
Briefing for:	National Assembly for Wales’ Health and Social Care Committee
Purpose:	Response to the inquiry into progress made to date on implementing the Welsh Government’s Cancer Delivery Plan.
Contact:	Gillian Knight. Macmillan SACT & AO Development Manager, South Wales Cancer Network Tel: 01792 530854 ext 60854 WHTN 01886 0854 email: gillian.knight2@wales.nhs.uk
Date created:	March 2014.

Introduction

1. I welcome this inquiry into the progress made to date on the implementation of the Welsh Government’s (WGs) Cancer Delivery Plan (CDP) by the National Assembly for Wales’ Health and Social Care Committee.

2. I have not provided answers to all the questions posed by the inquiry but am looking at ‘Whether Wales is on course to achieve the outcomes and performance measures as set out in the Cancer Delivery Plan, by 2016’, specifically looking at the ‘Delivering fast, effective treatment and care’ section and how the South Wales Cancer Network and Macmillan chemotherapy/systemic anti cancer therapy (SACT) and associated acute oncology (AO) project is supporting people having cancer treatment.

3. The aim of the Macmillan SACT and AO project is to review chemotherapy/ SACT and acute oncology services across the South Wales Cancer Network which will develop future services across South Wales to ensure that they are safe, patient-centred and cost effective.

What is chemotherapy/ systemic anti cancer therapy

4. Systemic Anti-Cancer Therapy (SACT) encompasses both biological therapy (therapies which use the body's immune system to fight cancer or to lessen the side effects that may be caused by some cancer treatments) and cytotoxic chemotherapy (a group of medicines containing chemicals directly toxic to cells preventing their replication or growth, and so active against cancer).

About the SACT & AO Project

5. This is a 2 year Project which started in April 2013 and will inform the long term service planning for the Health Boards within the South Wales Cancer Network (SWCN) geographical area. The aim of the SWCN Macmillan chemotherapy/systemic anti cancer therapy (SACT) and associated acute oncology (AO) project is;

a) to undertake a review of chemotherapy/SACT and acute oncology services which will inform the development of services across South Wales which are clinically safe, cost effective, patient-centred, and in line with Welsh Government policy, patient and carer expectation, and best practice; and

b) to develop service models, consistent with the above, for consideration and implementation by Health Boards across South Wales. This scoping work will be considering the need to provide chemotherapy and non-chemotherapy services for patients as locally as possible whilst also ensuring that these services are managed safely with patients being treated in appropriate facilities, by appropriately trained and experienced staff. It will aim to ensure that resources available across the network are used more efficiently and also that these services meet the requirements of the National Cancer Standards and other national guidance.

6. The chemotherapy development and review project is considering all Systemic Anti Cancer Therapy (SACT) services, both for solid tumours and haemato-oncology (blood cancer), provided for patients in the South Wales Cancer Network area i.e. those areas covered by the following Health Boards and Velindre NHS Trust:

· Abertawe Bro Morgannwg UHB

· Aneurin Bevan UHB

· Cardiff & Vale UHB

· Cwm Taf UHB

· Hywel Dda YHB

· Powys Teaching HB

7. Acute Oncology Services cover:-

a. Patients potentially suffering from the acute complications of cancer treatment (for example uncontrolled nausea, vomiting or diarrhoea), The emphasis will be on non-surgical treatment, rather than acute post-operative emergencies;

b. Patients potentially suffering from certain emergencies caused by the disease process itself, whether the primary site is known, unknown or presumed.

c. Services for Metastatic Spinal Cord Compression (MSCC), and the management of Cancer of Unknown Primary (CUP).

8. The project is also considering other chemotherapy related issues that may affect Health Board’s capacity to provide SACT services. The review will inform the development of a safe, clinical and cost effective patient centred integrated chemotherapy and associated acute oncology service strategy which is aligned with best practice, national policies and user expectations. Such a strategy is needed in Wales to ensure that services are planned with the patient at the centre of all services.

9. This project is ensuring alignment with other service improvement projects across Wales.

10. The project is taking into account Welsh Government policy and guidelines, and NICE and other guidance affecting Wales, but also look at best practice in the other nations of the United Kingdom, and in other countries.

Why project introduced

11.There are six Health Boards and Velindre NHS Trust within the South Wales Cancer network region and specialist/tertiary services are provided by Velindre Cancer Centre (Velindre NHS Trust) and Singleton Cancer Centre (Abertawe Bro Morgannwg University Health Board).

12. The development of new treatment strategies over recent years has improved the survival rates of many cancers which means that patients often require access to the non-surgical oncology services for much longer periods of time than was previously the case. This places an increased financial burden on patients who need to travel long distances for their treatment. Similarly, this causes problems for the cancer units within region as a result of increased demands on current capacity despite increased investment over recent years.

13. More efficient use of available resources across the network is required to meet demand and improve patient experience by ensuring patients receive treatment in a more appropriate location. In view of the trend towards the development of non-cytotoxic treatments such as monoclonal antibodies, this provides opportunity to utilise new clinical areas not previously used for cancer therapies for example, community hospitals and/or primary care facilities.

Impact on people affected by cancer and cancer workforce

14. The project is working across health organisations in Wales to consider SACT/AO services that are patient centred, safe, clinically effective and that services are delivered in the best place considering distances patients have to travel.

15. The project will support both people accessing services and those delivering services by aiming for core service standards considering staffing/workforce, associated knowledge & skills, systems for communicating and ensuring the right information available for right people as and when needed, ensuring that all patients and Health Care Professionals have a contact if any concerns or issues regarding aspects of chemotherapy/SACT or if cancer patient are acutely unwell.

16. This project is only part way through but there is a clear willingness for health organisations to want to work together and this project is facilitating and enabling this to happen.

Feedback from Patients/ professionals: We have established an all Wales chemotherapy and acute oncology nurses forum to enable nurses from across health organisations to come together to standardise aspects of cancer services, feedback from this recently established (Jan 2014) forum is positive.

We have patient /user representation on the project steering group who is engaging and actively participating in project direction and developments and the project lead has had positive feedback from patients at various engagement meetings regarding project.

Recommendations

17. From lessons learnt to date from the Project, these are a couple of the early recommendations that I would put forward, to note the project is still underway and further recommendations will be formally published as part of the project output.

· The Welsh Government support a one electronic prescribing system in Wales which would undoubtedly support service improvement, e.g. purchase & support an all Wales e-prescribing system as in Scotland.

· The Welsh Government and Health Boards should invest/promote the IT infrastructure to share cancer patient information across care settings/sectors. The key for chemotherapy is e-prescribing, one system and a SACT data set so we are able to understand and monitor activity across Wales. This was highlighted previously in the 2006 Welsh Assembly Government Strategy ‘Designed to Tackle Cancer’ but has not been achieved.

· Acute oncology service development is supported in a systematic way within health organisations across Wales.