NOSCAN Review Structure and Operating Framework

NoSPG is asked to:

• Approve the recommendations within the review

Aim

To describe the review process and subsequent recommendations

Purpose

48 stakeholders interviewed with emerging issues “themed” to develop recommendations. Key

themes of the report recommendations include:

• Increased clarity of purpose and function required, both in terms of roles within the

office and for the collaboration as a whole • Improved visibility of processes needed

• Data functions and capacity should be considered as a whole across the region

• Specialist skills required to support NOSCAN should be reviewed

• Urgent need for increased collaboration to sustain services across the NoS

Conclusion

NoSPG are asked to consider the detailed recommendations and agree that these

recommendations progress to an action planning stage.

NORTH OF SCOTLAND

PLANNING GROUP

Meeting: NoSPG

Date: 18th September 2013

Item: 42/13

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NORTH OF SCOTLAND CANCER NETWORK (NOSCAN) A Review of the Structure and Operating Framework July 2013

version Author / Amendments date

V0.1 JC 18/07/13

V0.2 JC / PG 24/07/13

V0.3 JC / RC 21/08/03

V0.4 JC / PK 02/09/13

V0.5 JC / PK / PG 03/09/13

V0.6 FINAL JC / RCAF 09/09/13

NORTH OF SCOTLAND PLANNING GROUP

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CONTENTS

Page

EXECUTIVE SUMMARY 3

INTRODUCTION

Summary of Recommendations 3

Background 4-6

MEHODOLOGY

Methods 7

Results 7-13

Discussion 13-14

CONCLUSIONS AND RECOMMENDATIONS

Detailed recommendations 14-15

Conclusion 15

APPENDIX I - Regional Workforce comparisons 16-20

APPENDIX II - NOSCAN Review Overview 21

APPENDIX III - List of Stakeholders 22-23

APPENDIX IV – Breakdown of NOSCAN and NoSPG staff 24

Acknowledgements

The author is grateful to interviewees for giving up significant amounts of time in order to

contribute.

In developing the questions and supporting the factual elements of the review the NOSCAN

Network Manager, Peter Gent, played a central role, as did the NOSCAN Clinical Lead, Peter King.

Other members of the regional planning team contributed hugely by arranging meetings and

“scribing”. This work was primarily carried out by Margaret Barton, Martha Hay and Ruth Nisbet.

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Executive Summary

NOSCAN as a collaboration of the six North of Scotland (NoS) Boards has been in existence for

11 years. The NOSCAN structure has evolved as the landscape for cancer services across

Scotland has changed.

The Scottish Government play an increasingly active role in quality performance monitoring and,

to a large degree, direct regional network activities, by setting national strategic direction and

supporting initiatives in specific areas, which often have regional aspects.

Nationally, cancer is one of the Scottish Government’s priorities, with a current focus on “Detect

Cancer Early”, development of national Quality Performance Indicators and increased scrutiny of

treatment, intervention and follow up support.

In the North of Scotland there are, currently, a range of sustainability issues including workforce

and treatment services, which will require new and innovative solutions. Short term solutions to

workforce issues are required; however a longer term view of future cancer services in the north

is urgently needed.

It is evident from this review process that NoS Boards increasingly recognise the need to work

together more, and that there is overwhelming commitment for the aims* of the NOSCAN

collaboration, ensuring the focus is on the needs of patients. With some adjustments, to

structure and process, those aims have the support of the constituent Boards and the NOSCAN

office.

* To facilitate collaborative work, across the 3 NoS Cancer Centres, for the benefit of patients.

Summary of Recommendations

• Improve longer term collaborative planning, as a matter of urgency.

• Increase clarity of purpose, commitment and structure.

• Boards should specifically address the need for a clear internal structure which supports

the aims of NOSCAN.

• Consider current MCN structures at Board and regional levels.

• Consider opportunities to streamline financial arrangements.

• Regional coordination of data and research functions should be considered.

• Increase focus on continuous improvement cycles.

• Improve communication at all levels.

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INTRODUCTION

Background

Three regional cancer networks were set up across Scotland following the launch of “Scotland

Against Cancer” (Scottish Executive Health Department 2001).

The three regional cancer networks serve different populations and configurations of cancer

services (see section “regional cancer networks”). In addition they are structured in different

ways with varying levels of staffing.

NOSCAN encompasses a range of primary care, diagnostic and interventional services, including

three specialist cancer centres, supporting work across a large geographical area, carrying

specific challenges associated with remote and rural cancer pathways.

Here we consider how NOSCAN, as a collaboration of cancer services in the north, functions;

assessing whether the network, including the regional office, is appropriately structured and

sufficiently resourced, to support Board, Regional and National priorities and those affected by

cancer, across the North of Scotland.

This review is concerned primarily with the structure and operating framework of the network

and is not concerned with aspects of service delivery or sustainability, which are the subject of

other focussed work (Operational review).

The review is sponsored by the chair of NOSCAN (Mr R Carey, CEO NHS Grampian) who, on

behalf of the Regional Cancer Advisory Forum (RCAF), commissioned The Director of Regional

Planning for the North of Scotland Planning Group (NoSPG) to carry out the review.

Regional Planning Group Alignment

The South East and Tayside regional cancer network (SCAN) is managed through the regional

planning group, with the network manager reporting directly to the Director of Regional Planning.

The West of Scotland regional cancer network (WOSCAN) reports through the regional planning

group but the network manager is not line managed by the Director of Regional Planning.

In the North of Scotland the regional cancer network reports through the North of Scotland

Planning Group and the network manager has been line managed through the acute sector

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management structure in NHS Grampian. In the recent past, due to interim arrangements in

regional posts, line management of the NOSCAN manager has fallen to the interim Director of

Regional Planning and these arrangements now require clarification.

Regional Cancer Networks

Specific comparisons between each regional cancer network and the resources available to them

are detailed in Appendix 2. This comparison shows the variation in how each network resources

and manages the cancer agenda regionally, demonstrating the difficulty in assessing whether

NOSCAN is appropriately resourced or not. Each of the regional cancer network managers and

colleagues from SCT described the differences in scale and the complexities of the arrangements

across each of the three regions.

Whilst NOSCAN serves a population of 1.3m, SCAN in the south east serves circa 1.3, and

WOSCAN in the west serves 2.6.

The challenges faced by NOSCAN, which works across three cancer centres and six NHS Boards,

with circa 23% of the population of Scotland spread across half of the total land mass of

Scotland, should not be underestimated.

What is evident from these comparisons is that:

• Data management and line management arrangements are inconsistent – the other

regional cancer networks have this resource but NOSCAN does not.

• There is consistency around funding arrangements for regional MCN clinical leads in that

no clinical leads are funded in any of the regional MCN structures.

• WOSCAN host a number of national networks and initiatives – this makes comparison of

capacity and output difficult when set against the compounding factors of differences in

population and number of cancer centres.

• Funding for Regional Pharmacist posts is not consistent across the networks – Each

regional cancer network has a regional pharmacy post and these are managed and

resourced differently.

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Funding Arrangements

NHS Grampian currently “hosts” NOSCAN in terms of financial management whilst NHS Tayside

play host to NoSPG financial arrangements. This may have the potential to cause ambiguity in

terms of the management of regional resources and currently relies on an excellent working

relationship between finance in NHS Grampian and NHS Tayside to run smoothly for certain

aspects.

Strategic aims of NOSCAN

NOSCAN's main objective on behalf of NoSPG (the North’s collaboration of Chief Executives and

Directors of Planning) is to promote equity of care and access to care by:

• negotiating with lead officers at SGHD and associated bodies to influence national policy;

• advocating cancer service improvement at Board and regional level;

• creating regional policies and securing adequate regional / local resources and investment to

implement them;

• planning at a regional level, those specialist cancer services appropriately provided at a level

beyond that of a single NHS Board, to the benefit of all patients across the North;

• identifying strategic gaps in services and leading national improvement projects on behalf of

NHS Scotland to rectify them;

• driving regional equitable improvements through NOSCAN wide MCN’s and sub-groups;

• creating long term regional cancer service improvement plans and directing local versions;

• delivering regional specific services and regional infrastructure;

• supporting implementation within the region at Board and service level;

• co-ordinating and integrating all cancer improvement effort in the North of Scotland;

• supporting redesign of cancer services to ensure they are delivered as efficiently as possible;

• ensuring collaboration across Scotland; and

• reporting on all of the above to NoSPG, its Boards, Scottish Cancer Taskforce and SGHD,

communicating these efforts and their outcomes to all members.

It is clear through the review process that the majority of these aims are being met. Some of

these aims have been explored further in the discussion section and specific areas have been

identified for future improvement.

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Methodology

Information was gathered from the three regional cancer network managers, and collated to

allow comparisons between the resource and structure across the regions.

Thematic, qualitative information was gathered by interviewing stakeholders (Appendix 3) using

structured questions to guide discussion. Interviews were transcribed and collated in an

anonymous format.

48 people were interviewed across a list of stakeholders including executive leads, operational

service managers and clinicians, NOSCAN office staff, patient representative, tumour specific lead

clinicians and general managers (Appendix 3 – list of stakeholders interviewed).

Discussions were held with Scottish Government colleagues (Scottish Cancer Taskforce),

focussing on the strategic direction of cancer services in Scotland, before recommendations were

finalised.

Questions (Appendix 2) were developed collaboratively with the substantive - and interim -

NOSCAN Network Managers, Clinical Lead and colleagues from the other regional cancer

networks. Input was also received from Scottish Government colleagues who lead the Scottish

Cancer Taskforce (SCT).

Questions were designed to gain some insight into how NOSCAN is meeting the needs of

stakeholders from across the spectrum. They were also designed to provide an opportunity to

highlight where regional planning and working has worked well, so that success criteria could be

gauged and built upon in future work.

Questions gave interviewees the chance to provide specific suggestions for improvement and

these have been listed later in the results section.

Whilst every effort has been made to conduct interviews in an objective and standardised way,

the report author does not purport to have used a robust scientific methodology in developing

recommendations.

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Interview Results

Collated interview outputs have been themed in the discussion section to support the formulation

of strategic recommendations, for consideration by the Regional Cancer Advisory Forum (RCAF).

Communication

The majority of respondents indicated that excellent communication was evident across the

network with relevant information being passed on timeously and available on the NOSCAN

website thereafter.

A significant number however indicated that there were obstacles in terms of communication

which ranged from too much information from the NOSCAN office (and no time to read it); to a

small number of respondents indicating that there was some work required around maintaining a

consistent and structured approach to communication between the NOSCAN office and

appropriate levels within Boards.

The majority of respondents indicated that they didn’t know the specifics of the NOSCAN work

plan or how it was prioritised, but in most cases felt there were appropriate mechanisms in place

to influence items on the work plan if the need arose. Generally there was a feeling that the work

plan was in the main dictated by national priorities and was in part disconnected from frontline

services.

A minority of those interviewed were concerned about a lack of inclusiveness when NOSCAN

office staff were involved with discussions at local level. On occasions discussions had taken place

with senior clinicians, with operational managers not always included appropriately.

“Links are better in local Boards when there are well functioning groups”

“A communication strategy was agreed for NOSCAN through local Boards and there are good distribution lists with a wide information sharing”

“Need some governance locally and a process to be set up”

“These are not fit for purpose”

“Engagement is highly important”

“The web site is excellent”

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Structure

Respondents were generally comfortable that existing resources within the NOSCAN office was

adequate, although the majority commented that they were not sufficiently close to the day to

day running of the network office to comment in detail.

In discussion, around the team and their roles, most felt that there was fragility and unnecessary

fragmentation in data functions (audit, tracker and research teams) and a lack of regional

coordination. It was generally recognised that this fragmentation was as a result of differing

funding and line management arrangements for the various staff groups.

Board structures were reported as “patchy” in terms of meeting local needs and also the wider

needs of the network. Some reported robust local processes but the majority were either unclear

or indicated that local structures weren’t functioning well. Respondents reported varying levels of

engagement with these structures and cited this as a symptom of the lack of clarity or the

functionality of that structure.

Roles within the NOSCAN office were almost universally reported as being unclear with a number

of responses indicating that these roles had become blurred over the past 1-2 years. This lack of

clarity was around specific responsibilities of the NOSCAN office (lack of overall clarity of

purpose) but was also focussed on how combined roles between the NOSCAN office and NHS

Grampian had led to uncertainty as to when some members of staff were acting on behalf of NHS

Grampian and when they were acting on behalf of NOSCAN.

“There is a perception that loyalties exist within NOSCAN to Aberdeen”

“We have a strong network and it fits well with NOSCAN”

“When it falls down it’s because of communication at local level”

“Audit capacity is an issue across all Boards”

“We need fully functioning MCN’s which need support and we are light on this”

“WOSCAN and SCAN employ audit staff linked through the regional network. We do not have anyone with data management skills to pull the North’s

information together”

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Board, Regional and National – tumour specific – MCN’s were raised by a number of respondents

as requiring some thought, perhaps rationalisation. In some areas Board MCN’s were thought to

duplicate Regional MCN activity and in others regional MCN activity was thought to be better

served by a national MCN. There was wide ranging support for the regional MCN manager role to

be focussed solely on MCN activities, to fully establish and maintain collaborative networking

opportunities across all tumour types. Respondents recognised that the MCN structure could be

improved by additional support.

There was broad recognition that national work streams would bear fruit in the fullness of time

and there was enthusiasm for the aspirations of the various national initiatives, however there

was uncertainty as to how managers and clinicians could be supported in a practical way to

engage fully with these initiatives, when there were such immediate and urgent needs around

delivering services on a day to day basis. Capacity and sustainability of frontline services being

foremost for the majority interviewed.

Few interviewees understood the relationship between NOSCAN and NoSPG and a very few

indicated that NOSCAN was on occasion viewed as a standalone entity.

Some referred to the perception of NOSCAN being “Grampian Centric” and factors alluded to

were the lead roles all being sourced from Grampian (Chair, Manager and Clinical Lead).

Most recognised that there was a clear structural role for NOSCAN and that role should be

focussed around sharing good practice, collating and presenting relevant data and facilitating

improvement work based on priorities set by the Boards and by national strategic direction (via

initiatives from SCT).

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Improvement suggestions

A summary of suggestions for improvement is included below:

• Improve communication lines at all levels

o Clarify Board communication structures

o Summarise communications to Boards where possible

o Tailor visits to suit Boards

• Review internal NOSCAN office structure

o Ensure capacity is in the right areas

• Hold regular NOSCAN meetings to develop the Continuous Improvement role

• Increase operational engagement by increased attendance by NOSCAN manager at

operational meetings within Boards

These improvements were generally based on the areas reported elsewhere in the results

section, and therefore need no further exploration here.

“Availability of figures re workload would be good; also outcomes data not yet available via audit”

“We need more work on how quality priorities can be delivered within the given

workforce or discuss what extra help is required”

“Need to see more data and research”

“opportunity to look at the future rather than crises management”

“Don't think they involve the right people - the people at the 'coal face' need to be consulted about the practicalities of a service”

“The NoS needs to operate as a region, similar to the SEoS and the WoS,

despite having 3 centres”

“we have to have infrastructure”

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Sustainability

A number of specific sustainability issues emerged with overriding short term concerns around

capacity (oncology workforce and radiotherapy most specifically) and concerns around the

medium term, recognising that the three oncology centres in the north might not be able to

continue to operate as separately in future. Competition for workforce in a small “pool” was

described by many as a specific hindrance to co-operative working.

It was recognised that some tumour specific pathways were already supported by the larger

cancer centres in the central belt, however there are potentially others who may require

innovative regional solutions and different levels of support, on a more sustainable long term

basis.

There was a high level of support for a short term piece of work to support immediate

sustainability issues and recognition that a project considering the longer term requirements of

cancer patients in the NoS is required. This would need to include Board, Regional, inter Regional

and National options. Many who were interviewed suggested that realistic sustainable service

models would support recruitment across the north and that recent short term crises had the

effect of making NoS posts being perceived as less attractive to prospective applicants.

“There is no resilience in the service - if it is one person down, then that is a big problem”

“3 issues - Workforce - transport – beds”

“Increasing numbers of patients, increasing numbers of therapies, more

specialisation necessary and difficulty in delivering best modern therapy to all patients”

“it is very much fire fighting and trouble shooting”

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Regional Working Exemplars

Support for regional working was evident and provided a number of examples where respondents

could clearly describe how the work had come about and what the success factors were. These

include:

• Upper GI surgery

• Gynaecological surgery

• Cross boundary support for elements of pathways delivered in remote areas

On further questioning respondents cited a number of success factors for these pieces of work,

however credible and effective clinical leadership was - by far - the most commonly described

factor.

Financial arrangements

Some respondents felt that clearer alignment with NoSPG, financial management arrangements,

would improve clarity and standardisation around regional processes. The majority of

respondents did not comment specifically on financial aspects of NOSCAN

“Good example was RARARI project which established chemo on the islands”

“The gynae network is a good example of a service that works regionally”

“Upper GI cancer services review”

“NOSCAN excels at regional project work”

“Improvements could be made by ensuring clarity around specific monies, and how network colleagues can have input into their use and reported at RCAF on

how they are spent”

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Discussion

In general stakeholders were very positive about the role of NOSCAN and although frontline

cancer services are currently under severe pressure there are clear opportunities to reduce that

pressure by working more collaboratively across the three cancer centres in the north.

A range of views were expressed throughout the interviewing process. The majority of these

were positive with a very few expressing frustration or difficulty in specific areas.

Board boundaries were sometimes cited as an obstacle to this collaborative approach by falsely

putting territorial priorities ahead of patient led priorities.

It is evident from the interviews that there is a desire to plan across the region acting more as

one regional service with support from the larger centres where appropriate. This planning

process needs to take cognisance of the co-dependencies between aspects of cancer pathways

and the location of delivery. Interviewees were mainly concerned with the care which would be

required around maintaining stability of surgical services in certain locations, by developing more

secure regional loci, potentially on a tumour specific basis.

There were a number of regional planning / working successes which demonstrated that, given

the right conditions and success factors, cross boundary arrangements can work extremely well.

There was recognition that improved non medical pathways in primary care, making more and

better use of community resources, could alleviate some of the pressures currently bearing down

on acute services.

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Detailed Recommendations

• The 3 NoS cancer centres should collaborate on developing sustainable

pathways for the long term, on a shared risk basis.

There are clear opportunities within the north region, based on this approach, where some pathways will undoubtedly involve support from the larger cancer centres and

others require new ways of working across the three NoS centres. Supporting these

developments in a planned way will secure safe and robust patient care in the NoS in the

longer term.

• The strategic aims and the role / remit of NOSCAN should be clarified.

Ensuring that Boards and the NOSCAN office are clear about expected outputs from the

collaboration.

• Boards contributing to the NOSCAN collaboration should clarify internal lines

of communication. Working closely with the NOSCAN office boards should identify particular communication

needs and support, which will support smoother communication from clinical staff and

managers through to regional groups.

• Responsibilities & roles in the NOSCAN office should be clarified.

These roles should be clarified, and made explicit, in terms of supporting the aims of NOSCAN alone. This will address the perception that the function of some roles has

become “blurred” by directly and indirectly supporting operational delivery within individual Boards.

• The relationship between NOSCAN and NoSPG should be made more explicit.

Clear line management of roles, and devolved responsibilities should be detailed, including decision making and lines of reporting.

• NOSCAN financial management, at a high level, should be amalgamated with

NoSPG financial functions.

Increased standardisation of processes across regional functions will ensure financial

reporting to collaborating Boards is streamlined.

• The NOSCAN office should clarify processes for agreeing items on the regional

cancer work plan. This will ensure stakeholders are clear how the work plan is constructed and what

process is used to prioritise.

• Data and research functions across the region should be linked more

explicitly.

It is evident that data functions are fragmented and sometimes fragile across the region, and sometimes within Boards. A coordinated approach could potentially deliver better

value for money, increase flexibility and increase the clinical benefits from an ability to

describe in detail cancer pathways, across the region, on a reliable and standardised

basis.

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• The NOSCAN office should develop an increased role around continuous

improvement (CI).

Services recognise the benefits of this type of activity and are keen to see NOSCAN

deliver on a broader CI agenda where they can build upon data collection cycles by

presenting data and facilitating learning.

• The NOSCAN office should facilitate improved collaboration between Boards,

the regional cancer advisory group and services.

Some support is required to promote a coordinated and transparent approach, to cancer

pathway development in the NoS. This should include appropriate escalation processes

within boards to ensure collaborative regional opportunities are not missed.

• Regional specialty resources should be reviewed in detail and considered as

part of a development plan to support current or future NOSCAN work. Although there are some mixed views, there is support for the role of regional

pharmacist. Consideration should be given to a substantive regional Pharmacist post

along with a review of other specialty skills and the ongoing need.

• NOSCAN should put in place a cyclical process to self appraise and review

processes. This should include review of lead role tenure / rotation and geographical distribution to

ensure engagement from all NoS cancer centres.

Conclusion

By keeping the patient at the centre of every planning decision, Board boundaries become less of

an obstacle and we can support sustainable pathways as close to home as possible, for the good

of patients in the north of Scotland.

This review process concludes with a series of recommendations which are presented to the

Regional Cancer Advisory Forum (RCAF) for discussion and agreement.

Implementation of these recommendations will require a series of actions, the majority of which

would be comparatively easy to achieve. Others, such as frontline service challenges will require

further extensive work but provide longer term stability and a streamlined approach to service

planning and delivery across the north.

Jim Cannon

Director Regional Planning

North of Scotland Planning Group

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Appendix I

NOSCAN Review - 2013

Aims of the Review

• To describe the background to the development of NOSCAN.

• To describe current NOSCAN staffing structures and funding arrangements.

• To describe other regional cancer networks, staffing structures and arrangements.

• To assess how well current NOSCAN arrangements meet the needs of the cancer

agenda.

• To establish the likely future function of NOSCAN to best meet the cancer agenda.

• To describe how NOSCAN currently interacts with NoSPG.

• To make recommendations on future network arrangements and interactions with

NoSPG.

Purpose and General Approach

This review has been instigated by the Chair of NoSPG and the Chair of NOSCAN and should be

viewed as part of routine processes to ensure continuation of the most appropriate and effective

support to cancer services across the North of Scotland.

NOSCAN is a collaboration between NHS Boards in the North of Scotland, which exists to plan

and deliver sustainable services to the population of the North and is supported by a small team. This review seeks to assess how well the cancer agenda is being served by this collaboration,

both within Boards, across the region and nationally, but also within the network office itself.

The review will be conducted as a series of semi-structured interviews (Appendix I) with

stakeholders (Appendix II) either in person, by VC or by telephone.

Strategic Context

NOSCAN's main objective is to promote equity of care and access to care throughout the North of

Scotland by planning, at a regional level, those cancer services appropriately provided at a level

beyond that of a single NHS Board, to the benefit of all patients across the North of Scotland. In addition NOSCAN has a clear remit in areas beyond planning, for example around data collation

and reporting.

NOSCAN acts on behalf of NoSPG to improve cancer services. NoSPG has delegated authority,

through the Board Chief Executives of the collaborating NHS Boards, to act corporately to ensure

the provision of services for the population of the North of Scotland. NOSCAN is therefore

responsible for the regional planning of cancer services. This means that we must ensure that cancer services are configured to deliver the best possible care for the population of the North of

Scotland as a whole.

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Scope and Accountability

As part of normal business within NoSPG, the review will be led by the Director of Regional Planning (Jim Cannon) with reference to a small review group consisting of external and internal

stakeholders. It is anticipated the review group may need to meet once or twice, however the

majority of input should be by email.

Timescales/Reporting

The review will be completed by June 2013 and will report to the NoS Regional Cancer Advisory

Forum (RCAF) and the North of Scotland Planning Group (NoSPG) thereafter.

Output

The final output of this review will contain:

• A description of the evolution of NOSCAN including a list of CEL’s which inform the work

plan.

• A clear description of the roles within the NOSCAN office:

o overview of responsibilities;

o lines of accountability;

o unfunded roles being carried out; and

o comparison with the other regional cancer network structures.

• A clear description of roles and responsibilities outwith the NOSCAN office, upon which

the work plan relies heavily:

o NHS Boards;

o Tumour specific – regional – MCN's; and

o Tumour specific – national – MCN’s.

• A description of funding arrangements including funding for roles and projects split by:

o central funding; and

o Board funding.

• A summary of stakeholders’ views on whether NOSCAN is achieving its strategic aims:

o from Board, regional (including inter-regional) and national perspectives.

• A summary of stakeholders’ views on future support required from NOSCAN.

• A clear description of how NOSCAN and NoSPG work together in terms of:

o Governance; o line management responsibility; and

o financial management.

• Options which will meet the strategic aims and Board requirements, where these are not

already being met, clearly identifying recommended options.

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Resources

The Director of Regional Planning will spend time working on the structured interviews and write

up of the final output and will liaise closely with the NOSCAN manager and other NOSCAN staff as appropriate, to contribute to meetings with stakeholders and also to supporting detailed work

around the current arrangements.

Jim Cannon Director of Regional Planning

Attachments: Appendix I – Interview Structure/Questions

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Appendix 1

Name: Title:

Tel No: Email:

Questions Comments

1.

How does your Board agree locally, the strategic cancer

priorities, requiring regional support/development? E.g. • Department level

• Sector / Divisional level

• Planning Department / Board level (such as

strategic cancer steering groups)

2.

How do you/your Board agree locally, the appropriate representation and participation in the established regional

structures e.g. Regional Cancer Advisory Group, NCAG, tumour specific MCN’s?

• Department level

• Sector / Divisional level

• Planning Department / Board level (such as

strategic cancer steering groups)

3.

What are the current structures and systems for communication, both locally and regionally for engaging

with regional cancer initiatives and are these fit for

purpose?

Yes / No

4.

How aware of the work that is being devolved nationally

(SCT) through the regions?

5.

What are the mechanisms to enable you/your Board to

engage/ influence the Regional Cancer Work plan?

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The current regional cancer office comprises of a Clinical Lead (2 sessions p/w equivalent),

Regional Manager (1.0 wte), Tumour MCN Manager (1.0 wte), Regional Cancer Pharmacist (1.0 wte fixed term appointment) and Administrative / PA support (1.0 wte). The office is supported

by a Chair, which rotates between the NoS Chief Executives.

Questions Comments

6.

(a) Do you consider the existing regional office support sufficiently resourced and structured to deliver current

and emerging priorities?

Yes/No

(b) Are you clear about roles and responsibilities of the

NOSCAN office?

Yes/No

7.

The national review of regional planning (2012)

highlighted the cancer networks as an example of

successful regional working. Are there any specific

examples that you or your Board may wish to highlight?

8.

Continuous improvement cycles require us to continually review whether we are providing the best possible

service. Please make any general comment here about

how regional cancer planning could better fit your needs,

being as specific as you can about suggested

improvements.

9.

Are you clear what specific items are in the current NOSCAN work plan?

Yes / No

10.

Are there major risks to sustainability of cancer services

within your Board / region?

Yes / no

If so what are those risks and how can they be mitigated?

11.

Can you provide examples of how data collection has

informed Continuous Improvement locally?

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Appendix II Regional network comparisons

Core Regional Cancer Network Resources

NOSCAN Personnel / roles

Regional Clinical Lead (2 sessions per week)

Regional Manager (1.0 wte)

MCN Manager (1.0 wte)

Regional Cancer Pharmacist (Fixed term until June 2014) (1.0wte)

Tumour specific MCN leads x 7 (1-2 sessions per week)*

*unfunded from regional budget

PA / Administrative support (1.5 wte)

SCAN Personnel / roles

Regional Clinical Lead (2 sessions per week)

Regional Manager (1.0 wte)

MCN Manager (1.0 wte)

Modernisation Manager (1.0 wte)

Groups & Communications Co-ordinator (0.9 wte)

Information Systems Developer (0.6 wte)

Executive Assistant (1.0 wte)

Administrator (0.5 wte)

Cancer Audit Manager (1.0 wte)*

*funded by NHS Lothian,

managed by

Regional Manager

Tumour specific MCN leads x 9 (1-2 sessions per week)

WOSCAN Personnel / roles

Regional Clinical Lead (2 sessions per week)

Regional Manager (1.0 wte)

Network Service Manager (1.0 wte)

MCN Managers (2.8 wte)

Administrative support (2.0 wte)

Tumour specific MCN leads x 8 (1 session per week)*

National MCN Manager** (1.0 wte)

National MCN Administrator** (0.8 wte)

Project Managers (2.0 wte) National Quality Programme**

Administrative Support for Quality Programme (1.0 wte)**

*unfunded from regional budget

**funding to host support

national MCN / projects

NB: Regional Cancer Pharmacists substantively in position in both SCAN & WOSCAN and structurally aligned to Pharmacy services.

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Appendix III

NOSCAN Review 2013 - Stakeholders

Peter King NOSCAN Lead Clinician NHS Grampian

Shelagh Bonner-Shand Interim NOSCAN Manager NOSCAN

Peter Gent NOSCAN Manager NOSCAN

Neil McLachlan NOSCAN MCN Manager NOSCAN

Mark Parsons Macmillan Regional Cancer Pharmacist NHS Grampian

Jane Tighe Cancer Centre Lead NHS Grampian

Marianne Nicolson NOSCAN MCN Lead, Lung NHS Grampian

Sami Shimi NOSCAN MCN Lead, Upper GI NHS Tayside

Dominic Culligan NOSCAN MCN Lead, Haematology NHS Grampian

To be appointed NOSCAN MCN Lead, Gynae NHS Grampian

Elizabeth Smyth NOSCAN MCN Lead, Breast NHS Grampian

Malcolm Loudon Board Clinical Lead and NOSCAN MCN Lead, Colorectal NHS Grampian

Satchi Swammi NOSCAN MCN Lead, Urology NHS Grampian

Lindsay Campbell National MCN, Hepatobiliary, Neuro-oncology & Sarcoma GG&C

Stephen Thomas Board Clinical Lead NHS Highland

Marthinus Roos Medical Director and Board Clinical Lead NHS Orkney

Gordon McFarlane Board Clinical Lead NHS Shetland

Alan Cook Interim Board Clinical Lead and Interim Cancer Centre Lead NHS Tayside

Gerte Plappert Board Clinical Lead NHS Western Isles

Lorraine Urquhart Local Cancer Services Representative/Manager NHS Grampian

Derick Macrae Local Cancer Services Representative/Manager NHS Highland

Simon Bokor-Ingram Local Cancer Services Representative/Manager NHS Shetland

Kerry Wilson Interim Local Cancer Services Representative/Manager NHS Tayside

Rachael Dunk Unit Head, Clinical Priorities Team SGHD

Evelyn Thomson Regional Manager WOSCAN

Kate McDonald Service Improvement Manager SCAN

Aileen Keel Deputy Chief Medical Officer SGHD

William Moore NoSPHN representative

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Bob Cromb NOSCAN Patient representative

Ruth Nisbet NOSCAN PA NHS Grampian

Roelf Dijkhuizen Medical Director NHS Grampain

Ian Bashford Medical Director NHS Highland

Roger Diggle Medical Director NHS Shetland

Andrew Russell Medical Director, Tayside NHS Board NHS Tayside

Jim Ward Medical Director, Western Isles NHS Board NHS Western Isles

Gill Chadwick Macmillan Lead Cancer Nurse, NHS Western Isles

Chrissie Lane Cancer Care Nurse NHS Highland

Sue Brown Unit Operation Manager, Grampian NHS Grampian

Clare Smith (Asst) Divisional Manager NHS Grampian

Margaret Somerville Director, Public Health NHS Highland

Roseanne Urquhart Regional and National Planning Lead (Acute Services) NHS Highland

Sarah Taylor Director, Public Health NHS Shetland

Nigel Hobson Nurse Director/Chief Operating Officer NHS Western Isles

Cara Taylor NOSCAN Nurse Consultant (rotational post) NHS Tayside

Lorna Wiggin Moving to new post on 1 July so speak to Jim (Kim Carr PA) NHS Tayside

Derek King Consultant Paediatric Haematologist NHS Grampian

Hugh Bishop Consultant Paediatric Oncologist NHS Grampian

Jim Foulis Clinical Service Manager - Renal NHS Tayside

1:1 meetings have been arranged (in person / by VC or TC)

Meeting couldn't be arranged within timescale

No Response

Questionnaire returned, no meeting held

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Appendix IV

NOSCAN Regional Office (September 2013)

Clinical Lead 2 sessions p/w equivalent

Regional Manager 1 whole time equivalent

Tumour MCN Manager 1 whole time equivalent

Regional Cancer Pharmacist 1 whole time equivalent (fixed term appointment)

Administrative/PA support 1 whole time equivalent

NoSPG Regional Team (September 2013)

Director of Regional Planning 1 whole time equivalent

Programme Manager 1 whole time equivalent

MCN Managers (Child Health) 2.6 whole time equivalent

Project Manager (Dental, Cardiac, Workforce) 1.0 whole time equivalent

Executive Assistant 1 whole time equivalent

PA/Administrator 1 whole time equivalent