scot.nhs.uk as are reports for all networks development workshops.