Wales Cancer

NetworkAn Introduction to the Wales Cancer Network

January 2019

Part of the NHS Wales Health Collaborative

Contents

Page 3-4 1. About Us

Page 4-6 2. Cancer Delivery Plan 2016-2020

Page 6 3. CIG/Collaborative Cancer Plans 2018/19

Page 7 4. Funding

Page 7-9 5. Update on Current Work Streams

Page 9-10 5.1 Prevention

Page 10-11 5.2 Detecting Cancer Earlier (DCE)

Page 11 5.3 Single Cancer Pathway (SCP)

Page 12 5.4 Delivering Fast, Effective Treatment &

Care

Page 12 5.4.1 Oncology Portfolio

Page 12 5.4.2 SACT

Page 13 5.4.3 Radiotherapy

Page 13 5.4.4 Acute Oncology Services

Page 13 5.4.5 Cancer Centre Collaboration

Page 14 5.4.6 Surgery

Page 14 5.5 Specialist MDT Governance

Page 14 5.6 Upper GI Services – South Wales

Page 14-15 5.7 Lung Cancer Initiative (LCI)

Page 15 5.7.1 Patient Awareness Campaign

Page 15-16 5.7.2 Lung Prehabilitation Project

Page 16-17 5.7.3 Pathway Improvements

Page 17 5.8 Bowel Cancer Initiative (BCI)

Page 18 6. Cross Cutting Programmes

Page 18-20 6.1 Person Centred Care (PCC)

Page 20 6.1.1Patient Engagement

Page 20-21 6.2 Macmillan Primary Care Cancer

Framework (MPCCF)

Page 21-23 6.3 Information & Intelligence (I&I)

Page 23-24 6.4 Research

Page 24-26 6.5 Cancer Site Groups (CSGs)

Page 26 7. Systems of Quality & Performance

Assurance

Page 26-27 7.1 Peer Review

Page 27 7.2 National Clinical Audit

Page 27 8. National Cancer Conference

Page 27-29 9. Working with Partners

Page 29 Contacts

Appendices

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1. About Us

The Wales Cancer Network (WCN) is a collaboration

between Health Boards and Trusts, health

professionals, the third sector and other stakeholders

to develop and improve cancer services with the aim

of improving cancer survival, and quality of life and

experience of those living with the impact of cancer.

It works towards this aim by supporting, advising and

reviewing cancer services whilst highlighting

inappropriate variation in services and facilitating

innovation in service delivery.

The WCN also supports Health Boards and Trusts to

meet the requirements of the Welsh Government’s

Cancer Delivery Plan, and other national strategic

plans and frameworks for cancer, and provides

advice and guidance to Welsh Government on

policy relating to cancer care in Wales. The WCN has

offices in Cardiff, Swansea and North Wales.

The Cancer Implementation Group (CIG) is the

Executive level multi-stakeholder body for cancer in

Wales and it functions as the WCN Board. The WCN is,

in essence, the delivery arm of CIG. The CIG leads

policy and strategy on behalf of NHS Wales and

oversees the development and delivery of the

Cancer Delivery Plan. This plan seeks to support the

prevention of cancer where possible, but when it

does occur to ensure the delivery of fast and

effective, high quality care, and to continuously

improve patient outcomes, namely survival, quality of

life and experience.

Like many other Clinical Networks, the WCN is part of

the NHS Wales Health Collaborative which is directed

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by Health Board Chief Executives and serves to

oversea programmes and projects on behalf of NHS

Wales.

Both the CIG and the NHS Wales Health

Collaborative are required to produce an annual

plan. A high level summary of the key milestones

and deliverables from the WCN’s 2018/19 plan is

reflected within the attached NHS Wales Health

Collaborative Work Plan (Appendix A – see Section

3.1 for WCN) with progress reported to NHS CEO’s

quarterly.

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2. The Cancer Delivery Plan 2016-2020

This plan was developed by the Wales Cancer

Network through the engagement of all cancer

stakeholders in Wales on behalf of the Cancer

Implementation Group (see appendix 2).

The eight domains of the plan were maintained from

the previous 2012-16 plan, namely:

1. Preventing cancer,

2. Detecting cancer earlier,

3. Delivering fast, effective treatment and care,

4. Meeting the needs of people with cancer,

5. Caring for people with cancer at the end of life,

6. Improving cancer information,

7. Targeting cancer research, and

8. Cancer service performance and plan delivery

Broadly, these domains which align with other

service delivery plans, have driven the establishment

of the five CIG subgroups:

5 1. Prevention

2. Detecting Cancer Earlier (DCE)

3. Patient Centred Care (PCC)

4. Information and Intelligence (I&I)

5. Research.

Palliative care has its own ‘National Board’. In

addition, there is the Macmillan Primary Care

Cancer Framework, which whilst having its own

board, reports to CIG and is managerially

responsible to the WCN. There has also been a

focused piece of work to improve lung cancer

outcomes through a Lung Cancer Initiative which

reports through the Cancer Site Group (CSG)

directly to CIG and there will soon be a similar

Bowel Cancer Initiative (BCI) which will effectively

do the same.

There have also been proposals regarding the

establishment of a ‘Fast, Effective Treatment and

Care CIG Sub-Group’ to broadly cover planned

non-surgical care (radiotherapy and systemic anti-

cancer therapy (SACT)) and unscheduled care

relating to cancer or acute oncology services

(AOS), although the governance around this is yet

to be finalised.

The diagram below depicts the current CIG sub-

group structure together with an illustration of

where various stakeholders input into the cancer

agenda.

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The plan encompasses the breadth of cancer issues

and is aimed at identifying deliverable objectives within

2018/19 as part of the wider 2016/2020 Cancer Delivery

Plan.

As above, WCN has work streams that address the

majority of the issues within the plan through formal sub

groups of CIG, are recognised priorities for CIG

(Macmillan Primary Care Cancer Framework, Lung

Cancer Initiative, Bowel Cancer Initiative etc.) or are

core WCN based organisational functions to deliver the

work of CIG (e.g. Cancer Site Groups, Peer Review

etc.). WCN now ensures that all pieces of work have a

project plan and an allocated project team. Whilst

plans are updated in real time, WCN hold a quarterly

review meeting to ascertain progress and risks. A

quarterly progress report is submitted to CIG.

3 The CIG/ NHS Wales Health

Collaborative Cancer Plans 2018/19

4. FundingThe Network is linked to three sources of funding:

1. Wales Cancer Network Core budget – provided

centrally by WG to the NHS Wales Health Collaborative

for the purposes of the WCN and maintains previous

investment in the different Networks and Cancer

National Service Advisory Group (NSAG).

2. External Project Specific funding – primarily from Third

Sector partners to support specific projects e.g.

Macmillan Primary Care Cancer Framework (MPCCF).

3. £1m Cancer Innovation Fund – currently this money is

made available to CIG on an annual basis. WCN advise

CIG who oversee the prioritisation and allocation

process. Welsh Government has provided assurance of

this funding for 2018-19 and 2019-20, after which,

funding across all delivery plans (not only cancer) is to

be reviewed.

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Below is a list of themes/topics that currently feature

within the WCN’s work programme. Many of the

themes are cross-cutting. In recognition of this, the

WCN has established a team of project and

programme managers to manage delivery and ensure

there is consistent and timely collaboration in areas of

interdependency.

5. Update on current work streams

A brief description of each of the WCN workstreams / programmes are given below and have been categorsied according to the 3 broad areas of work:

1. Cancer Pathway Programmes & Projects (Grey), which includes:

a. Prevention

b. Detecting Cancer Earlier (DCE), including the Single Cancer Pathway (SCP)

c. Fast, Effective Treatment and Care / Oncology (incluing SACT, Radiotherapy, Acute OncolgyServices, Cancer Centre Collaboration and Surgery)

d. Specialist MDT Governance

e. Upper GI Review

f. Lung Cancer Initiative (LCI) (including Prehabilitation)

g. Bowel Cancer Initiative (BCI)

2. Cross-cutting Programmes & Workstreams (Teal Blue)

a. Patient Centred Care (PCC)

b. Primary Care / Macmillan Primary Care Cancer Framework (MPCCF)

c. Information & Intelligence (I&I)

d. Research

e. Cancer Site Groups (CSGs)

3. Systems of Quality and Performance Assurance (Light Blue)

a. Peer Review

b. National Clinical Audit

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The CIG Prevention Subgroup has a key aim to advise

on evidence-based interventions to minimise the

population level risk of cancer. This can be achieved

through facilitating a co-ordinated, coherent, prudent

and evidence-based approach to cancer prevention in

Wales.

The subgroup is led by Public Health Wales (PHW) who,

following a cancer prevention workshop, determined

that the majority of primary cancer prevention should

be incorporated into a wider chronic disease approach

and aligned with wider programmes of work across PHW

to prevent other forms of preventable health conditions

such as heart disease. Using a similar approach, the

Prevention of Cancer work programme will focus on

prevention work within Local Health Boards and Trusts

seeking to address smoking, poor nutrition & obesity,

physical inactivity, sun protection and alcohol misuse.

5.1 Prevention

Cancer Pathway Programmes (Grey)

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How primary, secondary, tertiary and the voluntary

sector services can support this strategy is to be

determined and it may be that the WCN will focus its

efforts on secondary and tertiary prevention such as

prehabilitation, initiatives such as Making Every Contact

Count (MECC) and rehabilitation through enhanced

patient support. Discussion regarding this refocus are

currently ongoing with PHW colleagues.

5.2 Detecting Cancer Earlier (DCE)

The Cancer Delivery Plan describes an ambition for a

“relentless drive for earlier diagnosis of cancer” as one

of the best opportunities to improve patient outcomes.

The DCE CIG subgroup operates through a programme

board structure that incorporates initiatives across the

patient pathway from population awareness and

screening to referral from primary care, through

diagnosis to start of treatment.

Projects and focus of work include increasing screening

uptake specifically addressing bowel cancer screening,

vague symptom/rapid diagnosis pilots within ABM and

Cwm Taf Health Boards, a smoking cessation project led

in Hywel Dda and various pathway improvement

projects.

The programme is underpinned by information (stage at

diagnosis being a surrogate for survival), enhancing the

primary/secondary care interface by improving and

strengthening education, support and communication

across the primary/diagnostic intervals of the patient

pathway.

Strategic work continues with the other home nations

and the third sector in terms of learning from each

other

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5.3 Single Cancer Pathway (SCP)

It has been long argued that the existing Welsh

Government Cancer Waiting Time Targets (CWT),

namely the Urgent Suspected cancer (USC) and non-

USC targets do not reflect actual patient experience,

describe the capacity gap in cancer diagnostic services

or drive improvement. Whilst the SCP has been

developed to improve the timeliness of access to care,

through recording and reporting all patients from the

point of suspicion of cancer (PoS), it soon became

apparent that the development of more robust and

standardised structured site specific and generic

pathways also gave the opportunity to overcome long-

standing challenges for cancer services; to develop

information systems to support referral, recording,

tracking and reporting of whole pathway and

component waiting times. The Cabinet Secretary for

Health and Social Service announced in November

2018 that the SCP target will be adopted in Wales and

formally report from June 2019. It is intended that

adopting the SCP will: • Prospectively support patients through ‘intelligent’ pathways

and drive improvement through comparing performances

across cancer sites and Health Boards.

• Develop the information required to understand the current

capacity gap in diagnostic and treatment services and also

predict the future demand and allow services to plan

accordingly

The SCP also gives the platform to improve patient

support, through better and more consistent use of

information, prehabilitation and communication

between patients and healthcare professionals and

across all levels of care.

and identifying ways in which patients can be

diagnosed earlier.

The Single Cancer Pathway (SCP) is recognised as a

key driver to detect cancers earlier and therefore

forms an integral part of the DCE Programme.

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5.4 Delivering fast, effective treatment and care

* This is not as yet a recognised CIG Subgroup (but is

currently under consideration). There are, however, a

number of active areas of WCN work.

5.4.2 SACT

5.4.1 Oncology Portfolio

**Note a portfolio approach to this work is still under

consideration

The Oncology Portfolio within the WCN brings together a

strategic direction for improving oncology services and

pathways in Wales through a national governance

structure supported by a range of initiatives aligned to

the ‘Delivering fast, effective treatment and care’

section of the Cancer Delivery Plan 2016-20. This

includes All Wales initiatives and collaborative

programmes of work such as acute oncology,

multidisciplinary teams, systematic anti-cancer therapies

(SACT), and metastatic disease care. A single view of all

national change initiatives will be supported by a

refreshed governance structure covering the key

elements of oncology services and pathways in Wales.

Key initiatives involve advice to the Welsh Government

regarding a One Wales initiative as well as advice to All

Wales Medicines Strategy Group (AWMSG) and their

operational group, the All Wales Toxicology and

Therapeutics Committee (AWTTC). There is also work

through the Cancer Information & Intelligence Group

(CIIG) to develop a single instance of e-prescribing in

Wales. This will give unprecedented opportunity for a

Once for Wales approach to SACT but also to develop

a consistent approach to the SACT dataset, the SACT

treatment pathway in the SCP and value based

healthcare by linking activity to patient outcomes

through the new cancer information solution (CIS).

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5.4.3 Radiotherapy

This has a standing all Wales group known as the Clinical

Oncology Sub Committee (COSC) which the 3

radiotherapy (RT) centres in Wales contribute to

regarding all aspects of RT service, development and

research.

5.4.4 Acute Oncology Services

These are broadly divided into 3 groups:

1. Services that support patients with previously

undiagnosed cancer e.g. Malignancy of

Unknown Origin (MUO) and Cancers of

Unknown Primary site (CUP)

2. Services that support patients with

complications of cancer e.g. metastatic spinal

cord compression (MSCC)

3. Services that support patients with

complications of cancer treatment e.g.

neutropenic sepsis

5.4.5 Cancer Centre Collaboration

The Cancer Delivery Plan highlights the need for

collaboration and integration between key cancer

agencies in Wales to ensure equity of access and

delivery of service quality. The three cancer centres

in Wales have been approached to consider areas

where collaboration and joint working may be

beneficial as well as how there could be joint

oversight of the work described above. At this time

they have suggested that a workshop be held to

further explore common issues where collaboration

may be appropriate.

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5.4.6 Surgery **

**It is as yet undecided how the network will work to

ensure consistent access to surgical services other than

through Peer Review of Cancer Services and National

Clinical Audit.

5.5 Specialist MDT Governance

Through Peer Review and the review below it has been

recognised that the governance of multi-Health

Board/Trust MDTs is unclear. The WCN have

commenced work to ensure that all such MDTs have a

Memorandum of Understanding (MOU) that will identify

organisational ownership and a clear response to any

issues within these MDTs.

5.6 Upper GI Review – South Wales

The Network undertook an external review of the

structure of Upper GI Cancer Surgical Services in

South Wales in 2017. The recommendations of this

review were accepted by the NHS Wales Health

Collaborative Executive Group and they agreed that

the core recommendations would be taken forward

jointly by Cardiff & Vale and Abertawe Bro

Morgannwg Health Boards, with support from the

Wales Cancer Network. Discussions are now

underway with both Health Boards to establish a task

and finish group to develop a service specification.

5.7 Lung Cancer Initiative (LCI)

Lung cancer continues to be a national priority

and the WCN has taken forward a number of

separate projects as part of its Lung Cancer

Initiative. These include:

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• Patient Awareness Campaign

• Lung Prehabilitation Project

• Pathway Improvement, including ‘straight to test’

pilots and a joint working project with Novartis

5.7.1 Patient Awareness Campaigns

The awareness campaign intervention targeted anyone

over 50 years of age and urged them to visit their GP if

they had persistent cough symptoms for three weeks or

more. This was advertised on television (S4C and ITV),

radio stations, other adverts (e.g. online), and with

posters (in pharmacies and on buses) between 11th July

and 11th August 2016. The campaign evaluation was

undertaken by the Welsh Cancer Intelligence &

Surveillance Unit (WCISU) and is due to report its findings

imminently.

5.7.2 Lung Prehabilitation Project

Prehabilitation is a process that occurs between the

time of cancer diagnosis and the beginning of acute

treatment and includes physical, and psychological

assessments that establish a baseline functional level,

identify impairments, and provide interventions that

promote physical and psychological health. It is a

multidisciplinary concept that aims to prepare the

patient for any pending treatment.

The LCI: Prehabilitation and Optimisation Programme

(POP) was an innovative multi-modal programme

which included dietitians, occupational therapists,

physiotherapists and therapy support workers

working collaboratively in Health Boards across

Wales.

5.7 Lung Cancer Initiative (LCI)

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5.7.3 Pathway Improvements

Considerable work has been undertaken to improve the

lung cancer pathway, including a joint working project

with Novartis, testing the benefits of ‘straight to CT’,

developing a computer-based risk assessment tool and

community pharmacy access to chest X-Ray (CXR).

Discussions are on-going on a decision to pilot lung

cancer screening in high risk patients in Wales. Formal

publication of the results from the NELSON trial, which

Patients were signposted by their specialist nurse or

doctor into the innovative prehab service at

suspicion of lung cancer at rapid access lung clinics

rather than at diagnosis to ensure that the teams

had the maximum time to optimise a person’s

health, wellbeing and fitness. The prehab team

provided interventions for patients including exercise

classes, nutritional advice, and assessments of health

and wellbeing to ensure they were as fit as possible

up until their treatment start date, they would then

signpost patients into relevant services to support

them with any ongoing concerns during and beyond

their treatment.

This project was supported through the £1m

Innovation Fund as part of the Lung Cancer Initiative

and is nearing an end having reached the

evaluation stage. The project recently won a UK

Innovation award from Macmillan Cancer Relief. The

WCN recognise the benefits of prehabilitation in all

patients pre-treatment and will now seek to identify

ways of incorporating nationally agreed work

programmes within the Single Cancer Pathway and

pathways more generally.

was designed to assess the effect of low-dose CT screening on lung cancer mortality, are awaited but initial indications from the trial are very positive. Prior to the outcome of this trial, it was agreed in the first instance that the National Optimal Lung Cancer Pathway (NOLCP) and Pulmonary Nodule Pathway are embedded across all Health Boards in Wales before piloting lung cancer screening in high risk patients.

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5.8 Bowel Cancer Initiative (BCI)

The CIG have suggested that colorectal cancer be

given significant national focus and prioritisation.

The WCN support this and will be recommending

the optimum approach in terms of national

oversight and synergies between current work

streams.

Working closely with the third sector, Colorectal

Cancer Site Group (CSG) for their clinical expertise

and other key stakeholders, the Bowel Cancer

Initiative provides a coordinated national approach

to improving pathways and outcomes for patients

with, suspected of having, or at risk of colorectal

cancer. This provides a strategic direction and

activity towards the stated outcomes in the Cancer

Delivery Plan 2016-20 and will need to address the

areas of demand and capacity analysis,

infrastructure development and workforce planning.

In particular, the BCI will focus upon two main areas:

Screening (supporting the implementation of the

Faecal Immunochemical Test (FIT), an incremental

reduction in the screening age-limit and increasing

endoscopy capacity), and;

Pathway improvement (supporting the introduction

of Lynch Syndrome testing for all colorectal cancer

patients, developing national optimal pathways

and exploring ‘Straight To Test’ models)

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6 Cross Cutting Programmes (Blue)

The Meeting Peoples’ Needs section of the Cancer

Delivery Plan 2016-2020 has helped people to

understand the importance of making sure that we are

providing person-centred care in Wales. In 2017 a new

group was set up under the CIG, known as the Person-

Centred Care (PCC) CIG sub-group. The PCC sub-group

includes healthcare and other professionals from Welsh

Government, Health Boards, Primary Care, Universities,

and Cancer Charities in Wales.

The PCC sub-group works with a range of healthcare

professionals from all Health Boards and Primary Care

settings across Wales. It works at a national level to

identify and share examples of good person-centred

care. These examples show new ways of working

before, during and after treatment. The aim is to

improve the standard of cancer care, improve the

outcomes of care and improve how people feel about,

or experience, their care across Wales.

The PCC sub-group develops standards which can be

used to record and report on quality of care. These are

then used to contribute to the performance framework,

used by Health Boards and Welsh Government to

monitor progress. This ensures that people affected by

cancer have a say, and that what matters to them, is

taken into account during the planning and completion

of their care.

During 2018-2019 the PCC sub-group have been

addressing the following priorities:

6.1 Person Centred Care (PCC)

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• Planning for the implementation of the 3rd version

of the Wales Cancer Patient Experience Survey in

partnership with Macmillan Cancer Support and

Welsh Government.

• Communicating with health care professionals in

both primary and secondary care to ensure that

the fundamental elements of person centred

care and the recovery package are embedded

in the National optimal cancer site pathways (e.g.

key worker, holistic needs assessment and

associated care plans, treatment summaries,

prehabilitation and rehabilitation)

• Working in partnership with Cardiff University and

teams in health boards across Wales to start to

understand the challenges Wales faces, with

regards to the cancer workforce following the

Macmillan Cancer Nursing workforce census.

• Ensuring that there is suitable information

provided for people affected by cancer, on the

Wales Cancer Network directory of services

website page.

Within 2019-2020 the PCC sub-group will be

supporting teams to implement the consistent use of

the Holistic Needs Assessment, allocation of key

worker and use of treatment summaries in lines with

the cancer site optimal pathways. The sub-group will

also be looking to evaluate the range of self-

management programmes that are offered to

people affected by cancer, and current access to

welfare benefits advice across Wales. In addition to

this they will be engaging with health boards to

explore consistently embedding Patient Reported

Outcome Measures (PROMS) and Patient Reported

Experience Measures (PREMS) into service delivery.

Following the workforce review, the group will begin

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The Macmillan Primary Care Cancer Framework

(MPCCF) is a Macmillan funded project to create a

community of practice within primary care that focuses

on cancer and innovation. As a result of this project

each HB has a designated lead Cancer GP and

Community Nurse within their locale. This work includes

close interaction with DCE in terms of recognising early

symptoms and getting access to diagnostics.

The MPCCF Programme provides clinical leadership

aimed at supporting primary care health professionals,

producing a framework of tools and resources and

improving the integration between Primary and

Secondary Care.

6.2 Macmillan Primary Care Cancer Framework (MPCCF)

developing an action plan to ensure we have a

national consensus on how we sustain the cancer

nursing workforce across Wales.

There is a dedicated Patient Engagement and

Experience coordinator within the WCN whose remit

is to ensure the patient voice and experience is core

to all work streams and programmes. The Patient

Engagement and Experience work ensures the

improved ability to understand the experience of

care from the patient’s perspective and to deliver

the service improvement vision accordingly. Patients

have a voice in the Peer Review process by

providing feedback on their experience of treatment

and care.

6.1.1 Patient Engagement and Experience

in the WCN

In partnership with Health Boards, the Wales based

MPCCF Programme is involved in a range of

service improvement projects to support primary

care to provide the wide breadth of cancer care

required in communities. From diagnosis and

supporting through treatment to living with the

long-term consequences of cancer and its

treatment.

A new initiative for 2018 to 2020 focuses on the

development and rollout across GP Practices in

Wales of the Macmillan Cancer Quality Toolkit to

support service improvement in the quality of

cancer care.

There is increasing evidence that the leadership

shown by our Health Board GP Cancer Leads is

raising the awareness and the importance of

primary care in cancer service improvement.

Further information can be found here: Visit our

webpages

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6.3 Information & Intelligence (I&I)

The Cancer Intelligence & Information Sub-Group

(CIISG) have identified a number of key priorities

arising from “Cancer Information and Intelligence: A

Digital Health Strategy for Cancer in Wales 2017-20”:

• Cancer Informatics Solution

• NHS Wales Haematological Malignancy Data

Solution

• National Cancer Standards for Wales (National

Cancer Datasets)

• National Audits

• National Oncology E-prescribing Solution

• National Reporting and Performance Measures

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These priorities will be taken forward through a

number of work streams and projects, and project

teams have been established for each of them. To

ensure a co-ordinated approach, a Cancer

Informatics Programme Board (CIPB) maintains

oversight to ensure any interdependencies are

identified and exploited, which in turn reports to the

CIISG. Arguably the most important is the

development of a Cancer informatics Solution which

will replace Canisc and provide a fit for purpose

cancer information solution fully integrated into the

wider NHS Wales national informatics architecture,

enabling it to link to other clinical systems such as the

Welsh Clinical Portal, primary care etc. A Business

case is being developed for submission to Welsh

Government in Autumn 2018.

Linked to the above, the Wales Cancer Network,

NHS Wales Informatics Service (NWIS), Welsh

Government and Janssen Cilag are collaborating on

a project to develop a national database for

haematological cancers, starting with myeloma.

There was a commitment in the most recent Cancer

Delivery Plan to develop a performance framework

for cancer in Wales developing, recording and

reporting metrics that reflect the quality of care

being delivered. This work will include the

development of clinically appropriate performance

measures together with the development of business

intelligence tools to allow performance to be easily

reported and analysed. As part of this work, the

Cancer Network has recently appointed its first senior

data analyst.

The WCN Cancer Information Specialist Team

continues to support NHS Wales participation in the

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five National Cancer Audits, as well as providing

support to operational users of Canisc across Wales

in collecting and analysing patient data.

Work is also underway to improve NHS Wales’s

participation in the national cancer audit

programme. A new lung e-form has been

developed with NWIS to collect additional audit

data and other work streams include improving

clinicians’ access to their own audit data and

developing tools to help improve data quality and

completeness.

Underpinning all the work streams is a project to

develop a new National Cancer Data Standards for

Wales. This involves the development of cancer

datasets that cover all parts of the patient pathway

and will support the management of care for cancer

patients and greatly enhance the ability to measure

performance and clinical outcomes.

6.4 Research

CIG and the WCN recognise the importance of

excellent quality cancer research, not only for its

own sake but in enabling and driving quality,

innovation, best practice and optimising outcomes

for patients. The Cancer Delivery Plan contains a

number of actions including the development of an

all Wales Cancer Research Strategy, with CIG

agreeing a Research sub-group to take these

forward.

The production of a National Cancer Research

Strategy for Wales has been identified as the first

workstream to take this forward, and the WCN and

Wales Cancer Research Centre (WCRC) are

working in partnership to support and develop this.

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The initial scoping and planning phase is nearing the

end and the structure to develop the strategy is

starting to meet, bringing together the NHS,

academic, third sector, the public and other

stakeholders.

The strategy will emphasise the value of embedding

research in to service as it is recognised that

participating in research if often a surrogate marker

of service quality, likely to be associated with

improved outcomes, early adoption of new

treatments and technologies.

The WCN and WCRC are working together to

provide information on available trials and

recruitment for Clinicians, MDTs, Health Boards/Trusts

and to support peer review, and have jointly funded

a research post to identify and undertake pathway

research.

6.5 Cancer Site Groups (CSGs)

These have been formed from the previously National

(Cancer) Service Advisory Group and regional

network site-specific groups and support service

development, improvement and research across

Wales through the development of high quality local,

regional and national cancer site services. They have

recently been reformatted and established as

Clinical Site Groups (CSGs).

The CSGs provide expert advice to the Wales Cancer

Network (WCN) and the Cancer Implementation

Group (CIG) on policy development and support the

delivery of “Together Against Cancer; The Cancer

Delivery Plan 2016-2020.”

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Working together with the WCN, the CSGs support

the national work programme, aiming to drive

service improvement and enhance patience

experience through collaboration, sharing best

practice and highlighting areas of improvement.

CSGs form the WCN clinical structure and have a

diverse professional membership drawn from the

associated multidisciplinary teams (primary,

secondary and tertiary care) involved in the care of

patients within individual cancer sites. CSGs provide

the clinical leadership and expertise for key topics

that fit with National priorities and members support

the dissemination of information amongst local MDT

and service.

Each cancer site has a clinical lead, supported by

clinical leads for specific priorities including

audit/information, pathway improvement, with

project management and admin support being

provided by the WCN. Some examples of the

function of the CSGs include providing clinical

expertise for and validation of:

• national clinical audit

• the measures and standards for peer review

• cancer information and dataset development

• development and national optimal patient

pathways

• development and input into national and UK

clinical guidelines

There are 13 CSGs currently identified as part of the

CSG structure of the WCN:

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Brain Breast

Head and Neck Haematology

Lung Thyroid

Upper GI Colorectal

Sarcoma Paediatrics

Teenage & Young Adults Urology

Gynaecological

Each Cancer Site Group will hold a minimum of two

business meetings per year and a workshop every 1-2

years.

A number of CSGs are currently focusing on

developing National Pathways in collaboration with

the SCP programme and are outlining the routes and

optimal care processes that should be considered to

ensure services diagnose and treat patients in a

timely and efficient manner. Adopting these optimal

pathways will aim to improve survival outcomes for

the future and overall patient experience.

7 Systems of Quality & Performance

Assurance

7.1 Peer Review

Peer Review, by definition, is the evaluation of

scientific, academic, or professional work by others

working in the same field and constitutes a form of

self-regulation by qualified members of a profession.

Peer review of cancer services in Wales is a required

directive of Welsh Government under WHC/2017037

that uses clinical consensus through the Wales

Cancer Network, to measure quality and

performance against cancers standards and

national guidance as a tool for quality improvement.

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9. Working with Partners

The review programme is the quality assurance

mechanism spanning secondary and tertiary care,

by using qualitative and quantitative information

that is interrogated by a panel of peers and

discussed with the providers of services.

Further information including the review calendar

can be found on our SharePoint or Website pages.

7.2 National Clinical Audit

As described above in 6.3, the WCN Cancer Information

Specialist Team supports Health Board participation in

five National Cancer Clinical Audits. This process

enables clinical services to assure themselves of their

quality and also a vital tool to support benchmarking

and improvement.

8. A National Cancer Conference

The WCN provides a national conference for the

cancer community in Wales to enable the sharing

of good practice, highlight innovation and provide

networking and educational opportunities. In 2019,

the WCN is considering a different type of

conference. It is suggested that all of the UK home

nations should be invited to Cardiff to discuss issues

that feature in their strategic plans but with

different responses. The WCN is commencing work

to prepare the groundwork and infrastructure for

such an event.

The WCN has developed some highly productive

relationships with partner organisations and

agencies within the field of cancer in recent years.

These fruitful relationships help drive and support

our mutual ambition to improve cancer outcome

for the people of Wales.

In particular, the WCN places significant value on

its positive relationship with the third sector through

the Wales Cancer Alliance (WCA) and the

Network’s research partners, for example the Wales

Cancer Research Centre (WCRC) as is described in

an earlier section.

The WCN also has a well-established working

relationship with 1000 Lives Improvement Service,

the NHS Wales Delivery Unit (DU) and the NHS

Wales Informatics Service (NWIS), particularly more

recently in support of the planning and preparatory

work for the single cancer pathway.

The DU has lead the national work around

modelling the demand and capacity to

understand the implications of implementing the

SCP, developing the methodology used by HBs

and analysing the results. NWIS has also been

instrumental in developing the informatics

infrastructure to enable reporting against the SCP

metric and will support HBs in the use of Tracker 7

systems going forward.

The 1000 Lives Cancer Services Improvement

Programme works with both the Network and the

Health Boards to take forward improvement work

that will support the delivery of the Wales Cancer

Plan.

The support offered by 1000 Lives runs throughout

the activities of the Network. Support activities

range from dedicated improvement capacity and

support, data analysis and communications help.

The following are only some examples of how

closely 1000 Lives has supported the WCN work

programme:

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• Core members of the group tasked with designing, planning and testing the implementation of the Single Cancer Pathway.

• Planning, facilitation and funding of SCP workshops

• Support to the design and delivery of the DCE programme

• Pathway improvement work in all Health Boards

• IQT Cancer cohorts for the Network

1000 Lives continue to work closely with the Cancer Network and the Health Boards on the Cancer Improvement agenda in Wales. Priority areas for 2019 include ongoing data analysis work for the Single Cancer Pathway, work with the DCE programme, and further work to help Health Boards to understand their activity and demand.

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ContactsFor further information on the work streams and

activity of the Wales Cancer Network please visit:

Website: www.walescanet.wales.nhs.uk

Email: WCN.CommsTeam@wales.nhs.uk

Social Media:

Twitter: @WalesCancerNet

#CancerInWales

You Tube: Wales Cancer Network

AppendicesAppendix 1: Collaborative Plan 2018/19

Appendix 2: Cancer Delivery Plan