National Priorities 2003-04
NHS Lothian – Cancer Final
(a)
Title of Service:
CANCER
Cancer remains one of the key national priorities. The central document for
planning cancer services is the National Cancer Strategy – “Cancer in Scotland:
Action for Change”. Provides guidance and identifies state key tasks that we
need to undertake to improve both the prevention of cancer, its diagnosis and
treatment.
(b)
Local Position
The key targets we are working towards are included in the following PAF
indicators:



Compliance with NHS Quality Improvement Scotland (NHS QIS) – PAF
3.0201;
Reduction in mortality and increased survival rates (sctn) - PAF 1.02;
Compliance with waiting times for Breast cancer and child and adult
leukaemia – (2001 and 2005) PAF 4.11
Lothian Cancer Strategic Planning Group prioritises proposals for investments
against agreed criteria, which are also used, on a regional basis for prioritisation.
These criteria are consistent with the Cancer in Scotland: Action for Change and
Lothian’s Local Health Plan criteria. The criteria are as follows:







Equity of access;
Delivers current waiting times by tackling bottlenecks;
Standards (how it delivers our NHS QIS / SIGN / or other
relevant guidelines and standards);
Effective intervention / proven cost benefit;
Delivers 2005 waiting times maximum wait for urgent referral to treatment
for all cancers 2 months;
Other benefits (how it delivers the objectives of the national cancer
strategy).
There is evidence from 2 cohorts of >70 years patients of a change in the
utilisation of appropriate treatment and a significant improvement in survival in
this disadvantaged group of patients following the introduction of multidisciplinary
working.
1
National Priorities 2003-04
NHS Lothian – Cancer Final
(c)
Changes to Improve Services
Investments for 2002/03 that are now being fully implemented across Lothian
include:

Additional cancer MRI scanning facilities to reduce waiting time for MRI to
less than 2 weeks by Nov. 2003.

Additional clinical staff including consultants, nurses and therapists to
support patients with upper GI Cancers to provide rapid access diagnostic
clinics.

A molecular diagnostic monitoring service for haematological
malignancies to ensure a quick accurate diagnosis and effective disease
monitoring;

Six clinical nurse specialist posts for a number of different cancers to
improve the quality of care through support for patients before and during
treatment;

Expansion of chemotherapy day unit facilities at St John’s West Lothian
by Nov. 2002 to allow patients to be treated nearer to their own home;

Expansion of ward 1 facilities at the cancer centre at the Western General
Hospital by March 2004. This will improve the patients’ experience,
ensuring provision of high quality, safe chemotherapy services;

Appointment of a redesign manager to improve the patient pathway for
lung cancer patients by preparing an agreed action plan to meet the NHS
QIS (NHS Quality Improvement Scotland) standards and to lead the
implementation of the plan.

Implementation of Electronic Referrals to Breast Units in Lothian and
West Lothian.

NOF Cancer Awareness Projects: offer cancer awareness training to one
nurse per practice in LPCT, provide funding to facilitate cancer awareness
work within each LHCC, target provision at men and minority ethnic
groups. In NWELHCC and SEELHCC lay health voluntary workers will be
recruited and offered cancer awareness training and support to work with
their local communities.

Additional equipment for LPCT to support patients care at home.

Plans are being developed to deliver the 2005 waiting times target of a
maximum wait for urgent referral to treatment for all cancers of 2 months;

IM&T investments in the Cancer Intranet project and the Cancer
Information Network will begin to bear fruit with the development of linked
records and easier access to information, advice and guidelines.

Regional planning and investment in the ongoing Linear Accelerator
programme will be strengthened with the production of a business case
for one additional machine in 2004-5
2
National Priorities 2003-04
NHS Lothian – Cancer Final
Investments Planned for 2003/04: 










Additional palliative care consultant sessions to meet the needs
identified by the Public Health Directorate in its needs assessment of
Palliative Care in Lothian carried out in 2002.
Additional palliative care pharmacists and technicians to provide
timely advice and support to services in the community, including
hospices, on medicines management for palliative care patients.
Strengthen palliative care service provided in Primary Care to address
the need for generic palliative care identified in a survey of needs in
the community.
Rapid response delivery equipment service for patients with cancer
patients registered with a GP in LPCT.
Cancer and palliative care education for Primary Care staff to develop
their skills and capacity for palliative care patients in the community.
Additional 0.5 wte breast surgeon shared jointly between the Breast
Unit in Edinburgh and West Lothian and additional theatre session to
ensure continued compliance with NHS QIS and Waiting Times
standards and to facilitate a co-ordinated, pan-Lothian approach to
Breast disease.
Additional nurses to provide day care chemotherapy at WGH in order
to reduce waiting times for day case treatment to meet agreed targets.
Additional radiotherapy support for head and neck cases to reduce
waiting times for imaging, improve quality of care and facilitate multidisciplinary working.
Additional pharmacists for cancer services across Lothian to ensure
timely and safe advice and support to patients and service providers.
Additional equipment for LPCT to support patients care at home.
Development and staged implementation of a cancer registry in
primary care
Redesigning cancer services is a particular priority for the NHS. For instance
Lothian has attracted national funding from the Scottish Executive for a colorectal
cancer redesign. This will build on the opportunity afforded by the combination of
colorectal services in Edinburgh onto one site. A similar project is being
undertaken under the aegis of the SCAN Lung Group to redesign the lung cancer
service aiming to develop a single entry point for patients and a smoother
pathway avoiding unnecessary delays in investigations. A major NHS Lothian
investment in premises and a redesign of the breast cancer clinical service at the
Western General Hospital has led to improved efficiency and an improved
experience for women with breast cancer. These service redesigns in cancer are
already producing dividends in improved quality of service.
Progress that is made towards achieving our targets will be monitored by the
Lothian Strategic Planning Group through the Performance Assessment
Framework and the waiting times reporting.
3
National Priorities 2003-04
NHS Lothian – Cancer Final
In addition to this a number of developments have been progressed in the
palliative care arena including establishment of an MCN and completion of
palliative care needs assessment which informed the prioritisation of investments
(see palliative care investments above).
New Opportunity Fund: 3 round identified funding Cancer and Palliative Care
Projects. Project proposal have been received, prioritised and submitted to NOF
through NHS Lothian. The outcome of bids expected July 03.
(d)
Outcomes
–




Delivery of cancer services nearest the cancer patients home in a
timely fashion when appropriate.
– 90% compliance with 2001 waiting times for cancer.
By 2005 to have provided treatment within 2 months from urgent referral for cancer.
Compliance with NHS QIS standards for cancer.
Equity access to specialist services in medical and pharmaceutical staff across the
patient pathway.
Reduction in mortality and increased survival rates as measured by National
Cancer Registration statistics.
4