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Velindre Cancer

Strategy2016 - 2026

SHAPING OUR FUTURE TOGETHER

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TABLE OF CONTENTS

What are we about?..................................................3Forward....................................................................4How was this strategy developed?..............................7Where are we now?.................................................10Where do we want to be?........................................18How will we get there?............................................25How will we know we have got there?......................65

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OUR VISION

We want to lead in the delivery and development of compassionate, individualised and effective cancer care to achieve outcomes comparable with the best in the world.

Providing the best care with you when you need usOUR

MISSION

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1 Ahmad A.S., Ormiston-Smith N. & Sasieni P.D. (2015). Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. )British Journal of Cancer2 Macmillan (2015) Statistics fact sheet. 3 Macmillan (2015) Statistics fact sheet.4 Cancer Research UK (2014) Beating Cancer Sooner: Our Strategy 5 WCISU (2016) Population cancer incidence, mortality and survival with latest 2014 update data6 Macmillan (2015) A vision for cancer services in Wales to match the best in Europe7 WCISU (2016) Population cancer incidence, mortality and survival with latest 2014 update data8 WCISU (2016) Population cancer incidence, mortality and survival with latest 2014 update data

ForewordThe number of people who are diagnosed with cancer is increasing each year; in the UK, one in two people born after 1960 will be diagnosed with some form of cancer during their lifetime.1 In Wales, over 19,000 people are diagnosed with cancer every year. This is expected to continue to grow by 2% per year until 2030. By then, it is expected that 250,000 people living in Wales will have had a cancer diagnosis.2

As treatments have improved over the last 40 years, more people are living longer with cancer, survival following a diagnosis of cancer has doubled, and the focus has moved from being mostly about dying with cancer to living with and beyond cancer. In 2015, over half of people living with cancer are long-term cancer survivors (over 5 years from diagnosis)3 and it is hoped that by 2030 this figure will increase to above 75% .4

However, cancer still remains one of the main causes of death in Wales, accounting for nearly a third of all deaths. In 2014, there were 8,933 cancer deaths registered in Wales which was an increase of 7% since 2005.5 Outcomes for patients with cancer still fail to match those achieved by the best performing, or even the average performing countries. The latest figures show that we are currently 10 years behind the best in Europe for cancer survival in Wales.6

In addition, the gap in incidence and mortality between the least and most deprived socio-economic groups is widening and in some of our poorer communities, the incidence of breast and lung cancer are 63% higher with a much greater risk of mortality at one and five years in these communities.7 Forty percent of cancers are thought to be related to lifestyle factors. For example, between 2001- 2014, the biggest increase in incidence was seen in 65-69 year olds, mainly in women and partly due to preventable factors such as smoking, being overweight or obesity, poor diet, alcohol consumption, too much UV light and lack of exercise.8

The good news is that basic scientific and clinical research is developing new treatments which are targeting more precisely at an increasing rate, with drugs targeting the genetic and molecular causes of cancer and with radiotherapy using computer technology to avoid normal tissues. However, these treatments are becoming more complex and costly.

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The rising demand due to the ageing population, the increasing incidence and prevalence of disease and new treatments, together with the need to improve outcomes is all set in the context of an unprecedented period of financial austerity, and what are likely to be limited resources for health services for the foreseeable future. There is undoubtedly a need for us to take clear and decisive action.

In NHS Wales, we need to work in collaboration to:

Our cancer strategy therefore sets out how we can contribute, as a treatment centre, to optimise these population outcomes.

Our core role as a cancer centre is to deliver effective evidence-based cancer treatment; give support to live with and beyond cancer; and provide care at the end of life.

We also know that there is more we can do to play our part in the prevention of cancer and its early diagnosis, and we are keen to explore our role within this beginning stage of the patient pathway.

It is within this context that we set our vision:

Improve survival rates

Improve quality of life

Improve experience for patients, carers and families

To lead in the delivery and development of compassionate, individualised and effective cancer care to achieve outcomes

comparable with the best in the world.

We know that this vision is ambitious and that we cannot achieve it alone; it is dependent on collaboration and co-production with our stakeholders, including patients, carers, families, our staff, health boards, third sector parties, institutions of higher education and a number of other services.

To help us map out our road to achieving this vision, we have set ourselves 5 strategic aims: 1) Equitable and consistent care, no matter where 2) Access to state-of-the-art, world-class, evidence-based treatments3) To improve care and support for patients to live well with cancer 4) To be an international leader in research, development, innovation and education5) To work in partnership with stakeholders to improve prevention and earlier detection of cancer

This strategy outlines how we will achieve these aims and provide excellent, efficient, and equitable services, enabled by our talented and skilled workforce; improve information and communication technology; and harness the power of our strong and much loved brand, all in a sustainable manner.

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Our efforts will be underpinned by the principles of continuous improvement; always striving for excellence, sharing decision making and providing the very best patient experience. Importantly, our healthcare interventions will be prudent. We will focus on those initiatives which deliver the greatest value. To understand the value of our interventions we need to be aware of their cost and measure their outcomes.

Patients must be treated as individuals, with compassion, dignity and respect throughout their patient journey. The strategy seeks also to harness the energy of patients and communities and encompass their responsibilities to the health service. This means taking personal ownership for preventing illness and managing health; getting involved in the design and optimisation of services; and providing knowledge as experts through experience. It will also be reliant on the culture and attitude of health care professionals in embracing co-production with patients, seeing them as equals in decisions about their treatment and care.

This strategy has been co-produced with patients, professionals and our communities and is focused on the values that they have identified as being important to their health and wellbeing. The strategy is also closely aligned to Velindre NHS Trust’s Building Excellence strategy and helps embed our organizational values into day to day practice.

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How was this Strategy Developed?

Our People, Our Values – Making it Personal

The most important partnership we have is with our people. Both our staff and the people we provide a service to are at the heart of our organisation and shape what the organisation is today and what it will need to be in the future. In developing our strategy, we have been given the valuable opportunity to listen to people as they tell us what they think, what is important to them, and what their values are.

Based around the principles of Prudent Healthcare, this has allowed us to develop the following concepts:

Engaged, informed individuals, carers and families – enabling individuals to be involved more fully in all decisions about their care, to self-manage and truly say ‘No decision about me without me’;

Organisational and clinical processes – structured around the needs of patients, persons and carers using the best evidence available;

Health and care professionals working in partnership –listening, supporting and collaborating for continuity of care. Professionals starting with patients and people, not services;

Maximizing the contribution our people can make to imagining better cancer care – Over 80% of all patients with solid tumour cancers diagnosed in South East Wales will be cared for and their needs supported by Velindre at some stage during their illness; over 70,000 people affected by cancer, including patients, carers and families walk through our doors every year. This in itself is an immense wealth of experience and opportunity, which could be harnessed and used to improve the way that we integrate and provide care and encourage involvement in our organisational in a far more profound and fundamental way. We believe that this social contribution to the way in which we imagine better care is a key, but vastly underused, facet of the prudent healthcare principle of co-production.

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We have concentrated our efforts on developing the simple concept of co-production. This is an approach to developing health care and wider public services which involves people, communities and professionals in pooling their expertise to design and deliver more effective and sustainable outcomes and improved experience for all involved.

In co-production, citizens and patients have rights and responsibilities as equal partners with healthcare professionals and services. This can be at an individual or community level and can involve the public sector, the third sector and other agencies. The co-production process begins with the question ‘How do you want to live your life?’ rather than ‘What services are you eligible for?’

What did our People Tell Us: Patients, Carers, Families, Citizens?

What matters to me?

Our patients, carers and families have told us what is important to them.

Choice: People want more choice about what treatment and services they use, including where and how they access them;

Control: People want more control of their treatment decisions and to ensure we focus on the things they value most in life;

Communication and information: People want information about their diagnosis and treatment, together with uncomplicated and effective communication about the options they have. They also want the communication between the providers of services to be seamless and have these providers support their care;

Independence: People want to be supported to achieve their aims and the things they value most from the services they need. They wish to retain their independence as they live with and through cancer;

Highest quality of life: People want to receive the services and support that enable them to achieve the highest quality of life and delivers the things they value the most.

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What matters to our staff?

Our staff are an incredibly valuable asset within our organisation; their skills, experience, commitment, dedication and passion keep our services running and improving continuously every day.

Our Building Excellence Workforce and Organisational Development Strategy outlines how over the next 3-5 years the Velindre NHS Trust will develop a culture that enables each of us to be great and achieve the delivery of ambitious and exciting service change plans.

Development of this strategy involved a process of engagement. Based on conversations with staff, we know we need a values-driven culture where world-class services are delivered by a workforce that understands the difference it makes to the patient experience.

What our staff told us?

Our staff have identified the issues which matter most to them within the organisation.

Our organisational values reflect this.

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Where are we now?

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We deliver specialist non-surgical oncology services for a population of approximately 1.5 million people within the South East Wales area, and for some specialist services, provide support for the whole of South Wales.

We provide a wide range of services including:

Our specialist teams provide care using a well-established network multi-disciplinary team (MDT) model of service for oncology and palliative care, working closely with local partners and ensuring services are offered in appropriate locations in line with best practice standards of care. Our radiotherapy services are currently centralised at Velindre Cancer Centre, whilst our SACT and outpatient services are provided both centrally at Velindre Cancer Centre and in an outreach setting within our partner local health boards across South East Wales.

We are an ESMO (European Society for Medical Oncology) certified centre for integrated palliative care services. We have developed a strong reputation within Wales and beyond; over the years the ‘Velindre brand’ has become synonymous with ‘excellence’. We take pride in providing a first-class patient experience and are determined to further enhance the ‘Velindre Way’ by placing people at the centre of everything we do and going the extra mile.

The Services we provide

Systemic Anti-Cancer Treatments (SACTs)

Radiotherapy

Inpatient Care

Outpatient Care

Pharmacy

Diagnostics (specialist radiology)

Nuclear medicine - diagnostic and therapeutic

Specialist palliative care

Acute oncology hub

Teaching and education

Research and development

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Wales’ survival rates compare unfavourably with other counties. There remains some significant variation between performance in Wales and that of other United Kingdom countries.In Wales, we have:

Reasons for variation include those the health service cannot influence such as epidemiology, but also a number that can be.

Poorer performance in Wales is associated with:

As a specialist treatment centre, our outcomes following treatment are very good, and our head and neck, upper GI and gynae-oncology teams have published survival data comparable with other similar centres. However, whilst we play an important role in improving patient outcomes through delivering fast and effective evidence-based treatment and care, we are only a small part of the system and patient pathway.

Hence, we know that we need to do more to integrate support from the public, patients and colleagues elsewhere in the patient pathway, in the areas of prevention and early diagnosis, in order to improve outcomes for the population.

Our role in improving survival

The lowest of 1 and 5 year survival rates for colorectal cancer in the UK.

The lowest of 1 and 5 year survival rates for lung cancer in the UK.

The lowest of 1 and 5 year survival rates for breast cancer in the UK.

The lowest 1 and 5 year survival rates for colorectal, lung and breast cancer when compared with Australia, Canada, Denmark and Sweden.

Later diagnosis in the UK with cancers diagnosed at a later stage than comparator countries.

Unequal access to optimum treatment in the UK as suggested by variation in survival by stage when compared to other countries and lower survival for advanced stage disease in the UK.

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Our role in providing the best patient experience

At Velindre Cancer Centre, we pride ourselves on always delivering an excellent patient experience and believe that patient experience is not just about a survey or a buzzword; it is about a shared commitment to listening and learning across the whole organisation. It is fundamental that everyone understands and values the importance of delivering an excellent patient experience which is embedded within our culture.

We believe that a good patient experience is created through the following principles:

1. 2.

3. 4.

There are a number of ways in which we listen to our patients and their experiences. The Wales Cancer Patient Experience Survey 2013 (CPES) is designed to monitor national progress on cancer care. Overall Cancer Patient Experience Survey (CPES) satisfaction scores are high for Velindre Cancer Centre, but there is much more that could be gained from developing a person-centred values approach to what we do.

We also use surveys based on the NHS Wales service user experience framework, and have face-to-face conversations with our patients each month based on the set of core questions identified in the framework. These ask patients about their experience and also ask them to tell us how we can do better. These conversation opportunities enable us to capture the data in a meaningful way, where any issues identified can be discussed openly and often dealt with immediately.

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Complaints

Investigation of serious clinical incidents

These surveys have told us that the key areas for celebration are good relationships with staff, the kind and caring atmosphere at Velindre, and the way we take time to listen to and answer questions or concerns. Key themes for improvement are car parking, waiting times, and spaces for patients and visitors to relax and have a coffee.

We have set ourselves a target of 80% of our patients rating their experience as 9 or above which we regularly achieve. On the rare occasions that we don’t, we investigate contributing factors extensively.

We also capture experience information via patient stories. These stories can be produced in various formats – written, video, digital story, audio and graphic. Our social media channels offer a further means for patients and their families to comment on their experience at Velindre Cancer Centre as well as the placement of comment cards in key areas of the hospital.

It is through these channels that we know the areas that patients would like us to improve on; access to specialist nurses and improved information are areas which have been raised and which we will focus on.

As an organisation, we have very low rates of complaints and claims; however, when we do receive them, we investigate thoroughly through the Putting Things Right Process, identifying opportunities for learning, and ensuring that we offer to meet with patients, carers and family members to discuss the issues and findings.

At Velindre, we believe in the importance of an open, no-blame culture and therefore the Serious Clinical Incident Forum (SCIF) was established as a system to enable thorough investigation, learning and improvements in practice following an incident occurring. Incidents or near misses can be referred directly by any member of staff and are often self-referred by the consultant. This is a unique initiative which has been recognised nationally as the best practice.

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Our role in supporting people to live with the impact of cancer

and improving quality of life The number of people living with and beyond cancer in Wales is set to rise from 130,000 to 220,000 by 2030.9 Half of the people born since 1960 will be diagnosed with cancer in their lifetime and coupled with rising incidence rates and improved survival, this will put increasing pressure on Velindre NHS Trust to meet demand whilst continuing to deliver the highest levels of patient care, quality and experience.

Cancer can affect all areas of a person’s life, including relationships, work and finances.

We provide support to people with cancer to return to as good a quality of life as possible after active treatment has ended, or support them to achieve their personal goals if they will be living with either primary or secondary cancer for some time.

We know that 80% of all patient worries are around physical and emotional concerns, with the top five areas identified as:

We utilise the Holistic Needs Assessment (HNA) tool to help identify patient needs and offer services to support patients physically, emotionally, financially and spiritually. These include psychological services, benefits advice, and programmes such as managing fatigue and breathlessness, mindfulness, nutrition management and complementary therapies. These programmes empower patients in their own care pathway, facilitating their choice and control; patients can be preferred to these programmes at diagnosis, during treatment, after treatment or after long term follow up.

But with cancer incidences growing each year and more people surviving longer with cancer, we know that there is more that we can do to support patients, carers and families.

9 Macmillan, A vision for cancer services in Wales to match the best in Europe10 Macmillan, A vision for cancer services in Wales to match the best in Europe

Worry, fear and anxiety

Tiredness, exhaustion or fatigue

Pain and discomfort

Sleep problems and nightmares

Eating and appetite 10

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Leading in research, development and innovation

Research contributes to the health and wealth of Wales. On a national level, the delivery and management of high quality research and developmental work is a strategic priority within Wales. Within VCC, the research we do directly benefits our patients, and redefines cancer care for future generations.

VCC has established an excellent national and international reputation in research and has several areas in which it excels, specifically early and late phase SACT clinical trials and radiotherapy and physics. Additionally, we are supporting new talented researchers within the nursing and allied health professions to broaden the scope of the research we offer to our patients throughout their care pathway.

We have long established strong relationships with many of the large pharmaceutical companies and have an increasing portfolio of active clinical trials across Phases I-IV. The Early Phase Trials Program conducts research using new and novel treatments for patients with solid tumours, including first in man trials; it is the only unit in Wales. It provides opportunities for those patients resistant to existing treatment regimes to access new and novel treatments. It has allowed patients to access these new treatments without having to travel to England for care.

The VCC brand, and the ability to consistently set up and recruit to target, will continue to enhance our reputation, attracting non-commercially sponsored projects and investment from the commercial sector, a competitive area that is driven by performance and proven track records.

Our aim is to build upon this excellent platform and expand our existing strengths by developing new areas of research and innovation in order to broaden the portfolio of research we can offer to our patients.

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Leading in Education

Velindre Cancer Centre has a particularly strong track record and reputation within the field of medical education. This reputation underpins the high standards of patient care the Cancer Centre aspires to and as outlined within the Transforming Cancer Services Programme Business Case.

This is despite significant limitations in resources, especially availability of facilities to deliver education activities and information technology to deliver web-based education.

The ability of Velindre (and Wales) to host national/international level education activities is limited.

The majority of Velindre’s current education activities is executed as part of the duties conferred on Velindre in its role as a health care provider via, inter alia, statutes, statutory instruments, royal colleges, best practice, investors in people, GMC, Wales Deanery, higher education institutions, and others.

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Where do we want to be?

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If we realise our vision:

Our clinical outcomes will compare favourably with the best in Europe and the rest of the world;

Patients, carers and families will rate the quality and experience of our services as the best in Europe and the rest of the world;

We will have clinical leaders recognised as ‘world-class’ in innovation, education and research and development;

Staff will recommend us to their friends and family as the best employer they have worked for and somewhere they would want to be cared for.

Other people will come and visit us to learn from how we do things;

Highly talented people will want to work for us;

Patients will achieve the best possible quality of life for them, working as equal partners with us to achieve best possible physical, psychological and emotional health and wellbeing;

OUR VISION

We want to lead in the delivery and development of compassionate, individualised and effective cancer care to achieve outcomes comparable with the best in the world.

Providing the best care with you when you need usOUR

MISSION

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What are our drivers and challenges?There are a wide range of factors we have taken account of in developing our strategy. We have identified a small number of significant strategic drivers which have assisted us in formulating our strategy.

Cancer incidence is increasing

There continues to be variation in outcomes thruoughout Wales

More people are living with and beyond cancer

Resource are scarse

Treatments are becoming more complex and new advances are continuously emerging

we must meet increasing demand

we must help close the gap and ensure equity of access and equity in quality

we must work with people as equal partners to achieve best possible

quality of life and experience

we must deliver services in innovative ways to make the best of our resources with

sustainability and prudent healthcare at heart

we must be ready to deliver

We are working within a wider policy context

we must ensure we are aligned

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OUR DRIVERS EXPLAINED

The Welsh population is older, sicker and has higher levels of deprivation than other UK countries. All these factors affect people’s health and increase the demand on the NHS.

There is a correlation between cancer and age and social deprivation and unhealthy lifestyles; therefore, given VCC’s population demographic, a steady increase in demand for our services at VCC can be predicted.

We know that:

In Wales, cancer incidence has increased by 12% in the nine years between 2004 and 2013, including a 15% increase within the VCC catchment area;

The incidence of cancer in Wales is forecast to increase by 2% per annum up to 2031;

This is expected to result in an estimated 12,677 new cases per year in the VCC catchment population by 2031. This represents an increase of 35% since 2013;

The forecast increase is supported by catchment area population forecasts and an analysis of a number of determinant factors that are related to levels of cancer incidence. This demonstrates that a combination of an ageing population, living longer with relatively unhealthy lifestyles, together with some of the highest levels of social deprivation is likely to result in increased incidence of cancer in the South East Wales region and across Wales.

The gap in incidence and mortality between least and most deprived socio-economic groups is widening. Between 2001- 2014:

The gap widened between high lung cancer incidence rates in the most deprived areas and lower incidence rates in the least deprived areas;

Breast cancer had higher rates in the least deprived areas, with the gap decreasing, but mainly due to increased incidence among women in the most deprived areas;

Cwm Taf has the lowest one-year and five-year survival of all health boards and Powys has the best one-year and five-year survival;

The gap in one-year survival between the least and most deprived areas of Wales decreased,

In addition, treatments are becoming more complex and are taking longer to plan and deliver and therefore require a greater resource, which further impact the demand on our services.

It is clear that the ageing population, increasing incidence of cancer and poor lifestyles suggest that this pattern is likely to steadily increase and that demand will exceed our capacity if we don’t take clear and decisive action.Cancer incidence

is increasing

There continues to be variation

in outcomes throughout Wales

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condition, a new approach to longer term care is required to support individuals with ongoing treatment and rehabilitation, and to ensure patients are able to maximise their potential and enjoy the highest quality of life.

There is a need to develop a broader range of services which support individuals and helps them engage fully in society, including their workplace, following their recovery. This will require a change in relationships between patients and clinicians, with patients taking an equal role in designing and co-producing care.

As treatments have improved over the last 30 years, the focus on cancer has moved from being mostly about dying with cancer, to living with cancer. Survival rates in the UK have doubled in the last 40 years.11

As cancer is now recognised as a chronic

but increased slightly for five-year survival;

Testicular, prostate and breast cancer and melanoma had the best survival rates, but lung cancer had one of the lowest, along with acute myeloid leukaemia, liver and pancreatic cancers;

Although one-year survival gradually improved for lung cancer, it is amongst the lowest compared to many other European countries, along with a number of other smoking-related cancers;

The gap in one-year and five-year survival between the least and most deprived areas widened for bowel cancer;

The gap in mortality rate between the least and most deprived areas was extremely wide for lung cancer compared to other common cancers.

More people are living with and beyond cancer

The fact that survival rates vary between local health boards suggest that there are inequalities across the regions in prevention and awareness, the speed of diagnosis, patients’ ability to access optimal treatments in a timely fashion and patients’ take up of treatments.

11 Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival, Accessed October 2016

The Welsh Government strategy, Taking Wales Forward 2016-2021, highlights that our work in NHS Wales must be ‘guided by financial responsibility and realism’ and makes clear that we must prepare for a shrinking economy. As a result, we face tough choices on how we prioritise our scarce resources.

Austerity, whilst often perceived as a negative word, can also foster the perfect environment for innovation to thrive and new ways of working to emerge. We must continuously aim to be as productive and efficient as possible, ensuring that we spend every pound well.

Now, more than ever we must be bold in our decision making, clear on our priorities

Resource are scarse

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The intention of this strategy is not to highlight all of the policies which shape our day to day work; however, two fundamental drivers are explicitly mentioned below, due to their fundamental influence on our strategy. There are two major national policies shaping our thinking:

Wellbeing for Future Generations ActThe Well-Being of Future Generations (Wales) Act 2015 places a duty and accountability upon all public bodies to support the improvement of the social, economic, environmental and cultural well-being of Wales. The Act sets out a range of overarching well-being goals and sustainable development principles to ensure that all public bodies act in a manner that the needs of the future generations are not compromised by the needs of the present. The Act came into force in April 2016 and we must meet the Well-Being Act’s duty placed on us as a public body.

We will publish well-being objectives and a well-being statement explaining how the objectives harmonise with our organisation’s values and how it will help us achieve the well-being goals. We will also continue to work with other health boards, a wide range of partners and those who use our services to ensure we adopt and align with the principles of collaboration and involvement.

We know that on the immediate horizon are new advances in radiotherapy and also personalised medicine and immunotherapies- we must be geared up to deliver these treatments rapidly, whilst ensuring that we select the right and most effective treatment according to the patient’s needs.

Treatments are becoming more complex and new advances are

continuously emerging

We are working within a wider policy context

and focused on delivering the things that make the biggest impact on the lives of the people we serve.

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Work better together across organizations and care boundaries

Involve people reflecting the diversity of communities

Look to the long term as well as focusing on now

Take action to try and stop problems getting worse - or even stop them happening in the first place.

into services that people value and into outcomes that compare favourably with the best in Europe and the western world.

The Welsh Government will publish a new strategy covering the next 5 years and this will act as a key driver for us and our partners. We are actively participating in its refresh through clinical leadership. There will be a number of key priorities which we can expect to support us in developing our ambitions. These will include focusing on early diagnosis and the improvement of cancer pathways between primary care (general practitioners), secondary care (acute hospitals) and tertiary care (specialist centres like Velindre Cancer Centre); strengthening partnerships amongst health, local authorities and voluntary sector organisations; accelerating the principles of co-production and prudent health into practice (people-centeredness); strengthening system leadership through enhanced collaboration; personalised care; and cutting edge research and development.

Further to this, the Welsh Government will also be publishing a strategic document for end of life care, which will have a significant impact on the cancer strategy. In line with the End of Life Care Delivery Plan 2012-2016 and the projected vision from the End of Life Board for Wales, new areas that palliative care teams in Velindre and throughout Wales will be focusing on are summarised below.

We must sustain our services, grow to meet demand and then transform to achieve our vision.In order to meet the needs of our future generations, the cancer strategies of Velindre Cancer Centre, the local health boards and other service providers, mustalign around the needs of the individual patient to ensure that our efforts are focused on improving the health outcomes for our population, whilst maximizing efficiency and ensuring equity.

National Cancer Strategy and Delivery PlanThe Welsh Government’s ‘Together for Health: Cancer Delivery Plan 2012-2016’ sets out a clear vision for cancer services across Wales. We have been working with our partners and the people who use our services to translate our collective ambition

The principles of the Wellbeing for Future Generations Act will be embedded throughout our strategy and indeed become principles embedded into the core of the organisation.

Our efforts to drive forward medical advances must be underpinned by sustainability, enhance survival and improve quality of life, and build upon the principles of the Wellbeing of Future Generations Act and seek to:

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How will we get there?

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In order to achieve our vision, we have set out 5 strategic aims;

Strategic Aims

Strategic Aim 1:we must meet increasing demand

Strategic Aim 2:Access to state-of-the-art,

world-class, evidence-based treatments

Strategic Aim 3:Improving care and support for patients to live well through and beyond cancer

Strategic Aim 4:To be an international leader in research,

development, innovation and education

Strategic Aim 5:To work in partnership with

stakeholders to improve prevention and early detection of cancer

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How does our strategy link to improving quality, experience and outcomes

in Wales ?

Velindre Cancer Centre has a particularly strong track record and reputation within the field of medical education. This reputation underpins the high standards of patient care the Cancer Centre aspires to and as outlined within the Transforming Cancer Services Programme Business Case.

This is despite significant limitations in resources, especially availability of facilities to deliver education activities and information technology to deliver web-based education.

The ability of Velindre (and Wales) to host national/international level education activities is limited.

The majority of Velindre’s current education activities is executed as part of the duties conferred on Velindre in its role as a health care provider via, inter alia, statutes, statutory instruments, royal colleges, best practice, investors in people, GMC, Wales Deanery, higher education institutions, and others.

Delivering our Vision: Translating our strategic aims into excellent services

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is seamless, integrated and consistent

is provided closer to patients’ homes to improve accessibility and reduce inequity

is delivered at the place and time of their need

meets individual patient expectations and needs

optimises the use of technology

avoids duplication, variation, harm and waste

provides maximum value

What we need to do to achieve this

Transforming Cancer Services in South East Wales

What this means

We know that many patients wish to have their treatment and care within their own homes or within the community they live in. This fits in better with their lives and reduces the travel times for them and the people that often accompany them.

We need to deliver care as close to home as possible, for as many patients as possible, where it is safe and appropriate to do so.

We already provide a number of services closer to home and over the last 5 years have been actively working to establish outpatient services and SACT delivery units closer to the homes of patients in South Wales.

We know there is more we can do.

We know that many patients wish to have We need to ensure that wherever care is provided, be it at our specialist cancer centre, in a local health board or at home, care is of an equally excellent high standard.

We need new systems and models of care to enable us to adapt to the quickly changing landscape, and to respond to increasing demand and complexity of treatment.

We have developed a transformation programme which seeks to place people at the centre of the conversation, identify what they value most from the services we provide now and how that may change in the future, and deliver it in the most efficient and effective manner. The transformation programme has two distinct phases with the first phase being the evolution of the current services we provide by:

Strategic Aim 1: Equitable and

consistent care, no matter where

We need a service model that enables the delivery of care that:

Improving patient pathways through the use of co-production and prudent health principles

Taking more services to patients’ homes

Providing more services within local community settings

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Providing radiotherapy services closer to home

Providing a comprehensive acute oncology service across South East Wales with senior medical and nursing oncology presence within acute settings

Building a range of enhanced outreach facilities to deliver care in a more equitable, less fragmented and more efficient manner

Building a state of the art new Velindre Cancer Centre for specialist care and drive improvement across Wales

Strengthening system leadership and collaboration

The second phase of the programme will focus on the development of any added value that Velindre Cancer Centre can offer in the areas of public health and prevention, early diagnosis and detection, and the management of patients in acute settings. The programme commenced in 2014 and it will assist us in understanding what world-class services look like and how we achieve them.

We have designed a clinical model which we believe will place people at its centre.

Hub:

Patient (The patient is seen as the ‘hub’ and they could reside in one of a number of possible places, i.e. own home, family member’s home, hospice etc).

Spokes:

Velindre@ providing SACT, outpatient and ambulatory servicesVelindre@ Radiotherapy providing radiotherapy, SACT, outpatient and ambulatory servicesVelindre Cancer Centre providing radiotherapy, chemotherapy, outpatient, ambulatory and inpatient serviceVelindre Cancer Centre for Leaning and Innovation to support research, innovation and development

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What we will do

Work with patients and families, local health boards and third sector partners to implement the new clinical service model with: - Velindre@ outreach services fully implemented by 2020 - Velindre@ radiotherapy satellite services implemented by 2021 - Velindre Cancer Centre built and fully operational by 2022 - The Velindre Research Institute fully formed and the new facilities available in 2022

Create purpose built Velindre@ outreach locations which will partner excellent health board services in: - the delivery of excellence, in terms of services Velindre delivers, i.e. SACT, clinical reviews, ambulatory care - a focus for excellence in services led by HBs, i.e. research and allied health patient support

Continue to review the service model to identify world-class practice and embed it accordingly

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Strategic Aim 2: Access to

state-of-the-art, world-class,

evidence-based treatments

We know that timely access to the most appropriate and effective evidence-based care is proven to improve outcomes; prudent principles will underpin the way in which treatment choices are made, ensuring that patients are equal partners in their care, and that we undertake the minimum interventions for the maximum benefits

Radiotherapy is an essential cancer treatment that experts suggest contributes to four in ten cases where cancer is cured. It is a relatively cheap, safe, cost-effective treatment that is associated with high levels of patient satisfaction. We are the only provider of specialist radiotherapy services in South East Wales and wish to develop our expertise in an area which we have forecast will grow significantly in the future.

We have developed a radiotherapy strategy, Shaping the Future of Radiotherapy, which builds on the key achievements of the service to date, while moving it towards a unified and ambitious goal.

We have set ourselves a simple mission;

What this means

We will be organised and resourced in a manner that will enable us to quickly implement the most effective evidence-based treatment or care to patients wherever they are within their treatment journey, whether that is a new drug or new radiotherapy technique.

What we need to do to achieve this

Developing world-class radiotherapy services

To Become a Centre of Excellence for Radiotherapy

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Every patient has access to the best treatment appropriate for them, which is timely and delivered in the most efficient and effective way possible

The radiotherapy service will be at the forefront of technological advances through its continual assessment and adoption, for the benefit of all patients

An integrated and empowered workforce that is motivated, values driven and innovative

A service that is maintained and future proofed with effective and appropriate funding to enable clinical, technological and research developments

To expand radiotherapy research through effective leadership, resources and investment

A high quality service which utilises comprehensive data, evidence-based practice and research to drive forward innovation

Establish a culture of collaborative working and partnership that reflects and prioritises the values of the organisation

And a clear vision;

There are seven aims which our radiotherapy strategy will adopt to achieve its vision and ultimate mission. These seven aims are based on the seven attributes to achieve a world-class radiotherapy service12 and put the patient at the core to achieve the vision set out above.

To deliver an efficient and high quality radiotherapy service which puts the patient at the centre, enabled by a motivated and supported workforce, where research drives quality, and technology improves experience.

12 The Tavistock Institute ‘Recommendations for achieving a world-class radiotherapy service in the UK’ 2014

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What we will do

Implement our radiotherapy strategy

Continue to review the service model, clinical and technological advances to identify world-class practice and embed it accordingly

Promote and foster partnership working with academia and industry partners to innovate and develop

Become a CTRad accredited Centre of Excellence in Academic Radiation Oncology by 2021

Become an established Centre of Excellence for Radiotherapy by 2026

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Developing World-Class Systemic Anti-Cancer Therapy (SACT)

Our objective is to provide safe, effective and efficient person-centred SACT services. SACT encompasses biological therapies and cytotoxic chemotherapy. There are hundreds of different types of SACT regimens, some delivered as sub-cutaneous, intravenous, intrathecal injections or as oral agents: either as single agent drugs or in combinations.Patient survival is increasing, in part to wide range of therapeutic SACT options that are available today. We are keen to further exploit this, working with our partners, to ensure that patients have access to treatments which support them in achieving the best possible outcomes including the latest technologies.

Stratified Medicine

Stratified or targeted medicine and care offers an exciting future for cancer services within Wales; treatment that is specific to the individual or small cohorts and which utilises a wide range of tools to better understand and treat a patient’s cancer. It has become clear in recent years that the reason for this lies in the individual differences that exist between cancers at a genetic and molecular level. As each patient is unique, so are their cancers.

Stratified medicine involves taking large groups of patients and sub-dividing them into smaller groups based upon certain features of their cancers or tumours. They are then treated with therapies that are directly aimed at these characteristics. As we know all too well, not all cancers of one type, whether they be of the colon, prostate or breast, respond the same way to conventional treatments such as radiotherapy or SACT.

We know that in the future, patients will have their own individual cancer pathway and treatment, from imaging to biopsy to genomic analysis, to leading edge medicine and technology, and to state of the art clinical trials and treatment; we want to be ready to deliver.

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What we will do

Develop robust data and information systems to improve the planning of SACT service

Work with our local health board partners to develop a Pharmacy Technical Services Strategy for Wales that will facilitate the care of patients with SACT treatments closer to their home

Continue to ensure prudent use of our skilled workforce, maximising the potential for non-medical prescribing and advanced practitioners

Further strengthen our horizon scanning processes to improve access to leading advances including immune therapies, biologics and combination therapies and disinvesting in outmoded medicine

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Strategic Aim 3: Improving care and support for patients to live well through and beyond cancer

Living with Cancer: Improving Health and Well-being

We need to support people with cancer to return to as good a quality of life as possible after active treatment has ended, or support them to achieve their personal goals if they will be living with either primary or secondary cancer for some time.

We support the principle that “Only by focusing on the whole person can the patient’s experience during their cancer pathway be as good as it can possibly be. This is true for those who survive cancer, are living with or beyond cancer, or someone who is nearing the end of life.” 13

People require holistic support from diagnosis onwards, encompassing their physical, emotional, financial, psychosocial, and information and support needs, throughout their entire cancer journey. Care should be built around what matters to the person, and individuals should feel prepared for the life consequences of their cancer and its treatment. They should be equipped to manage their care and have control over their life as a whole.

Managing the consequences of treatment needs to be a key focus, particularly for people with intermediate and long-term survival.

We know that psychological and emotional support services provided by professionals play an important role in meeting the needs of people affected by cancer. They promote self-management and coping skills, reduce depression, anxiety and pain, and potentially increase survival rates.

Providing appropriate and timely psychological and emotional support services can save money for health and social care providers and also benefit the wider community in terms of enabling cancer patients to feel well enough to return to work as well as to community and social activities.

We also understand that physical activity and a healthy lifestyle helps not only to manage consequences of treatment such as fatigue, depression and heart damage, but also to reduce the risk of the disease worsening, recurring or causing death in people living with cancer.

Patient feedback has highlighted that information on financial support is not as accessible as they would like. We need to address this.

13http://www.macmillan.org.uk/about-us/what-we-do/we-ma-ke-change-happen/we-shape-policy/living-with-and-beyond-cancer.html

“Increased psychological and emotional support throughout and after treatment is critical.

It’s important that it is regularly offered as psychological and emotional states can change

through and after treatment. Early offerings of service may be turned

down but needed later.”

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What we will do

Facilitate the integration of cancer services with our healthcare partners;

Develop our work force capability to support and enable person-centred values, enhance our ability to communicate better, and develop programme to develop cancer health literacy in our patients, families and staff;

Enter into strategic collaborations and engagements with healthcare and non-healthcare partners to maximise the potential for innovation to support person-centred values and to maximise health and wellbeing;

Improve communication with patients and carers receiving care and support at Velindre Cancer Centre and the Velinde@ outreach facilities using a wide range of tools, including a patient portal which provides patients with their own records;

Strengthen our patient, family and carer education and training programmes and ensure they are seamlessly integrated into the patient’s journey;

Enhance the availability and accessibility of Velindre resources for patients through better use of social media and innovative communication channels, such as Vine, etc;

Integrate more fully supportive cancer care and rehabilitation services into the patient pathway at Velindre Cancer Centre and the Velindre@ outreach facilities;

Improve access to a range of holistic and complementary therapies for the cancer centre which support psychological wellbeing;

Improve access to financial and social support through a number of different mediums;

Work with Maggies to develop a Maggies Centre on the site of the new Velindre Cancer Centre.

Introduce a wider range of patient self-management programmes in partnership with a range of voluntary sector partners;

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Developing World-Class Acute Oncology Services

Cancer care does not begin or end in the cancer centre and we are increasingly aware that patients require unscheduled care, often multiple times during the course of their journey. This includes those with new cancers (22% of all cancer diagnosis), complications of cancer treatment and complications of cancer itself. Local (ABUHB) and national data demonstrates between 5-10% of all patients in acute setting in the UK have an active cancer diagnosis. The projected increase in need for cancer care and planned local delivery of treatments will increase the role of local health boards in delivering acute cancer care.Many patients in South East Wales will present to A&E with a primary diagnosis of cancer where there is less oncological clinical knowledge or expertise available to them given the acute focused nature of the A+E service. This can result in patients being admitted on to a general medical ward for a test and waiting longer for an accurate diagnosis. There is compelling evidence of poorer outcomes for patients presenting as emergencies.

There are also occasions when patients become unwell at Velindre whilst receiving highly toxic treatments and suffering side effects such as sepsis or equally, suffering from the side effects of their cancer, such as spinal cord compression. Since 2013, Velindre and local health boards have made significant progress in establishing an acute oncology service (AOS) within South Wales using a hub and spoke model. Velindre acts as the specialist hub and is available to provide specialist advice to acute oncology nurses and health professionals located within the local health board to improve identification and effectiveness management of patients who present with symptoms. However, there is more collaborative work to be undertaken to ensure that care is coordinated and seamless. We aim to continue to support patients across South East Wales through providing central expertise and specialist skills. We have a vision for an AOS service model in Wales which includes:

Establishment of full multidisciplinary AOS teams in each health board

Pathways built around patients and focused on admission avoidance

IT systems which enable seamless care across organisations

Reported outcomes and across organisation performance monitoring of services

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What we will do

Develop an assessment unit (assess to admit) or hub of AOS; either within the planned local cancer centres or within acute admissions units;

Sustain across the sector working between health boards, VCC and community/palliative care teams, facilitated through already established AOS MDT;

Review our admissions policy to include transfer of patients who do not require specialist input from VCC.

Deliver acute cancer care 7 days a week;

Sustain 24/7 triage of patients through VCC AOS telephone line;

Develop new ways of working, such as ‘one stop’ clinics;

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Developing World-Class Palliative Care Services

It is a sad truth that 167,000 people in the UK still die from cancer each year1. Yet access to high-quality care and support, including palliative care, is not a universal experience for these people or their families. Wider research shows that one in four people don’t get the care and support they need at the end of their life2.

With the right level of high-quality care, as well as support for family and friends, people can be supported to live as well as possible until they die.

Our palliative care services are considered excellent, and we will continue to plan, secure and deliver well-coordinated palliative and end of life care on a 24/7 basis in line with published standards and guidance. Our aim is to provide world-class palliative care in Velindre and more widely in the community and in peripheral hospitals.We align our aims closely with the vision of the End of Life Care Board for Wales and its strategic direction, which entails:

Although the mortality rate for cancer is decreasing, the number

of people dying from cancer is expected to increase due to factors such as the UK’s ageing

population and variation in survivorship across different types.

It is essential that the provision of quality palliative and end of

life care stays high on the agenda for cancer care and that it adapts to the evolving nature of cancer

mortality in the UK.

Supporting living and dying well

Detecting and identify patients early

Delivering fast, effective care in palliative illness

Deducing the distress of terminal illness for the patient and their family

Supporting research and training in palliative and end of life care

We understand the importance of individuals and families being in control to plan and set out their wishes and we want to work in partnership with our patients and families to have honest conversations that enable us to achieve with them their wishes at the end of life.

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What we will do

Continue to support all providers who care for dying patients to participate in the All Wales audit of the Care Decisions documentation;

Have clear funding streams for specialist palliative care services which are above the minimum levels advised by the End of Life Board;

Support end of life communication and palliative care training programmes, including GP training, nursing home support and education for nurses and allied healthcare professionals;

Establish and prioritise people’s preferences for place of death, including having first and second preferences of place of care, so that unexpected outcomes and symptoms can be mitigated for.

Support patient and carer self-management programmes; support the patient and carer voice; and encourage their participation in cancer patient experience surveys, in particular the iWantGreatCare surveys of palliative care patients and their families;

Encourage serious illness conversations, including finding out about wishes for the last weeks of life and listening to people’s views on treatments and investigations. Explain what treatments can entail and that some can have detrimental effects on quality of life;

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Strategic Aim 4: To be an international

leader in research, development,

innovation and education

What does this mean?

We are committed to creating a world-class research capability that is equal to the best elsewhere in the UK and Europe, with the ability to rapidly translate innovation into practice. Participation in research is a core component of the clinical care delivered at VCC, such that every patient and/or their families can discuss options for participation in research with their health care professional team.

We will have a thriving culture of research, development and innovation across all of our services, embedded as a core activity, led by talented staff from all professional disciplines. All staff will understand the benefits that research brings to our patients and to VCC, and the context in which we deliver it. All of our staff will be engaged in supporting and promoting research to our patients. Doing so will ensure that our patients have access to the latest cutting edge research that will benefit their care now, and transform clinical outcomes for future generations.

We have a strong and proven track record in delivering SACT clinical trials and in leading radiotherapy research, and, as our preferredpartners, we have fostered a wide range of partnerships with higher education institutions. We wish to maximise our

partnerships with other public bodies, commercial organisations and institutions with world-class capabilities in engineering, pharmacy, computing and innovative product development.

We will expand our portfolio of projects to encompass all clinical states, technical departments, palliative care, and adjunctive therapies, thus capturing the entire journey of our patients. We will expand our existing strengths by developing new areas of research in order to broaden the portfolio of research we can offer our patients.

The next step change is to innovate. Our success in adopting innovation will help support growth in the industries of life sciences, which, in turn, these industries will then invest in developing the technology and services the NHS needs for its development. The link between innovation, research and development and economic renewal is critical.

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What will we need to do to achieve this?

Our ambition must be for a Velindre defined by its commitment to innovation, demonstrated both in its support for research and its success in the rapid adoption and diffusion of the best, transformative, most innovative ideas, products, services and clinical practice.

Invigorate sets out the actions we must now take to make innovation and the research and development of life sciences central to what we do as an organisation. Invigorate is designed as an integrated set of measures that together will support Velindre NHS Trust in achieving a systematic change in the way the organisation operates.

This will be achieved through advancing work in the following areas:

Investigate: To build and organise research infrastructure and capacity. To develop our workforce capability and skill mix and to support areas of research excellence

Innovate: To identify key opportunities and close working with the life sciences and new technologies hub covering innovations in care

Integrate: To enter into strategic collaborations and engagements with our partners (both healthcare and non-healthcare) on a local, national and international basis

Potentiate: To enhance financial strength and sustainability and maximise commercial opportunities to enhance the organisations economic growth through innovation

Educate: To develop innovation, person-centred educational programs for both patients and staff to improve on cancer literacy in order to maximise the opportunities presented through innovation. Develop the concept of the Centre for Learning (C4L) into a network (physical and virtual) that will maximise innovation opportunities, education and research and development on a local, regional, national and international basis

Regenerate: To expand the organisations expertise into the area of cellular technologies

Disseminate: To increase the organsation’s involvement in the dissemination of innovative technologies working with the Life Sciences and New Technologies Hub

Numerate: The big-data revolution is under way in health care. Over the last decade, the industry has been aggregating years of research and development data into medical databases such as disease registries, while healthcare organisations have digitized their patient records. Meanwhile, public stakeholders have been opening their vast stores of health-care knowledge, including data from clinical trials and information on patients. Information management and technology is central to achieve the potential locked in big data and Numerate will seek to develop this potential to its maximum.

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What we will do

Establish an Integrated Research and Development Unit to take forward our agenda;

Provide the resources required for the consistent delivery of high quality, innovative research;

Future proof and horizon scanning to maintain our position at the forefront of cutting edge research;

Implement the InVigorate strategy to achieve our ambition of becoming a world leader in innovation, research and development;

Establish an innovation board to drive improvement;

Develop a commercial strategy to support our ambitions.

Support the national priority to generate wider economic and social benefits for South East Wales through the development of strategic partnerships and collaborative working within South East Wales, all of Wales and internationally to achieve excellence;

Align the wide range of expertise within and outside South East Wales around a coherent strategic research agenda that supports the triumvirate of highest quality clinical care, academic excellence, and evidence-based innovation;

Elevate the established areas and broaden our areas of strength, building upon proven track records for securing competitive and commercial funding, and in leading practice change;

Seek out a wide range of partnerships across health, other public services, academia, the voluntary sector and industry to enhance our strategic capabilities and competence;

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Professional education, training and development

Education is fundamental to the sustainable delivery of high quality care and the best outcomes for patients, and is inextricably linked to quality patient care.

Education includes providing education and information to patients and families as well as education and learning for health care professionals. This is part of a broader network formed of partnerships with stakeholders.

We are committed to prioritising education and learning for patients and carers and embedding this in the clinical model.

As care at Velindre will increasingly become centred around and tailored to the individual and will be delivered more locally to the patient, the concept/scope of education needs to be broadened and invested in. We must focus on improving the cancer literacy of the population we serve to empower patients and families to make informed decisions which best suits them.

Focusing on delivering care to the individual has informed the vision for education at

Prioritising education for patients, carers and staff (clinical and non-clinical);

Involving and empowering patients/carers to access information and education, im-proving cancer literacy, patient activation and self-management;

Attract, train and retain the best workforce;

Use education as a means to deliver high quality clinical care, wherever it is delivered and to adapt to new treatments and use education to support collaboration and deli-very of seamless, integrated clinical care in all setting (for both scheduled and unsche-duled care);

Support all partners in the SE Wales region and beyond;

Develop and deliver a clear strategy for both patient and staff education;

Ensure the long term sustainability of the clinical model across the region through education programmes.

Our vision will be realized by:

Deliver excellence in clinical care through excellence in education

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What we will doDevelop a new education and training strategy which sets out our vision and ambition for education and learning; to ensure patient and family involvement in strategy development;

Implement a designated facility for education activity, both patient and staff can take place at the new Velindre Cancer Centre, Velindre @ Radiotherapy Satellite and Velindre@ Outreach Centres);

Build an infrastructure in South East Wales which allows for dissemination of information across a variety of platforms, including digital;

Develop an information one-stop-shop, work with 3rd Sector parties to develop a comprehensive suite of information which can be tailored to address specific cancer questions;

Develop a skills laboratory which lends itself better to the immersive hands on training required of our staff;

Develop more undergraduate, postgraduate and continued professional development courses;

Ensure a sustainable workforce by partnering with Skills for Health and other agencies to develop apprentices;

Advance the Welsh government’s STEM agenda by exploring opportunities with schools;

Create a network that allows information sharing and knowledge transfer between partners;

Adopt a more international approach to education and partnering with world-leaders in all disciplines;

Adopt a more innovative approach to solving healthcare issues such as game jams.

Partner with companies pushing the boundaries in innovative technologies with potential healthcare application, i.e. virtual and augmented reality;

Designate a facility for education activity for both patient and staff;

Develop skill sets for managers to support them to deliver the service changes through the development of the Managers Skills Framework;

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Strategic Aim 5: To work in partnership to improve detection and support the early diagnosis of cancer to

improve outcomes

What does this mean?

In order to give patients the best chances of achieving the best possible outcomes, NHS Wales must focus efforts on prevention and early diagnosis. Prevention and early intervention is a national priority and it is clear that NHS Wales need to invest time and resources in services and actions that promote health, well-being and personal responsibility and to shift resources towards community-based interventions.

As a specialist treatment centre, we are responsibile over the patient pathway from referral for treatment following diagnosis. However, we do have unique and valuable expertise that we can offer to the wider cancer network and we will work in collaboration with organisations to understand what and how we can best contribute.

Our culture and approach focuses on people and not on artificial boundaries that are created by organisations. We are therefore committed to working with the people who use our services, and the organisations that we partner in delivering them, to ensure the seamless movement of patients to the right

Whilst we are a provider of tertiary services, we see opportunities in the future to offer more value across the cancer system. We will explore how we can work closely with Public Health Wales and our local health boards to reduce the number of people getting cancer; how we can work with GP clusters to ensure that GPs and patients have quicker and direct access to diagnostic tests; how we can improve patient pathways to reduce variation; how we can improve staging pathways; and how we can do all this in a new partnership with the people who use our services.

Cancer and the many issues associated with it have a significant impact on public health in Wales. Research suggests that approximately one third of the most common cancers in the United Kingdom could be prevented through improving diet, maintaining a healthy body weight and physical activity. Smoking tops the list as the most important preventable cause of cancer; a fact largely well understood by people.

Whilst Velindre NHS Trust does not have a statutory responsibility to provide public health services, we believe that we have a moral and ethical responsibility as a stakeholder within society to make a positive and sustained contribution to making Wales a healthy nation.

What will we need to do to achieve this?

Defining our role in improving public health

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What we will do

Work with Public Health Wales, local health boards and the Welsh government to explore how Velindre NHS Trust and Velindre Cancer Centre can make a more significant contribution to public health and cancer prevention through its existing expertise and strong brand within Wales (i.e. cancer leadership);

Develop a more systematic approach to sharing the information we have on cancer outcomes with a range of partners and the public to better inform the public health agenda and strengthen public engagement, public health programmes and awareness. This includes improving our relationship with the Welsh Cancer Intelligence and Surveillance Unit (WCISU);

Inform the design of our clinical pathways to include opportunities to support public health interventions and ‘teachable moments’ such as smoking cessation, healthy eating and increased levels of exercise through ‘making every contact count’;

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Working in partnership with primary

Primary care is about those services which provide the first point of care, day or night for more than 90% of people’s contact with the NHS in Wales. General practice is a core element of primary care. It is not the only element; primary care encompasses many more health services, including, pharmacy, dentistry, and optometry. It is also ,importantly, about coordinating access for people to the wide range of services in the local community to help meet their health and wellbeing needs.

The earlier a cancer is diagnosed, the best chance there is of complete cure and better quality of life. The importance of early detection of cancer cannot be understated if clinical outcomes are to be improved in Wales as it is recognised as the single most important factor in improving cancer patient survival. There is a recognition of this in Wales and three important streams of work are underway:

Improving the ability of general practice to detect cancer at the earliest opportunity by:

supporting GPs to develop their skills, knowledge and experience in relation to cancer

improving clinical pathways to remove any unnecessary blockages and gatekeeping, similar to the model used in Denmark

Working collectively across all sectors to better manage cancer as a chronic condition

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What we will do

Work with Public Health Wales, local health boards and the Welsh government to explore whether Velindre Cancer Centre can make a more significant contribution to improving detection rates in primary care;

Develop a more systematic approach to sharing the information we have on cancer outputs and outcomes with GP clusters within South East Wales and improve our IT linkages with primary care data;

Use the GP resource allocated to us to develop networks with primary care services across South East Wales and undertake joint multi-disciplinary teams (MDTs) with GPs;

Explore the potential for providing a direct point of contact / support line for primary care within the acute oncology service and rapid assessment unit being developed;

Explore the potential for providing primary care with the facility to access medical/clinical oncology advice directly from Velindre Cancer Centre if required during clinical time;

Actively seek to support the development of a range of tools which can support primary

Develop shared follow-up arrangements;

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Supporting the early diagnosis and staging of cancer

We currently support colleagues across Wales in general practice in detecting cancer as soon as possible. We are also keen to understand what more we can do to assist in improving this vital element of the cancer system.

Improve access to diagnostics tests for patients with symptoms of cancer through additional capacity

Innovate services

Focus on staging improvement

Triain the workforce: staffing gaps already present a constraint on how many diagno-stic tests can be performed across Wales on a daily basis. This will need to be ad-dressed by developing new training pro-grammes to improve recruitment, retention, and to develop enhanced capabilities for staff, as a key enabler to role innovation.

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What we will do

Work with local health boards to determine what additional role we undertake to improve cancer detection rates

Improve specialist diagnostics in secondary cancers

Develop dedicated radiology team who specialise in cancer

Explore the role of genetic testing and personalised medicines

Explore improvements to staging pathway

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PrinciplesWorking with people to make the best choices

Shared decision-making is a process by which a patient is involved as an equal and active partner with the clinician in clarifying acceptable medical options and choosing a preferred course of care appropriate to the individual. Patients should leave consultations feeling that any concerns have been heard and addressed, with an understanding of what the clinician has communicated to them, fully prepared for the next phase of their journey.

We want to equalise the relationship between patients and clinicians, ensuring that patients have the level of choice and control that they value.

What we will do

Support a shift in the relationship between patients and staff, digital technologies, and develop a better cancer literacy through education for patients, carers, persons and healthcare staff and improve skills;

Enable patients to have access to all their test results and treatment records online;

Encourage serious illness conversations, and explore wishes and preferences in advance of anticipated healthcare challenges;

Ensure that we measure how empowered patients feel about the choices they make through patient activation measures.

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We place a high value on the experience that patients and carers have with us. We have a proven track record of providing patients and carers with excellence and place this at the centre of everything we do. This has been achieved through the skills and commitment of our staff, from nurses to catering staff to radiographers; our tenacity in going the extra mile on every occasion; and a continuous conversation with patients and carers about what they value most which allows us to ensure that this is our focus.

We have worked closely with patients to gain a better understanding of the things they value the most and how we can work together to translate that into tangible improvement. The areas identified included:

High quality, credible information sources with different ways of accessing information;

Time required during consultation varies according to needs, online booking with flexibility to change;

Holistic and complementary therapies, specialists for the cancer centre (clear impact on psychological wellbeing);

Value in coming to a centre where everything is co-ordinated in a single location

Consistent quality of care across GPs and consultants with standard level of expertise

Recognition and value of the Velindre ‘brand’ (excellent and trusted);

Quality of care consistent irrespective of location and or costs (implications for outreach services);

Different forms of communication i.e. Skype, phone, person, email and other virtual types of contact with consultants and healthcare professionals;

Support for Me and My Family (informal – people with a similar experience to share stories, experiences and coping strategies and formal methods);

Being fully informed about all options available (honest dialogue);

Option to have treatment at home or at centre;

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What we will do

Deliver the best patient experience.

Develop better communications and information sharing with patients and carers to ensure an equal relationship.

Reduce waiting times on the day of appointment for patients in Velindre Cancer Centre

Improve the experience for patients whilst they are waiting

Develop innovative consultation methods to provide patients with greater choice based around the things they value most, i.e. telephone consultations and Skype

Improve our website to provide better information to patients and carers

Improve communications between professionals within our organisation and vertically across the cancer pathway between organisations

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Securing Continuous Improvement in our Services

In order to achieving our vision and transform cancer services, we must maintain, sustain and continuously improve, not only through research and innovation but by constantly learning from others, adopting and sharing best practice and learning from others.

What we will do

Work with people, patients, families and carers to identify what they value most to inform future in the services

Work with patients, local health boards, voluntary sector partners and the All Wales Cancer Network to define, design and implement best practice patient pathways

Increase our change management capability through training our staff in programme management and implementation and continuous improvement (IQT)

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Enabling Success

Workforce: Being the employer of choice

We have an excellent reputation as an employer of choice and we wish to build upon this position of strength. We recognise that the quality and experience of service that patients, families and carers receive is directly related to the excellence, passion and commitment of the staff who work for us. We are committed to attracting, training and retaining the best talent from around the world to come and work for us to support us in realising our ambitions in providing the best patient care and clinical outcomes. We also acknowledge that we are competing in a global market for the best people and, therefore, we need to develop an organisation that has a unique selling point which attracts the best people.

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Information, Communication and Technology

The cancer pathway is a complex one which crosses many interfaces between people and organisations. Our existing systems do not adequately support patients, families, carers or our staff to effectively manage this journey as they often stop at the boundaries of organisations, thus creating silos. The current systems have also been developed from one perspective, the healthcare provider. This results in a number of problems:

We are developing a vision of a person-led information system which will provide efficient data collection and allow for information to be available and shared with the appropriate user at the right time, from patients wishing to access information on their care through to clinicians within Velindre Cancer Centre and at our partners organisations.

How our information systems can support patient-centred care

Inability to capture data on clinical outcomes

Inability to easily track patient journeys across the cancer pathway

Inability to share patient data and information easily between organisations

Inability for patients to access their own records to assist them in leading their care

Significant lag times between the capture of patient data and it being available for clinical decision-making in real time

Difficulty in the collection of secondary data for assurance and service improvement; it is time consuming and resource intensive

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What we will do: Continue to invest in computer technology to improve the patient, family

and clinician’s experience

Reduce patient’s requirements to travel or wait unnecessarily for long periods of time by offering remote video or audio clinics via Skype technologies;

Reduce time in hospital for those patients who must attend or choose to attend a treatment centre, by using electronic check in technologies;

Continue to provide free onsite access to the internet;

Deliver a better patient experience for patients who spend longer hours or days onsite such as patient entertainment systems;

Increase the availability of patient information onsite by keeping the patient informed of expected waiting times and deliver key patient information via electronic displays strategically located throughout the site;

Increase the availability of patient information offsite via future technologies such as a patient portal to access medical records online and increase the capabilities of patients becoming more involved in the co-production of their treatment;

Publish rich media format information for patients and family education via the new media centre and using social media and Web2.0;

Develop app-based systems using any handheld devices and software solutions to support co-production and persons-based information systems.

For Patients

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Increase the reliability and availability of systems by moving more systems and data to national data centres;

Improve the integration between systems in use in Wales to make data more accessible between health organisations, including social care and ensure secondary uses of data;

Improve the speed of information becoming available by recording patient observations at the bedside to make information instantly available;

Increase the use of remote access to systems, such as radiotherapy planning systems, to reduce the time wasted moving between departments and sites;

Increase the use of systems with clear information feedback mechanisms and alerts to prioritise care where it is needed most and improve patient outcomes;

Increase the use of digital technologies to improve the flow of patients within the hospital and between departments to make them as efficient as possible;

Increase the use of handheld computing technology with app-like views of data to improve the accessibility of data, where it is required at the bedside;

Develop data warehouse technologies to support clinicians with easy to manage tools to tap into historic rich data sources of clinical data to visualise the data and interrogate this for patient and clinical benefit.

For Clinicians and Support Staff

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Capital investmentWe have a very ambitious programme of capital development for cancer services over the next ten years. The ten-year capital development plan for cancer care totals £500 million. We believe that this investment will enable us to achieve our vision and position us amongst the best tertiary cancer centre in Europe. Key element of our capital programme include:

We will also continue to invest in our existing estate and technology to ensure our services continually improve during our transformation journey.

What we will do

Investment in leading radiotherapy edge technology to enable us to provide highly specialist treatment and advance our position as a leading centre in Europe

Development of the Velindre@ outreach and Velindre@ radiotherapy facilities within the local communities we serve. These will enable the delivery of systematic anti-cancer treatment, outpatients appointments, therapeutic and rehabilitation services in high quality environments close to patients’ homes

Development of a new Velindre Cancer Centre Cardiff by 2022 which will provide us with world-class facilities and an environment that is second to none

Development of the Centre of Learning and Innovation which will provide a virtual and physical focus to progress our research, innovation and development activities

Development of a wide range of information technology solutions including a new patient administration system, chemotherapy prescribing system and patient information system

Development of a Maggies Centre in partnership with Maggies on the site of the new Velindre Cancer Centre

Continue to seek opportunities to increase our capital resource to accelerate our programme

Implement our ten-year capital investment programme

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Effective planning and commissioning for value

Strong planning and commissioning is vital to delivering world-class cancer services in Wales. Commissioning should be undertaken on the basis of whole pathways of care. It is recognised that the planning and commissioning of cancer services has progressed within Wales over recent years. However, there is still a great deal of work required if we are to achieve our ambitions within Wales.

We are the only provider of tertiary cancer services in South East Wales and our local health board partners have acknowledged that the current planning and commissioning arrangements require strengthening if we are to collectively achieve our shared ambitions for cancer services.

Work with local health boards and the Welsh Health Specialised Services Committee (WHSSC) to define, design and implement a new planning and commissioning framework

Review and revise our strategic and operational plans to ensure they align with the commissioning intentions of our local health board partners

What we will do

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Establishing our reputation and brand as a leading tertiary cancer centre

We have an excellent reputation and a very strong brand which has strong recognition and high value. We wish to continue to develop these strengths, and the Velindre brand, nationally and internationally to promote the work we do, that of our local health board partners, and Wales as a nation. This will allow us drive forward our programme of work and place Velindre at the forefront of the fight against cancer.

What we will doDevelop a communication, engagement and marketing strategy which strengthens maximises our reputation and develops our brand;

Develop an approach for measuring our brand value and reach and its positive/negative impact;

Strengthen our approach and systems for collecting patient satisfaction and experience ratings;

Harness the power of our people, patients, carers and families to allow them to use their professional skills to imagine better.

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Making a difference through strong and collaborative system leadership

Cancer still remains one of the greatest challenges for healthcare systems across the world. With an ageing population, an increasing incidence of cancer and survival outcomes which do not compare favourably with those across Europe, we are clear that a fundamental step change is required in cancer care.

Velindre Cancer Centre is unique in that we are a specialist cancer centre, we have a critical mass of talent and expertise, and a strong reputation for the high quality of care we provide to the people who use our services.

We are excited about the opportunities to work in close collaboration to develop the system of cancer care in Wales and fully exploit all the talent and excellence within it. To achieve our full potential, we must fully utilise our talents and expertise to have a more direct impact on cancer care nationally, where all of our partners believe it can add value to what they do and the services that people require from us collectively. We recognise the need to continue to improve the non-surgical tertiary services that we provide, and are not complacent about this as there is still much that we can do better.

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How will we know we have got there?

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Measuring success

Strategic Priority What will success look like

All patients will access the appropriate levels of radiotherapy as part of their treatment

All NICE/AWMSG drugs and recommended technologies will be implemented upon approval

1, 2 and 5 year survival rates post treatment are comparable with the best in Europe

Patients, families and carers will be able to work in partnership with people who provide services to identify their aims and the things they value most.

Patients will have a wider choice of ways and locations to access and receive the services they require

More patients will receive care at home or within their local community

The quality of care will be excellent wherever it is provided

There will be no unhelpful variation in services

Patient harm will be eradicated

All patients, families and carers will rate their experience as excellent

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All treatment will be personalised and precise to achieve optimum effect and avoid harm

The highest quality of care, treatment and expertise will be available to every patient

Patients will manage their care using digital technology and access services when they need them

Patients will only stay in hospital when it is absolutely necessary

The Velindre@ outreach facilities, Velindre@ Radiotherapy and Velindre Cancer Centre will be built, providing patients with services in a world-class

Quality of life measures will be comparable with the best in Europe

All patients will undergo a holistic needs assessment and be provided with a plan which supports them in living with and through cancer

All patients will have access to a wide range of physical and psychological support services to support them living well

Patients will receive services which are specific to their needs and focus on the issues they value most

Patients will be well informed about their disease and will be able to make choices about their future aims and needs

Conversations between patients, families and organisations who support them will be simple,

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effective and focus on the things patients value

A range of resources available to better inform people about the experience of illness and of intervention

Palliative care services will be used throughout the patient’s journey and not seen as a last option

All patients with a terminal diagnosis will die in their preferred place

All patients will be able to participate in research and clinical trials should they choose to

Research and clinical trials will be available at all locations and not simply at specialist centres

A high number of chief investigators will be based at Velindre Cancer Centre and lead on national and international trials and research

A wide range of partnerships with health, higher education institutions and commercial organisations

A thriving research, development and innovation network will be in place in Wales which drives improvement in clinical care, quality of service and patient outcomes

Wales seen as the place to undertake research, development and innovation by peers and partners

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Velindre will make a significant contribution to improving the public health of the population

The incidence of cancer will fall and continue to reduce

The diagnosis of cancer will improve in primary care with a significant increase in the number of cancers detected at stage 1 and 2

We will support this with a wide range of measures to ensure we are able to determine where we are on our journey. These will include outcome measures such as 1, 2 and 5 year survival rates together with output measures such as patient waiting times, infection rates and patient experience.

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