CANCER IN SCOTLAND: ACTION FOR CHANGE - Fifth Monitoring Reports: 1 October 2003 - 31 March 2004
West of Scotland Cancer Network (WOSCAN)
Fifth Monitoring Report
1 October 2003 to 31 March 2004
Introduction
This monitoring report is submitted on behalf of the West of Scotland Regional Cancer Network, covering the period 1 st October - 31 st March 2004. It summarises the continuing impact of additional investment monies, provided to help implement Cancer in Scotland, in sustaining and supporting continued improvement in cancer care throughout the West of Scotland, as well as reporting progress in the development of West of Scotland Cancer Networks.
Investment Plans/Monitoring
Investments made are clearly demonstrating direct improvements and benefits to patient care. Specific details of each of the investments and the improvements they have made across the West of Scotland can be found in the detailed monitoring investment schedules provided with this report.
Few posts now remain unfilled due to recruitment difficulties. Where such issues persist reviews of current proposals are being undertaken. For example, in Lanarkshire it has not as yet been possible to recruit to 2 Consultant Oncologist posts. Discussions between Lanarkshire and the Beatson Oncology Centre are taking place; reviewing and revising proposed work plans and requirements for these positions. In the interim, funding has been reinvested on a non-recurring basis.
Regional Working & Regional Cancer Advisory Group (RCAG)
Recognising the complexity of the organisational structure and environment in which the West of Scotland Cancer Network operates, together with the challenges and opportunities associated with this, the RCAG is currently undergoing a period of review. As part of this review, we are looking at how to reorganise and restructure regional groups and working arrangements in order to ensure that we are best positioned to develop and take forward what is a challenging programme of work. As part of this review we will be looking to strengthen partnership working between regional MCNs, clinicians, managers, the regional planning group, other NHS organisations and the population we serve.
Quality assurance is an integral part of the work of Regional Cancer Networks and the RCAG. As such, we are required to have a defined quality assurance programme, accredited by NHS QIS. Work has been undertaken to develop and agree a programme that is both realistic and challenging while ensuring that the programme developed supports the development of MCNs and continued improvements in care delivery. NHS QIS's accreditation panel is scheduled to meet to assess our submission on the 31 st May 2004.
Together these actions will help to ensure that the West of Scotland Cancer Network continues to develop in a way that is supportive of improving cancer services through regional working.
Patient and Public Involvement
Patient and public involvement in cancer care/service development continues to be supported and actively developed both locally and regionally. Patient representation is now established on a number of key working groups locally and regionally. In Ayrshire, for example, 2 patients now participate in Ayrshire's Cancer Steering Group, supported by staff from the Ayrshire Cancer Support Group and Lead Nurse, and both have undertaken Advocacy training. In Forth Valley development days are planned to engage the public and local community to become actively involved in shaping cancer care/services. Patient representation has also been established on a number of Regional MCN Advisory Boards. To further develop and support this work we are in the process of recruiting to a patient/user involvement development post with interviews scheduled for the 27 th May.
Managed Clinical Networks (MCNs)
Breast Cancer MCN
Lead Clinician: Professor George
Network Manager: Christine Morran
The Network is currently working to produce the first West of Scotland MCN Breast Cancer Annual Report. This report will form a baseline for future service development and improvement.
2003 data for the West of Scotland MCN for Breast Cancer, collected on a common dataset and database, is now held in the MCN office. Some of the analysed data will be presented in the Annual Report to be published in 2004. The network recognises the contribution and commitment of the MCN members including the audit staff of in region.
The West of Scotland MCN has produced a patient information record, which will be launched and distributed available to patients mid 2004. This information will be offered in addition to the high quality information already used.
The network welcomed two patient/carers to the Advisory Board at the December meeting and we look forward to supporting the soon to be appointed Patient/User Involvement worker for the region.
The education programme of the network continues to provide opportunity to regionally inform, debate and discuss patient management. This forum will also be used to regionally agree patient management and develop protocols for specific areas. Currently being addressed for consensus are Patients with a Family History of Breast Cancer and Follow-Up of Patients Diagnosed with Breast Cancer.
Colorectal Cancer MCN
Lead Clinician: Mr I Finlay
Network Manager: Kevin Campbell
Following the success of the first National Colorectal MCN event held in May 2003, the National Steering Group, chaired by Mr Finlay, was asked to construct a programme for a meeting in 2004. This meeting will take place on 23 April 2004 and the programme for the event will concentrate on investigation and diagnosis. The National Steering group also agreed a national comparative presentation of data from all three regions for this event. West of Scotland MCN staff, assisted by ISD, have taken the lead in producing comparative results, based on audit data returned across Scotland, for all new cases diagnosed in 2002.
Presentation of these comparative audit results is an important first step in developing further national collaborative working on areas of clinical and service development.
The Network has produced its second annual report including results of 2002 audit data. These results included analysis of further data points from pathology. The report re-iterated the problems identified in our first annual report around delays between referral and surgery. It also endorsed the results from the first year that showed that surgical preparation and performance are good across the Network. Confidential hospital-based reports have been prepared and the Lead Clinician and Network Manager will meet with representatives from each of these individual units to discuss the results.
Production of patient-held information packs is now complete. The production process has taken around twenty months, from review of all existing patient information provision, to printing and distribution of this new pack. The pack consists of a core set of information that can be further added to and tailored to each individual patients treatment and information needs. Sufficient quantities have been produced to accommodate provision to all newly diagnosed colorectal cancer patients throughout the next three years.
The resource from the Centre for Change and Innovation has been facilitating local services in mapping their patient pathways and identifying potential areas for improvement in service provision. Potential reductions in delays in the early part of the pathway have been identified through this work and planned improvements are underway.
Gynaecological Cancers MCN
Lead Clinician: Dr Jo Davis
MCN Manager: Kevin Campbell
Summary of key achievements since MCN established:
Involvement of all clinicians treating gynaecological in the MCN process
Pan regional prospective audit of ovarian cancer - 1999 onwards
Pan regional prospective audit of endometrial cancer - 2001 onwards
Pan regional prospective audit of cervical cancer - 2003 onwards
Publication of 2 annual reports, including analysis of management of ovarian cancer
Development of Gynaecological Oncology Nursing Module by the MCN Nursing subgroup in collaboration with Paisley University
Increased specialist surgical involvement in treatment of ovarian cancer
Pan regional multi-disciplinary team review of all gynaecological cancer patients
Implementation of teleconferencing and information management systems to support regional MDT
Reduced involvement of non-specialists in elective surgery for ovarian cancer
Established regional redesign programme
Established patient and carer involvement group
Produced and published consensus guidelines for the management of ovarian cancer
Produced and published consensus guidelines for the management of endometrial patients
Secured NOF funding for production of standardised patient held information packs
Secured regional funding for addition specialist gynaecological oncologist
Undertaken research of the patient journey from the patients' perspective
Established MCN educational programme
Summary of work in progress:
Quality Assurance of Ovarian Cancer Prospective Audit Data
Produce Clinical Guidelines for the Management of Cervical Cancer in the West of Scotland
Produce Clinical Guidelines for the Management of Vulval Cancer
Establish Network of Lead Nurses, with an interest in Gynaecological Oncology to influence local service improvements
Regional Implementation of redesign outcomes
Produce MCN Annual Report - including analysis of audit data relating to the management of ovarian and endometrial patients and survival outcomes for ovarian cancer
Ensure early referral to Regional MDT, as per the Network Guideline, for the Management of Ovarian Cancer
Define and Agree Regional Gynaecological Oncology Service Model
Written Protocols for the use of Chemotherapy for each gynaecological disease
Produce standardised patient held information packs for use throughout the MCN
Increase public and patient/carer involvement in the MCN agenda
Main challenges:
Establish local management and clinical support for regional lead link nurses
Produce robust and sustainable regional service model for gynaecological oncology with management support
Attract and retain specialist surgical staff
Maintain continued collection of prospective audit data
Priority areas for development 04 / 05:
Haemato-oncology MCN
Lead Clinician: Dr EJ Fitzsimons
Network Manager: Shirley Anne Savage
The Haemato-oncology (Blood Cancer) network continues to develop. The Advisory Board and sub-groups continue to progress various pieces of work.
An audit facilitator is now in place for haemato-oncology who is working with clinicians on blood cancer registration and dataset development. Funding has been secured for an audit officer to assist the facilitator in collection of data with a focus on drug use and costs.
A database is being developed by the WoS MCN IT Team and audit facilitator to enable collection of blood cancer data in Scotland. This database will be common across Scotland and will also be used in the East and North Networks.
Registration of lymphoma cases across the West of Scotland was started in January 2004. These cases are registered mainly via pathology but backed up with clinical registration. Registration of all the other blood cancers is underway through clinical registration.
Development of datasets and data definitions for blood cancers is well underway in conjunction with the East and North Blood Cancer Networks and ISD. Once these are agreed across the three Scottish Networks they will be built into the database and the audit facilitator will start collecting data across the six health board areas.
The regional lymphoma MDT (via teleconferencing) for pathology review of lymphoma and clinical discussion continues to develop. More geographical sites across the West of Scotland are now linking in to this meeting. The registration and clinical discussion forms for this meeting have been further developed to facilitate collection of audit data on the patients presented at these meetings.
The network continues to further utilise the teleconferencing facilities with a quarterly meeting to discuss network issues.
Education days are run throughout the year via the network. The last education day in November concentrated on leukaemia and trials.
Protocols for the treatment of lymphoma are being developed with the East and North networks.
The Haemato-oncology and Head & Neck networks are working together to develop referral guidelines for neck lumps.
The Haemato-oncology network is working in close collaboration with the Scottish Cancer Research Network (SCRN) to increase participation in haematological clinical trials. Funding has been secured for 1 year for a trials co-ordinator for haemato-oncology.
Head and Neck Cancer MCN
Lead Clinician: Mr K MacKenzie
Network Manager: Shirley Anne Savage
The work of the Advisory Board and subgroups of the managed clinical network in Head and Neck Oncology continues. In the last year there has been considerable co-operation between the various groups involved in the care of head and neck cancer patients.
The final draft of the National Head and Neck Cancer Audit (1999-2000) was submitted to the Scottish Executive in November 2003 and we await its publication. This will allow comparison of data within the West of Scotland and with the rest of Scotland.
A dataset and data definitions have now been agreed for Head & Neck cancer across Scotland based on the DAHNO (Data for Head and Neck Oncology) dataset from England and Wales. This should allow comparison of Scottish data with the rest of Britain.
The use of the DAHNO database has not been possible, as the DAHNO database will not be supported in Scotland due to the IT Strategy of the Scottish Executive. This has therefore delayed the collection of head and neck cancer data. An alternative database platform is now being sought for head and neck cancer in Scotland.
Regional clinical meetings have been running once a month since November 2003. These meetings use the teleconferencing facilities and bring together the local multi-disciplinary teams (MDTs) across the region to discuss complex head and neck cancer cases. These meetings have been extremely successful and given considerable benefit to clinicians and patients.
A summary of the activity to date took place at an Education Symposium in May 2003 at Glasgow Royal Infirmary with a presentation from each of the sub-groups. Another symposium is planned for 12 th May 2004. Topics for discussion at this include network update, Clinical Nurse Specialist (Role and Evaluation) and WoS Cancer Awareness Project update. There will also be presentations and discussion with members of the lung network to discuss joint protocols for treatment of synchronous head & neck and lung primaries and an opportunity for the members of the network to present their current work or research.
The production of a patient information package for head and neck cancer patients is almost complete. This will be distributed across the 5 health board areas to all head and neck cancer patients.
A project to provide a description of various patient pathways from time of referral to treatment and follow-up in the various sub-specialties and MDT's across the region is underway. This project may be developed further in collaboration with the Centre for Change and Innovation, Cancer Improvement Programme.
The network holds a registration of head and neck cancer research carried out by members of the MCN. This aims to encourage greater collaboration in research across the network.
The Head & Neck and Haemato-oncology networks are working together to develop referral guidelines for neck lumps.
There are plans to develop protocols and guidelines for treatment of Head & Neck cancer in conjunction with the South East Cancer Network (SCAN) Network.
Lung Cancer MCN
Lead Clinician: Dr Noelle O'Rourke
Network Manager: Susan Buchanan
The MCN Advisory Board continues to be all-inclusive and open to all those interested in taking the network forward. It will meet in April to discuss the progress of the Network against CSBS recommendations and to look at the first six months of MCN data collected throughout the West of Scotland.
Mike Peek, Consultant Physician in Leicester has been invited as a guest speaker to share the English experience of sustainable changes that have been made within the Lung Cancer Patient Pathway.
An Inaugural meeting of a newly appointed Executive Steering Group will take place prior to the Advisory Board Meeting. The terms of reference for this group are to provide a conduit to local service provision and implementation of Network initiatives.
The following protocols have been developed:
1. Oncology/Radiotherapy Guidelines
2. Guideline for the Referral of a Suspected Lung Cancer
3. Guideline for Palliative Care
4. Guidelines for Radiology and Imaging
5. Chemotherapy Guideline (This document is currently under annual review)
6. Guidelines for referral to Allied Healthcare Professionals
a. Speech and Language Therapy
b. Occupational Therapy
c. Physiotherapy
d. Psychology
Guidelines for future development Include
1. Surgical referral guidelines
2. Systematic approach to record keeping
First meeting held and terms and reference agreed:
Encourage knowledge of, and access to, clinical trials and research within the West of Scotland in the area of Lung Cancer. This would apply to all health professional and lay members.
Encourage communication and collaboration of interested health professional and thus improve patient access to appropriate information and participation if desired.
The specific remit of the group would be first to document current trials, then to publicise it through meetings and the web site, then to provide information on future research and developments, while working in close collaboration with the SCRN Network.
The Patient Information Subgroup has developed the patient information pack and patient information video, which is now complete and ready for dissemination in May. A launch of the pack has been organised for Clinical Nurse Specialists as they will be the main gatekeepers and this will be followed by a wider launch aimed at all health care professionals in June. This group will then amalgamate with the Patient and Public awareness group and take forward patient stories.
This group continue to train trainers in communication skills. The group recently met to agree a forward planning Strategy for the forthcoming year.
Palliative Care MCN
Lead Clinician: Professor J Welsh
Network Manager: Hazel Taylor
The Palliative Care MCN has recently held a successful half-day consensus event on pain tools. Patients were closely involved in the consensus process with two focus group meetings being held with cancer patients. These were arranged with the assistance of the cancer charity Tak Tent. A presentation of the views expressed by patients was delivered by the manager of Tak Tent at the consensus event, and had a powerful influence on all who attended. A summary report was produced and circulated widely, to allow for comment from all members of the network. It is hoped that a recommendation will be agreed at the next Steering Group Meeting. Agreement on the use of a standard pain tool across the region will enable the development of a regional pain audit.
MCN Sub Groups are actively taking the network forward, and a number of developments are taking place as a result of their activities. A selection of this work has been described below.
A number of evidence based symptom guidelines are currently being developed, and are being based on existing guidelines where possible. The first five guidelines have been distributed for comment and will be tabled for agreement at the next Steering Group Meeting.
The Education Sub Group has been working on an educational framework that will identify the different core competencies required at different levels by staff delivering Palliative Care. A meeting has been held with NES, who have agreed to provide accreditation for the framework once complete.
Clinical Audit remains the most challenging area for the MCN. However with the development of guidelines and agreement on a common pain tool, it is hoped that this process can begin to move forward. Palliative Care involves both specialist and generalist practitioners in all areas of the health Service from community services to the specialist provision in hospices/specialist palliative care units, which are funded predominantly by charities with some NHS funding. This will make co-ordination of clinical audit particularly challenging, and will require a dedicated resource, funding will need to be identified to provide this additional support.
The MCN is currently developing links with Palliative Care organisations on a local, regional and national level. Links between the regional and local MCNs are being established as the local networks emerge. This enables all the Palliative Care networks to be aware of developments across the region, providing a forum for decisions on local implementation and providing opportunities to share problem solving and best practice as appropriate. On a national level agreement has been reached with the Scottish Partnership for Palliative Care on future joint meetings between the West of Scotland MCN Strategy Group and the Partnership's West of Scotland Regional Group. This will reduce duplication of regional meetings that look at strategic issues, and provide better communication links to national developments in Palliative Care.
The first step towards inclusion of issues related to treating patients with non-malignant conditions has been made, with a presentation on the need to include Palliative Care professionals in the multi-disciplinary teams treating Motor Neurone Disease.
Some of the challenges for the coming year include: -
The development of regional clinical audit
Co-ordination of clinical audit across all Palliative Care providers
Publication and distribution of initial symptom guidelines
Completion of Educational Framework
Identification of additional funding to support both audit and the expansion of network activities into non-malignant conditions
Skin Cancer - MCN
Lead Clinician: Dr R M Herd
Network Manager: Susan Buchanan
The second Advisory Board meeting took place in December 2003 where a strategy for the development of the Network was discussed including three key priority areas for the forthcoming year. It was agreed to set up subgroups to take forward the following areas:
1. Audit and Data Collection
2. Research
3. Education
4. Patient Information
5. Clinical Trials
The Lead Clinician and the Manager have now visited 4 out of the 5 Health Board areas and completed a high-level service map of the current service provision. This will provide the basis for Network development and strategic planning and will be presented at the next Advisory Board Meeting.
The first meeting of the Audit and Data collection, Patient information and Education will take place in the next 2 months.
Upper G.I. Cancer MCN
Lead Clinician: Mr B Williamson
Caretaker Manager: Christine Morran
Much has been achieved in the development of a national dataset and database, which is currently being trialed in key centres. It is recognised that user friendliness is central to the success of the audit and therefore the time taken to deliver a tool acceptable to all is paramount.
Opportunity to participate in MDT meetings involving professionals from across the region is taking place at Glasgow Royal Infirmary and Western Infirmary. It is open invitation and meetings are weekly and fortnightly.
A programme of meeting dates of the Advisory Board will be circulated. The Board is currently seeking patient/carer representation to enhance the structure that presently exists.
Funding has been made available for the Upper G.I. Network to develop a patient information record and a sub-group of nurse specialists with input from other healthcare professionals are working to deliver this.
Sponsorship has been made available for the nurse specialists to hold an event that will bring patients/carers and healthcare professionals together. They recognise this as a source of valuable information to improve the service
The network hopes to advertise and appoint two key individuals to the network structure in the coming few months, the network manager and an audit/data manager.
Urology MCN
Lead Clinician: Mr G Hollins
Network Manager: Hazel Taylor
The MCN initially focused its efforts on Prostate Cancer, in particular the development of clinical guidelines. However as this work is nearing completion it has now been agreed to expand the group to include all Urological Cancers. This will require adjustment to the current MCN structures, and the recruitment of additional members. In order to complete this process a service mapping exercise will be completed.
Work has already begun on the review of audit forms for all urological cancers. Forms used by Scottish Urological Cancer Audit have been updated, and are currently out for consultation with network members. It is hoped that these forms will be ratified at the next Steering Group Meeting. Arrangements for the implementation of the audit across the region can then be made.
The Patient Information and Counselling Sub Group have now begun work on a Patient Information booklet for patients with Prostate Cancer. The sub group, which has active patient involvement, is adopting a patient information format developed by West of Scotland Patient Information Group. Once produced, this information will be available to all new patients as a folder. However it is also hoped that sufficient funds will be available to provide a website version, thus allowing access to those patients who have already been diagnosed. Nursing Sub Group has recently been formed and members have agreed to be actively involved in the development of this information.
Challenges for the next twelve months include:
Publication and distribution of Clinical Guidelines for Prostate Cancer
Establishment of effective Clinical Audit
Development of Patient Information
Expansion of Network to provide representation for all Urological Cancers at a regional level
Pharmacy Cancer Network
Regional Cancer Care Pharmacist: Ms M Maclean
The Pharmacy Cancer Network steering group is now formally recognised as a sub-group of the RCAG with agreed terms of reference. The steering group has met on two occasions to monitor and progress the work plan agreed in September 2003.
Significant progress has been made including:
To help ensure new cancer medicines are introduced in a timely and efficient manner information has been collated for all adult cancers in a single document and been circulated to key staff involved in the planning of cancer treatments in Health Boards across the region. This will be a dynamic document developed in conjunction with key clinicians within the MCNs.
A needs assessment of the educational requirements of community pharmacists and support staff in the prevention, early detection and pharmaceutical care of patients undergoing treatment for cancer was completed by Forth Valley.
Increasing awareness of oral cancer is a priority and community pharmacists are playing their part in encouraging patients to come forward.
To help ensure pharmacy services remain safe and efficient we have re-applied the capacity-planning model for pharmacy staffing and service provision for cancer patients in hospital. A report and action plan is being developed in conjunction with colleagues from NoSCAN and SCAN.
A prospective audit of the treatment of non-small cell lung cancer (NSCLC) undertaken in collaboration with the Lung MCN is nearing completion. Data collection is complete and is currently being analysed. The results will inform the review and update of the current West of Scotland protocol for the management of patients with NSCLC.
Work is under way, in collaboration with colleagues in other regions, to develop a specification for a chemotherapy prescribing and administration system and address the feasibility of a regional approach.
Three cancer care pharmacists are now qualified and registered as supplementary prescribers and are in the process of establishing their practices. Further cohorts of pharmacists are undergoing training. These new roles are being developed to help improve patient care and access to treatment.
The significant investment in pharmacy staffing together with co-ordination and collaboration through the Pharmacy Cancer Network is resulting in continued improvements in the delivery of pharmaceutical care to patients.
Scottish Cancer Research Network
Network Lead: Professor J Cassidy
Network Coordinator: Mrs A Gordon
The Scottish Cancer Research Network (SCRN) has been established, in part, to increase accrual of cancer patients to peer reviewed trials but also to contribute to improvement in cancer care for patients across the West of Scotland.
Recruitment of staff is now complete - see attached table with breakdown of information and start dates. Recruitment of staff has taken longer than anticipated due to local processes and, although all posts were centrally graded and funding in place, all local trusts repeated the grading evaluation process prior to recruitment progressing.
SCRN Staff recruitment | | Start date |
North Glasgow | Network Coordinator
Computer Programmer
Administrator | July 03
Nov 03
Jan 04 |
Forth Valley | 1 trials practitioner, 1 data manager | 01 Mar 04 |
Lanarkshire | 2 trials practitioners, 1 data manager | 05 Apr, 17 Apr 04 |
Ayrshire & Arran | 1 research nurse, 1 data manager | 08 Mar, 22 Mar 04 |
South Glasgow | 2 research nurses | 29 Mar, 05 Apr 04 |
Argyll & Clyde | 2 research nurses, | May 04
(Date to be confirmed) |
Verbal agreement has been obtained from the Scottish Executive to allow slippage to be used regionally and the intention is to use the slippage to employ additional staff to increase patient recruitment to cancer trials. A draft plan has been produced but no further action will be taken until written confirmation is received from the Scottish Executive.
The finance departments across the region have been notified to defer all unspent SCRN ring fenced budget to next year.
Suitable trials for local implementation are being identified with the initial focus on cancers in breast, colorectal, lung and haematology. It is anticipated that recruitment to trials will be slow in the first year. There are likely to be some local differences across the region as some health board areas already have a history of participation in research, but some do not and will need significant assistance to initiate the process.
The first SCRN (West) steering group was held on March 04 with a view to holding meetings at 3-monthly intervals.
Development of an electronic system to support patient recruitment to cancer trials is ongoing and meeting agreed timelines. The system will provide robust monitoring and reporting mechanisms on screening and recruitment figures across the region.
The main challenges for the SCRN in the West of Scotland over the next six months are:
Obtaining agreement from trusts to support and meet the costs of trials
Identifying further sources of funding to support trials
The impact of the EU directive and its impact on non-commercially funded research
Integrating the research network staff across the region
West of Scotland Cancer Centre: Beatson Oncology Centre
Medical Director: Professor Alan Rodger
The last report advised that recruiting additional Clinical Oncologists, Medical Oncologists and Therapy Radiographers remains a challenge.
During 03/04, however, the BOC has successfully recruited 5 new Clinical Oncologists and 3 new Medical Oncologists, 4 of whom commenced 03/04 and 4 of whom will commence 04/05. Unfortunately, we have also seen the departure of 1 Senior Lecturer in Medical Oncology, this year, with a further departure 04/05 of a Senior Lecturer in Medical Oncology and a Clinical Oncologist to continue their career development. A Medical Oncologist also left through ill-health retirement.
There has also been very successful recruitment of therapy radiographers. By September 2004 we will be up to very near the full-establishment having successfully recruited a balance of 14.0 wte.
Phase II of the West of Scotland Cancer Centre has also been progressing. The preferred bidders, Miller Construction, were appointed on 30 January 2004 and work is due to start on site during May 2004 to prepare for the building works commencing in July. The end of 2006 remains the target date for completion. A fantastic package of radiotherapy equipment including the first 3 Linear Accelerators has been secured as part of the Project to include image-guided radiotherapy (IGRT) and stereotaxy.
A successful re-configuration of beds within the Centre has been undertaken, so that all wards are now tumour-type based with integrated medical and clinical oncology support. Medical Oncology in-patient activity has also transferred from the St Mungo Unit at GRI to the BOC.
The BOC website continues to develop and from the patient/public involvement perspective a Patient Satisfaction Survey was carried out, which in the main, was very positive and an action plan on the findings is being developed. A meeting is also planned with BOC senior managers, public-involvement staff and patient representatives to develop future strategies to involve patient/public in our decision-making.
IM&T
A West of Scotland IM&T Group has been formally set up as a sub-group of the RCAG. The group is chaired by Robin Wright (Head of IT, Lanarkshire) Members include IM&T Leads for each Board area, clinicians and MCN Mangers/IT staff. The purpose of the group is to engage collectively to develop plans to support the generic and cancer site specific needs of various MCNs as they develop, including support for prospective cancer audit. The group will provide a focus/forum to help progress implementation of the national e-health strategy.
Progress is also being made in a number of other areas. For example:
Access to electronic guidelines from each GP practice now fully established in Ayrshire.
Progressed appointment of BOC IT Client Manager to locally coordinate the BOC's IT requirements; ensure existing IT systems are fully utilised; administer and train users on the ChemoCare system, etc.
Commenced a project to upgrade and rollout ChemoCare. New features in the system will allow improvements in managing the risks associated with chemotherapy administration; improve reporting and the quality of data available to clinicians, management and MCNs; facilitate the standardisation of chemotherapy regimes and support processes for introducing new regimes; improve the reliability and availability of the system; roll out the system's electronic prescribing facilities to all areas undertaking Chemotherapy administration.
Commenced a project to integrate the scheduling and delivery of radiotherapy treatment. These are currently supported by separate IT systems on separate networks with patient details manually re-keyed between them. The treatment system (VARiS) is being integrated with the NHSGG IT network and a direct interface to the Patient Administration System is being developed.
Worked with the ECCI project managers in the West of Scotland to gain access to each Health Board's SCI Store for retrieving lab results. These are essential to the chemotherapy treatment process and are usually chased by phone and fax, so tying up nurses' time. Online access is now being utilised for South Glasgow and Lanarkshire results, and other areas are promised to progress over the coming months.
Undertook a 'Day in the Life of a Junior Doctor' study where IT staff shadowed medics to observe the utilisation, issues and gaps in the current IT systems and processes. From this short and long-term action lists have been agreed, and various short-term measures have already been implemented (availability of PCs, etc.). This study will now be followed up with similar work looking at other medical/nursing staff.
As an early adopter of the planned NHSGG Portal project a BOC project team has begun working on patient pathways for head and Neck, breast and haematological cancers.
Working to facilitate the rapid rollout of the North Glasgow Immediate Discharge Letter System to improve the efficiency of patient discharges and communication with GPs. By the implementation of IDLS within the Beatson and across all sites of North Glasgow Division, the electronic approach ensures the following benefits:
Electronic production of Discharge Letter ensuring clarity and legibility
Information captured from Immediate Letter can be used for Final Discharge Letter
Electronic transfer of letters to GP (SCI Gateway by December 2004)
Provision of information to patient
Automatic coding of diagnoses/procedures
Electronic link to Pharmacy
Clinical and managerial audit
Service Improvement
Work ongoing in the West of Scotland continues with support being provided by facilitators from the Centre for Change and Innovation. The focus of this work to date has centred on gynaecological, colorectal and lung cancer services. Discussion is ongoing to identify and agree the specific foci of work for the coming 18 months.
NOF
The grant making process for current round of NOF awards is now completed with the remaining 6 deferred projects, reported previously, now resubmitted and approved.
Projects approved in previous rounds are progressing well. For example:
Second phase of the oral campaign ended 15 th March '04. Audit of the impact of the campaign on services on all sites is taking place. A full audit of all mouth cancers diagnosed within a 7 month period (Oct '03 - April '04) is to be conducted retrospectively to establish: how many cancers have been detected during the campaign period; what % of cancers have been picked up earlier and; how many patients came forward as a result of the campaign.
Work is ongoing in preparation for the launch of the colorectal campaign in October 2004. In response to concerns expressed by the service it has been agreed that 100k of the total NOF budget be redirected to support specific local initiatives that will support the effective management of increased referrals to the service that are anticipated. Proposals are currently being developed and will be assessed by the project steering group when it next meets in May.
A successful meeting was held with the national project team and local representatives from all 5 west of Scotland Health Board areas to agree and plan a way forward with progressing the roll out of GSFS to all practices over the coming 3 years. GSFS has already been implemented in a number of practices with many others expressing an interest to become actively involved. Additional facilitation resource is being provided via NOF funding and discussion is ongoing to agree local 'roll out' plans that identify the exact nature of support required to build on the work that is already ongoing.
Report Prepared May 2004
Submitted by Evelyn Thomson on behalf of the West of Scotland Cancer Advisory Group