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: [email protected]
Social Media:
Twitter: @WalesCancerNet
#CancerInWales
You Tube: Wales Cancer Network
AppendicesAppendix 1: Collaborative Plan 2018/19
Appendix 2: Cancer Delivery Plan