CMCA – The Year Ahead

CMCA – THE YEAR AHEAD
By Managing Director Jon Hayes

I am delighted to welcome you to Cheshire & Merseyside Cancer Alliance’s new-look website. We are sure you will find it even more informative and easy to use than our old site, which has served us well for the last four years.

It’s not just our website which is new. We are also launching a refreshed programme of initiatives aimed at improving cancer care for our local population across Cheshire and Merseyside – more on that later.

This last year has been tough for everyone, right across the globe. The COVID-19 pandemic has devastated many lives, not least through illness and loss of life, but also through financial hardship, loneliness and a sense that our entire understanding of ‘normal life’ has been turned upside down.

Despite the pandemic’s inevitable disruption and the necessity of the NHS to focus on caring for those affected by the COVID-19 virus, I am heartened by the dedication of cancer professionals across our region and their determination to keep cancer services running as near to normal as possible.

Cancer Alliances were established across England and Wales in 2016, creating collaboration between healthcare organisations, public and social care bodies and cancer-related charities to transform the diagnosis, treatment and care for cancer patients in the region they serve. These partnerships lead to more effective planning of services and initiatives with the ultimate aim of improving outcomes for everyone touched by cancer.

The pandemic brought incredible challenges and threatened to derail some of the huge gains we have made during the five years of the Alliance’s existence. But the groundwork put in before March 2020 meant we were able to flex and adapt.

During a year of Coronavirus, the Alliance has brought cancer teams together from primary care and hospitals right across Cheshire and Merseyside to ensure patients have the fastest possible access to diagnostic tests and cancer treatments. We have continued to focus on improving all aspects of cancer services, including prevention, early detection, treatment and aftercare.

Another major development in improving the care of patients with cancer in our region over the past year – despite the pandemic – was the opening of the state-of the-art hospital in Liverpool operated by The Clatterbridge Cancer Centre NHS Foundation Trust.

The 11-storey building in the heart of the city’s Knowledge Quarter not only has unrivalled facilities for patients, but enhances the trust’s ability to undertake research into new treatments and diagnostics – now right next to the academic institutions it partners with.

The COVID-19 pandemic led to a reduction in urgent suspected cancer referrals across the country as fewer people approached their GP surgery with signs or symptoms of the disease. However, by the end of September 2020, referral rates were back above pre-pandemic numbers and now continue to be ahead of previous years.

Even so, it is important that the Alliance continues to highlight national public health messages, with the help of its partner stakeholders, to raise awareness of the need for early cancer diagnosis. We will also continue to push cancer prevention information and support our partner CCGs, local authorities and trusts to amplify those messages.

The Alliance works with Primary Care Networks (PCNs) – now a maturing layer of primary care organisation – which need to meet contract requirements to enhance this early diagnosis. Our support includes education and training resources, facilitating collaboration, presenting approaches and tools for safety netting (where patients are monitored throughout the diagnosis process) and enabling links with other professionals, including cancer charities.

We need to be mindful that further waves of COVID-19 may dissuade patients from coming forward to GPs or attend screenings or hospital appointments – and Coronavirus may also take a toll on the capacity of healthcare organisations. However, we have processes to ensure the Alliance can adapt to this situation.

It is reassuring to know that the volume of cancer treatment has remained relatively consistent through the pandemic and is now fully restored. However, the number of patients coming through the system needing investigation, diagnosis and treatment means additional capacity will be required over the coming year.

Over the last few weeks we have put a lot of time and energy into planning our work programme for the next 12 months to ensure continued progress for CMCA across prevention, early detection, screening, treatment and aftercare.

To improve our cancer outcomes; prevention, early detection and early diagnosis are the most effective means we have at our disposal. People diagnosed with cancer at an early stage have the best chance of curative treatment and long-term survival.

Despite cancer screening programmes, improved awareness and faster diagnostic pathways, only 54% of patients with cancer in England had their cancer detected early (at Stage 1 and 2) in 2018. NHS England's Long Term Plan (https://www.longtermplan.nhs.uk/) sets a target to detect 75% of cancers at Stage 1 and 2 by 2028. This means an extra 55,000 people each year will survive cancer for five years or more following their cancer diagnosis.

So, to improve prevention and early detection, in 2021/22, CMCA is planning to:

• Promote, encourage and empower people to have healthier lifestyles through community engagement and targeted prevention programmes of work in smoking and obesity with our partners
• Diagnose more cancers through cancer screening programmes before signs/symptoms of cancer appear with projects focused on improving uptake to the breast, bowel and cervical screening programmes with our public health colleagues
• Empower patients to present early with possible signs and symptoms of cancer – embark on a community engagement programme, initially in areas where there are known inequalities and bigger gaps in cancer outcomes
• Support primary care to manage patients in accordance with best practice, meeting the requirements of their GP contracts and working towards earlier identification of cancer with high quality cancer referrals when they suspect their patients may have cancer symptoms
• Understand and start to tackle health inequalities and the impact of cancer

Screening programmes across Cheshire and Merseyside are now fully operational after disruption due to the pandemic. The Alliance has funded breast, cervical and bowel cancer screening co-ordinators, who work with communities and GP surgeries to increase the number of screenings and promote their importance.

The Targeted Lung Health Check progamme, which helps to detect lung cancer in its very early stages – will be launching very soon with an initial focus on Liverpool, Halton and Knowsley.

We are also incredibly excited to be part of the NHS Galleri Study – for which Cheshire and Merseyside is one of the pilot areas – a blood test that can identify a range of cancers, and we also support innovations such as cytosponge and colon capsule endoscopy.

Development and implementation of Rapid Diagnostic Services (RDSs) is a key priority within the NHS Long Term Plan – and for CMCA. RDSs aim to bring together diagnostic equipment and expertise to ensure that cancer is diagnosed or ruled out quickly, and that patients feel supported throughout.

CMCA will be working with all cancer teams over the next three years to ensure all patients have access to an RDS. Through this process, CMCA will provide funding and support to teams to develop gold standard services ensuring they all provide the eight key components of an RDS:

• Early identification of patients where cancer is possible
• Timely referral
• Broad assessment of symptoms
• Coordinated testing
• Timely diagnosis of patients’ symptoms
• Appropriate onward referral
• Excellent patient coordination and support
• Access to clinical trials and research opportunities

The Alliance is investigating how the emerging Community Diagnostic Hubs – centres where patients can attend for quick diagnosis of a range of health concerns – can complement these RDS pathways.

CMCA has been working with GPs and hospital teams to implement Faecal Immunochemical Testing (FIT) as part of the response to the pandemic. FIT is a stool test that is designed to identify possible signs of bowel disease by detecting faecal occult blood (hidden blood).

By using this test, GPs can assess the risk of a patient having bowel cancer (those with lower risk symptoms) and it can be used in secondary care to triage those with higher risk symptoms. This ensures that only those who require them receive further invasive diagnostic tests. It also enables secondary care teams to prioritise the most urgent patients.

FIT has now been implemented widely in Cheshire and Merseyside and access to the test will continue to be expanded to all areas. As a response to the challenges presented by COVID-19, its use is being further extended to those patients currently on endoscopy and surveillance waiting lists. This means that those who are most likely to have a serious diagnosis continue to be seen most quickly.

CMCA values its partnership with organisations such as C&M Endoscopy Network, C&M Imaging Network and C&M Pathology Network and will continue to work closely with them.

The Alliance is also focussed on personalised care, which aims to give people more choice and control over the way their care is planned and delivered. It is based on what matters to them and their individual strengths and needs. We want people to have the same control and choice over their mental and physical health as they now expect in all other aspects of their life.

A one-size-fits-all health and care system cannot meet the increasing complexity of people’s needs and expectations and evidence shows patients have better experiences and improved health and wellbeing if they can actively shape their care and support.

NHS England’s Long Term Plan sets a target that by 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including Holistic Needs Assessment, a care plan and health and wellbeing information and support and new patient level data used to track delivery.

It also states that by 2021 “after treatment, the person will move to a follow-up pathway that suits their needs, and ensures they can get rapid access to clinical support where they are worried that their cancer may have recurred”.

In 2021/22, CMCA is planning to:

• Promote personalised care for all people with cancer – support our partners to embed holistic needs assessments, care plans and health and wellbeing into the care pathway for all people with cancer with a focus on this being community driven
• Support the implementation of Personalised Stratified Follow-Up (PSFU) for all appropriate people with cancer at the end of treatment, empowering patients through the delivery of education to improve self-management and understanding of their personalised plan of care and support
• Explore the use of PSFU for those with long-term conditions where there is a high risk of cancer to enable early diagnosis
• Optimise patients who are suspected to be or have been diagnosed with cancer to improve their health and wellbeing through prehabiliation and rehabilitation
• Understand and start to tackle improvements in patient experience

CMCA’s workforce programme will continue to support the development of a skilled, multi-disciplinary cancer workforce. Our programme incorporates the main requirements of the NHS People Plan, with a focus on retention and recruitment, as well as training and development.

We are working in collaboration with the North West HEE Cancer Workforce programme to develop knowledge and skills in the priority specialisms. The Cancer Support Worker (CSW) Framework supports the development of a North West accredited learning programme, skills passport and education framework for CSWs, who are important professionals in supporting people on all stages of the cancer pathway. Health Education England (HEE) is funding this project and building on the successful work the Alliance has done in this area.

We are also supporting the Endoscopy Network with the Bowel Cancer Screening Programme to accelerate accreditation training so we can expand the workforce in this area to support an increase in capacity in preparation for extending the age-range of those invited for screening.

One important development in the coming months will be the creation of a new online education and resource hub which will allow the workforce team to deliver an expanded and sustainable education programme, offering more courses and education material online to all types of cancer professional.

The Alliance is also piloting an online Multi-Disciplinary Team (MDT) Coordinator training course which, if successful, we will roll out across Cheshire and Merseyside. It would provide a standardised training offer for all MDT Coordinators throughout the region.

As well as this, we have secured funding to develop a system-wide model for specialist head and neck speech and language therapy services across Cheshire and Merseyside.

The Alliance is also committed to maintaining the Cheshire and Merseyside Cancer Surgical Hub, designed to ensure that patients continue to have access to urgent cancer surgery irrespective of where they live. The hub oversees a single waiting list for cancer patients and ensures that patients are offered treatment at another hospital in the region if the waiting time at their local hospital is too long. We have even offered help to hospitals as far afield as Birmingham and Bristol. In the year to March 2021, more than 600 cancer patients had their operations facilitated through the hub, which ensures everyone from across our region receives equal access to surgery.

So you can see that Cheshire & Merseyside Cancer Alliance has a huge array of wide-ranging programmes covering the whole cancer ‘journey’. Over the coming months we hope to showcase all of them on our updated website.

All these diverse initiatives are designed to end up in one destination. The reduction in inequalities and variation of cancer outcome across the whole of our region and the very best patient experience for those facing cancer in the population we serve.