From strategy to action - securing support for cancer awareness and early detection work

Merseyside and Cheshire Cancer Network persuaded the chief executives of all its PCTs to pay for work to improve awareness and early detection of cancer before the Cancer Reform Strategy was even published.

Network director Pat Higgins says it was surprisingly easy to get agreement. The Cancer Registry had prepared data showing excess deaths from cancer and how variations between some tumours pointed to inequalities.

‘We said, “Here is the data and here is what we are going to do about it.” I think people hadn’t realised until they saw those figures. Chief executives still quote them, three years on.’

A strategy was developed over the next few board meetings, after discussions with the public and sexual health networks about their priorities and in put from patient and clinical groups. The network board had already agreed a member of staff should work full time as inequalities manager, using service improvement money to employ a public health consultant one day a week. ‘They left us to get on with it once they had signed off on the direction of travel and the resources to do it.’

‘It is about turning their attention to it, developing the buy-in at strategic level, and then cascading it down to all the stakeholders.’

The Humber and Yorkshire Coast Cancer Network has had a similar experience. Its board has signed up to a two year programme of work and is recruiting a social marketing expert to lead it. Their job will be to project manage work on awareness of lung cancer, using the Doncaster model, skin cancer in men over 50 applying a project developed in Liverpool and to evaluate a volunteer led awareness project from North East Lincolnshire.

Network director Julie Taylor-Clark says it was easy to get the board behind these priorities. The area has dramatic inequalities between the industrial towns and cities and a more affluent rural hinterland and the chief executives of the PCTs, especially the two spearheads facing the most challenging targets, Hull and North East Lincolnshire, have backed the work with enthusiasm. ‘They correspond between meetings,’ as Julie puts it.

Just as important, the network has been able to effect a change in the priorities of some of the key site specific tumour groups. ‘A year or two ago they would have said, “This is nothing to do with us, this is GP land.” Now they see themselves as responsible for the whole patient pathway.’ As with the board, the leadership came from tumour site chairs who were convinced by the data, which suggested they could improve their outcomes only by working with primary care on early detection.

But Julie stresses that the network is at the beginning the process. The next two years will be crucial, as evidence will have to be gathered to prove that investing in awareness and early detection does lead to savings in treatment costs later.

North Trent Cancer Network’s strategy came about because of concern about persistently high mortality rates and inequalities in outcomes among GPs and public health directors and anecdotal evidence that people in deprived areas were getting different access to treatment. A strategy was developed and presented to the network board in March 2009, which determined which cancers to focus on – breast, colorectal and lung with the priority improving screening rates and early diagnosis.

According to network director Kim Fell, the network set itself the ambition of bringing a cancer awareness and early detection dimension to the work PCTs were already doing on prevention including obesity, smoking cessation and excess alcohol consumption. ‘We wanted to see if we could connect with that using a health improvement worker in each of the PCTs to get the messages of early presentation out into the local community’, she says.

‘We have almost got a local team operating within the PCT, with the cancer lead GP, service improvement facilitator and health improvement person working closely with the public health teams and community workers.’

In North East London Cancer Network, poor survival rates for one particular cancer led to a local target being set.

The network’s one year survival rate for breast cancer was the second worst in the country and, because of that, its five year survival rate was lower than the rest of London. The network determined to bring its survival rates in line with the London average – a target that was ‘ambitious but not too ambitious’, according to programme director Jennifer Layburn.

To try to understand what was happening, a detailed data analysis was conducted, working with Thames Cancer Registry. The results were not as clear cut as they had hoped. Network director Bob Park says, ‘Beware of assumptions and averages!’ Late stage of the disease at diagnosis, patients suffering from other conditions alongside the cancer and deprivation all appear to play a role in the poor one year survival rate.

The network has commissioned surveys using the CR-UK cancer awareness measure (CAM) and the first use of a new national breast cancer awareness measure so targeted interventions can be developed. Clinical teams have agreed to review all deaths within a year of diagnosis of breast cancer for any lessons that can be learnt.

With this work underway, the network is about to embark on a similar exercise for colorectal cancer, where one of the PCTs has the second best survival rate in the country and another the second worst.

‘Having done breast, we are fairly clear what route to take,’ Jennifer says.

Anglia Cancer Network has used its strategy to create a coherent story about awareness, early diagnosis and prevention and has set up a structure to implement the work as it develops. Network public health consultant Gina Radford says, ‘There is a real danger that you have all these stand alone projects but have no strategic or delivery structure within the network.’

To underpin the strategy, a baseline assessment, showing where cancer was being diagnosed late, has been completed. A survey of people’s attitudes, using the cancer awareness measure (CAM), has been commissioned in each of the PCTs, to reveal more about late presentation.

The next piece of the jigsaw was prevention, Gina says. Skin cancer was chosen as the focus, and two projects have been commissioned. The final stage was the RCGP/NCAT national audit of cancer diagnosis in primary care, which will identify any issues that can lead to a speeding up of the process of diagnosing patients.

The work is managed by a Laedi steering group, which reports to the network board. Two groups have been set up, which report to the Laedi steering group, one supervising the primary care audit and the other the cancer awareness measure. Both groups have representatives from the PCTs on them.

Gina Radford says, ‘When we come out with the results, these groups can take the outcomes forward.’

North London Cancer Network has taken a similar approach, setting up a primary care and prevention board, made up of public health consultants and primary care cancer leads from the network’s PCTs, to oversee its national awareness and early detection (NAEDI) work. Currently the board is responsible for four NAEDI funded projects, the primary care audit, the cancer awareness measure (CAM), the Laedi baseline assessment and a social marketing project on adolescent sunbed use in Islington PCT.

Network assistant director Julie Lees says it is hard for the GPs who attend to get the time. ‘But once they are there, they are so passionate about the work that they don’t want to stop.’

The combination of the board, and the four projects, gives the NAEDI work a real focus, Julie says. ‘You can see the direction we are going in.’

Anglia Cancer Network public health consultant Gina Radford Gina.radford@cambridgeshire.nhs.uk
Humber and Yorkshire Coast Cancer Network director Julie Taylor-Clark julie.taylor-clark@hey.nhs.uk
Merseyside and Cheshire Cancer Network director Pat Higgins Pat.Higgins@mccn.nhs.uk
North East London Cancer Network programme director Jennifer Layburn jennifer.layburn@btinternet.com jennifer.layburn@bartsandthelondon.nhs.uk
North London Cancer Network assistant director Julie Lees julie.lees@uclh.nhs.uk
North Trent Cancer Network cancer director Kim Fell kim.fell@ntcn.nhs.uk

• Merseyside and Cheshire Cancer Network strategy
• Peninsula Cancer Network strategy
• Anglia Cancer Network CAM tender
• Anglia Cancer Network CAM results

Case study written by Ros Bayley on behalf of the National Cancer Action Team