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Ka Mohio ka whakatipu

Knowing is Growing

Dear Stephanie

Welcome to this quarterly Central = Cancer Network=20 (CCN) newsletter. I trust you will find the = updates of=20 interest.

I recently returned from the Inaugural = Australasian Clinical Networks Conference - Network to = Network=20 2010. The conference focused on four themes;

evaluation and outcomes of = clinical networks=20
consumers as network participants = and=20 partners in improving care
connected and collaborative care, = how=20 networks are collaborating
establishing and maintaining = effective=20 networks

The presentations identified for me = that we=20 appear to be on the right track with how networks are = evolving=20 in NZ and there is strong evidence that clinical = networks do=20 improve patient care and outcomes.

Please share this newsletter with your = colleagues and interested parties.

Jo Anson
Network Manager

Website updates

Kaupapa Maori section = added
Pacific Communities section=20 added

Please note that work continues on = both sections=20 and your feedback would be appreciated.

Upcoming events

Central Region Palliative Care = Network=20 Forum - 4th June 2010, Palmerston Nth

The Palliative Care Network is pleased = to=20 announce that two speakers will be presenting in = Palmerston=20 North on Friday 4th June. Professor Merryn Gott, = Director of Research will be speaking on =E2=80=9CThe = Ageing=20 Population: Challenges for Palliative = Care=E2=80=9D and Doctor=20 Michal Boyd will present on =E2=80=9CPalliative Care = in=20 Non-Malignancy, including dementia=E2=80=9D.

The forum is expected to run from 10am = until 4pm=20 and is being held at Addis House, Cancer Society = Rooms, 135=20 Ruahine Street, Palmerston North.

This forum is open to any stakeholder = with an=20 interest in Palliative Care. Please register = your=20 interest to attend with Stephanie Fletcher, CCN.

Regional Consumer Representative = Forum =E2=80=93 June /=20 July, Wellington (date to be advised)

CCN proposes holding their six monthly = regional=20 consumer representative forum in Wellington on a = Saturday in=20 the middle of the year.

Proposed agenda items include;

Updates from group members on their Consumer=20 Representative activities=20
Updates on CCN projects=20
Cancer Control NZ Patient Experience Survey = results=20
Training session - basic statistics and = epidemiology for=20 cancer control=20
Workshops =E2=80=93 development of cancer = consumer information=20 pamphlets

Please contact Stephanie Fletcher, CCN, to = register=20 your interest in attending.

Latest Publications

Release of Cancer Projections: Incidence 2004-08 = to=20 2014-18

The Ministry of Health has released updated = projections of=20 cancer incidence in New Zealand. The = report, Cancer Projections: Incidence 2004-08 = to=20 2014-18, is available on the Ministry's = website.

The report uses data from the Cancer Registry from = 1956 to=20 2006 to project incidence by five year age group and = sex to=20 2018, for 29 cancer 'sites'. An appendix = provides a=20 detailed analysis of recent trends in prostate cancer=20 registrations.

Patient Experience Survey

For the first time people who need outpatient = cancer=20 treatment have been surveyed to gauge their = experiences in the=20 public health system. The Cancer Control Council (now = named=20 Cancer Control New Zealand) received 2239 responses, = or a 66%=20 response rate to the survey, which is now closed.

Initial results show that overall satisfaction with = the=20 publicly funded outpatient cancer care system is very = high -=20 with 97 percent satisfaction levels. Although patients = who=20 responded to the survey generally rated the quality of = care=20 and services overall very highly, ratings for certain = aspects=20 of care could be improved.

The strength of the 2009 Cancer Care Survey is that = it=20 allows specific aspects of cancer care to be teased = out as=20 areas of strong performance or opportunities for = improvement.=20 The Voice of Experience Part One = contains=20 all the preliminary descriptive results for the = survey.

Regional results can be found in The Voice of Experience Companion = Report: New=20 Zealand Cancer Care Survey Results for Eight Treatment = Services Report.

Survey results can be found on the Cancer Control NZ website. =

Updates on Current CCN = Workplan

Demystifying Cancer Toolkit

CCN has developed a toolkit to assist districts to = plan,=20 deliver and evaluate Demystifying Cancer workshops for = Maori=20 or Pacific communities. This concept originated in = MidCentral=20 DHB where they have been running these workshops = successfully=20 for a few years. The workshops are an opportunity to = bring=20 together service providers across the cancer continuum = to=20 present cancer and cancer service information which is = tailored to specific communities and delivered in a = community=20 setting.

An associated piece of work = due for=20 completion by May 2010 is a second toolkit = =E2=80=98Cancer Care=20 Co-ordination =E2=80=93 Supporting Integration of = Services=E2=80=99 which=20 supports districts to undertake a stocktake of cancer=20 coordination services along the patient pathway. This = will=20 assist with identifying all cancer services in a = district who=20 could potentially be involved in planning and = delivering a=20 Demystifying Cancer workshop, as well as identifying=20 opportunities for improved integration of services to = better=20 support the patient=E2=80=99s journey.

For more information see the website or contact Ali Hamlin / Caren Rangi, Addressing = Inequalities Service=20 Improvement Facilitators.

Addressing Inequalities Pilot Funding = 2009/2010

CCN is funding Local Cancer Networks $10K per = district to=20 undertake initiatives to address inequalities in their = areas.=20 The team have been facilitating workshops for the = local cancer=20 networks to assist them to identify what the = inequalities are=20 in their areas, where progress is being made in = addressing=20 these and where they might target this funding. = Interest is=20 being expressed in both the Demystifying Cancer = programme and=20 the Cancer Care Coordination =E2=80=93 Supporting = Integration of=20 Services process as a good focus for this funding.

For more information see the website or contact Ali Hamlin / Caren Rangi, Addressing = Inequalities Service=20 Improvement Facilitators.

CCN Regional Cancer Control Hui 11th and 12th = March

CCN hosted a two day hui at Orongomai Marae, Upper = Hutt,=20 the purposes of which were to;

progress the development of the Maori leadership = model=20 for CCN and identify the process for managing = requests for=20 representation at a national level=20
share learnings on cancer control activities = across the=20 region with a particular focus on addressing = inequalities=20
enable Local Cancer Network members to meet and = discuss=20 challenges and opportunities =20
support the development of the addressing = inequalities=20 programme for the 2010/11 CCN Work plan

The two day programme focused on cancer control = activity in=20 the region with an addressing inequalities focus = and=20 Maori Leadership. A powhiri was held on = day one=20 which approximately 70 participants were = involved=20 in. Day two was primarily to discuss Maori = Leadership=20 within the CCN region and approximately 35 = participants were=20 involved. Representation across the two days consisted = of; the Ministry of Health, DHB=E2=80=99s = Iwi Health=20 providers, Iwi Management groups, marae committees, = Public=20 Health, NGO=E2=80=99s, Pacific communities, and = consumers. We were=20 also fortunate to have colleagues from the = Southern and=20 Northern Cancer Networks to support us which was = extremely valuable in raising the profile of networks = from a=20 national perspective.

Presentations from the hui, as well as the hui = booklet are=20 available on our website or contact Ali Hamlin, Addressing = Inequalities Service=20 Improvement Facilitator.

Cancer Centre Collaboration Project

CCN has been engaging with the clinical leadership = teams of=20 the two cancer centres to identify opportunities to = build on=20 the existing collaborative activities between the = centres to=20 better service the regions population. Meetings are = proposed=20 for June between the teams to present on and discuss = issues=20 which would benefit from a regional conversation.

For more information see the website or contact Robert Bull, Project Manager.

Regional Multidisciplinary Meeting (MDM) = Development=20 Project

CCN has been progressing the project to support = improved=20 regional access to lung and bowel Multi-Disciplinary = Meetings.=20 The project is looking into the following areas:

current configuration of lung and bowel MDMs in = the CCN=20 region, access to these and recommended future = models=20
assessment of the current functioning on the = MDMs=20 including infrastructure support eg = Video-conferencing,=20 administrative support=20
proposed methodology for routine reporting of = MDM=20 indicators

Papers outlining the findings and recommendations = are=20 currently being reviewed by the MDM teams before being = presented to the MDM Advisory Group and respective = regional=20 Lung and Bowel Steering Groups for decisions. A paper=20 recommending improvements to the video-conferencing = facilities=20 to support regional MDM development is also being = reviewed=20 prior to going to the regional Chief Information = Officers=20 Group for decisions.

Learnings from this project will be rolled out to = support=20 the other MDMs across the region later in the year. =

For more information see the website or contact Shirlee McLean, Project = Manager.

Regional Cancer Control Indicators Report

The first Cancer Control Indicators Report for the = CCN=20 region was published in February 2010. This report = brings=20 together currently reported data to present a = =E2=80=98joined up=E2=80=99 view=20 of several cancer related indicators. It also captures = commentary from service providers or other experts = about what=20 the data tells us about the current state of service = delivery=20 in our region. This report will be produced every six = months=20 (Feb / Aug) and additional indicators will be = developed and=20 reported as it evolves, including expanding on the = tobacco=20 control indicators, bringing online the Medical = Oncology=20 indicators and reporting on initial indicators for the = lung=20 and bowel tumour streams in the next report. =
=20
This report will be of interest to a wide range of = stakeholders, including the CCN Governance Group and = Local=20 Cancer Networks, who can use the information to assist = with=20 their monitoring roles and to inform their planning.=20

For more information see the website or contact Rebecca McDowell, Central TAS.

Work Due for Completion in the next Quarter:

CCN Annual Work Plan for 2010/11=20
Cancer Care Coordination =E2=80=93 Supporting = Integration of=20 Service toolkit=20
Regional Lung Clinical Nurse Specialist Model=20
Regional Bowel Report and implementation plan=20
Cervical screening services report=20
Scoping a project to support the development of=20 integrated health promotion planning

National updates

National Lung Cancer Working Group

This group has an initial focus on the development = of a=20 generic lung cancer pathway (including recommendations = on a=20 minimum standard for investigation, treatment and = ultimately=20 supportive care) with agreement on:

entry points and referral=20
timelines and waiting times between critical = points=20 on the pathway=20
KPIs and the percentage of cases referred for = assessment=20 and treatment=20
planning at multidisciplinary meetings = (MDM)

The group has agreed on three KPIs to be measured=20 initially:

referral to FSA: patients to be seen in a median = of 15=20 days; ultimately all seen <15 days=20
referral to first anticancer treatment - = patients to=20 have treatment in median 29 days=20
% of cases discussed at MDM >70%, although = ultimately=20 100%.

As our ability to measure service and outcomes = performance=20 improves we expect to add more detailed measurements = including=20 survival outcomes against stage, ethnicity, domicile = as well=20 as toxicity data. This should provide a good evidence = base as=20 to where networks and DHBs concentrate their efforts = to=20 improve lung cancer outcomes.

This will be the first national tumour stream = working group=20 to be established. If this initiative is successful,=20 consideration of a national bowel cancer working group = will be=20 discussed in July 2010.

National Collaboration for Bowel Cancer

Staff from regional cancer networks and the = Ministry of=20 Health met recently to discuss work that has been = carried out,=20 and planned activity related to bowel cancer. The = Ministry of=20 Health included an overview and update on the = development of a=20 national screening programme. Funding for the=20 implementation of a national screening programme is = yet to be=20 secured.

The Ministry of Health recently advertised for a = National=20 Clinical Quality Lead for Colonoscopy. = Applications=20 closed on 15 March. The person will work with = District=20 Health Boards to lead service improvements, implement = quality=20 standards and work with the sector to facilitate = improved and=20 extended training programmes.

Improving Supportive Care for Adults with Cancer = in=20 NZ

The Ministry of Health recently released the Guidance for Improving Supportive Care = for=20 Adults with Cancer in New Zealand (the=20 Guidance). Broadly, the Guidance was = developed to=20 help address the burden of cancer in New Zealand, = inequalities=20 in cancer access and care, and the quality of current = support=20 services. This evidence-based document provides best = practice=20 advice for ensuring that adults affected by cancer = have access=20 to the essential support and rehabilitative care they = need=20 throughout their cancer journey.

The Ministry has contracted Health Outcomes = International=20 (HOI) to take stock of current cancer support services = available in each of the four cancer network regions = and to=20 measure these against priority areas in the Guidance. = Baseline=20 information about supportive care services and = consumer access=20 to these will be used to identify gaps in service = delivery=20 across the country. Based on the gaps analysis,=20 recommendations for service development at both = regional=20 and national levels will be developed and included in = a=20 national Implementation Plan for cancer support = services.

In conducting the service stocktake and developing = the=20 subsequent Implementation Plan, HOI will be consulting = with=20 sector stakeholders through key informant interviews, = a survey=20 stocktake tool (administered online/phone), and sector = workshops in each of the four cancer network = regions. =20 Additionally, an Implementation Working Group will = help to=20 guide the project and includes personnel from key=20 organisations such as M=C4=81ori Health, CANGO, = consumer=20 representation via the Cancer Society, the Ministry, = and=20 supportive care.

Throughout the project, HOI will be working closely = with=20 the four cancer networks, to identify the full range = of cancer=20 support service providers and to ensure that the = stocktake and=20 resultant Implementation Plan meet the needs of the=20 sector.

The project is set to kick off with a full = implementation=20 group meeting in June 2010 with a Draft Implementation = Report=20 due to the Ministry in December 2010.

If you have any queries about the project, please = contact=20 Arden=20 Corter or your regional Cancer Network = Manager.

Evaluation of Regional Cancer Networks

Cancer Control New Zealand have appointed Ruth = Herbert from=20 Trio Consulting Limited to carry out the review of the = four=20 regional cancer networks.

The first stage of the evaluation due for = completion by end=20 of June 2010 focuses on a process evaluation, = including=20 reviewing:

Development and implementation of the networks=20
Whether the networks meet the expectations = listed in the=20 Cancer Control Action Plan, and have fulfilled the = Ministry=20 of Health=E2=80=99s objectives for the networks=20
Roles the Ministry of Health and the National = Cancer=20 Control Implementation Steering Group play in = developing and=20 operating the networks=20
Similarities and differences between the four = networks,=20 and whether some have been more effective than = others.=20

Subsequent to this it is proposed the evaluation = will shift=20 focus on reviewing the impact / outcome of the = networks.=20
Ruth will be conducting face-to-face interviews = with=20 regional network staff, Ministry of Health, advisors = and=20 stakeholders. We will keep you advised of this = process=20 should you wish to have the opportunity to be = involved. =20

District Updates

MidCentral Local Cancer Network

Simon Allan, Chair of the MidCentral Local Cancer = Network=20 has provided an update on recent activity within their = region.
=E2=80=9CIwi = co-ordinators: we have an=20 action research program in place for our 4 iwi cancer = care=20 co-ordinators and this is producing good results to = date.

The Community Oncology nurses have linked well to = establish=20 their positions and increase workload providing good = support=20 for those patients with cancer not covered by the = clinical=20 nurse specialists in the breast, colo-rectal and = haematology=20 areas.
Together with the Cancer Society we have = been=20 assisting consumers to articulate some improvements to = information and patient flow patterns within the = cancer=20 journey and further meeting are to occur.

A look at data points within the treatment area has = demonstrated that we have some way to go to achieve = meaningful=20 and timely data around cancer treatment outcomes.

The Palliative Care Partnership continues to give a = strong=20 lead in primary/secondary integration and the = education=20 program is popular. Liverpool Care for the Dying (LCP) = is now=20 rolled out across most of the district and we will = also be=20 training level 2 aged residential care facilities. = GP=E2=80=99s and=20 district nurses have embraced the LCP as a useful tool = to=20 assist with patients dying in their preferred=20 environment.=E2=80=9D

Radiotherapy wait times remain within the 6 week = target but=20 there will be real pressure to manage the projected 4 = week=20 target at year=E2=80=99s end.

Psycho-oncology continues to deliver 100% of = contracted=20 service and is a popular service.=E2=80=9D

For further information on the MidCentral Local = Cancer=20 Network please contact Simon Allan by email.

Contact = Details

Jo Anson

Manager

Jo.anson@midcentraldhb.gov= t.nz

063508622

0274463261

Simon Allan

Clinical Director

Simon.allan@midcentrald= hb.govt.nz

Andrew Simpson

Clinical Director

Andrew.simpson@ccdhb.org.nz

Shirlee McLean

Service Improvement

Facilitator

Shirlee.mclean@midce= ntraldhb.govt.nz

063508986

0275680533

Ali Hamlin

Service Improvement

Facilitator

Ali.hamlin@midcentraldhb= .govt.nz

063508804

0274490922

Caren Rangi

Service Improvement

Facilitator

Caren.rangi@midcentrald= hb.govt.nz

0212272983

Stephanie Fletcher

Support Coordinator

Stephanie.fletch= er@midcentraldhb.govt.nz

063508918

Robert Bull

Cancer Centre

Collaboration Project

Robert.bull@midcentral= ddhb.govt.nz &nb= sp;

0210686072

Jon Herries

Regional MDM

Development Project

Jon.herries@ccdhb.org.nz
=
048062593
=

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