NHS Highland

Better Cancer Care – Action Plan

2008/09

Progress /
G - green on track
A - amber some delay but expected to be completed
R - red no progress or major delay in implementation
B - blue completed
(BS) - black - Balanced Score Card

Better Cancer Care Report Actions

BCC Section 2: Prevention / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status /
1 / Continue to implement a wide-ranging and ambitious programme of action to reduce smoking levels in Scotland / Cathie Steer / NHS Highland Tobacco Policy
Tobacco Strategy
The focus for local delivery sits with CHPs and is monitored as part of Heat Targets. / Ongoing / Green
2 / Expand entitlement to free school meals as part of a comprehensive approach to improve diet and tackle obesity / Cathie Steer / Health Priority Schools Act: Implemented locally as a joint venture with Highland Council
“Your Choice to Healthy Living: Action Plan.” (separate arrangements in A+B)
NHS Highland Health Weight Strategy: due launched as a joint strategy. / Ongoing / Green
3 /

Work with local and national partners to continue to expand access to physical activity

/ Cathie Steer / Council Led Physical Activity Strategy – has NHS Input / Ongoing / Green
4 / Consider the findings of the national consultation on alcohol and publish an action plan for Scotland on tackling alcohol misuse / Dougie Montgomery / Await publication of National Plan
HDAAT Strategy is a joint venture
Local Enhanced Service for Alcohol Screening and Brief Intervention has been established.
User-friendly assessment tool in use to opportunistically identify at-risk people who could then be offered a Brief Intervention.
Activities monitored locally through the delivery of the Highland Drug and Alcohol Action Plan [includes interventions to deliver HEAT Target , CEL directives, and local interventions agreed by Highland Drug and Alcohol Action Team [HDAAT]
Joint working – partnership between NHS Local Authority, Voluntary Sector. Key priority areas focus on a tiered approach to screening, access to services, integrated care processes. / To be confirmed
Ongoing
Ongoing
Ongoing
Ongoing / Green
Green
Green
Green
5 / Support NHS Boards to implement the recommendations of Equally Well, the report from the Ministerial Taskforce on Tackling Health Inequalities / Cathie Steer / This Inequalities Health Check is being progressed as part of the single outcome agreements
Local Programme “Well Health”
Performance monitoring via JCCYP and the recommendations are being progressed via Community planning arrangements. / Ongoing / Green
BCC Section 2: Prevention / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status /
6 / Consider the potential ways in which community pharmacies can reduce inequalities in health, for example, by targeting services to address the health disadvantages of those groups of people living in the most deprived areas / Mary Morton/
Maureen Thomson / National Community Pharmacy Contract being implemented locally. Monitoring and reported via Highland Partnership Forum (Strategy meetings)
Implementing a process to plan Pharmaceutical Care Services (PCS).
Draft PCS Plan completed Nov 2007
SG not released requirements for PCS Plans
Public Health Service (PHS) element of the contract aims to encourage the pro-active involvement of community pharmacists and their staff in supporting self care, offering suitable interventions to promote healthy lifestyles and establishing a health promoting environment across the network of community pharmacies by participating in national and local campaigns e.g. cervical cancer. Sign posting to local services.
Public Health Service (PHS) Patient Services
1. Smoking Cessation – well embedded in mainstream practice.
2. Sexual Health:-
-  Emergency Hormonal Contraception
-  Chlamydia testing and treatment
Acute Medication Service (AMS) introduces the Electronic Transfer of Prescriptions (ETP) and supports the provision of pharmaceutical care services for acute episodes of care and any associated counselling and advice.
The national implementation of the Electronic Transfer of Prescriptions (ETP) in support of the Acute Medication Service (eAMS) is nearing completion. 85% of general practices are enabled with ETP and 80% of community pharmacies enabled.
Chronic Medication Service (CMS) will allow patients with long-term conditions to register with a community pharmacy of their choice for the provision of pharmaceutical care as part of a shared agreement between the patient, community pharmacist and General Practitioner (GP). It introduces a systematic way of working and formalises the role of community pharmacists in the management of individual patients (including cancer patients) with long term conditions in order to assist in improving the patient’s understanding of their medicines and optimising the clinical benefits from their therapy.
The Palliative Care Model Scheme developed a network of community pharmacies holding a stock of palliative care medicines.
Prescription charges reducing from April 2008. Cancer patientscan be advised of availability of pre-payments certificates (season ticket) and can purchase them in the community pharmacy. / In line with SG timetable
In line with SG timetable
Dec 2008
Dec 2008
Ongoing
In line with SG timetable
In line with SG timetable
In line with SG timetable
7 / Continue to roll out the HPV Immunisation Programme / Ken Oates / Local implementations led by Health Protection Team.
Monitored nationally.
Specific action underway to target school/ leavers. / Ongoing / Green
8 / Improve public awareness about the risks of exposure to the sun through awareness-raising campaigns and the implementation of controls on the use of sun beds / Cathie Steer / NHS Highland actively support Sun Awareness week each year.
(No specific analysis of impact on incidence locally or nationally) / Ongoing / Green
9 / Consider Health and Safety Executive advice expected in November 2009 on occupational links to cancer / Cathie Steer / Due for local consideration via Healthy Working Lives programme
10 / Support a comprehensive programme of cancer prevention research. / National Prevention Research Initiative: no local projects in progress at this time
BCC Section 3: Early Detection of Cancer / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status /
11 / Provide advice through the National Advisory Group to NHS Boards on further national, regional and local actions that can be taken to increase the
uptake of cervical screening services, particularly amongst younger women / Susan Vaughan / Participating [as a rural board] in Nationally commissioned research project specifically looking at the barriers to uptake. This is to identify effective interventions to promote uptake, particularly by younger women.
Bespoke Media training for Health Board
co-ordinators undertaken by lead officer, to effectively promote the screening programme.
Proactive media awareness raising, through radio, newspaper/ health magazine / Ongoing / Green
12 / Carry out a programme of research and attitudinal surveys through NHS Health Scotland into the reasons for non-uptake of cervical cancer screening in order to inform this advice / Susan Vaughan / As above - plus
Uptake monitored by a CHP-based statistical report which highlights area for improvement as well as areas of greater achievement. (Uptake and defaulting rates)
Project planned to identify good practice so as to cascade appropriately. / Ongoing / Green
13 / Fund a pilot for the ‘test of cure’ treatment pathway to determine how this programme may be integrated with the Scottish Cervical Screening Programme
in both a clinically and cost effective way / Active decision NOT to participate in the ‘Test of Cure’ due to fundamental changes which have been implemented recently in the local operation of the programme e.g. change to a direct referral system as at 1 Feb 2009
Also an increase in workload of the cytology laboratory due to HPV surveillance.
Await results of pilot and to await guidance in change to protocol. / tbc / Green
14 / Take advantage of the opportunity provided by the HPV immunisation programme to reinforce messages about the continuing importance of cervical screening / Susan Vaughan / Media messages most recent Jan 2009
Advice to all GP Practices including links to new national leaflet
Publicity in the national and local newspapers / Ongoing / Green
15 / Consider and respond to the recommendations of the Cervical Cytology Laboratory Review Group on the future laboratory requirements of the cervical screening programme when it provides its advice in 2009 / Mark Ashton/
Tim Palmer / National Laboratory Review underway in which all laboratories are participating. A number of options have been discussed [Principles for the review include future workload planning, workforce and quality assurance issues and cost-effectiveness]
Local Lab is piloting a new imager (seen on page 33 of the Strategy document) which will increase detection rate, and alleviate future manpower difficulties. / Date of report being issued - to be confirmed / Amber
16 / Ensure that the Scottish Bowel Screening Programme is rolled out across Scotland by the end of 2009 / Dennis Tracey/
Jim Docherty/
Surgical DGM / Steering Group includes all those with a vested interest and a participation in Bowel Screening.
Progress and issues monitored and addressed via NHS Highland Bowel Screening Steering Group and will provide basis for ongoing governance once programme established. / A & B
April 09
(with NHS GGC)
North Highland
Dec 09 / Amber
Amber
17 / Consider actions that might be taken within primary care to improve uptake of the Scottish Bowel Screening Programme / Dennis Tracey/
Jim Docherty/
Surgical DGM / Discussions with GP S/C who are represented on Screening Group underway.
Agreement in principle that GPs will provide face-to-face pre-colonoscopy counselling in rural areas / As above / Amber
BCC Section 3: Early Detection of Cancer / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status /
18 / Look at means to encourage relevant individuals’ participation in Scottish Bowel Screening Programme, for example, by exploring the use of Keep Well
projects for inclusion of Scottish Bowel Screening Programme information / Susan Rose/
Karen Carson / Local action to be considered following national guidance.
Links already made locally in terms of learning from Keep Well projects.
Communication strategy under development. / As above / Amber
19 / Monitor compliance with the NHS QIS standards for the Scottish Bowel Screening Programme / Dennis Tracey for
Bowel Screening Steering Group / Plans for implementation cognisant of QIS Standards
Monitoring and reporting via Steering Group / As above
Once programme established / Amber
n/a
20 / Implement two x-ray views at each breast screening round by April 2010. There may need to be redesign of roles and services to achieve this / Peter Hendry / Two-View implemented at Highland Breast Unit.
Mobile Screening Unit implementation for all rounds of screening [i.e. first and subsequent rounds] has commenced / Commenced ahead of 2010 deadline
2nd HB to commence
Completion by autumn 2011 / Green
21 / Support screening services to examine the processes involved in the breast screening pathway and explore opportunities for improvement / National monitoring report compares with QA targets
22 / Consider any developments in technology or screening tests that may improve
the screening programmes / National
Service Level Agreement in place with National Services Division [NSD]
Technical – digital imaging being looked at nationally (e.g. logistics in relation to the mobile units)
23 / Complete the Chief Scientist Office-funded study which seeks to address the information gap relating to ethnicity and medical recording / National
24 / Work with the Chief Scientist Office to examine opportunities to support Scottish researchers and patients participating in lung cancer research trials / National
BCC Section 4:Genetic and Molecular Testing for Cancer / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status /
25 / Invest in more genetic consultants, genetic counsellors, laboratory staff and appropriate psychological support to strengthen Cancer Genetic Services and
meet recommendations made in the Calman Review’ of Genetics / National
26 / Continue to support NHS Education for Scotland, Scottish Genetics Education
Network and other stakeholders to enhance the genetic knowledge and skills of all healthcare professionals / National
27 / Update the protocols to identify the groups of high-risk individuals and stratify their risk and improve the organisation of the surveillance programme for those at high risk across Scotland / Christine McIntosh / Distribution of Revised guidance – CEL(2009) 06
Cancer Genetic Services in Scotland – Management of Women with a Family History of Breast Cancer. Local feedback being collated in relation to distribution and compliance / Green
28 / Support the development of a public engagement network to raise awareness and understanding of the potential benefits of genetic services / Christine McIntosh for
CSG / Consider how best to take this forward via Cancer steering Group/ local patient reps networks / To be confirmed / Amber
29 / Explore the role of the molecular diagnostics models for achieving integration into routine practice / National
30 / Convene a short-life working group to advise the Scottish Government on the feasibility of national collection of tissue and consider, in conjunction with patients and other key stakeholders, the issues surrounding consent, storage, and access. / Christine McIntosh / National
Local – seek opportunities to participate in national work and contribute via consultation process / Ongoing
BCC Section 5:Referral and Diagnosis / Action Point/s / Lead
Person / Action / Target Timescale / Delivery
Status
31 / Work with the Scottish Primary Care Cancer Group, NHS Health Scotland, health promotion teams, voluntary groups, patients and others to assess how
to improve public awareness of common cancer symptoms to encourage patients to present early / Christine McIntosh for CSG / Await further National steer.
Local: Cancer Steering Group to discuss proactive actions via communications and media routes which raise awareness of alarm symptoms, and encourage swift response to symptoms / September 09 / Amber
32 / Work with partners (including regional cancer networks, NHS Boards and the Scottish Primary Care Cancer Group) to audit levels of electronic referral and support NHS Boards to further increase such referrals in line with established best practice / Bill Reid / HEAT Target - E7 [e-referral management]
Current responsibility for implementation sits with eHealth