Scottish Government

CANCER IN SCOTLAND: ACTION FOR CHANGE
West of Scotland Cancer Network
(WOSCAN)

Monitoring Report
1 April 2004 to 30 September 2004

This monitoring report is submitted on behalf of the West of Scotland Cancer Network, covering the period 1 ^st April - 31 ^st October 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 Managed Clinical Networks.

2. Regional Cancer Advisory Group (RCAG)

Over the summer months a review of working arrangements has been undertaken in order to ensure that we are best placed to address the many current and future challenges that we face. This process is now drawing to conclusion. Membership of the RCAG Executive Group will be confirmed by December 2004. New working arrangements will be introduced from January 2005. In summary the following has been agreed:

2.1 Aims for the Future

Fundamentally, there is a united desire to ensure that:

• Cancer services and the structures that underpin them remains patient focused and clinically led.
• The focus of all activity is on improved patient outcome.
• MCNs are supported to play a leading and proactive role in the planning, delivery and redesign of cancer services across the region and become integral components of local and regional planning.

2.2 Regional Cancer Advisory Group Executive

It is recognised that the West of Scotland Cancer Network and RCAG is a collaborative involving NHS Argyll & Clyde, Ayrshire & Arran, Forth Valley, Glasgow and Lanarkshire. The RCAG Executive facilitates understanding of regional issues, supports and progresses pieces of work on a regional basis and has and advisory role to NHS Boards and the Regional Planning Group. The main function of the RCAG Executive is:

• To provide high-level strategic guidance to constituent NHS Boards and the Regional Planning Group.
• To progress work on priority issues identified via West of Scotland Cancer Group Plenary and by the Regional Planning Group.
• To ensure a coherent and equitable approach is taken to the development of cancer services across the West of Scotland, taking account of local and regional priorities.
• To agree and review annual work programmes with regional MCNs and specialty networks/services.
• To review MCN audit data and report to Chief Executives.
• To ensure adequate two-way communication and accountability between MCNs, RCAG, NHS Boards and the Regional Planning Group.

2.3 New Ways of Working

The West of Scotland RCAG Executive will formally be established as a sub group of the West of Scotland Regional Planning Group.

• A West of Scotland Board Chief Executive will chair the West of Scotland RCAG Executive.
• A plenary meeting will be held annually, bringing together all interested parties to discuss and agree a programme of work.
• Network Lead Clinicians and Managers will agree an annual programme of work with the RCAG Executive, in light of the above plenary meeting and following discussion/agreement with relevant MCN Advisory Boards, which is regularly reviewed with the RCAG Executive.
• Crosscutting specialty groups (e.g. pharmacy & nursing) and specialist services (e.g. paediatrics & cancer genetics) agree an annual programme of work with the RCAG Executive, in light of the above plenary meeting and following discussion/agreement with relevant specialty groups, which is regularly reviewed with the RCAG Executive.
• Ad hoc, short life working groups will be established for specific tasks.

3. Regional and National Managed Clinical Networks (MCNs)

Regional

3.1 Lung

The Network has recently analysed the first six months of MCN data for the West of Scotland with exception of Argyll and Clyde, who were unable to provide prospective data collection for 3 out of 4 hospitals. This data will be used to identify the areas of quality improvement initiatives for the forthcoming year in conjunction with NHS Quality Improvement Scotland (QIS) Quality Assurance framework, SIGN Guideline recommendations and NHS QIS Standards (formerly Clinical Standards Board for Scotland, CSBS).

The Network has organised visits to each of the Health Boards in November to discuss each hospitals audit results, actions required and implementation strategies.

The Network has documented its progress against NHS QIS standards and this has been circulated to each of the Lead Clinicians for Lung cancer in each Health Board.

Waiting Times

The Network has reported the six weeks waiting times data for the whole population of lung cancer patients broken down into the 4 treatment modalities, Surgery, Radiotherapy, Oncology and Supportive Care. This data has been reported to all lung cancer clinicians throughout the West of Scotland and will be included in the annual report.

Redesign

The Network has worked collaboratively with the Centre for Change and Innovation (CCI) cancer improvement facilitator for lung cancer and mapped the surgical and radiotherapy pathway. Work is ongoing in these areas to identify potential delays. This work is intended to inform action plans to be implemented with the support of service providers to improve the patient pathway.

Referral

The Network has visited each Health Board's Lead Cancer GP to discuss the implementation of the Lung Cancer Referral Guidelines and plans for implementation.

In addition the Network has produced 10 guidelines for interdepartmental referrals and it is hoped that an implementation programme will be agreed during the Health Board visits in November.

Audit/Quality Improvement

The Network is in the process of producing its second annual report and will report on Lung Cancer data for Ayrshire & Arran, Forth Valley, Lanarkshire, and Greater Glasgow.

The West of Scotland Pharmacy Network carried out an audit of Chemotherapy usage within the West of Scotland; these results were used to inform the revision of the Chemotherapy Guideline and will be reported in the annual report.

The second edition of the chemotherapy guideline is in the process of being circulated for final ratification, and will be published next month.

Patient & Public Involvement

The Network continues to develop the Patient and Public involvement sub group.

Education & Training

The West of Scotland Lung Cancer MCN has prioritised the development of a communication skills training strategy to address the need of all professionals involved in lung cancer care across the region.

This was supported by a recent education event, which held workshops dealing with 'An angry patient' and 'A family in conflict'.

There are two forthcoming education events organised.

1. MARS Study - a study of surgical intervention in Mesothelioma
2. Ethical Issues - Resuscitation Policies.

3.2 Colorectal

Changes in Representation on the MCN Advisory Board

The MCN has now embarked on a review of the representative members on its Advisory Board. Re-nomination of Lead Clinician was sought from each of the colorectal services and, Mr Ian Finlay has recently been replaced by Mr Bob Diament as Lead Clinician for the MCN. Other representation on the Advisory Board will now be reviewed.

Education Programme

The National MCN Steering Group for Colorectal Cancer prepared a programme for a national event held in April 2004; 'A Focus on Diagnosis'. The West of Scotland MCN took the lead in preparing a national comparative presentation of service performance based on prospective audit data, for inclusion in the programme. Data were collated from all three regions and a data analysis toolkit prepared to report a selection of the NHS QIS (formerly CSBS) standards. The meeting was very well attended and the results were well received.

The Network is currently preparing a programme for the next regional event to be held in November, focussing on the various aspects of specialist nursing care provided to colorectal cancer patients.

Audit

The prospective audit of colorectal cancer continues, now in it's fourth year. Data, to the end of 2003, have been collated and are currently being prepared for analysis. Results of the first three years of activity will be reported and presented at the education event in November. Results will be published in the next MCN annual report.

A review of the data set collected for colorectal cancer patients was undertaken in August of this year. This was the first MCN review of the data set since audit began in 2001. An open meeting was held to allow contributors to the audit process to discuss proposed changes. Changes agreed at the meeting resulted in preparation of a revised data collection proforma, which was circulated for further comment. Final version will be recommended to the Advisory Board, when it next meets in November, for ratification.

Patient Information

The patient-held information pack developed by the MCN was introduced for use across the region in April. The pack, which has taken over 18 months to prepare, will be offered to all newly diagnosed colorectal cancer patients. The colorectal nurses will lead the introduction and provision of the information packs, providing each patient with add-in components to meet their individual needs along their care pathway.

Referral Guidelines and Waiting Times

Introduction of the MCN consensus 'Guidelines for Referral of Patients with Colorectal Symptoms' is progressing well across the region. The pilot implementation in South Glasgow has now expanded to cover all GP practices across South Glasgow. Discussions are on-going for a pan-Glasgow implementation of this process. Implementation in Ayrshire and Arran is now underway with full coverage expected by the end of the year. Implementation in Forth Valley is planned to coincide with the reconfiguration of the colorectal services in early 2005.

Waiting Times for colorectal cancer patients have now been reported throughout 2003 and into 2004. The West of Scotland results against the target have shown no improvement over this time; approximately 40% of patients start treatment within the target 2 months.

3.3 Gynae-oncology

Education Programme

The MCN Education Programme has continued to provide opportunities for health professionals involved in the care of gynaecological cancer patients to focus on specific aspects of patient management. The event in May focussed on the management of patients with ovarian cancer and included results of 4 years of clinical audit of the management of ovarian cancer patients. These results demonstrated some improvements in the management of these patients over the time: reduction in number of clinicians performing surgery; increased use of Risk of Malignancy (RMI) scoring, leading to more cases being suspicious of cancer pre-operatively; improved pre-operative work-up of patients suspicious of cancer; increased numbers being reviewed by regional MDT; early outcome measures which show better than expected results. The results, however, indicated that the service continued to lack sufficient specialist gynaecological oncologist resource to meet the demands of the service.

The event in August dedicated one session to the management of endometrial cancer patients. Following on from the May event and further discussion at the Advisory Board, the second session focussed on determining a sustainable regional model for delivery of gynaecological oncology services in the West.

Regional Gynaecological Oncology Service

Discussions at recent educational events are being followed up with clinicians and managers within each health board, to gain further understanding of local issues and needs. This work will be progressed to production of an agreed service model. Implementation of this model will be progressed with West of Scotland Health Boards via the RCAG and Regional Planning Group.

Audit

The prospective audit of ovarian cancer continues, now in it's fifth year. Data, to the end of 2003 are currently being collated and prepared for analysis. Results will be published in the next MCN annual report. Audit of endometrial cancer is nearing completion of the second year of data recording. Results for the first year of audit were presented at the MCN education event which focussed on the management of endometrial cancer. Prospective audit of cervical cancer was launched in the spring of this year.

Patient Information

The patient-held information pack developed by the MCN was introduced for use across the region in September. The pack, which has taken over 18 months to prepare, will be offered to all newly diagnosed ovarian cancer patients. The gynaecological oncology nurses will lead the introduction and provision of the information packs, providing each patient with add-in components to meet their individual needs along their care pathway. This pack was launched with a training day at the end of August for those involved in the provision of information.

Referral to Specialist Gynaecological Oncology Service and Waiting Times

The Gynaecological MCN has continued to progress the development of the regional MDT process, which is supported by teleconferencing and information systems. The MCN has continued to work with the suppliers of these systems to improve the capabilities of the systems.

Clinicians have responding positively to improvements in this process, with increased number of patient referrals through the regional MDT. This process should reduce waits for patients requiring surgical intervention by a specialist gynaecological oncologist. MCN guideline documents for the management of both ovarian and endometrial patients have been circulated to all gynaecologists across the region. Widespread use of 'Risk of Malignancy' (RMI) scoring, a component of the guideline for ovarian cancer, will assist earlier identification of those patients with increased risk of cancer; resulting in earlier intervention.

Guideline Development

A guideline for the medical management of ovarian cancer patients has been produced. This will be ratified at the next Advisory Board meeting.

3.4 Breast

Prospective Clinical Audit

The MCNs first year of prospective audit data (2003) will be presented in the Annual Report. Performance will be compared with the standards set by NHS QIS (formerly CSBS). Each individual audit department received the queries developed centrally in the MCN office to enable local interrogation of the data, allowing clinicians to assess their own performance against the standards.

In October 2004 the members of the Network were given the opportunity to meet and consider the performance of the West of Scotland with the data for all the fourteen hospitals delivering the Breast Service being the focus of an education meeting held in Ayrshire. Good discussion and sharing of information took place. Performance against the standards was high and areas for improvement were considered. Review of the dataset was deemed necessary and a sub-group is to be reconvened to take this work forward.

Patient Information & Involvement

The patient information record developed for the service is now in use and it is planned that the uptake and value of the information it contains will be audited.

The Network looks forward to working with and facilitating the role of the newly appointed Patient User Involvement workers and further developing patient involvement in the work of the Network.

Education Programme

The planned education programme for 2004 included a meeting to look at the key issue of the pathway of patients with a family history of breast cancer. Resulting from this a sub-group was formed to develop a guideline for the Network. In addition the Network has agreed to participate in the national research study evaluating mammographic surveillance in women <50 years with a family history of breast cancer.

Annual Report

The first annual report will be in circulation November/December 2004.

3.5 Urology

Development of MCN

• The MCN has introduced a wide circulation list to improve communication with all professionals involved in the care of people with urological malignancies.
• A newsletter was produced and distributed during July to help raise awareness of MCN activities.
• A webpage has been developed within the WOSCAN Website.

Implementation of Guidelines

• The majority of the work on Prostate Guidelines is currently being prepared for consultation. However the oncology section is still outstanding due to current staffing levels and associated pressure on services.
• Details of the SIGN Bladder Event were circulated and there was a strong West of Scotland presence at the event.

Implementation of issues identified at Network Development Workshops

• During the Open Education Event in November 2003 Clinical Audit was identified as a key priority. Draft Audit forms were produced based on both British Association Urological Surgeons (BAUS) and Scottish Urology Cancer Audit (SUCA) forms. However work has been temporarily halted due to the imminent development of a National Data Set.

Waiting Times

• SUCA data has been obtained to provide baseline information for waiting times.
• Awareness is being raised with professionals of the cancer waiting times target set for December 2005.

Redesign

• Two CCI Facilitators have been made available to the MCN. There has been initial interest in using these services:
  • To help improve the Prostate Cancer Pathway within the Oban area
  • To help improve the Bladder Patient Pathway within Forth Valley

Referral

MCN has not been actively involved in this activity, but is aware of local developments within Health Boards.

Audit/Quality Improvement

• Work was temporarily halted on the development of an audit data set due to the development on a National Minimum Data Set.
• The MCN would like to use the SUCA Audit as a baseline, but this has yet to be published.

Palliative Care

• There are Specialist Palliative Care professionals both within the Steering Group and the Nurses Group Membership.

Patient Involvement

• There are two Prostate Cancer Patients on the Steering Group.
• Prostate Cancer Patients are working alongside the Nurses Group in the development of a Patient Information Folder.

3.6 Head & Neck

The work of the Advisory Board and subgroups of the MCN 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.

Audit

• 
  National Audit The final draft of the National Head and Neck Cancer Audit (1999-2000) was submitted to the Scottish Executive in November 2003 and we still await its publication. This will allow comparison of data within the West of Scotland and with the rest of Scotland.

• 
  Dataset A dataset and data definitions have now been agreed for Head and 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.

• 
  Database The use of the DAHNO database has not been possible, as it 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. Development of a Microsoft Access database by the WoS MCN IT team is now underway.

The WoS have also put forward a bid for Head and Neck Cancer to be early implementers of the Generic Clinical System. If this goes ahead then this system should provide a means by which the head and neck cancer data can be collected and analysed.

Funding was secured to purchase PCs/laptops for each of the multi-disciplinary teams (MDTs) to allow collection of audit data.

Clinical Meetings

Regional clinical meetings have been running once a month since November 2003. These involve use of the teleconferencing facilities and bring together the local MDTs across the region to discuss complex head and neck cancer cases.

These meetings have been further developed to include reviews of previous patients presented and provision of a formal report on cases discussed at the meeting, to the referring clinician.

These meetings have been extremely successful and have given considerable benefit to clinicians and patients.

Education

The second annual education symposium took place on 12 ^th May 2004, where topics such as Evaluation of the Clinical Nurse Specialist's Role, West of Scotland (WoS) Cancer Awareness Project and tobacco advertising were presented. There were also 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.

Another education day is planned for May 2005, which will be held jointly with the South East Cancer Network (SCAN) Head and Neck Cancer Network.

Patient Information

The production of a patient information booklet for head and neck cancer patients is almost complete. This will be distributed across the 5 Health Board areas to all new head and neck cancer patients.

Patient Pathways

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 Multi Disciplinary Teams (MDTs) across the region was carried out. This project is being further developed in collaboration with the Centre for Change and Innovation, Cancer Improvement Programme. Service Mapping sessions will be undertaken in Ayrshire and Glasgow Royal Infirmary.

Research

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. A database of suitable funding organisations is now being developed.

Joint Project with Haemato-oncology

The Head & Neck and Haemato-oncology Networks are working together to develop referral guidelines for neck lumps.

Protocols

The SIGN Guidelines for Head and Neck Cancer are now out for consultation.

The development of protocols and guidelines for treatment of Head & Neck cancer in conjunction with the SCAN Network continues and will take account of the above SIGN Guidelines.

Allied Health Care Professionals (AHPs)

Development of dietetic guidelines for treatment of head and neck cancer patients is underway. This includes a reference document suitable for dieticians and a summary document for use by other clinicians.

Other AHPs such as Speech and Language Therapists have been extremely pro-active in the Network with others such as Physiotherapy and Occupational Therapy now coming on board.

Nursing

The nurses from the West of Scotland continue to work nationally in the Scottish Head and Neck Oncology Nurses Forum.

3.7 Haemato-oncology

The Haemato-oncology (Blood Cancer) Network continues to develop. The Advisory Board and sub-groups meet regularly to progress various pieces of work. The three Scottish networks link closely to ensure common data collection and protocols for all Scottish blood cancer patients.

Audit

• Scottish Blood Cancer Datasets
  Development of datasets and data definitions for blood cancers continues in conjunction with the East and North Blood Cancer Networks and ISD. The lymphoma dataset has been agreed and data collection has started. Work is well underway on the others and once these are agreed they will be built into the database and data collected across the six Health Board areas.

• Scottish Blood Cancer Database
  A database is being developed by the WoS MCN IT team and audit facilitator to enable storage and recall of blood cancer data in Scotland. The lymphoma section of this is now complete and work will start soon on the acute leukaemia section. This database will be common across Scotland and will also be used in the East and North Networks.

• Data Collection in the West of Scotland
  Registration of lymphoma cases across the West of Scotland was started in January 2004. Cases are registered mainly via pathology but backed up with clinical registration. Registration of all other blood cancers is underway through clinical registration. To date there are over 880 registrations of blood cancers, some 350 of which would not have been previously registered with the Scotland Newcastle Lymphoma Group (SNLG) and the Scottish Leukaemia Registry (SLR).

The audit facilitator for haemato-oncology has been in post 10 months and is working with clinicians on blood cancer registration, dataset development and collection of audit data. Funding has been secured for an audit officer for two years to assist the facilitator. A member of staff has been appointed and will take up post in November.

Multi-disciplinary Team Meeting (MDT)

• Regional
  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. A formal report on cases discussed at the MDT is now forwarded to the referring clinician.

• Local
  There are also local MDT meetings to discuss patient treatment. The Network team are currently visiting all local teams to discuss and map current services including MDT meetings.

Teleconference

The Network continues to further utilise the teleconferencing facilities with a quarterly meeting to discuss network issues.

Education

Education days are run throughout the year via the Network. The last education day concentrated on leukaemia and trials. A further education day is planned for 2005.

Protocols

Protocols for the treatment of lymphoma are being developed with the East and North Networks.

Pathological protocols for diagnosis are under development by the Diagnostics and Pathology sub-group.

Joint Project with Head & Neck

The Haemato-oncology and Head & Neck Networks are working together to develop referral guidelines for neck lumps.

Clinical Trials/Research

The Haemato-oncology Network is working in close collaboration with the Scottish Cancer Research Network (SCRN) to increase participation in haematological clinical trials. Entry of patients (<65 years) with acute leukaemia to national sponsored clinical trials exceeds 80%.

The Research Sub-group is compiling a register of trials and research participation across the Network.

Website

A website with information on the management and treatment of Chronic Myeloid Leukaemia (CML) has been developed across the three Scottish Blood Cancer Networks. The plan is to further develop this website to include a patient information section.

Nursing

The haemato-oncology nurses have now set up a nurse's forum to facilitate nursing involvement across the Network.

3.8 Skin

The MCN has visited each of the Health Board areas and completed a high-level service map outlining each Board's service provision and patient pathway for patients with skin cancer. The information gained through this process is being used to inform the Network and its development for the forthcoming year.

The following issues have been identified throughout the region.

• There are no referral guidelines currently in use for referral of patients with Skin Cancer from primary to secondary care, or interdepartmental referral guidelines for patients within secondary care.
• There are no protocols or guidelines in place for the management and care of patients with Skin Cancer.
• There is currently no skin cancer audit or dedicated audit resource.
• There is no uniform patient information.
• There is no specialist nursing resource.

Waiting Times

This data has been incorporated into the data sets currently being developed by the MCN. During the recent visits Health Boards were only able to give us approximate information on waiting times.

Redesign

Redesign is currently being done within each of the five Health Board areas for dermatology (not specific to the skin cancer pathway). The Network invited the CCI programme to the last advisory group to assess if work can be done collaboratively to look mapping the skin cancer pathway using the Plan Do Study Act (PDSA) cycle. This work is ongoing, and it's anticipated that several of the hospitals throughout the region will act as pilot sites for skin cancer mapping exercises.

Referral

The Network has set up a protocol and guideline group who are working collaboratively with the CCI to ensure the development and implementation of national guidelines on the referral and management of patients with Melanoma, Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC).

Audit/Quality Improvement

The Audit subgroup of the MCN has produced minimum data sets for SCC and BCC. This has been circulated to all dermatologists in the West of Scotland for ratification and comment. This is being done in consultation with the Lead Consultants for NOSCAN and SCAN. A copy of the data sets has been sent to ISD for review and data definitions. Comments will be collated and reviewed by the Audit Subgroup at the next meeting in November. Once this process is complete the IT department within the Network will develop the database.

Melanoma data will continue to be collected by Scottish Melanoma Group (SMG), however, the process of sharing of information between the Network and SMG need to be formalised.

The Network will require support from the clinical effectiveness departments of each of the 5 Health Boards to collect the data. Meetings have been organised in November to assess what resource is required and what resource is available.

Nursing Framework

The Network has recognised the need for specialist cancer nursing support for Skin Cancer patients, however there is currently no funding available for a specialist resource. The Network will pursue this issue in line with recommendations made by Cancer Nursing Framework.

The first meeting of the Nurses group within the Network will take place in November. The Framework will be discussed and each of the Nurses representing the 5 Health Boards will be asked to review their local staffing requirements.

Patient & Public Involvement

The Network has a large and active patient information group (50% patients) who have completed a review of the current literature, and are in the process of drafting a patient information pack for melanoma patients and an information leaflet for SCC and BCC. This work is being supported by Dr Sue Williams with funding from the RCAG.

3.9 Upper Gastrointestinal (GI)

Lead Clinician Mr B Williamson

During the last 6 months a Regional Audit Facilitator has been appointed to the MCN, but no suitable candidates were found for the post of part-time manager of the MCN.

Audit

The combined upper GI data set has been the subject of intense discussion and development in association with the Managed Clinical Network in SCAN. A preliminary pilot of this data set is taking place in Glasgow Royal Infirmary and there are still some residual issues, which it is hoped will be resolved at a meeting on 26 October 2004. Following general agreement about the data sets utility, Roadshows are planned in each of the Hospitals contributing to the upper GI data set with the Lead Clinician and MCN Audit Facilitator. Considerable concern has continued to be expressed from the clinicians in Glasgow Royal Infirmary (GRI) and from the clinicians in Argyll and Clyde Health Board, as there is absolutely no audit support available to support the completion of this data set.

Meetings have been held with the Chief Executive of Greater Glasgow Health Board and Argyll and Clyde Health Board and assessments are underway as to how the infrastructure to support data accrual and data analysis can be improved in these two areas. Ayrshire and Arran Health Board, Lanarkshire Health Board and Forth Valley have all indicated that they have adequate audit infrastructure to support data accrual in these areas.

Patient and Public Involvement

The MCN Nursing Group has held a successful meeting with patients and members of the public to promote and understand the information requirements and the patients and carers experience through the cancer pathway. This work will be presented at the CCI conference in November and an article has been submitted and accepted for publication in a professional journal.

3.10 Palliative Care

For the first time this monitoring report includes details of some of the activities within the Local MCNs for Palliative Care that is helping to improve the quality of care and services provided.

Development of MCN

• All five Health Boards have now either established a local MCN or identified an existing group which can begin to take on this role.
• The first joint meeting with the West Sector Group of the Scottish Partnership for Palliative Care has been arranged for 16 ^th November 2004.

Implementation of Guidelines

• A framework for the publication of Clinical Guidelines is being developed.
• The National Gold Standards Framework Project is being co-ordinated by the newly formed West of Scotland Primary Care Group.

Implementation of issues identified at Network Development Workshops

• A recommendation for a Pain Tool has been agreed and is due to be published shortly.
• Forth Valley Palliative Care MCN are developing a Pain Tool based on the West of Scotland recommendations which will be easy for both patients and professionals to use.

Redesign

• The Palliative Care Re-configuration Project in Glasgow is working on improving out of hours care for Palliative Care patients in the East Glasgow Local Health Care Co-operative (LHCC)/Community Health Partnership (CHP).
• A New Opportunity Fund (NOF) funded Project Manager is now in place to run the non malignant Palliative Care Project.

Audit/Quality Improvement

• Forth Valley MCN has completed the first stage of its Pain Audit Project. This has been well received by those practitioners who took part.
• Ayrshire & Arran MCN has audited the use of pain medication in partnership with local Pharmacists. Pharmacists and GPs are working together to improve feedback and communication on prescriptions for pain and associated symptoms.
• The Regional Audit Group have drafted an audit of patient care in the last few days of life.
• The West of Scotland Palliative Care Research Group is planning a pilot of their research proposal for Break Through Pain.
• The second Research Education Event was held in June 2004.

Education

• The Education Sub Group has presented the work completed to date on Educational Core Competencies to the Steering Group and this is currently being circulated for comment. On completion this document will be sent to NHS Education Scotland for their approval.
• Argyll and Clyde recently held a Consensus Workshop on Palliative Care, to provide an opportunity to reflect and share experiences from the successful education initiative, the 'Palliative Care Roadshow' and discuss the formation of a local MCN.

Palliative Care

• All Palliative Care MCNs in the West of Scotland have multidisciplinary involvement across all settings, including links with Social Services.
• A joint Education Day on Improving Communication was held in October between the Lung Cancer MCN and the Palliative Care MCN.
• A bi-annual newsletter is being produced to raise awareness of the Palliative Care MCN.
• Ayrshire & Arran MCN have completed a Palliative Care training needs assessment within Community Hospitals.
• A Palliative Care Manual is being developed by the Forth Valley MCN for distribution across all settings.
• Forth Valley and Argyll and Clyde are both currently developing Palliative Care websites to provide information for both the public and Health Care Professionals.
• A website page is being developed for Palliative Care on the WOSCAN website, and will provide professionals across the region with links to local sites as well as access to MCN documents.

Patient Involvement

• A leaflet and posters have been printed to recruit patients and the public to join in activities to help shape the future of Palliative Care in the West of Scotland.
• Details of the Patient contribution to the Consensus on Pain Tools have been provided to SIGN as part of their activities in collating information for the forthcoming review of the SIGN 44 Pain Guideline.
• Lanarkshire MCN has an active patient group which has been helping to inform the direction of the MCN.

3.11 National Managed Clinical Networks

Bone & Soft Tissue Sarcoma

John Mooney was appointed manager of the Scottish Sarcoma Network and took up the post in August 2004. He has been making contacts throughout Scotland and plans to establish an MCN Advisory Board in the near future. Working groups will work on a number of issues, such as the national sarcoma database, treatment pathways and protocols, patient involvement, and quality assurance. With this in mind, a general meeting of the MCN is scheduled for November 2004. This meeting will also allow a forum for discussion of the format of national sarcoma MDT meetings. It is anticipated that the structure and remit of the MCN will be formalised by the end of 2004.

4. Pharmacy Network

Regional Cancer Care Pharmacist Ms M Maclean

The Pharmacy Cancer Network steering group continues to meet on a quarterly basis to monitor progress with the agreed work plan and to plan future work. Subgroups have been formed to take work forward. A significant proportion of this work is also done in collaboration with colleagues in the other regions through the Scottish Cancer Pharmacy Group. For example, the review of existing guidelines for the safe prescription and supply of chemotherapy is nearing completion and is the result of the joint effort of representatives from the three regions.

Preventing and detecting cancer early

Two initiatives were presented at the Cancer in Scotland: sustaining change conference: the Greater Glasgow pharmacy smoking cessation project and the Forth Valley assessment of the educational needs of community pharmacists and staff in the prevention, early detection and support of patients with cancer.

Community pharmacists are now playing their part in preparation for the bowel cancer awareness campaign.

Improving access to treatment and care

• Ensuring equity of access to new cancer medicines
  To help ensure new cancer medicines are introduced in a timely and efficient manner information on potential new treatment developments has been collated for all cancers in a single document. This is circulated to key senior staff involved in the planning of cancer treatments in Health Boards across the region. With support and input from the MCNs this information has been refined and a second edition has recently been issued.

To help ensure equity of access across the West of Scotland work is now underway, through the RCAG, to develop a regional system for the introduction of new cancer medicines.

• Clinical effectiveness
  A prospective audit of the treatment of non-small cell lung cancer (NSCLC) undertaken in collaboration with the Lung MCN has been completed and reported. The results have informed the review and update of the current West of Scotland protocol for the management of patients with NSCLC.

• Supplementary prescribing
  Further cohorts of cancer care pharmacists are being trained and registered as supplementary prescribers and are in the process of establishing their practices. These new roles are being developed to help improve patient care and access to treatment.

Investing in staff and technology

• Electronic prescribing, administration & monitoring
  Progress has been made, in collaboration with colleagues in the other regions, to develop a specification for an electronic chemotherapy prescribing and administration system and to develop a strategy and business case for implementation. The recruitment process is now under way to appoint a project manager to take this work forward.

The 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. Projects and services developments have been presented at national and UK meetings including four poster presentations at the Cancer in Scotland: sustaining change conference.

5. West of Scotland Cancer Nurses Group (WoSCNG)

The main focus of the work of the west of Scotland Cancer Nurses Group over the past 6 months has focussed on implementation of the recently published "Framework for Nursing People with Cancer in Scotland.

Current Status

• Summary of Framework document presented at RCAG.
• Framework Implementation Group set up as a sub group of the WoSCNG, working within the context of the WoSCNG. Involves cancer nurse lead from each of the 5 WoS Health Board areas plus additional representation from Glasgow. Includes paediatric oncology.
• Regional benchmarking template agreed.
• Framework Implementation Group currently benchmarking current situation in all Board areas.
• Meeting on 1 ^st November to collate information on WoS basis and agree draft regional action points.
• Draft regional action points to be discussed at full meeting of the WoSCNG on 23 ^rd November and will be taken forward through short life working groups.

The following regional work is being led by the WoSCNG, current status as below:

1. Cancer Continuous Professional Development Strategy (CPD)
2. Malignant Spinal Cord Compression
3. MCN Lead Nurse Project
4. Cancer Nurse Education

(1) Cancer Continuous Professional Development Strategy The Strategy has been developed by a multi-professional group of health care professionals involved with patients with cancer on behalf of the WoS Cancer Network in collaboration with NHS Education for Scotland. It has been extensively consulted on across the WoS including regional workshops in each Board area. Strategy almost ready for publication following ratification by RCAG. It is then planned to develop a regional Learning and Development Plan and it is anticipated that individual Board areas will also develop plans to prioritise CPD in relation to the strategy.

(2) Malignant Spinal Cord Compression Work is ongoing at the WoS Cancer Centre to take forward recommendations of the RCAG-funded work "Malignant Spinal Cord Compression: An Audit of Clinical Practice at the Beatson Oncology Centre". Main areas:

• Developing Guidelines/Flowchart
• Developing an Integrated Care Pathway
• Developing Patient and Staff Information

Multi-professional regional group set up to progress work on a regional basis. First meeting 22nd November 2004.

(3) MCN Lead Nurse Project Two main aspects of this work.

• Formalising the nursing contribution to MCN's
• Implementation of 2003/05 workplan. Key aspects include:
  • Improving communication structures
  • Role development of specialist and non cancer specialist nurses
  • Promoting effective user involvement
  • Developing and implementing regional standardised approach to patient information
  • Contributing to cancer nursing education agenda

(4) Regional Approach to Cancer Nurse Education New 12 month clinically based cancer nurse education programme has been developed by the West of Scotland Cancer Centre in collaboration with the other West of Scotland Health Board areas through the lead cancer nurses/nurse consultants. QA / accreditation through Glasgow Caledonian University. The aim of the course is provide an integrated and systematic approach to training and education of D and E Grade registered nurses working on a regular basis with patients who have cancer. It is based on the principle that clinical expertise will be developed both in the classroom and in the clinical setting. First intake of students - October 2004. Key aspects of the course are clinical mentorship, competency assessment and ongoing evaluation of the programme.

Plans for next 6-12 months

Continue with projects already committed as above
Progress regional action points from the cancer nursing framework

6. Scottish Cancer Research Network (SCAN)

SCRN staff are now in place across the West of Scotland, the following provides a breakdown of staff in each of the Health Board areas. There were significant delays in recruitment of staff across the region mainly due to local processes. Two vacancies have to be re-appointed but do not anticipate any problems in recruiting staff to fill the posts.

6.1 Breakdown of SCRN staffing across region

North Glasgow
1 Network Manager from July 2003, 1 Computer Programmer, November 2003. 1 Network Administrator, January 2004. No vacancies.

South Glasgow
2 Research Nurses, 1 Vacancy. A review of SCRN resources in South Glasgow is being considered, both posts will be filled by Dec 04/Jan 05.

Argyll & Clyde
2 Research Nurses, no vacancies.

Ayrshire & Arran
1 Research Nurse from March 2003, 1 Data Manager, March 2004, no vacancies.

Lanarkshire
2 Trials Practitioners, 1 Data Manager, no vacancies.

Forth Valley
1 Trial Practitioner from March 2004, 1 Data Manager from March 2003. 1 Vacancy. Trial Practitioner post to be re-appointed, interviews arranged from November with new start date December 2004.

A number of trials have been submitted to Ethics and R&D across the region. The process for ethics has improved significantly with the introduction of the COREC system, however obtaining R&D approval is a more complex process. We are however working in collaboration with the R&D departments in the West of Scotland to standardise our processes.

The trials submitted for approval over the last six months have been from the breast, colo-rectal, lung and haematology portfolios and include screening, therapeutic and diagnostic trials. Within the next reporting period we would anticipate increased recruitment in these specific areas as, during the period March - Sept 2004, we have put in place new systems to collect recruitment numbers which were previously were difficult to track.

Patients are now actively being recruited into NCRN peer reviewed non-commercial cancer trials across the West of Scotland, supported by SCRN staff. The SCRN monitoring report April - Sept 2004 to the Scottish Executive will provide a breakdown of recruitment figures to cancer trials, by disease site, across the region.

There has been a considerable under-spend in the first year of the budget due entirely to delays in recruitment of SCRN staff across the WoS. The amount identified as slippage is approximately £200,000 and does not include funds allocated to start-up, which have been carried forward from 2002-03. A plan for use of SCRN ring-fenced funding has been developed but will not be implemented until approval from the SE is obtained.

6.2 West of Scotland Objectives from SCRN monitoring report April - September 2004

• Identify local network staff to lead on training, writing Standard Operating Procedures (SOPs) and communication strategies by October 2004. Target achieved. Development of a strong team with ownership of initiatives. Initially aim to look at three areas and develop as network progresses.
• Implement strategies to collect information on cancer-trial recruitment across the region by December 2004. Produced an Access database for SCRN staff to collect local numbers. Oracle web based application being developed, will provide immediate data capture. Aim to collect information in different disease areas and across treatment modalities.
• Increase patient awareness for cancer trials across the network by October 2004. Target achieved.
• Increased recruitment to cancer trials in minimum of three sites within the region by December 2004. Two areas within region have achieved target by October 2004. Demonstrates effective use of network resources and the impact of the network.
• Identify strategies for capacity building within network by March 2005.

7. West of Scotland Cancer Centre: Beatson Oncology Centre

Medical Director - Professor Alan Rodger

During the period April - September 2004, the Beatson Oncology Centre has continued to work towards moving to the new West of Scotland Cancer Centre in 2007. One of the key milestones was to have the building works officially launched. This was carried out by the Minister for Health on Wednesday 7 ^th July 2004.

During the period we have seen 2 Consultant staff leave - a Clinical Oncologist to Industry and a Senior Lecturer in Medical Oncology to Australia. However, 3 new Clinical Oncologists have joined us during this period. Consultant staffing remains a challenge. There has been more positive news with other staff groups - we have recruited almost the full compliment of therapy radiography staff and we are retaining staff in nursing, pharmacy and admin and clerical well. Radiotherapy Physics remains another challenging area in the recruitment of Clinical Scientists who are very necessary for our exciting replacement and new equipment programme.

£4.4m is being spent (£4 m from the SEHD and £400k from the Robertson Trust). This will deliver the first 3 linacs for the new Centre, but will also allow us to upgrade current equipment to deliver stereotactic radiosurgery, image guided radiotherapy and respiratory gating.

We remain focused on reducing waiting times for radiotherapy and these six months have seen specific project work done on capacity and demand. Early indications are that radiotherapy waiting times have reduced slightly.

Developing our IM&T Strategy as we move towards a state of the art cancer centre has been another area of intense focus. We continue to develop our web site.

Patient/public involvement has also been an area of focus during this period.

Finally, we continue to work with West of Scotland colleagues on the increasing use of chemotherapy both within the Centre and District General Hospitals (DGHs) around the West of Scotland. Excellent horizon scanning continues apace, alongside the financial planning required to sustain this level of activity.

Another eventful 6 months for the BOC!

8. West of Scotland Boards

8.1. Argyll & Clyde

Cancer Steering Group

• NHS A&C are currently modernising the remit, structure and membership of the Cancer Steering Group to take account of the move to a single system.
• The new structure will complement the new remit, structure and membership of RCAG and meet the needs of the national and regional cancer improvement agenda (e.g. monitoring/service redesign/public involvement).

Redesign

• NHS Argyll and Clyde has just completed a wide consultation process on proposals to modernise services across the single system. The new cancer patient pathways agreed will be built into the clinical strategy.

Waiting times

• NHS A & C continue to work towards meeting the cancer waiting time targets for 2005 and are currently preparing our cancer waiting times action plan for submission.
• The maximum waiting time for a CT scan has reduced from 5 weeks to 4 weeks and for an MRI scan from 14 weeks to 9 weeks.

Referral

• Electronic referral now available to all 96 GP practices in NHS Argyll and Clyde. Training and usage of the system is progressing with 72 practices trained; 32 referring electronically (1346 referrals in September).
• SCI Outpatient Management system in all 4 hospital sites.
• Referral protocols and guidelines available for breast (with direct booking)/ colorectal/gynaecological and head and neck cancers. Protocols developed for upper GI and lung but not yet on the system.
• Scottish cancer referral guidelines available on the "guidance" tab on SCI Gateway and as hyperlinks in the cancer protocols.

Audit/Quality Improvement

• Work is in progress to map current cancer audit capacity and demands to support MCNs and the national and regional quality and effectiveness agenda.
• The project will develop a standardised IM&T Clinical Audit System in the short term (currently stand alone dbases store local data)
• The overarching structure for clinical performance monitoring has been agreed for the single system.
• Current discussions being held on reporting mechanisms for local MCNs and quality and effectiveness (e.g. QIS) to feed into the Divisional CG structure.

Bowel Cancer Framework for Scotland

• Public Awareness campaign featuring media advertising to promote early detection of bowel cancer to launch on 1 ^st November 2004.
• Primary care health professionals (130) have attended bowel cancer symposiums delivered by colorectal surgeons.
• As part of the WoS Awareness Campaign for Colorectal Cancer ways of managing the expected increase in referrals for bowel systems are being examined (an endoscopy capacity and demand study has recently been completed).
• A nurse endoscopist has been trained. Also 3 currently in training across the single system to increase capacity.
• Nurse-led low-risk rectal bleeding clinics are being piloted in 3 hospitals for six months (will be audited to identify the number of patients using the clinics).

Palliative Care

• As of September 2004 a professional group has been established for NHS A & C (representing all professionals/organisations involved in palliative care including patient/carers). The group will focus on improving existing networking, sharing practice and taking a strategic lead in palliative care service provision and development across the NHS System.
• Two rural group practices have adopted the Gold Standards Framework (GSF) for palliative care.
• Information session on GSF arranged for other practices in the single system.

Nursing Framework

• The benchmark project to identify the current position/actions required and timescales for implementing the Nursing Framework has been completed.
• Responsible leads have been identified to action the framework .

Cancer eHealth/IM&T

• NHS A & C supports the development of a national/regional IT system for cancer services.
• Joint discussions being held between Lead Cancer Clinicians/Directors of IT/Clinical Governance staff on developing a single system approach to the development and ongoing support of clinical audit systems which fits the national IM&T plan and supports the quality improvement agenda (e.g. MCNs/QIS).

Patient Focus Public Involvement

• Patients were full participants in the development of the new cancer pathways which will inform the clinical strategy and NHS A & C cancer plan .
• Within the new CSG structure work is ongoing to secure patient/public representatives to join the group and a Patient and Public Involvement sub group will be set up to take forward the cancer public involvement agenda.
• NOF funded project to develop an electronic resource for patients, families, carers and professionals is being developed (two information workers will liaise and involve statutory and voluntary providers, carers and patients to identify and meet information needs of patients and families at each stage of the patient journey.
• A NOF funded project is developing hand held records for patients receiving chemotherapy.
• Patients with cancer were full participants in joint meetings between NHS A & C lead cancer clinicians and BOC colleagues on future oncology service needs for Argyll and Clyde population.

8.2 Ayrshire & Arran

Managed clinical networks

• Regional Response.
• Within Ayrshire and Arran the Cancer Audit Support Team facilitate the collection and analysis of data in support of the MCNs via the Multi-Disciplinary Team meetings. The MTDs include Clinicians, Oncologists, Specialist Nurses, AHP's and other disciplines that may be involved in the care of the patient. Meetings are video-linked and may be linked with sites across the West of Scotland Network. There is very active involvement by Ayrshire and Arran clinicians in regional MCN activity.

Waiting times

• Ayrshire and Arran Cancer Waiting Times Performance Plan has been completed including Action Plan in support of the 2005 Waiting Time target at the maximum wait from urgent referral to treatment for all cancers will be two months.
• Action Plan includes detailed information on current performance utilising local, regional and national data.
• The plan includes a specialty by specialty analysis of bottlenecks in the system and funding priorities to support waiting time reductions.
• Waiting Times Plan has been submitted to the West of Scotland Regional Group.

Redesign

• There will be a major review of Cancer Services in Ayrshire and Arran as part of the wider Ayrshire and Arran Services Review Project. The first meeting of the Cancer Services Group is being held in November 2004 with wide representation from key stakeholders.
• The Lead Cancer Nurse has completed a review of Oncology Units in Ayr and Crosshouse including recommendations for future service delivery.
• Ayrshire and Arran is committed to moving towards site specialisation of Oncology Services in line with West of Scotland Oncology Strategy.
• A major Breast Cancer Redesign Project has been completed and will be incorporated into the wider review of cancer services.

Referral

• Good progress has been made in promoting the Scottish Referral Guidelines for Suspected Cancer (NHS HDL (2002) 45). Guidelines have been distributed to all GP's and are available electronically. This work is being led by the Macmillan Lead Cancer GP.
• A local clinical guidance internet site has been developed which builds the national guidelines into a symptom based front page and this will be ready for publishing shortly.
• The NOF Breast Project has further promoted these guidelines and it is planned to roll out the work established in this clinical area to other conditions.
• The overall aim is to encourage referrers to recognise patients who have symptoms and signs which require urgent attention and for these patients to be seen within the recommended timescales.

Audit/Quality Improvement

• The Cancer Audit Support Team is well established with three clinical facilitators and two assistants.
• Currently audit data is collected on all priority cancers ie lung, breast, colorectal and gynaecology and in future collection will be carried out on all cancers in line with government guidelines. Data is also currently collected on endometrial, cervical, upper GI, urological and haematological cancers.
• The Audit Team supports clinicians and managers in working towards government standards and guidelines.
• The framework for nursing people with cancer in Scotland focuses on improving patient care in partnership with the patient and this is the main objective of the Audit Team.

Palliative Care

• The Ayrshire and Arran Palliative Care MCN working well. Activity includes: standardisation of evidence based practice throughout Ayrshire; developing communication skills and education on aspects of Palliative Care.
• Palliative Care MCN links with cancer multi-professional team locally regarding developing and integrating clinical practice.

8.3 Forth Valley

Managed Clinical Networks

• Role of Cancer Board reviewed-identifying the need for local focus to bring together Lead Clinicians for each site specific MCN, with specific time in their job plan to run local MCN and represent Forth Valley at regional MCN. Lead Clinicians appointed for all site-specific groups.
• Palliative Care MCN established, other site specific groups in various stages of being formalised.

Waiting Times

• Local Implementation Strategy developed.

Redesign

• Nurse Led Pre Assessment Clinic.
• Nurse Led Colorectal Clinic.
• Nurse/Pharmacy Led Pamidronate Clinic.
• Lung Cancer Fast Track Service.
• Nurse Led Urology Histology Clinic.
• Appointment of Prostate Cancer Charity Clinical Nurse Specialist.
• Secondment of ENT Nurse to Head & Neck Nurse Specialist post for 6 months.

Referral

• Colorectal & lung referral proforma developed and in use.
• Breast, gynaecology, urology, head & neck referral proformas developed.
• Haematology referral proforma nearing completion.
• Upper GI due for completion December 2004.
• Dermatology proforma being developed regionally.
• Working with IT to link referral proforma with SCI gateway.
• Creation of Co-ordinators for Patient Pathways Post x 2 (job advert out).

Audit/Quality Improvement

• Pilot audit of SIGN 44 by Palliative Care MCN across all care settings-leading to development of Pain Assessment Tool - due to be implemented and audited thereafter.

Bowel Cancer Framework for Scotland

• Bowel Cancer Awareness training being rolled out across Acute and Primary Care Operating Divisions by Forth Valley & Lanarkshire Bowel Cancer Awareness Project.
• Local implementation team for West of Scotland Bowel Cancer Awareness Campaign.

Palliative care

• Developing Palliative Care Manual.
• Development of Palliative Care Strategy.
• Gold Standards Framework Scotland Project-20 of the 57 practices in Forth Valley recruited.
• Pilot Project for District Nurse Placements to Strathcarron Hospice-14 DN's recruited-long term project will be opened up for Community Hospitals and Acute Division nursing staff.
• Development of Care of the Dying Patient Pathway in Acute Division.
• Syringe Drivers Central Management System implemented across NHS Forth Valley.
• Development of website by Palliative Care MCN.
• Development of Forth Valley Cancer & Palliative Care Newsletter.

Nursing Framework

• Work led by West of Scotland Cancer Nursing Group to identify regional themes & priorities.
• Action plan developed by Macmillan Lead Cancer Nurse to implement framework locally in Forth Valley.

E-Health

• Local Implementation of IM &T Strategy for NHS Forth Valley.
• IT Subgroup established from Cancer Board.

Patient Focus Public Involvement

• Development & implementation of Forth Valley Cancer & Palliative Care User Involvement Strategy.
• Audit of Patients on Cancer Services Across Forth Valley carried out.
• Patient Information Steering Group commissioning Research Project leading to development of Forth Valley Information Policy for Patients with Cancer.

8.4 Glasgow

Waiting times

• Work is continuing locally, regionally and nationally to identify, implement and report waiting times for all cancer specialties.
• Plans to address shortfalls against the 2005 targets are being drafted as those shortfalls are identified.
• Issues still exist in relation to data capture and data definitions.
• Undertaking scoping work looking at IT systems and processes to support the capture of waiting times information.
• Pan-Glasgow imaging project commenced to improve access and speed of diagnostics process. Target to image and report upon all suspect referrals within 4 weeks thereby enabling achievement of the December 2005 target.
• Nurse endoscopists are being trained and introduced across the city to improve access to endoscopy.

Redesign

• CCI initiatives in service redesign continue to be implemented and publicised.
• Redesign work is being undertaken in Urology services to improve speed of diagnosis.
• Further work is being undertaken to identify the potential for electronic support systems.
• The development of pan-Glasgow integrated services, e.g., head and neck oncology is being undertaken in preparation for the implementation of the Acute Services Review and to standardise and improve the delivery of services in the city.

Referral

• Team Diagnostics approach for colorectal cancer: roll out nearing completion in South Glasgow and introduction of similar system commenced in the North.
• Haematuria referral currently being developed.
• Plans under development for a phased introduction/development of Team Diagnostics across all specialties over forthcoming year.

Audit/Quality Improvement

• Audit continues to be an issue. The need for IT systems to support this is paramount and being looked at locally and regionally.
• The demands that performance information be included in clinical audit are causing some clinicians to detach from the process.
• Work is underway in Glasgow to ensure an integrated and planned approach to clinical audit and performance monitoring that ensures timely reports with minimal duplication of effort.
• The potential for the use of E-Health developments is being explored.

Glasgow continues to play a committed role in the development and implementation of agreed datasets for cancer.

Palliative Care

• Palliative care continues to be subject the work of a specific Palliative Care group whose recommendations are expected imminently.
• A combined primary care cancer sub-group functions enabling issues from palliative and primary care to feed into the wider cancer arena and vice-versa.

Cancer eHealth/IM&T

• The potential for the use of SCI Store, SCI Gateway and the Glasgow Portal is being explored for cancer services.
• The development of referral and triage processes based upon symptoms and agreed across primary and secondary care is continuing - these processes will readily transfer to electronic usage once systems exist to take them.
• Cancer services in Glasgow are also participating in the development and introduction of a referral management system that will also support the introduction of electronic management of referrals.

8.5 Lanarkshire

Managed Clinical Network

• Participation in Regional Networks
• NHS Lanarkshire are currently reviewing the Lanarkshire geographical network as a sub-unit of the West of Scotland Cancer Network in the light of the move to single-system working.
• NHS Lanarkshire standing Cancer Committee currently reviewing cancer strategy
• Consideration being given to development of the lead cancer team for Lanarkshire in conjunction with the Beatson Oncology Centre

Waiting Times

• Action Plan submitted and capacity planning underway
• Achieving around 95% for "maximum wait from urgent referral to treatment" for breast cancer patients
• Other cancer types building on experience in breast cancer
• Data capture at different states of maturity for other cancer types
• Bottle-necks identified and being addressed
• A review of endoscopy capacity underway

Redesign

• Redesign of specialist oncology services underway for breast, colorectal and lung cancers
• Specialist oncology input to breast cancer focused on two hospital sites as an interim towards identifying a single hospital site in Lanarkshire
• Breast cancer redesign around capacity planning has successfully achieved and maintained target waiting times
• Fast-track colorectal service introduced at Hairmyres hospital
• Fast-track haematuria service introduced to all three hospitals

Referral

• Lung cancer faxed referrals and priority chest CT slots
• Electronic referral software now available to 85 of the 101 practices in Lanarkshire
• Electronic referrals developed for skin, breast and lung cancer
• Skin cancer protocols conform to Scottish Cancer Referral guidelines
• Other referral protocols in process of development by clinicians locally

Audit/Quality Improvement

• Cancer audits well established (between one and five years) for lung, colorectal, breast and gynaecological cancers and have been introduced during 2004 for haematology and urology
• Regional audits in Upper GI, head and neck and dermatology expected to commence in 2005
• Progress determined by time taken to establish agreed national/regional datasets and produce standardised MCN data collection systems
• Annual assessment versus NHS QIS standards taking place locally via established multi-disciplinary clinical groups a well as regionally for lung, colorectal and breast cancers
• Clinical governance reporting taking place via multi-disciplinary clinical effectiveness working groups addressing standardised NHS QIS based agenda and linked to health and clinical governance process

Bowel Cancer Framework for Scotland

• Bowel cancer awareness training being rolled out across Acute and Primary Care Operating Divisions by Lanarkshire and Forth Valley Bowel Cancer Awareness Project
• A review of endoscopy capacity underway

Palliative Care

• Palliative Care MCN well established with active clinical leadership and appropriate management support
• Palliative Care MCN fully involved in developing NHS Lanarkshire's Palliative Care strategy and currently involved in review of NHS Lanarkshire Cancer Strategy
• Palliative Care MCN members involved across the Lanarkshire Cancer Care Groups in both Acute and Primary Care Divisions
• Palliative Care Guidelines funded through Change & Innovation and in conjunction with Cancer Relief MacMillan in draft form and due to be published in the near future

Nursing Framework

• Clear leadership within cancer nursing developed and nursing career structures formalised
• Lead cancer nurses have been appointed for haematology, breast, colorectal and will shortly be appointed for lung
• Cancer and palliative care education programme established for clinical support workers
• Major cancer sub-groups have active nursing representation
• Nurse-led clinics being developed where possible and appropriate
• Patient mapping initiative has been undertaken to identify and target nursing resources accordingly
• Ongoing actions include: consideration of feasibility of nurse-consultant in cancer; continued review of best practice and critical analysis of relevant research; review of education programme; protocol development to support nursing initiatives; cancer element of the nursing, midwifery and health visiting strategy being developed

Cancer eHealth/IM&T

• Electronic referrals well advanced and cancer specific protocols will be the next stage of that development
• Participating with partners in the West of Scotland in developing common solutions for all cancer networks, initial step being a collaborative involvement in the generic clinical system for head and neck

Patient Focus / Public Involvement

• Bowel cancer patient outreach group established supported by specialist nurses and TakTent in community setting with patient-driven agenda
• Lead colorectal nurse specialist undertaking interviews with structured questionnaire on "Patients' experience of completing treatment for colorectal cancer"
• Patient questionnaires used for those attending the skin cancer clinic at Monklands Hospital
• West of Scotland Cancer Information booklets introduced
• Patients and public will be involved in proposed redesign of services under Lanarkshire's "Picture of Health" which will include further redesign of cancer services

9. West of Scotland Cancer Awareness Project

Oral Cancer Campaign

An audit of 580 patients attending outpatient clinics at 11 sites across the west of Scotland provided the following results:

• 64% of the patients had seen or heard the campaign on oral cancer.
• 68% of those that had seen the campaign said it had encouraged them to seek advice more quickly.
• 5% of patients seen had a provisional diagnosis of a malignant lesion.
• 52% of these responded that they were aware of a mouth cancer campaign.
• 69% (of the 52%) indicated that the publicity had made them seek advice more quickly.
• 7% had a provisional diagnosis of a potentially malignant lesion.
• 74% responded that they had been aware of a mouth cancer campaign.
• 69% (of the 74%) indicated that the publicity had made them seek advice more quickly.

The project was awarded the 'Best Campaign for Inequalities and Health' by the Association of Healthcare Communicators for the oral cancer campaign in October 2004.

The project is currently writing up results of the oral campaign for publication and is hosting a dissemination seminar at the Royal College of Physicians and Surgeons in Glasgow early in 2005.

Bowel Cancer Campaign

• The Minister for Health is launching the bowel cancer campaign in Glasgow campaign on the 1 ^st November.
• The campaign will be on television and radio during November and then between January and February 2005.
• £100,000 of the project budget has been allocated to the 5 NHS Boards to support service provision during the campaign.

10. Patient Focus & Public Involvement

Regional Patient and Public Involvement Development Workers : Charlotte Woods and Jackie Bell

Interviews have now taken place for the above post and we are delighted that Charlotte and Jackie will take up post, on a job share basis, from 1 ^st November.

The focus of their work will be to support and take forward the development of a co-ordinated approach to the planning and delivery of effective patient and public involvement in cancer care and service development across the West of Scotland. They will be working closely with a wide range of people and organisations to build on and further develop the considerable amount of work already ongoing in this area, some of which is highlighted in other sections of this report.

11. Patient Information

The West of Scotland MCN for gynaecological cancer commissioned research into the experiences and views and suggestions for improvement of women with gynaecological cancers. Findings from 31 in-depth interviews highlighted that women wanted improved and relevant written information at a time that was appropriate. The Scottish Executive report 'A Guide to securing access to information' also indicated that comprehensive, jargon free information should be provided for patients at each stage of their cancer journey. NOF slippage money provided an opportunity to review the information already available and to develop a comprehensive, add-on information package for women and also a magazine - 'Women Talking about Women's Cancers' - based on the interviews with the women. The MCNs for colorectal and head and neck cancers were keen to produce similar information packages and the MCNs for lung and breast cancers adapted forms of the concept for their patients. Cancer slippage money was obtained to carry this work forward. Patients and carers have been involved in development and testing of all the information material.

Progress

• Information packages for all new patients with colorectal, gynaecological, breast and lung cancers have been developed and are in use.
• Website versions of the above are either in use or being patient tested before going 'live'. These are particularly useful for established patients who do not have access to the written information packages.
• 'Bookmarks' providing details of the website are being printed for distribution throughout the cancer clinics in the region.
• The needs of people who are blind, deaf, have learning difficulties or who are from ethnic minorities have been addressed.
• The information package for people with head and neck cancer is at final draft stage and will be patient tested over the next few weeks.
• Underspend has allowed the MCNs for prostate, upper gastro-intestinal and skin cancers to start developing similar information for their patients. Funding may allow only the production of website versions of the information.
• The 'Women Talking about Women's Cancers' magazine has been printed and copies made accessible to the public via health promotion departments throughout the region.
• An evaluation strategy is being finalised and an audit tool has been developed.

12. Cancer eHealth/IM&T

• The West of Scotland Regional Cancer IM&T Group continues to meet regularly to devise and influence policy and implementation issues relating to cancer information and associated technologies. It's membership is expanding to include general management and information management representatives thereby further developing it's role in relation to information management and utilisation rather than focusing upon technology. A proposal to utilise the intended Generic Clinical System toolkit to initially produce a system to support the management/care of people with head & neck cancer being submitted to the national cancer e-health group for consideration.

13. Summary

This report has sought to reflect the significant amount of work that has been undertaken locally and regionally over the past 6 months 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. These include:

• RCAG membership and working arrangements have been reviewed.
• Regional work plan is being progressed and actions identified & being undertaken to progress towards achievement of the 2005 waiting time target for all cancers - this poses significant challenges for local Boards and the region as a whole.
• MCNs and specialty groups continue to develop a pace - work ongoing to further integrate MCNs with local and regional planning mechanisms.
• Collaborative work with CCI continues to improve patient pathways - work over the coming 18 months will focus on Urological and Head & Neck cancers.
• Implementation of national prospective audit continues - significant challenges with data capture and resourcing persist.
• There has been successful recruitment of key staff within the Cancer Centre - recruitment difficulties persist for some specialties.
• Regional Patient and Public Involvement Development Workers have been appointed to support and further develop patient and public involvement in all aspects of our work.
• Information materials developed via MCNs are now in use across the region with work ongoing with other patient & professional groups to develop other materials.
• Work to develop integrated IM&T solutions continues on a regional basis.

Over the coming months work will continue with all of the above and the West of Scotland Cancer Network, in conjunction with SCAN and NoSCAN, will be working with NHS QIS to successfully complete the process of Network Accreditation.

Report submitted by Evelyn Thomson, Regional Network Co-ordinator on behalf of West of Scotland Cancer Network.