Hywel Dda Health Board’s Cancer Delivery Plan 2013-16 · During Q3 12/13, the team identified the need to monitor closer the screening update rates after variation identified across

Hywel Dda Health Board’s Cancer Delivery Plan 2013-16

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Hywel Dda Health Board’s Cancer Delivery Plan 2013-16

1. Background and context

Together for Health – Cancer Delivery Plan was published in June 2012 and

provides a framework for action by Local Health Boards working together with

their partners. It sets out the Welsh Government’s expectations of the NHS in

Wales to tackle cancer in people of all ages, wherever they live in Wales and

whatever their circumstances.

The Plan is designed to enable the NHS to deliver on their responsibility to meet

the needs of people at risk of cancer or affected by cancer. It sets out:

• The population outcomes we expect

• The outcomes of from NHS treatment we expect

• How success will be measured and the level of performance we expect

• Themes for action by the NHS, together with its partners

2. Hywel Dda Health Board’s Cancer Delivery Plan

The attached document is Hywel Dda Health Board’s plan that outlines the

action we are planning to progress to improve outcomes for patients, in a patient

centred way. Our plan has been developed to match the patient pathway and

covers the following areas:

1) Preventing cancer: people live a healthy lifestyle, make healthy choices and

minimise the risk of cancer

2) Detecting cancer quickly: cancer is detected quickly where it does occur or

recur

3) Delivering fast, effective treatment and care: so people have the best chance

of a cure

4) Meeting people’s needs: people are placed at the heart of cancer services

with their individual needs identified and met so they feel well supported and

informed, able to manage the effects of cancer.

5) Caring at the end of life: people approaching the end of life feel well cared for

and pain/symptom free

6) Improving information

7) Targeting research

Each of the seven areas has been reviewed to determine the actions required

along with current status, expected outcomes, timescales and lead officers. The

Cancer Delivery Plan provides a focused framework for bringing all the initiatives

which have an impact on a cancer patient’s pathway together in one document.

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Many of the actions/initiatives which are included in Hywel Dda Health Board’s

Cancer Delivery Plan are already part of other local Health Board and National

Plans. Due to Hywel Dda Health Board’s close working relationship with

Abertawe Bro Morgannwg University Health Board, for example, our Cancer

Delivery Plan has been aligned to ensure compatibility for the further

development of working relationships/arrangements.

3. Governance Arrangements/Monitoring Mechanisms

The Health Board is also producing a Cancer Annual Report which provides a

baseline for our population on our current services and will provide a platform for

taking forward and monitoring the actions contained within our Plan.

Progress against the Cancer Plan will be monitored through quarterly meetings

of the Cancer Clinical Programme Group alongside the monitoring of the Cancer

Annual Report.

In addition to the above, it is expected that Health Boards will report progress

against their local delivery plan milestones to their Boards on a quarterly basis

and to the public, via their websites. It is expected that this Local Delivery Plan

and its milestones will be reviewed and updated annually.

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1. PREVENTING CANCER – PEOPLE LIVE A HEALTHY LIFESTYLE, MAKE HEALTHY CHOICES AND MINIMISE RISK OF

CANCER

Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead

Completion date

PC1 Engage effectively on Local Service Boards to ensure appropriate local population outcomes are identified within single integrated plans and actions of all partners are clearly set out, monitored and measured.

PC1 Membership of the Cancer Clinical Programme Group to include Public Health representation.

CPG Terms of Reference and Membership currently being reviewed to align with work of Population Health Programme Groups. To work in partnership with Hywel Dda Public Health Team to improve services and tackle inequalities, placing emphasis on disadvantaged groups and deprived areas.

Head of Cancer Services

October 2013

PC1 Population Health Programme Groups to include representation from Public Health

Alignment of officers to each Population Health Programme Group

Director of Public Health

October 2013

PC1 Three LSBs operate within the Health Board area (aligned to the three counties of Carmarthenshire, Ceredigion and Pembrokeshire). The LSBs meet regularly to discuss ‘ need’ and the ‘need assessment’ work.

Single integrated plans (developed by the LSB and local authority) are in place and Public Health have inputted into the outcome measures and are involved in the monitoring of the SIPs


Ongoing review by the LSBs

PC2 PC2.1 PC2.2 PC2.3 PC2.4 PC2.5

Work with local government, Public Health Wales, GPs, pharmacists, dentists, opticians, the Third Sectors and others to use data on cancer incidence and mortality to identify, implement and audit local strategies, clearly stated population outcomes and performance measures and targets to prevent cancer. In particular, to: Promote better public awareness of cancer risk factors; Reduce smoking, obesity and excess alcohol intake; Reduce the gap in inequalities in incidence and mortality rates for cancer; Work collaboratively through the Cancer Networks; Encourage participation in the programme of health checks for people over 50 facilitate access to personally relevant, clear

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Completion date

and consistent health advice PC 2.1-2.5

Team Briefings by the Chief Executive will include briefings, where appropriate, on Public Health priorities

Public Health Strategic Framework identifies the following as priority area: tobacco, obesity, sexual health, imms and vaccinations, alcohol, mental wellbeing and making every contact count.


Ongoing reviews

PC 2.1-2.5

Public Health Strategic Framework identifies: tobacco, obesity, sexual health, imms and vacc, alcohol, mental wellbeing and making every contract count as key areas of work. The relevant key priorities for the Hywel Dda area are:

• Reducing smoking prevalence and protecting people from exposure to tobacco smoke

• Improve diet and nutrition and reduce overweight and obesity

• Decrease alcohol consumption

• Increase uptake of Imms and Vacc rates (including those which have an impact on cancer: HPV for Cervical Cancer prevention)

• Increase mental well being

• Decrease environmental risks (skin cancer prevention)

• Reducing premature deaths The team work across all settings and life

Reducing smoking prevalence and protecting people from exposure to tobacco smoke Tobacco action plan in place (refresh required in 2013

• Foundations for Change (F4C) target across all 3 counties. Close fits with Strategic Implementation Groups.

• Hywel Dda Pledge made re: helping 5,000 people stop smoking or preventing people from starting (2015 target)

• Currently monitored at Public Health Leadership Team

• As Population Health Programme Groups commence, the Tobacco Action Plan will fit with the transformation work being undertaken and the identified need to increase pre-surgery activity and also link with Smoking Cessation and our Smoke Free Sites. The Public Health Team are working with Public Health Wales (Stop Smoking Wales) to

Principal Officer

Refresh during 13/14 (by end of Q3)

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Completion date

improve the service model and ensure services are offered more flexibly (as part of Tier 1 discussions). The Public Health Team are exploring a Level 3 pharmacy scheme for smoking cessation. Waiting times for Stop Smoking Wales Services are being monitored.

Key stakeholders include: local authorities, Public Health Wales, Third Sector, County Voluntary Councils, Tobacco Network/ASH, Primary Care, Clinicians and Pharmacy.

course areas. Established links are in place with Public Health Wales. A national Consultant in Public Health (CPH) lead will be established by Public Health Wales during 13/14 Strengthen links to preschools, healthy schools and workplaces. During 2013/14 there will be an increased focus on developing Public Health links with primary care. Public Health Team to focus resources in specific settings where evidence indicates they will be most efficiently used. These settings include:

• Local authority settings eg pre schools, schools and school nursing

• Primary care

• Pharmacy

• Workplaces

• Vulnerable populations including Communities First

Use Foundation to Change approach to reduce health inequalities and improve health across the whole of the population by interventions that create supportive

Improve diet and nutrition and reduce overweight and obesity Overweight and obesity action plan in place (full refresh required by end April 14)

• F4C targets/actions being agreed across all 3 counties for monitoring through the Health Board Strategic Implementation Group

• Hywel Dda Pledge made re: helping 12,000 people to lose weight (2015 target)

• Fit with Population Health Programme Group

• Close fit with 3 SIPs

• Monitoring in place through the Public

Principal Officer - with links to Dietetics/ Therapies

Refresh by April 2014

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Completion date

Health leadership team. Key stakeholders include: local authorities, Public Health Wales, Third Sector, Primary Care, Clinicians and All Wales Leadership Group. During 13/14, the Public Health team will explore opportunities to develop further action relating to childhood obesity and the obesogenic environment. Links have already been made with local partners and Public Health central support sought.

2013/14 (Q4)

environments. Use the Health Board’s ‘Helping Group’ to raise awareness of practical messages around cancer.

Decrease alcohol consumption Plans in place to decrease alcohol consumption refresh required by end April 14)

• Brief intervention training roll out being monitored

• Monitoring in place through Public Health Leadership team

• F4C priority in all 3 Counties. Key stakeholders include: local authorities, APB, Public Health Wales, Third Sector, Primary Care, Clinicians.

Principal Officer

Refresh by April 2014

Increase uptake of Imms and Vacc rates Consultant Plan reviewed

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Completion date

for those which have an impact on cancer ie HPV Vaccinations 3 County Plan in place (refreshed annually)

• Monitored by Public Health Leadership team and also Quality and Safety Committee


• Strong links to the nursing team already established.

Targets in line with national requirements. Key stakeholders include: local authorities, Public Health Wales, Primary Care, school nursing

Public Health

during 13/14 as normal part of Imms and Vacc programmes and planning

Increase mental well being Public Health Action Plan required

• Close fits with Mental Health Partnership Board and will dovetail to relevant Population Health Programme


• Links being explored between the brief intervention portfolio and ‘psychological management’

Key stakeholders include: local authorities, Public Health Wales, Third Sector, County

Consultant Public Health

To be completed by December 13.

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Completion date

Voluntary Councils, Primary Care and Clinicians. Decrease environmental risk (skin cancer prevention)

• This is currently under review for 13/14 - will be discussed at Public Health leadership forum given the priority list of actions for the team

• Activity for 13/14 is likely to relate to healthy pre-school, school setting and proactive communications activity. The Public Health Team are already linked to ‘sun safety’ agenda with the Local Authorities.


April 14 (by end Q4)

Reducing premature deaths

• F4C identified life expectancy and health inequalities as core areas to monitor improvement for all three counties. County plans are being developed.

All Public Health stakeholders contribute to this agenda.

Consultant Public Health

Yearly review.

Increase screening update (new local focus) – see also section re: detecting cancer quickly Work with Public Health Wales to increase Screening Uptake (national targets in place):

• Public Health Wales plans in place – regular reports received

• Link person with Public Health Wales agreed

• Monthly monitoring in place already through Public Health Leadership Team

• Public Health Wales project on


September 13 – complete unless otherwise noted.

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Completion date

• Breast

• Bowel (PRIORITY – see below)

• Cervical During Q3 12/13, the team identified the need to monitor closer the screening update rates after variation identified across the three counties. Agreement that the main focus for 13/14 will be the Bowel screening programme.

‘inequitable compliance’ – due for completion end of financial year.

This links well to the F4C programme given the focus on inequalities and life expectancy. This is a new priority area for the Hywel Dda Public Health Team with Public Health Wales as the lead screening organisation. The overall worst performing screening area is bowel screening hence the identified target area. Variation in cervical screening has also been noted especially in Ceredigion. Key stakeholders include: local authorities, Public Health Wales, Pharmacy, Primary Care, Third Sector and Clinicians.

PC 2.4

The South Wales Cancer Network will develop an implement in partnership with the Health Boards:

• Sharing good Cancer Rehabilitation Practice event annually

• An Allied Health Professional and Nursing Head and Neck Cancer Pathway

• A Fatigue pathway for cancer patients

Hywel Dda Health Board staff to participate and present to the groups.


Ongoing

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Completion date

• Metastatic Spinal Cord Compression education

• Cancer key worker education event

The Cancer Network will develop and improve web based information eg Cancer Services Directors.

2.5 Roll out of the Public Health Wales/Wales Government ‘over 50s’ health check scheme.

50+ health check will be supported by the Public Health Team (main lead is Public Health Wales). It is cross cutting work with other lifestyle activity work. In its initial format, the focus will be on the Community First area in Carmarthenshire (as per Welsh Government guidance), however information is being shared with relevant partners.

Public Health Wales/ Director of Public Health

Ongoing

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2. DETECTING CANCER QUICKLY WHEN IT DOES OCCUR OR RECUR

Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date DC1 DC2 DC3

Screening Regularly review, plan and deliver screening programmes as recommended by the Wales Screening Committee Promote better take up of screening programmes to meet the best practice uptake targets – particularly targeting those less likely to take up screening Provide sufficient capacity, workforce, infrastructure and equipment to treat and care for people referred to the cancer screening programmes

DC1

Regularly review, plan and deliver screening programmes as recommended by the Wales Screening Committee

Residents across the Health Board are offered the following screening services Breast Test Wales Screening is provided by Public Health Wales mobile units. Uptake in 2011/12: Ceredigion = 29.7% Carmarthenshire = 76.5% Pembrokeshire = 81% Hywel Dda = 75.7% Wales = 73.5% Minimum uptake standard is 70%, while target is 80% Please note that care is required when reviewing uptake rates in localities because of the rotational organisation of this screening programme.

Director of Public Health (in conjunction with PHW)

Ongoing

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date Cervical Screening Wales

The cervical screening target standards 12/13 is 80% of eligible women aged 20 to 64 years. Screening occurs first then commences to assessment and treatment. Update of cervical screening in 2011/12 was: Ceredigion = 75.9% Carmarthenshire = 67.5% Pembrokeshire = 75.8% Hywel Dda = 74.1% Wales = 76.3% Since 1st April 12, cervical smears taken from women living in Hywel Dda are transported for processing at the Cervical Screening Wales Laboratory at Llantrisant and returned for screening and reporting at ABMU laboratories. The results continue to be issued back to women as usual. The HPV vaccination programme is being rolled out across Hywel Dda.

Bowel Screening Wales Colonoscopy services are delivered

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date well for the Health Board and the waiting times for the clinics are consistently within standard. The first stage of screening uses bowel screening kits (sent through the post). If further investigation is required, the assessments are undertaken at 3 sites across Hywel Dda: For 2011/12 the uptake rate: Ceredigion = 53.4% Carmarthenshire = 52.5% Pembrokeshire = 52% Hywel Dda = 52.6% Wales = 51.1% Ceredigion endoscopy service is already JAG accredited and the Carmarthen and Withybush units have just achieved JAG accreditation. Double reporting of cases identified by screening can cause delay. There is ongoing work around centralisation of pathology services and consultant recruitment The reviewing and planning of cancer services will become an integral part of the role of the new Population

AMD Pathology

Ongoing

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date Health Programme Groups.

DC1-3

Increase awareness of the signs and symptoms of Cancer Awareness raising/training - to encourage people to recognise the signs and symptoms of cancer and see their GP if there are issues.

This is a new area of work for the Public Health Team which will commence in October 13.

• Explore working with primary care communications

• Communication work already in place through the ‘Helping Group’, however further opportunities to raise awareness will be considered.

• Consideration will be required on the impact on diagnostics and services

• Consideration will be given to the fit with the Making Every Contact count approach.

Key stakeholders include: local authorities, Public Health Wales, Third Sector, Primary Care and Clinicians NB: Prevention section also includes information on screening programmes.

Consultant Public Health Director of Public Health

October 13 – April 14 (in first instance)

DC2 Promote better take up of screening programmes to meet the best practice update targets – particularly targeting those less likely to take up screening. The Hywel Dda Public Health Team

The Public Health Team are linked into Public Health Wales Activity/projects looking at update rates. A Specialty Registrar in Public Health


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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date are liaising with the screening engagement team of Public Health Wales regarding possible further wider health community work.

based in Hywel Dda Health Board undertook a piece of work on coverage and access for cervical screening in Hywel Dda and the three counties during 12/13. The conclusions were that work is needed to increase the uptake of cervical screening and links are being established between the local public health team and the screening engagement team. The report highlighted that most women in Hywel Dda attend their GPs for smears but other access points are important to give women and choice. Work to review the Sexual Health Service is ongoing but aims to be completed by March 2014.

March 2014

DC4 DC5 DC6 DC7 DC8 DC9 DC10

Early Diagnosis Use National profiling data of cancer prevalence, mortality and survival rates to inform targeted action on particular cancers and communities Raise public awareness of cancer symptoms needing prompt GP assessment Raise GP awareness of symptoms to promote prompt referrals in line with national guidance, local pathways and waiting time standards Work with GPs to introduce evidence based Risk Assessment Tools to help identify those at most risk of having cancer Provide GPs with direct and prompt access to diagnostics to diagnose cancer Audit the pathway for each person diagnosed with advanced cancer and act on findings to improve services for early diagnosis Develop acute oncology services to support the needs of people admitted as emergencies

DC4 Using information to inform service plans and provision

The recently agreed national lead (Consultant Public Health) in Cancer

Consultant Public Health (PHW)

Ongoing

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date

(for Public Health Wales) will support Public Health practitioners across Wales at a local level on issues relating to cancer. The Public Health Team has relevant information with Health Board colleagues and relevant parties.

DC4 Adopt good practice arising from the ABMU/Cancer Research UK project on attitudes of people with early cancer symptoms.

To provide patients with appropriate information and awareness to contact services when they notice changes that could be cancer. Encourage people to be more self awareness and promote positive attitudes.

Head of Cancer Services/Patient Experience Manager

Commence January 2014

DC5 The Health Board participates in public awareness raising using a number of mediums including the “Healthy Wednesday” scheme to reflect national awareness weeks and promote other aspects of health and well-being.

The Health Board will continue to develop, participate and support programmes for awareness and symptom recognition. Links to the ‘Helping Group’

Assistant Director of Corporate Services/Public Health Wales

Ongoing activity

DC5 Establish a local planned programme in line with National Awareness Days for Cancer and related risk factors to be led by MacMillan Information Co-Ordination Team

Improve communication with public by working in partnership with South Wales Patient Forum to establish planned awareness days .

MacMillan Information Co-Ordination Team/ Assistant Director of Corporate Services

Ongoing

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date DC6

In house PTFL (Practice Time for Learning) already in place in GP Practices. NICE guidance summary sent regularly to primary care. Explore monthly updates (bullet point guide) via GP newsletter – staggered around early signs of cancers. A range of information eg SIGN guidance, etc is easily accessible on the internet. GP Forums exist in Pembrokeshire, Ceredigion and Carmarthenshire (3 localities) where the opportunity exists for clinical colleagues to inform/advise/interact with primary care. GPs with an interest in dermatology have regular MDT meetings with secondary care colleagues and audit their work.

GP Practices Clinical Effectiveness Co-ordinator AMD Primary Care and Primary Care Officer - GMS Consultant Dermatologist

Ongoing October/November view to start in January 2014

DC7 Introduction of risk assessment tool in primary care.

Identify the most appropriate risk assessment tool (poss Hamilton Assessment Tool) to help identify those

AMD – Primary Care

January 2014

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date most risk of having cancer within the

Primary Care setting. For inclusion on GMS newsletter as a standing item.

DC8 Design and implement clear pathways for rapid access to diagnostic services and treatment for patients with suspected cancer eg colorectal cancers. Ensure provision of rapid access clinics for patients with red flag symptoms eg post menopausal bleeding, haematuria.

Standardised and clear proforma for urgent referral of common cancers. The aim is to improve management of USCs by reducing inappropriate or unclear referrals. In collaboration with South Wales Cancer Network agree diagnostic specialist pathways with Hywel Dda Health Board. Improve capacity of rapid access clinics for patients with red flag symptoms eg post menopausal bleeding, haematuria. These cause bottlenecks on various pathways and are a significant issue with respect to SAFF target breaches.

MDT Lead Clinicians/Assistant Director of Clinical Services/ Head of Cancer Services

DC9 Introduce automatic review of patients who have presented with late stage cancer and act upon the findings.

The Health Board is currently working to improve compliance with the recording of the stage of cancer at diagnosis. Review of cases of advanced diagnosis will be commenced as part of the MDT annual audit cycle.

MDT lead clinicians/Assistant Director of Clinical Services

Annual review

DC10 Hywel Dda Health Board will explore the establishment of a Project Board to develop a sustainable oncology model which operates across the three counties.

The scope of the work needed to be undertaken by the Project Board is currently being worked up. This will include summary terms of reference, outline work programme and

Associate Director of Clinical Services/ Health Planning Manager/ Head of Cancer

Establishment of Project Board November/December 13

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Ref Planned Actions 2012-2016 Current Status/Expected Outcomes Responsible Lead Completion date The Project Board will work with South Wales Cancer Network to co-ordinate and deliver high quality, equitable patient care.

membership of the Project Board. Work areas include:

• Development of an acute oncology model

• Ensuring effective and sustainable staffing models

• Ensuring activity information is managed effectively

• Ensuring consistent service provision across the three counties.

• Exploring cross border issues

• Consideration of medicines management issues including aseptic units

• Linking into the work being undertaken with regards to patient transport.

Alignment of the Project Board with Cancer Programme Group and relevant Population Health Programme Groups.

Services

Timescales for work programme will be determined at first Project Board meeting.

DC10 Develop an agreed transport protocol to ensure Hywel Dda Health Board patients meet the criteria for PET scans at UHW

Currently these arrangements are made on an adhoc basis often outside the current Welsh Ambulance Trust contractual arrangements

Assistant Director of Strategic Partnerships

December 13

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3. DELIVERING FAST, EFFECTIVE TREATMENT AND CARE


Completion date

TC1 TC2 TC3 TC4 TC5 TC6 TC7 TC8 TC9

Review, plan, reorganise all services where appropriate to deliver best experience and outcomes in line with latest evidence, standards and guidance Provide definitive treatment consistently in line with national waiting times targets Identify mechanisms to plan and deliver equitable access to new diagnostics and treatment procedures in line with evidence Determine Individual Patient Funding Requests promptly and equitably across Wales using the All Wales protocol, exceptionality criteria and training Plan radiotherapy services strategically through the Cancer Networks Undertake complex surgery in line with peri-operative care standards as in the ERAS programme Reduce surgery and chemotherapy related mortality by eliminating preventable deaths Participate in national and locally clinical audit and other quality improvement activities and reflect action to be taken in local cancer delivery plans Participate in peer review and reflect learning in local cancer delivery plans.

TC1 Develop Health Board Wide MDTs The Health Board commenced a programme to integrate county based MDTs in 2010. The Urology and Dermatology MDTs were already integrated and since 2010, the Lung, Breast and Colorectal MDTs have been integrated. These are 3 services which still have county based structures:

• Gynaecology: the MDT is expected to integrate in November 2013.

• Upper GI: the MDT will integrate to

Clinical Lead for Cancer

Dec 2013 (except haematology)

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Completion date

reflect the new service models

• Haematology: will integrate once the service model for Ceredigion is agreed

TC1 Review, plan, reorganise all services where appropriate to deliver best experience and outcome in line with latest evidence, standards and guidance.

The Health Board will empower MDTs to offer patients the best possible diagnostic, treatment and rehabilitation care within Hywel Dda and as locally as possible to the patient’s home. Service reviews will take into account the need to ensure safe, sustainable services and the need to minimise patient travel.

Associate Director of Clinical Services Population Health Group Leads

Ongoing


Through the work of the Population Health Programme Groups, an ‘improving service user experience framework’ has been developed. This will guide involvement and ensure that planned improvements consider the impact of experience on care, treatment and outcomes of care. Shadowing, observations and patient stories will be built into our improvement work to ensure improvements are grounded by real experience of people.

Patient Experience Manager

Population Health Groups to commence October/November 13


Provision of information and advice to patients undergoing chemotherapy regarding neutropaenic sepsis. Audit of current neutropaenic sepsis policy

Consultant Haematologist

Completed

24


Completion date

compliance Exploring current attitude and behaviour through the use of patient stories with a view to improving the awareness and information provided to put into place speedy response.


Dec 2013

April 2014

TC1 To act upon the outcome of Peer Review visits to improve service provision and organisation.

Quick implementation of recommendations will ensure that the services provided by the Health Board reflect latest best practice.

Clinical lead for Cancer/Head of Cancer Services

Timescales according to action plans

TC1 Ensure agreed NICE guidelines are embedded within the MDT functions.

Implementation of NICE Clinical Guidelines and NICE Cancer Service Guidelines will help ensure services are provided to acceptable standards. Review of implementation status of guidance should be undertaken; audit as required.

MDT Leads/ Clinical Effectiveness Co-ordinator

Within 4 months and thereafter annual

TC2 The Health Board regularly achieves the 31 day target but is consistently underperforming against the 62 day target. The key areas to improve are Urology and Lung

Capacity planning is underway to identify both cancer and non-gaps. Review of whole cancer diagnostics pathways will support the delivery of care in target.


Regular review

TC2 Hywel Dda Health Board is committed to sustainable achievement of the target by ensuring that any USC referral will be

Refining systems and processes to monitor key stages within the pathway. Meeting has been held to start reviewing

Director of Operations

Ongoing

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Completion date

treated within target date. Hywel Dda will work to achieve the target sustainability by aligning its workforce, finances and clinical capacity to this priority area. We recognise that there are specific challenges for us relating to diagnostics, particularly radiology. This will also include more frequent and clinically led liaison with counterparts in tertiary providers (particularly ABMULHB) and ensuring these systems are robust, sustainable and support ongoing timely and high quality cancer provision.

the diagnostic pathway. Operational managers are authorised to work with clinical teams to ‘step-up’ additional capacity when necessary to ensure that the standard (urgent suspected cancer referrals are booked within 10 days) is maintained. We have developed an increased emphasis on breach reporting and sign off clinically to assure our Board that patient safety, quality and standards of care are being appropriately managed. In particular, engagement is taking place with Clinicians regarding their cancer performance and sharing of data.

Assistant Director of Clinical Services

November 13

TC3 Work with tertiary providers to ensure provision of advanced diagnostics and treatment as locally as possible, along with rapid access to services where it cannot be provided locally.

Patients have access to EBUS, IMRT, IGRT, CHART, and other new optimal treatments as required to ensure our patients receive the best care possible.

Clinical Lead for Cancer/Head of Cancer Services

Ongoing

TC4 To establish a network Individual Patient Funding Request system to ensure consistency and transparency of decision making and to minimise delays in the pathway for cancer patients

Hywel Dda have an IPFR panel every other week. In emergency situations, emergency panels are convened via telephone/video conferencing. The IPFR Panel members have recently


Ongoing Review

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Completion date

Subsequently, to determine Individual Patient Funding Requests promptly and equitably across Wales using the All Wales protocol, exceptionality criteria and training

attended an All Wales IPFR information day where a number of cases were discussed to ensure all Health Boards in Wales were consistent in their decision making. Head of Cancer Services liaises with IPFR managers within Wales and has meetings to discuss cases, concerns, etc.

TC5 Hywel Dda does not provide radiotherapy services but accesses services provided by ABMU and Betsi Cadwaladr Health Boards, Velindre and Shrewsbury & Telford NHS Trusts for patients being diagnosed with cancer by Hywel Dda doctors.

Opportunities are presented by emergency technology (mobile units for the treatment of certain cancers) which will need to be explored in time. Hywel Dda Health Board will work with the South Cancer Network to ensure the requirements of its residents are provided for. Review of current transport arrangements for HDHB patients to be undertaken for those travelling to ABMU and Velindre. The trend for those attending Singleton requiring Non Emergency Patient Transport (NEPT) continues to increase. Alternative transport provision, currently provided by WAST to be considered as part of NEPT Strategy 2013-16 and review of WAST.

Head of Cancer Services Assistant Director of Strategic Partnerships

Ongoing Review

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Completion date

TC6 Embedding of ERAS across all surgical specialties

Hywel Dda Health Board has a fully developed ERAS programme in place in all three counties, along with a General Surgery ERAS Board however this is not yet embedded in all specialty areas and to the same extent

Director of Operations

July 2014

TC7 Compliance with National Guidance (Wales) on preventable deaths

Hywel Dda Health Board is reviewing all patient deaths. The process will change shortly following the publication of National Guidance (Wales) and this may help to identify and eliminate preventable deaths.

AMD Information & Research (Anaesthetics Department)

End of 2013

TC8 To establish a range of Population Health Groups which will integrate clinical audit activity and quality improvement activities.

Clinical audits are currently undertaken by the relevant surgeons for example colorectal, breast, haematology, urology. ‘Cancer’ will be framed within each of the Population Health Programme Groups. Hywel Dda’s Clinical Audit Department will support further development of audits. A workplan will be developed in partnership with the Programme Groups.

Population Health Programme Group Chairs AMD Information & Research (Anaesthetics Department)

Ongoing Review

TC9 Participate in the peer review programme

Peer review completed for Lung and Upper GI Urology is due for completion Spring 2014 with Colorectal, Head & Neck and Gynaecology being reviewed in 2014/15


Completed Spring 2014 2014/15

TC9 Monitor MDT compliance against the Cancer Standards data completed Head of Annually

28


Completion date

National Cancer Standards Data set. annually and will be reported to MDTs Cancer Services

TC9 Develop integrated MDT performance toolkit including nationally collected standard/audit data and local performance measures to support MDT functioning.

Pathway tool in development. Discussion has been had with Cancer National Specialist Advisory Group (NSAG) Core Team have been had regarding the development of the National Cancer Standard Database to incorporate all such information and to become a key source for Peer Review and self assessment.


2014

29

4. Meeting People’s Needs. People are placed at the heart of cancer care with their individual needs identified and met so

they feel well supported and informed, able to manage the effects of cancer.


Completion date

MN1 MN2 MN3 MN4 MN5 MN6

Assign a Key Worker to each person with cancer, from the point of diagnosis onwards, to co-ordinate their ongoing care Review and design services recognising the changing needs of people with cancer and to deliver person centred services to meet ongoing needs as locally as possible in line with National Standards Assess the clinical and non clinical needs (such as information needs on accessing financial, emotional and spiritual help) of people following a diagnosis of cancer and draw up and implement a careplan to be reviewed regularly Provide each patient and GP with an “end of treatment” summary to inform the care plan Support patient participation in cancer patient experience surveys and include action on the outcome in local cancer delivery plans Plan and deliver co-ordinated services for metastic cancer patients and measure outcomes

MN1 Key Worker Plan

Around 80-90% of patients are provided with a key worker at the point of their diagnosis. Coverage is not, however, equitable across the Health Board or for all types of cancer.

• Head and Neck - 1 post in Carmarthenshire for whole of Health Board. Need to establish contact arrangements for patients accessing services from Bronglais and Withybush

• Upper GI - Gap in Ceredigion, support provided by generic oncology nurses in Pembrokeshire

• Haematology – Gap in

Deputy Head of Cancer, Nursing and Quality/ Assistant Director of Therapies and Health Science

Situation under ongoing review. Will be reviewed in light of MacMillan patient satisfaction findings

30


Completion date

Carmarthenshire and Pembrokeshire

• Gynaecology – Gap in Carmarthenshire. Support provided by “Women’s Cancer Nurse” service in Ceredigion (combined with Breast). Support provided by generic oncology nurses in Pembrokeshire

It is considered that there is insufficient capacity in the Urology, Colorectal and Dermatology Services A bid for 3 wte Macmillan Dermatology CNSs was approved by Macmillan in September 2013.

MN1 Key Worker Plan

To develop a key worker concept with a patient and family centred care approach. To ensure key workers work with the interests of patients in mind, and tailor care to fit their needs.


Project plan to be scoped by April 14.

MN1 Ensure cancer patients are supported as the recover in the community

The Health Board has participated in the Macmillan Practice Nurse Scheme to improve cancer awareness and service within primary care.


Ongoing

MN1 Development of a chemotherapy advice line

The Health Board is establishing a neutropaenic sepsis admission single contact number which will ensure patients

Assistant Director of Clinical

Neutropaenic admission via a single contact

31


Completion date

are supported through the admission process and the admitting teams are aware of treatment requirements. Work around a more general advice line is being addresses through the Oncology Services review

Services point Dec 2013 Chemotherapy advice line 2014

MN2 Develop patient Focused services A Macmillan Patient Focused Care Project has been funded to support the development of cancer services. Recruitment to commence in Autumn 2013.


January 14

MN2 Establish Patient Focused work stream Work stream to be sub-group of Cancer Programme Group. To be established Autumn 2013.


January 2013

MN2 Further development of MDTs The MDT must also identify the broader care issues which need to be addressed in order to maximise the potential for the patient to “return to normal” post recovery. Potential role for CNS to be explored and collaboration with third sector organisations

Associate Director of Clinical Services via Oncology Services review

May 2014

MN2 Review oncology services to ensure they are designed around meeting patient needs

The Health Board is planning a review of Oncology Services with a view to restructuring. Further information is provided in the Detection Section.

Assistant Director of Clinical Services/ Health Planning Manager

To commence November 13.

MN3 Improve information and support provided to patients with cancer

Funding for three Macmillan Cancer Information and Support Workers (one

Head of Cancer Services/Patient

January 2014

32


Completion date

including their families and carers through establishing a Macmillan Cancer Information and Support Project against the Health Board

per county) approved in 2013. Posts are currently being recruited to and are planned to be in post early 2014.

Experience Manager

MN3 Site Macmillan Info-Pods in Bronglais, Withybush and either Glangwili or Prince Philip hospitals.

Info-pods to be designed into the development of the Chemotherapy Units at Bronglais and Withybush General Hospital. A pod and an environment to be installed at the Carmarthenshire hospitals. Additional information environment will be installed at appropriate community settings to support the service.

Modernisation Manager/ Head of Cancer Services

March 2014

MN3 Development of psychological support services for patients

The Health Board is in liaison with MacMillan Cancer Care and other agencies regarding the development of psychological support services for patients.


Ongoing

MN3-4

Implement Macmillan Holistic Care Plan for all Cancer Patients

The Macmillan Holistic Assessment and Care Plan toolkit is being used/piloted by Lung Nurses in Ceredigion and Carmarthenshire, and Breast Nurses in Pembrokeshire. Review to be presented to CPG in Autumn 2013. It is anticipated that it will be rolled out to all cancer patients post review.

Deputy Head of Cancer, Nursing and Quality

January 14

MN5 Embed patient experience within Cancer Services

The experiences of patients, their families and carers will underpin all of our work to review, improve and deliver cancer services. We will adopt appropriate


November 13

33


Completion date

methodologies to support this process including surveys, focus groups, stories, shadowing and observations of care. The Health Board has supported the Wales National Cancer Patient Survey and will act upon its results. Local patient surveys and stories to be used to inform MDT development and assessment of performance.

Patient Experience Manager/ Deputy Head of Cancer, Nursing and Quality

April 14

MN6 Develop service to manage patients with metastic cancer

Metastatic cancer is being considered by the National Cancer Implementation Group. Hywel Dda to work with ABMU to assess the potential for a South West Service


April 2014

34

5. CARING AT THE END LIFE – PEOPLE APPROACHING THE END OF LIFE FEEL WELL CARED FOR AN PAIN AND

SYMPTOM FREE.


Completion date

EOL1 EOL2 EOL3 EOL4 EOL5 EOL6 EOL7

Plan, secure and deliver sustainable, high quality End of Life care for HDHB population. Support all providers who care for dying patients to participate in the All Wales audit of the Integrated Care Priorities documentation. Have clear funding streams for specialist and palliative care services which are above the minimum levels advised by the Palliative Care Implementation Board Support participation in cancer patient experience surveys in particular the IWantGreatCare surveys of palliative care patients and their families. Support people to die in their place of choice. Support people who die in usual place of care. Care home support team established and evaluation supporting improved care and increased support of care home staff. Training and education lead by SDCS to improve patient and family involvement in advanced planning and identifications preferences. [DOC: EOL care in HDHB Care Homes.] Support people with palliative care needs on a Primary Care Practice, Palliative Care and Respite. HDHB: Doc Foundations for Change – Development Of Integrated Services with Primary Care, social care and third sector.

Specialist palliative care is delivered across Hywel Dda Health Board by Specialist Palliative Clinical Nurse Specialist within 3 counties in each acute and community hospitals and community settings (including care homes, each of which has a named CNS). There is one specialist in patient palliative care facility at Ty Bryngwyn and designated palliative beds in other community and acute hospitals.

Medical Director

In place EOL1 Deliver well co-ordinated palliative and end of life care on a 24/7 basis in line with published standards and guidance (Together for Health Delivering EOL Care, Welsh Assembly 2013)

7/7 CNS support is in place in all settings. Management In place

35


Completion date

24/7 Consultant rotas have a direct responsibility for the inpatient units and support elsewhere., including when necessary direct assessment in any setting.

lead palliative care (County Director Carmarthen)

Palliative Care Consultants participate in the Regional On Call rota by phone.

Medical Director

Ongoing

Non specialist providers are supported by Health Board Teams in following existing all Wales guidance on symptom control and other areas.

Medical Director

Ongoing

Continue to monitor and evaluate the service provided

Management lead palliative care (County Director Carmarthen)

Annual reviews undertaken

Participate in Health Inspectorate Wales Peer Review Process for palliative and end of life care and the development of action plan in line with key recommendations.


Ongoing

The Health Board has embraced the development of Foundations for Change in the delivery of HDHB Health Care for the whole population. End of Life care has been identified as a specific measurable outcome.


Ongoing

Work with third sector (Marie Curie Nursing Service, British Red Cross, Paul Sartori,

Assistant Director of

December 13

36


Completion date

Shallom, Skanda Vale) and health board teams to provide integrated approach to care.

Strategic Partnerships

Devolve the following Service Level Agreements with the third sector into each respective county team to ensure they are integrated into mainstream palliative care services:

• Marie Curie/British Red Cross – Carmarthenshire

• Marie Curie – Ceredigion

• Paul Sartori Foundation – Pembrokeshire

Support the following third sector organisations in taking forward an agreed model of respite/end of life care.

• Shalom House – Pembrokeshire

• Skanda Vale – Ceredigion

Assistant Director of Strategic Partnerships

December 13

Increasing use of CANISC to improve communication across the pathway.

Medical Director/Head of Cancer Services

Ongoing - constantly developing system

Introduced with the Marie Curie Nursing Service a service to improve access for patients with dementia to specialist palliative care

Head of Community Nursing

Partial implementation June 2013. Further appointment to

37


Completion date

be made. Pathways development of Advanced Care Plan documentation. Implementation on going.

Medical Director

Ongoing

3 counties Palliative Care Implementation Group has been established in HDHB. This board supports each county’s palliative care implementation plan.


Meet quarterly

EOL2 Online Support/Use of ICP Three County P.C.I.G. and work plan agreed. Launch of Advanced Care Plan Document and approach. The ICP is promoted within the Health Board with designated staff undertaking the rolling training programmes to all staff and partners in care delivery.

Medical Director

Ongoing

Allocation of funding is co-ordinated via the Hywel Dda Implementation Board. The funding is utilised effectively and a number of key recommendations have been implemented.


In place EOL3 Clear Funding Streams

Need for ongoing assessment of unmet needs with Palliative Care Services.

Medical Director

Ongoing

EOL4 Ensure the experience of patients and their families and carers underpins service improvement and delivery.

I Want Great Care survey questionnaire commissioned by the All Wales Implementation Board for Palliative Care. All patients and / or families seen by the service with the exclusion of those whose condition made it inappropriate are offered I Want Great Care questionnaire.

Clinical Nurse Specialist (Macmillan)

Underway

38


Completion date

Audit of 3 years data completed and to be presented to teams. Develop further patient experience surveys across the Health Board with focus on end of life. In addition, Health Board developing a “patient stories” approach to capturing patient and carer experience to inform service development. Information and awareness of patient stories should be used to inform service improvement and delivery.

Lead CNS Palliative Care Patient Experience Manager

Underway Ongoing

End of life will cut across all Population Health Groups - currently being established

Medical Director

November 13

Roll out of the implementation of the Advanced Care Plan Documentation and Education.

Medical Director

This has commenced (Sept 13) - ongoing

Continued use and audit of Integrated Care Priorities (ICP).

Medical Director


EOL5 Need to improve further assessment and understanding of performance against preferred place of dying within acute setting. This will be guided by work being undertaken by end of life care group and national work on developing outcome

GP palliative care registers established. Medical Director


EOL6 Support people who die in usual place of care

Care Home Support Team (CHST) established. Evaluation supporting improved care and increased support of

Management lead palliative care (County

In place. Annual evaluation

39


Completion date

care home staff. Training and education lead by Specialist Palliative CNS to improve patient and family involvement in advanced care planning and identifications of preferences.[ DOC: EOL care in HDHB Care Homes. HDHB Advanced Care documentation]

Director Carmarthen)

Just in case boxes rolled out within the Health Board

Palliative Care Medicines management Advisory

Annual evaluation of service

EOL7 Support people with palliative care needs on a Primary Care Practice, Palliative Care and Respite. Work with third sector organisations to support carers of those with Palliative Care needs.

HDHB doc Foundations for Change Outcome measures. Development Of Integrated Services with Primary Care and Social Care. Development Of Integrated Services with Primary Care. Doc “End of Life Care in HDHB 2013” partners, Local Authority and voluntary agencies. Currently the Health Board are working specifically with the following third party organisations to enhance current services for family carers:

• Cruse Cymru to develop a regional bereavement service

• Marie Curie to pilot their new carers service for end of life patients across the three counties

Management lead palliative care (County Director Carmarthen) Assistant Director of Strategic Partnerships

Ongoing January 14

40


Completion date

• Further development of the Cancer Information Service across Carmarthenshire

• Development of specific respite services with Shalom House in partnership with Crossroads.

6. IMPROVING INFORMATION


Completion date

II1 II2 II3

Record and use clinical information for all cancer patients using CaNISC Report performance against National Cancer Standards and cancer site specific clinical quality indicators to Boards at least annually Publish regular and easy to understand information about the effectiveness of their cancer services

II1 Discussions to be held on an all-Wales basis to resolve the integration issues between CaNISC and Myrddin to ensure efficient use of both systems and assure data quality between the two. The Welsh Clinical Portal is targeted to achieve this integration; timescales awaited.

The Health Board continues to use CaNISC for the management of cancer patients from first outpatient appointment to the commencement of their treatment. The Health Board’s primary patient administration system is Myrddin upon which all activity is recorded. This does not readily translate into CaNISC so that CaNISC can be used to map the whole patient pathway. In addition, because CaNISC is only used to the point that a patient receives their first definitive

NWIS

41


Completion date

treatment it is not currently possible to automatically provide information on the whole care pathway for individual or groups of patients. The use of two systems also results in an administration burden which could be eradicated if there was either a single system or the systems were integrated properly.

II1 Improve compliance with data collection requirements for key indicators, e.g. stage of cancer at diagnosis.

The Health Board will use audit results to monitor improvements in compliance with data completeness and take action to improve these as required. Colorectal, lung, upper GI,lower gastro, breast undertaken on an annual basis.

Head of Cancer Services/Assistant Director of Clinical Services/ Deputy Head of Cancer, Nursing and Quality

Annual basis

II1 Develop MDT specific reports and information strategies to ensure clinicians own the information and are in a position to act upon findings derived there from.

Development of a specific tool utilising the pathway data from CaNISC has been commenced with the DSU. This will allow performance data to be presented to MDTs. The inclusion of other data, such as cancer staging, will require interrogation of the CaNISC database and will be developed as a second phase.

Head of Cancer Services/DSU

2014

II2 Annual reporting of performance Compliance is reported annual to the Health Board and from 2013 this will form part of the Cancer Annual Report.


Annually

II3 Publish Annual Report Welsh Government provides Local Health Boards with trend analysis of cancer incidence, mortality and survival


Annually

42


Completion date

to inform local service planning which is included in the Cancer Annual Report.

II3 Participation in Audit and Peer Review. Analyse and benchmark information to facilitate and inform Local Health Board’s participation in national clinical audit and peer review. Explore feasibility of publishing meaningful information to patients. Information should be produced in an easy to understand format.

Head of Cancer Services /Cancer Network Head of Cancer Services/Patient Experience Manager

Ongoing To start April 2014

7. Targeting Research


Completion date

TR1 TR2 TR3 TR4 TR5 TR6

Foster a strong culture of research, in particular to: Offer all appropriate patients access to relevant clinical trials. Maximise the use of Welsh Government funding for NHS research. Provide effective and efficient research governance processes to enable a speedy start-up and delivery of clinical trials. Support and encourage protected research time for clinically-active staff. Promote the use of key research facilities such as the Wales Cancer Bank, Wales Cancer Trials Unit, Wales Cancer Research Network and the Marie Curie Research Centre. Collaborate effectively with other Local Health Boards and NHS Trusts, Universities and industry in Wales to enable a speedier application of research and introduction of new technology into the NHS.

TR1 Explore options and make necessary changes to enable HDHB to consider collaborating with other Health Boards on oncology and palliative care studies.

Oncology and Palliative Care clinicians and other oncology nursing and research staff need to be available and appropriate research infrastructure in place to enable

Clinical Lead for Cancer

2016

43


Completion date

such trials to be opened to patients at HDHB.

Trials are open in every hospital (4 sites). Ensure that patients who are involved in clinical research are provided with appropriate information and adequate support to participate safely


TR1 Work with Abertawe Bro Morgannwg University Health Board (ABMU), the Wales Cancer Research Network (WCRN) and the National Institute for Social Care and Health Research Clinical Research Centre (NISCHR CRC) to increase the number of trials on the research portfolio for less common cancers.

Liaison between HDHB and ABMU oncology teams facilitated by WCRN and NISCHR CRC should increase participation in clinical trials involving less common cancers depending on the local research strengths and interests, and available resources.

Clinical Lead for Cancer Supported by R&D Office and Individual Disease Specific Consultant Leads

2014

TR1 Build on existing relationships with the ABMU Cancer Centre to increase opportunities for HDHB patients to become involved in radiotherapy trials.

Collaboration with ABMU will ensure that cancer patients are given the opportunity to participate in radiotherapy trials, provided they are able to travel to ABMU to do so.

Led by individual Health Board oncology teams

2014

TR1 All cancer multidisciplinary teams (MDTs) to continue to be made aware of current open cancer trials and to actively participate in the planning of future trials.

Cancer MDTs receive a copy of the current South West Wales Research Portfolio, which includes oncology trials, from NISCHR CRC. Where HDHB R&D Department receives information about active and forthcoming cancer trials in the

Led by Cancer MDTs lead Supported by R&D Office

2013

44


Completion date

area from the WCRN, the R&D office will ensure that these data are shared with cancer MDTs.

TR1 Where research studies are not available locally, facilitate HDHB patient referrals to other Health Boards and NHS Trusts. Liaison with local NISCHR CRC Network Manager to facilitate this.

Review and development of HDHB’s patient referral pathways may enable cancer patients to be offered the opportunity to participate in research which is undertaken at neighbouring HBs and NHS Trusts. The forthcoming Focus4 trial (colorectal cancer) will demonstrate how this is working in practice.

Led by appropriate teams responsible for patient referral pathways within HDHB R&D Office, and Individual Disease Specific Consultant

2014

TR2 The R&D Department to maintain close contact with cancer research staff to discuss potential funding opportunities for research.

The R&D office has representation on the HDHB Research Nurse Group and will explore opportunities to liaise further with cancer physicians in order to discuss and promote their research interests and priorities.

R&D Office 2015

TR2 Ensure that all new research projects are reviewed to highlight any excess treatment costs (ETCs) or service support costs that may need to be applied under the NISCHR Attributing Costs of R&D (AcoRD) guidance.

Improve current systems and processes to highlight any ETCs or service support costs, and adapt these systems, including communication channels, to allow for forthcoming changes imposed by NISCHR whereby ETCs will be submitted via the R&D Department.

R&D Office 2015

TR2 Exploring issues of the cost saving Discussions between the R&D and R&D Office, 2015

45


Completion date

effect of taking part in clinical trials, such as study drugs being made available free of charge, resulting in a negative cost to the Health Board which could be recouped and reinvested in the HB’s research infrastructure.

Finance Departments to explore the potential for recovering cost benefits should enhance the infrastructure for conducting clinical trials at HDHB.

Finance

TR3 The cancer research teams will continue to work within the current research governance processes, working closely with the R&D Department.

Existing relationships with the HDHB research community will be built upon to continuously improve the standard of Site Specific Information forms submitted to the NISCHR Permissions Coordinating Unit (PCU).

Cancer research teams within Hywel Dda Health Board. R&D Office,

2013

TR3 Ensure all processes involved with conducting clinical trials are carried out according to Standard Operating Procedures (SOPs) which are compliant with Good Clinical Practice (GCP).

All staff involved in recruiting patients into cancer research studies will work to appropriate HDHB, West Wales Organisation for Rigorous Trials in Health (WWORTH), NISCHR CRC or trial specific SOPs as required, and compliance with this will be checked via random research governance audits.

R&D Office 2014

TR3 Ensure that all research staff involved in Clinical Trials of Investigational Medicinal Products (CTIMPs) are GCP trained, and liaise with NISCHR CRC to ensure that HDHB in-house GCP training provision is synchronised with the NISCHR CRC Training Programme to maximise opportunities for staff to attend appropriate training as locally as

All staff working on cancer studies which are CTIMPs will attend GCP training as required by the Health Board, and the R&D Department will continue to maintain a training record of staff trained via in-house or external courses (NISCHR CRC, online training, etc).

Deputy Head of Cancer, Nursing and Quality (for nursing side) – Clinical Lead for Cancer R&D Office

2013

46


Completion date

possible. TR4 Encourage clinicians and Allied Health

Professionals (AHPs) to apply for NISCHR AHSC research funding (e.g. Clinical Research Fellowships, Research for Patient and Public Benefit award scheme) and other research grant awards (e.g. Cancer Research UK Research Bursaries and Clinical Scientist Fellowships).

NISCHR AHSC funding calls and any other external research funding opportunities are circulated to all HDHB and academic partner research staff. Support is provided by the R&D Department to help HDHB staff to produce and submit their funding applications.

R&D Office 2013

TR4 Ensure that NHS consultants, where appropriate, have adequate time allocated in their job plans to enable them to formulate research proposals, discuss clinical trials with their colleagues and patients, and recruit subjects into cancer clinical trials.

To be included in current revision of job planning process across Hywel Dda.

Director of Clinical Services

November 14

TR4 Explore options to provide and support protected research time for clinically-active staff including nurses and AHPs.

Discussions were held in February 2013 with the Assistant Director of Therapies & Health Science, the Assistant Director of Nursing (Workforce), the Head of Learning & Development and the R&D Managers to explore the concept of introducing ‘research leave ’ as an alternative to ‘study leave’, where staff could be released for an agreed number of hours/days over a set period to work on a named research project.

Therapies & Health Science, Nursing Workforce, Learning & Development and R&D Departments

2015

TR5 Collaborate with NISCHR CRC to promote and enable the use of key

Following the WCB’s withdrawal of HDHB’s license at Withybush General

R&D Office/Pathology

2014

47


Completion date

research facilities such as the Wales Cancer Bank (WCB), Wales Cancer Trials Unit (WCTU), Wales Cancer Research Network (WCRN) and the Marie Curie Research Centre (MCRC).

Hospital (WGH) in early 2013 as a result of Pathology services being consolidated to Glangwili General Hospital (GGH), HDHB now has to pay ABMU to process, store and transfer its patients’ tissue samples to WCB. The R&D Department will continue to explore the options to enable the reinstatement of HDHB’s WCB license in the future, in order for the HB to meet the WCB’s targets (20% of people diagnosed with cancer agreeing to donate samples to WCB by 2016). All potentially eligible patients for open trials in the Health Board are being identified through MDT and screening for clinics.

Department

TR5 Where possible, engage with research partners to maximise HDHB’s collaborative opportunities for cancer research. Liaison with NISCHR CRC and WCRN to facilitate this.

Maximise opportunities for HDHB staff to collaborate with research partners by raising awareness of ongoing or forthcoming cancer trials and by facilitating attendance at cancer-related conferences, meetings and events which could increase research activities via networking.

Head of R&D R&D Office Involvement of NISCHR CRC

2014

TR5 Liaise with partner organisations to report on the Performance Measures relating to research, as outlined in the ‘Together For Health – Cancer Delivery Plan’ (Welsh Government, 2012):

Existing collaborations between HDHB R&D Department, other Health Boards and NHS Trusts and the local Cancer Research Networks will be expanded to include plans to achieve targets relating to

Associate Director Clinical Services R&D Office

2014

48


Completion date

Percentage of patients recruited into high quality clinical research (Target: Double recruitment to rarer cancer trials by 2016); Percentage and number of people diagnosed with cancer who consent to donate samples to the Wales Cancer Bank (Target: 20% of people diagnosed with cancer agreeing to donate samples to Wales Cancer Bank by 2016). Liaison with various partners to facilitate this ie Velindre NHS Trust, WCB, WCRN, WCISU, Cancer NSAG sub groups, Cancer Implementation Group.

research outlined in ‘Together For Health – Cancer Delivery Plan’. Specifically, how to implement the strategies relating to Clinical Trials and Research, as suggested by the Cancer National Specialist Advisory Group in June 2012, in order to improve outcomes and patient experience.

TR6 Build upon the networking and collaborative opportunities being established via HDHB’s involvement in the South West Wales NISCHR AHSC Regional Hub.

Increase the number of collaborative research projects with academic and industry partners, and explore resulting opportunities to protect and commercialise any potential intellectual property rights.

R&D office/NISCHR AHSC Hub partners

2014

TR6 Collaborate with Health Research Wales and the AHSC Industry Managers and Industry Lead to develop the industry research portfolio within HDHB.

Assess the HB’s potential involvement in cancer commercial studies in the future, including the need to ensure sufficient oncology clinicians and nurses are in post, and other appropriate resources such as clinical space and equipment are available to meet the requirements of a given research protocol. Raise awareness among the HDHB research community of

Oncology teams/To be confirmed R&D Office

2014

49


Completion date

opportunities to participate in commercial research studies, including those undertaken in partnership with Small and Medium Enterprises (SMEs).

TR6 Through the Health Research Wales Industry Manager’s liaison with HDHB’s Research Nurse for Commercial studies, prioritise nationally approved UK Clinical Research Network (UKCRN) portfolio studies and those on the NISCHR Commercial Research Register.

Raise awareness of Commercial Research opportunities by liaising with cancer research teams to undertake feasibility assessments of new cancer trial proposals submitted to HDHB via Health Research Wales.

R&D Office 2013

TR6 Promote opportunities HB-wide between cancer research teams and the Clinical Research Centre at Prince Philip Hospital (PPH), and explore opportunities for research staff at Bronglais General Hospital (BGH) to use dedicated research space in partner organisations’ neighbouring premises i.e. Aberystwyth University.

Generate promotional material to publicise the facilities and resources which are available to HDHB researchers undertaking cancer trials at all HB sites to encourage an increased level of cancer research activities across HDHB.

R&D Office 2013

Documents

Hywel Dda Health Board’s Cancer Delivery Plan 2013-16 · During Q3 12/13, the team identified the need to monitor closer the screening update rates after variation identified across