DRAFT FOR CONSIDERATION AT THE STEERING GROUP MEETING Cancer Delivery Plan. Interim Progress Report

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1 DRAFT FOR CONSIDERATION AT THE STEERING GROUP MEETING Cancer Delivery Plan Interim Progress Report Health Board: Cwm Taf Health Board Reporting Period: November 2012 March 2013 Highlights / Key Achievements November - - Obtained approval from Macmillan for a Clinical Nurse Specialist for Skin Cancer. - Submission of Peer Review Self Assessment documentation for End of Life/Palliative Care Teams. December - - Establishment of a Community Cancer Awareness Network which includes a range of partners such as South Wales Cancer Network, Rhondda Cynon Taff Local Authority, General Practitioners, Public Health, Macmillan Libraries Project, Patient Representation, Voluntary Sector Organisations. The aim of this partnership is to raise awareness of signs and symptoms of cancers and promote their early detection. An agreement was reached with the Chair of Cwm Taf to undertake 3 campaigns per year for different cancers. The first cancer to chosen by the Mayor of RCT Local Authority was prostate cancer. The membership of this Network is still being extended. - Submission of an application to Tenovus to provide a Counselling Room at Royal Glamorgan Hospital. This room could be used for multiple purposes by hospital and voluntary sector staff providing services to cancer patients. Currently awaiting the outcome of the application. - Submission of Peer Review Self Assessment documentation for the two Lung Multi Disciplinary Teams within Cwm Taf. - Urology - Establishment of Nurse Led PSA clinics across Cwm Taf. January - - Community Cancer Awareness Network commenced their work focused on raisings awareness of the signs and symptoms of prostate cancer within the community. Actions 1

2 included information given at Local Authority Open Days, circulating a signs and symptoms leaflet with payslips to all Rhondda Cynon Taff Local Authority staff, submitting an article for the Local Authority s Well-Being Magazine and Outlook Magazine which goes to each household in RCT, leaflets sent out to all pharmacies across the Cwm Taf area etc. Meetings were held within the Health Board to plan the work around informing GPs, raise awareness at GP CPD event, highlight the newly agreed guidelines for referral to secondary care and where possible the Health Boards could plan for an increase in the number of referrals. Consultant Urologist has also agreed to write a patient information for GPs to hand to patients when they come to their surgeries. - Reviewed our Cancer Services meeting structure to make it fit for purpose for the delivery of the Cancer Plan. Membership of Cancer Services Steering Group now reflects the themes within the Cancer Plan. Progress reports in each area will now be brought to this group and collated into an overall response to be submitted to Welsh Government on a quarterly basis and publication on our internet site - GP Facilitators - The 2 GPs have made significant progress over the first quarter in which they have been in post. A Steering Group for the project was held on 31 st January and Macmillan are very pleased with the progress made to date. In particular the GPs have undertaken work to develop robust palliative care registers within primary care, developing standardised end of life care planning tools, protocols and pathways, exploring ways to support Out of Hours primary care and manage end of life in primary care and their involvement in implementing changes to access to palliative care medication, including Just in Case Boxes. They have also compiled a questionnaire which has been distributed to District Nurses covering a range of issues related to the management of patients in the community setting. A report will be compiled when these questionnaires have been return. - Cancer Rehabilitation - the audit of AHPs time spent delivering care to cancer patients has been completed. This was an action within the Cancer Rehabilitation Standards. February - - Lymphoedema Training session held on 13 th February for all Multi Disciplinary Team Members. This in house training 2

3 aimed to improve the understanding of the Lymphoedema service and how to refer. In particular the training also focused on preventative measures. - Awareness Days - a breast cancer awareness event was held by Breast Clinical Nurse Specialists at Royal Glamorgan Hospital on 12 th October, another event was held on 4 th February to support World Cancer Day. - Award of Specialist status - The Colorectal MDT at Prince Charles Hospital has been awarded specialist status by the Association of Coloproctology of Great Britain and Ireland (ACPGBI). The team was given the ST-Specialist grade, which means it is recognised by the ACPGBI as a unit suitable for the training of coloprotology specialist registrars during the latter stages of their sub-specialist learning. Professor Haray, a consultant in colorectal surgeon is a leading specialist in laparoscopic bowel surgery stated that this is gratifying recognition of all the hard work put in by various team members in providing training, which includes live operating master classes, not only for registrars but to all grades of staff, including nurses. - Palliative & End of Life Care a paper was taken to Executive Board where there was agreement with the principle of providing complex palliative care in a dedicated area on the Royal Glamorgan Hospital site, subject to the evidence of need and availability of a suitable area. - Advance End of Life Care Planning the new All Wales Advance Care Planning tool (wipads) has been developed by Dr Back and is available on March - The Breast Care: Passport to Rehabilitation Course - a joint project between the breast cancer team and Breast Cancer Care Cymru which includes AHP input commences in March 2013 within Cwm Taf. This is a 4 session group programme covering exercise, diet, managing lymphoedema, complementary therapies,, fatigue and coping strategies. These 4 sessions were held during the month of March Lung Audit NSAG/LUCADA evaluation session - A session between all members of the Prince Charles Hospital and Royal Glamorgan Lung MDTs was held on 8 th March. The purpose of this session was to formally review the outcomes of these audits and to develop an action plan to address the audits recommendations. 3

4 - Submission of Bids to Macmillan for their Practice Nurse Education Programme by 22 nd March - This programme aims to increase practice nurse education in managing cancer as a chronic condition, supports workforce and pathway redesign, supports new ways of working and enables a greater number of cancer patients to be cared for in primary care. Over 60 applications have been submitted to Macmillan from across South Wales, we are currently awaiting to hear the results of the application process. - Marie Curie SLA the current Service Level Agreement is being revised with Marie Curie to align and integrate their service more with ours, to support delivery of the Palliative Care & End of Life Care Strategy Update from the Head and Neck Multi Disciplinary Team - Patient Satisfaction Survey - The Team have undertaken an audit on patient satisfaction survey which has been accepted as a paper in the Cancer Nursing Journal. This cross-sectional study is a qualitative audit of patient satisfaction with the Head and Neck MDT based at the Royal Glamorgan Hospital. Globally the feedback was very positive but through anonymised questionnaires the team have been able to highlight areas for improvement and focus on optimising the standard of care provided for patients. - Establishment of a patient support group - In November 2012 the Team established a Head and Neck patient support group which now meets every 2 months. The aim of the group is to provide support and education for Head and Neck cancer patients and their relatives. - Development of a Pathway for Alcohol Detoxification - The Team have initiated a pathway for alcohol detoxification of Head and Neck cancer patients prior to treatment. This involves new patients being assessed by the Clinical Nurse Specialist using a recognised alcohol screening tool. Those identified at risk of developing alcohol withdrawal symptoms during treatment are admitted with support of the Alcohol Team, and detoxed before treatment. This allows proactive rather than reactive management. It also reduces post operative complications, hence reduces hospital stays. The Alcohol team follow up patients in community to hopefully prevent lapsing back into heavy alcohol consumption. 4

5 Update from the Cwm Taf Local Public Health Team (November 2012 March 2013) Alcohol Alcohol Brief Intervention Training Alcohol Brief Intervention training is being rolled out, led by Public Health Wales. The training has been promoted to a range of community partners, including those working with young people. Food and Fitness Joint Care Programme The JCP is a pilot for those patients with a BMI of 30 or above who have chronic hip or knee pain to receive support with weight loss and increase activity in order to manage their condition more effectively. The 16 week programme is being piloted in four locations across Cwm Taf and commenced at the end of January. The National Exercise Referral Team are delivering the programme and are supported by the Public Health Team and dieticians. Feedback from participants has been positive. Community Weight Management A toolkit to support the community in establishing weight management groups has been developed and mapping of groups established as a result has taken place in the past four months. Historically twenty-one groups have been set up in Rhondda-Cynon- Taff and Merthyr Tydfil. A nutrition course, cookery session and behavioural change session has been delivered. Nutrition Qualifications The Public Health Dietetics Team have delivered four Agored Cymru Level 2 Community Food and Nutrition Skills qualifications to School Nurses, community weight management groups and staff in local care homes. The Agored Cymru Level 1 Introducing Community Food and Nutrition Skills qualification has been delivered to part time Youth Workers. The Agored Cymru Level 2 Community Food and Nutrition Skills for Older Adults has been delivered to a variety of managerial and operational roles within care settings, as well as to staff working within the community providing care to older adults. Tobacco Smoke Free Homes Pilot 5

6 The Smoke Free Homes pilot aims to reduce environmental tobacco smoke exposure. The project is being piloted in two Communities First areas and has been developed in partnership with the Communities First teams and Registered Social Landlords. A training package to deliver the pilot is in its final stages of design. No Smoking Day 13 th March 2013 Cwm Taf Public Health Team promoted No Smoking Day 2013 via Communities First clusters, the youth service, Canopi, School Nurses, Healthy Schools Team, and Corporate Health to encourage the uptake of local stop smoking services. Smoking Brief Intervention Training Brief Intervention training is being rolled out across Cwm Taf. The training is a half day session provided by Stop Smoking Wales for all professionals who come into contact with smokers on a regular basis. The training has been promoted to a range of community partners. BASICS Cwm Taf Public Health Team has been working closely with the Faculty of Health, Sport and Science, University of Glamorgan, and Obstetrics Gynaecology and Sexual Health in Cwm Taf to develop a study to define the barriers to giving up smoking during pregnancy. The BASICS (Barriers to Uptake of Smoking Cessation Services in Pregnant Women) questionnaire has been designed to obtain information about the smoking history of post partum mothers, their current smoking activity, and their views on smoking cessation support and aids to smoking cessation. This study has been funded by the Cwm Taf Health Board R&D department to a sum of MAMSS Work is progressing on a research project (MAMSS Models for Access to Maternal Smoking Cessation Support) to determine if alternate models of behavioural support established as part of maternal care increase the uptake of behavioural support and improves quit rates amongst pregnant women. This study has been funded by the Cwm Taf Health Board R&D department to a sum of 29, Training In collaboration with the University of Glamorgan, student midwives have received a lecture on understanding the higher rates of smoking in areas of social deprivation, and the importance of the midwife in supporting quit attempts, as defined in NICE guidance. 6

7 In collaboration with Stop Smoking Wales, a programme of brief intervention training has been delivered to midwifery staff. Extensive training on factors that impact on poor health, including smoking, has been provided to prescribing advisors, so that they are able to support GPs to increase referrals to smoking cessation services. Challenges - Progressing the application to Macmillan for a shared Level 4 psychology post with Cardiff and Vale Health Board. Discussions are ongoing. Corrective Actions Planned - A range of options are being considered to fit the available financial envelope available for the psychology post. Options have been costed and are in the process of being shared with the directorates. - Options for professional supervision for the post are also being considered. Priorities for Next Quarter - Cancer Standards - commence the data collection and completion of data sets for Cancer Standards monitoring and reporting. - Peer Review - Develop a plan to address any findings from the End of Life and Lung Cancer Peer Review processes. - Key Worker - Continue the further implementation of the Key Worker across all cancer specialities. - Audit the pathway for each person diagnosed with advanced cancer and act on findings to improve services for early diagnosis - This target has been prioritised for action and a meeting between Clinical Audit, Cancer Co-ordinators, Cancer and Planning Lead was held during March to progress this work. Palliative & End of Life Care: o map the whole system pathway to determine the future model of care; o develop a longer term plan for provision of acute, complex palliative care on the RGH site; o develop an interim plan for provision of specialist palliative care enabling the transfer of services from Y Bwthyn; 7

8 o Link Palliative & End of Life Care into service; o Introduce revised SLA with Marie Curie from April Cwm Taf Local Public Health Team: Brief Intervention Training Continue to promote the training to our community partners and increase referrals in to stop smoking services. Joint Care Programme Completion of the Joint Care Programme pilot and evaluation with a view to rolling out the programme across Cwm Taf. Community Weight Management Assessment of progress and further needs will be determined through further meetings with community groups. A newsletter will be issued for community groups and further training is planned for June Nutrition Qualifications Pilot Agored Cymru Level 2 Community Food and Nutrition Skills qualifications with second year Health and Social Care students at Merthyr College. Agored Cymru Level 2 Community Food and Nutrition Skills qualifications delivery to members of the initial response team, Health Board catering staff and Health Care Assistants and Tenovus staff. Smoke Free Homes Pilot Delivery of the Smoke Free Homes Pilot including monitoring of initial progress. MAMSS Implement programme BASICS Progress research and commence evaluation. 8

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