P-03-150 National Cancer Standards - Oral Evidence Session                                                                                                                  Doc 2

Petitions Committee

Date: 20 November 2012

Venue: Senedd, National Assembly for Wales

Title: National Cancer Standards Compliance

Purpose

1.  This paper provides evidence for the Minister for Health and Social Services’ attendance at the Petitions Committee to discuss National Cancer Standards. This subject has been considered by the Committee on a number of occasions between 2008 and 2012.

2.  The evidence paper:

· explains the movement away from centrally monitored cancer standards towards monitoring by Local Health Boards (LHBs);

· looks at delivery of the Together for Health- A Cancer Delivery Plan;

· considers monitoring of the Together for Health- A Cancer Delivery Plan  

Summary

3.  Whilst standards are valuable to LHBs to support the delivery of consistent

     services, monitoring standards does not provide an assessment of the

     quality of a service, nor understand a patient’s experience of those

     services. The focus of Together for Health- A Cancer Delivery Plan

     concentrates on driving quality and patient centred outcomes, not on the

     mechanics of service delivery.

4.  Designed to Tackle Cancer in Wales, published in 2006 and the Strategic Framework published in 2008, set the policy direction for improving cancer services in Wales. This document focussed on the implementation of Cancer Standards as this was appropriate for the time.  Cancer standards underpin the building blocks of cancer services, focussing on the elements of diagnostic and treatment process a patient should expect to receive.

5.  There is no longer a requirement for LHBs to routinely report compliance

      with the National Cancer Standards to the Welsh Government.

      Assessment and monitoring of the Standards is a matter for LHBs. The

      Welsh Government does however insist they monitor themselves against

      the Standards and report to their Boards.

Compliance

6.  LHBs are responsible for assessment and monitoring of National

Cancer Standards. Services must also comply with more

recently published specific cancer standards (those for sarcomas;     children, teenagers and young people; rehabilitation of adults with cancer; palliative care).

7.  To support Health Boards in monitoring standards, the Quality Delivery

Plan tasks Healthcare Inspectorate Wales (HIW) to introduce a process of

      peer review against standards, beginning with cancer and end of life care

      in 2012.  This has strong clinical support.

8.  Clinical audit and outcome review is critical to continuous service

     improvement.  All NHS organisations providing cancer care must

     participate in all relevant National Clinical outcome reviews, set out in the

     Welsh Government’s National Annual Audit Programme and then act on

     the findings.

The Cancer Delivery Plan

9.  The Cancer Delivery Plan aims to plan secure and deliver safe, sustainable, high quality cancer care for local populations. It provides a framework for action by Local Health Boards and NHS Trusts.  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 the Welsh Government expects.
• The outcomes from NHS treatment the Welsh Government expects.
• How successes will be measured and the level of performance the Welsh Government expects.
• Themes for action by the NHS, together with its partners.

10. The Welsh Government and Macmillan Cancer support are working      together to identify the non-clinical aspects of cancer care that patients and their families need to help inform service planning and delivery and will undertake a national cancer patient experience survey. The results will allow organisations to identify areas where improvements are needed. It will also allow better understanding of whether certain cancer types, ethnicity, communities, age groups or genders experience poorer care and allow this to be addressed.

  11. The Cancer Delivery Plan now sets actions up to 2016 for NHS Wales working with its partners.  The Delivery Plan says for our population the Welsh Government wants:

• People of all ages to have a minimised risk of developing cancer and, where it does occur, an excellent chance of surviving, wherever they live in Wales.

• Wales to have cancer incidence, mortality and survival rates comparable with the best of Europe.

12. The Welsh Government will use the following indicators to measure success:

• Cancer incidence rates (European Age Standardised Rates)
• Cancer mortality rates (European Age Standardised Rates)
• 1 and 5 year cancer survival rates

13. The Plan also identifies a small set of NHS Performance Measures and sets a level of performance for each one for delivery by 2016.  A series of performance indicators and output measures have been developed for cancer. The data for each of these indicators and performance measures was provided to each LHB in September 2012. They then used this data to produce their annual reports and, in the interests of transparency,

      are in the process of making these available to the public through their websites. An all Wales annual report on cancer is being produced based upon each  individual LHB annual report and this will be published before the end of 2012.

Monitoring

The All Wales Cancer Implementation Group

14. The role of the Cancer Implementation Group is to provide leadership and support for the delivery of effective person centred cancer care in Wales.

      Its aim is to act as a forum to drive forward, support and oversee LHBs’ efforts to deliver the Welsh Government’s vision for beating cancer in Wales by taking forward the actions set out in the National Cancer Delivery Plan for 2011-12 to 2015-16 and delivering measurable progress towards delivering incidence, mortality and survival rates for cancer in Wales comparable with the best in Europe by 2015.

 15. The Group is to:

• Provide a co-ordinated all Wales approach to supporting NHS Wales
• Facilitate the sharing and promulgation of best practice across Wales
• Identify constraints and solutions to specific clinical and operational issues
• Provide Welsh Government  with intelligence on local issues and progress with implementation
• Agree how best to measure success

16. The Group has already met three times this year.  It has set up clear work streams with a subgroup on Clinical Effectiveness focussing on better follow up care and early diagnosis work.  A Person Centred Care Group has also been established and is leading work on, Key Workers, Care Plans and developing a national cancer patient survey working with Macmillan.

Measuring success

17. The Quality Delivery Plan sets out how the Welsh Government will monitor performance and progress in improving health and health care in Wales. 

18. The Quality Delivery Plan places requirements on NHS organisation to monitor a set of quality metrics and report them to the public, and hence to Welsh Government, and their Boards at regular intervals. The Cancer Delivery plan measures form part of the quality delivery plan.

19. Within the Programme for Government and Tier 1, two targets for cancer waiting times have been set.

Accountability

20. The Welsh Government holds the NHS to account on how well it delivers  the outcomes we want.  The lines of accountability are through the LHB and Trust Chief Executives to the Chief Executive NHS Wales and via the Chairs of the Local Health Boards and Trusts to me as Minister for Health and Social Services.

21.  Progress will be overseen through monitoring the specified levels of          performance by 2016 for each of the NHS performance measures.