Pathway Improvement Programme

Following the initiation of the Pathway Improvement Programme in 2025/26, the 2026/27 programme aims to go further, to streamline and integrate all aspects of operational performance and pathway improvement planning into a single, cohesive framework.

By uniting previously separate sections such as operational performance, faster diagnosis, and treatment variation, the programme seeks to optimise cancer pathways from initial referral through to treatment, maintaining a particular emphasis on areas where pathway breaches most frequently occur.

Care 1.jpg We will focus efforts on providers in the lowest quartile overall against the three CWT standards, and on providers with pathways in the bottom quartile nationally, where these are not already covered by the bottom quartile providers. The programme has been developed to ensure that all performance-related objectives are addressed as a coherent whole and is reflective of the approach set out in the 26/27 operational planning pack.

The programme prioritises nationally mandated pathways, as well as some locally defined priorities and incorporates new elements such as the bowel cancer implementation programme which will focus on the introduction of Colofit. The programme will also continue to incorporate the delivery of Hepatocellular Carcinoma (HCC) Surveillance improvement initiatives, as well as a number of cross cutting workstreams including robotic surgery provision, capacity and demand management modelling support, MDT improvement, workforce and referral management optimisation, CDC utilisation, and the agreement and implementation of an inter-provider transfer (IPT) policy.

Beyond local performance improvement initiatives, the programme will take a wider leadership role, generating and coordinating large programmes of work to shift the dial on performance through transformation.

This takes the form of articulating target operating models (TOM) which are a statement of where the health-care system would like to develop as one and is appropriate in instances where local and structural barriers produce a limit to the performance improvement ambition. Examples include the establishment of a lung collaborative (supported by GIRFT), a skin summit which brings the whole system together across primary and secondary care to tackle each part of the pathway and address seasonal weakness, and a ‘Fit for the Future’ gynaecology plan which entails a root and branch review of the construction of gynae cancer services in Cheshire and Merseyside.

In line with the review of the wider CMCA clinical leadership model, governance processes within the programme priority pathways (Breast, Gynae, Lung, Lower GI, Skin, and Urology) will be reviewed and realigned under the newly established Specialty Boards. This approach will ensure that strong clinical leadership at the heart of operational improvement.

The programme has projects underway across several priority tumour sites.

For further detail on what each project involves, please contact ccf-tr.admin.cmca@nhs.net:

Breast

Senior Project Manager: Ashley Breckell ashleybreckell@nhs.net, Project Manager: Hannah Spriggs hannah.spriggs@nhs.net

The project aim is to support the sustained improvement of Breast FD performance and patient pathways for all Urgent Suspected Cancer (USC) and Symptomatic referrals. Breast has been highlighted as a National Faster Diagnosis priority by NHS England, so several goals have been set to support 28, 31 and 62-day performance within all Breast providers across Cheshire and Merseyside. This will look at quality of referrals, triage, triple assessment capacity and demand, supporting services such as Radiology, Pathology and Oncology, MDT optimisation, workforce, patient communication, treatment variation and low risk pathways which can diverted away from USC clinics (breast pain).

Clincal Lead- Sonia Bathla -Consultant Breast Surgeon

Colorectal

Senior Project Manager: Sarah Wood sarahwood7@nhs.net

The primary focus for 2026/27 will be the implementation of ColoFIT as part of the USC referral pathway and developing alternative pathways for those patients not meeting the referral threshold for USC because of this. There will also be work to further improve compliance with the Urgent Suspected Lower GI cancer referral pathway to improve CWT performance.

We will also support with symptomatic transformation projects to increase capacity for asymptomatic endoscopy and enable the implementation of FIT @80 in early 2027.

Clinical Lead- Miss Ramya Kalaiselvan - Consultant Robotic General and Colorectal Surgeon

Gynaecology

Senior Project Manager:Jen Hodge, jen.hodge@nhs.net Project Manager Sophie Kaye, sophie.kaye3@nhs.net

This programme aims to take forward the recommendations of the CMCA Gynae Cancer Review (2022) and deliver nationally mandated deliverables within the Cancer Alliances Planning Pack, contributing to the delivery of Faster Diagnosis standards and other key objectives to improve cancer pathways for patients. Work includes supporting Liverpool Women’s Hospital to transform Gynaecological cancer services as the primary regional centre and collaborating across the system, establishing Gynae cancer units at all trusts, development of localised unscheduled bleeding on HRT pathways and development of a C&M approach to follow up and support.

Clinical Lead- Ms Sally Pennington, Consultant in Obstetrics and Gynaecology

Hepato-Cellular Carcinoma (HCC) Surveillance

Project Manager:Laura Cesar laura.cesar@nhs.net

We take a lead role in improving liver surveillance services across Cheshire and Merseyside, focusing on identifying more people at risk of liver cancer, and diagnosing more liver cancers at an earlier stage.

Main areas of focus will be:

To develop a system-level dashboard. Using national surveillance coding, it will provide a system overview, highlight capacity priorities, and inform CDC utilisation and targeted interventions
Continue to support providers to progress IQILs accreditation. We will also identify any remaining providers (via an expression of interest) and fund their enrolment
Support providers to ensure all patients on HCC Surveillance are captured in a robust tracking system
Continue radiology improvement work including education, coding, standardised reporting, LIRADS, processes for automated call recall
Pilot the management of stable surveillance patients via a Community Diagnostic Centre(CDC) (Paddington). Assess options to extend pilot to other CDCs
Scope options for RPA to support the automation of some administrative burden experienced in services
Working with trusts to ensure compliance with the newly developed Cheshire and Merseyside HCC Surveillance Standard Operating Procedure and provide support to achieve a standardised service across the patch
Provide training opportunities to Liver Clinical Nurse Specialists to ensure a highly skilled workforce

Clinical Lead- Dr Ed Britton, Consultant Hepatologist

Lung

Senior Project Manager: Ashley Breckell, ashleybreckell@nhs.net, Project Manager: Jen Wright jennifer.wright46@nhs.net

The aim of the project is to continue the planned work outlined in the Lung Collaborative webinar in 2025, overseeing the governance and delivery of projects that collectively support the improvement of lung cancer performance across the region; projects including the below:

To maintain a focus on pathway improvement at provider level, via the completion of in-depth reviews (IDRs). This will include pathway analysis and process mapping which will result in fully developed improvement plans.

Introduce and utilise joint specialist tertiary clinics for neoadjuvant and high-risk patients, cutting the pathway days for patients and reducing multiple appointments

The implementation of a Single Queue Diagnostic (SQD) system across the system, to allow for quicker access to CT Guided biopsy, whilst also exploring scope for improvements in PET CT, pathology, CDC collaboration and the use of CT-DNA

On-going monitoring and any required improvement work related to - 70% of patients with NSCLC stage IIIB-IVB and PS 0-1 receiving systemic anti-cancer therapy (SACT)

Clinical Lead- Dr Andy Wight,Consultant Respiratory Physician

Skin

Senior Project Manager: Heather Morrison heather.morrison15@nhs.net, Project Manager: Kathryn Rees kathryn.rees2@nhs.net

The aim of this project is to produce a strategy which will ensure the long-term sustainability of skin cancer services across Cheshire and Merseyside, including consistently achieving 28- and 62-day standards set by NHSE. The strategy will focus on six workstreams: referrals, optimal triage, capacity and demand, standardised communication and patient information, consistent clinical management, and workforce optimisation, and will provide system partners with a clear plan and the necessary guidance with which to implement it. 

Clinical Lead- Mr Alex Benson Consultant Plastic Surgeon

Urology

Senior Project Manager: Sarah Griffiths sarah.griffiths16@nhs.net, Project Manager: Laura Cesar laura.cesar@nhs.net

The project aim is to support the delivery of the Cancer Waiting Times Standards and the Best Practice Timed Pathways for Urology. As identified by NHS England, Urology is classed as a priority pathway, and the main areas of focus will be implementing Standards of Care for optimising MDTs, utilising bladder bio-makers, diagnostic investigations, treatment variation and supporting radiology and pathology initiatives, as well as working with our providers and system partners to undertake urgent suspected cancer pathway improvement work.

Clinical Lead: Mr T Nambi Rajan Consultant Urologist

C&M Robotic Assisted Surgery Project

Senior Project Manager Carys Kinsella carys.kinsella2@nhs.net

The aims of this project are:

To review and establish the current context and scope of robotic assisted surgery across Cheshire & Merseyside for cancer and non-cancer surgical interventions;

To set out a gap analysis comparing current usage of robotic assisted surgery comparing current capacity with future demand and opportunities for growing robotic provision.

To develop a structured framework for delivery of robotic assisted surgery across Cheshire & Merseyside, based on the recommendations of the GIRFT Report, ‘Implementation of robotic assisted surgery, (May 2025) to ensure equitable future service planning and design.

Our programme also collaborates with other programmes at the alliance to deliver work on Referral Management Systems, Multi-Disciplinary Teams and Workforce optimisation.