Cancer Clinical Advisory Group Response to Role Delineation Framework and Green Paper

Transcription

1 Cancer Clinical Advisory Group Response to Role Delineation Framework and Green Paper Service description What suggestions do you have to improve the service description? Cancer Clinical Advisory Group proposed service level description: Hospital/ Ranking Medical Oncology RHH LGH NWRH MCH Radiation Oncology (when established) N/A Haematology Question from Cancer Clinical Advisory Group Is it possible to have two Level 6 service descriptions for the same cancer related discipline to maintain? Response: The terminology used in the Role Delineation Framework is confusing and not consistent with the terminology used in other jurisdictions. Role Delineation is most commonly applied to the role of an individual or a professional/staff grouping not to a clinical service. The commonly used terminology to define and classify a clinical service is Service Capability Framework. In cancer a number of jurisdictions including Victoria, Queensland and Western Australia have already implemented the use of Service Capability Frameworks and at a national level this terminology has been endorsed by the COAG National Cancer Expert Reference Group. Although the classification of cancer services using an integrated cancer services model has some merit, the service capability frameworks used in other jurisdictions adopt a different approach in that they consider the differing service level capabilities within each of the specialist oncology disciplines of radiation oncology, medical oncology, clinical haematology and surgical oncology rather than using a combined classification for all services. The above table lists the specialist cancer disciplines and the proposed service description level for each of the cancer services in Tasmania if a statewide cancer services model is adopted. The model presented in this paper also does not consider the varying requirements of the different tumour streams nor the complexity within some tumour streams. The table at Appendix 1 highlights the evidence based optimal referral rates for various cancers that have been divided into tumour streams. The strategic vision for cancer services in Tasmania is that service delivery will be characterised by integration, standardisation of clinical processes, transparent accountability and coordination of service delivery to patients. Services for patients and their families and carers will be patient focussed, coordinated and linked across health sectors. Page 1 of 7

2 Therefore this framework also utilises the existing resources of each of the cancer services to provide high quality services to the vast majority of cancer patients with the most complex patients referred interstate. This model is working with Gynae Oncology where patients have surgery in Hobart but are referred to Launceston for HDR Brachytherapy and to the patients local centre for external beam radiation therapy. Currently, the North West Regional Hospital cancer service would fit into a level 4 cancer service. However, with the establishment of on-site radiotherapy services in early 2016, higher level services in medical oncology, palliative care, emergency services, medical and surgical services, radiology, pathology, allied health and nursing may be required to support the on-site radiotherapy service. However the NWRH will still remain a Level 4 service with a linked/networked radiotherapy service with the North which will be necessary to ensure that appropriate support will be provided in the NW. This has been formalised already with an integrated service plan with the Launceston Oncology Director responsible for both services. A new state-wide clinical trials model with potentially increased capacity to improve clinical quality and service efficiency, equitably and sustainably meet future demand, and ensure fiscal responsibility does sound good in theory but implementation may be potentially limited by the regional nature and lack of transport infrastructure of cancer service delivery in Tasmania, and the limited potential for improvement of service at the price of significantly increased cost. Level 4 clinical trials states that the service refers patients to higher level cancer clinical trials services but does not coordinate or administer clinical trials, but the service may provide trial therapies to enrolled subjects in partnership with a Level 5 or Level 6 service. In reality, this will not occur. Clinical trial sponsors will not allow trial therapies to be administered outside the registered trial site which will be a level 5 or 6 clinical trials service according to the role delineation service description. All services described appear to be in a hospital setting. There is minimal reference to care outside of a hospital setting whereas Section 3.2 of the Green paper is discussing the balance of care shifting from the hospital to the community. The service descriptions include minimal efficiency on service provision and how that could be achieved. Treatment delivery is only one aspect of the cancer journey. Aspects of improved psychosocial care, particularly in the rural/regional setting, and recognition of the significance (and drain on resources) of survivorship need to be included. Service requirements Questions: Consider the service requirements specified for Levels 1-6, do you feel that the service requirements for each level are appropriate? What suggestions do you have to improve the service requirements? What are the appropriate minimum service volumes that need to be maintained to ensure the competence and professional practice of the multidisciplinary team are sustained? What is the current and likely future demand for the service? Response: In accordance with the proposed service level description table for each cancer related service, it also needs to provide for the appropriate service level description for each of the tumour streams and complex cancers, incorporating standardised and implemented state-wide practices, systems and information, effective and transparent cancer care pathways and referral pathways. Page 2 of 7

3 There are some services where minimal volumes need to be maintained to ensure safe and sustainable clinical practice. HDR Brachytherapy, Bone Marrow Transplants, and Aphaeresis would be areas for consideration but no benchmarks have been set to date. With an ageing population and projected growth in cancer incidence it is likely that demand will grow. Workforce requirements Questions: Consider the workforce requirements specified for Levels 1-6, do you feel that the workforce requirements for each level are appropriate? Are there services with key person dependencies that would benefit from clinical redesign to ensure the quality, safety and sustainability of the service? Are their professional guidelines around staffing levels (for example, issued by Colleges) that need to be taken into account for this service? Response: Opportunities for specialised staff to cover on call for each other across disciplines and regions could be investigated further. E.g. The Medical Oncologists and Clinical Haematologists share an on call roster at the LGH currently. On call arrangements between LGH and the NWRH once they have permanent full time medical staff could be facilitated to ease the issue of sole person dependencies for the North West Regional Cancer Centre. Paediatric Oncology is one area with sole person dependency with Professor Daubenton and closer ties with the Royal Children s Hospital should be investigated with the likely retirement of Professor Daubenton in the near future. An identified gap statewide is the lack of adolescent/ young adult cancer medicine expertise. The opportunity to develop expertise in this area and the related areas of Paediatric Oncology and Survivorship Care should be considered as a matter of urgency given the current sole person dependency. These areas of practise have considerable synergy and by virtue of the relatively small numbers should be managed in a state wide service to provide consistency of care/equity of access to expertise. Support service requirements Questions: Consider the support service requirements specified for Levels 1-6, do you feel that the support service requirements for each level are appropriate? What suggestions do you have to improve the service requirements? Response: The support service requirements for each level should also include medical, surgical and allied health support services. Additional information With the move to one Tasmanian Health Service and the implementation of the Tasmanian Clinical Services Profile (TCSP) what do you think are the main gaps, issues or barriers that need to be considered to ensure TCSP s successful implementation? Page 3 of 7

4 Response: A State-wide approach should be considered to ensure research, clinical trials, training, education and peer support are implemented, including a state-wide focus related to staffing roles where appropriate and safe to do so, and state-wide standardised systems, information, and procurement. It is essential to maintain sustainable partnerships and collaboration with private and non-government organisations. There must be a requirement for clear and transparent communication to the public to address the reasoning on why specialised cancer services will be provided at specific locations. Transport and accommodation infrastructure and education for patients and family needs reform, as many patients may be transferred between hospitals when their level of care needs to be escalated or de-escalated, and careful assessment of capacity to ensure that higher level services can cope with the overflow/transfers from lower level services. How we best ensure the proper integration of services across regions/hospital campuses? Principle 3 of Appendix 2: Tasmanian Cancer Services summary of planned principles and objectives envisages a functionally single, integrated cancer service for Tasmania in which care is provided as close to the patient s home as safely and sustainable as possible. Both the South and North cancer services already effectively operate as comprehensive cancer centres in conjunction with other disciplines. Medical and radiation oncology, as well as haematology services, are part of the same integrated, coordinated, multidisciplinary and patient-focussed approach to treatment. Moreover, the provision of treatment services in each discipline is provided in accordance with standard evidence based guidelines and protocols. Central Leadership: need to seek regular updates on the performance, outcomes, needs and issues from the local leaders, need to promote state-wide issues on a national level i.e. training/education, trainee accreditation, staff recruitment and retention, etc. should not impose excessive and redundant regulations, which would only reduce efficiency at the local level. Local Leadership: Clinical/Non clinical leaders to provide central leadership with local knowledge (workload, outcomes, issues, needs) so that services can be appropriately commissioned. Regular consultation and feedback to central leadership. Ensures local agreement and compliance to role delineation and performance measures. Local leadership may need some flexibility with urgent local service commissioning. The need for interdisciplinary education and peer support is the key to an integrated approach. Modern videoconferencing technology makes this easier and with the 3 main hospitals having a MDT video wall as part of their cancer centres this should be easier and more cost effective to initiate and maintain. What support needs to be provided or strengthened to ensure patient access to services? In accordance with Principle 3 and 5 of Appendix 2: Tasmanian Cancer Services summary of planned principles and objectives includes reference to care and referral pathways, palliative care services, survivorship plans and survivorship needs to ensure patient access to the cancer services. Transport and accommodation options and effective communication of these options will be essential. Can you identify opportunities for clinical redesign / alternative models of care to better ensure the sustainability of services? The importance of Cancer Care Coordination in facilitating passage along the cancer journey needs to be emphasised once again. According to the COSA guidelines, Tasmania should have 1 FTE cancer care Page 4 of 7

5 coordinator for every 250 new cancer cases. Having an accepted benchmarking tool for medical oncology and haematology nursing staffing would be beneficial. Currently there is no accepted model nationally or internationally and some models are population or chair based when ideally they should be activity based. Ensuring that referrals provide the necessary test results for treatment decisions to be made without the need to delay options while awaiting test results post initial consultation. Referral pathways and referral templates would be useful tools to facilitate this end. How do you think technology such as video-conferencing can be best utilised to ensure access to services? Video conferencing in the cancer care setting may work well in other better resourced jurisdictions but with a limited workforce in Tasmania to engage in video conferencing, it may not be the most efficient method of service delivery. However, videoconference is useful for visiting services in the outpatient setting or perhaps for 24 hour advice in emergency/surgical/medical services but has limitations beyond these circumstances. The current Role Delineation paper includes minimal reference to provision of outreach services or any service to remote locations. Video conferencing could possibly be utilised for Multidisciplinary review (MDT) for rarer or more specialised cancer cases. Can you identify alternative patient pathways to improve access to services? Cancer prevention, screening and early detection is part of the cancer continuum. Early detection can save lives, enable people to live longer, all resulting in less cost to the health system. The whole cancer spectrum needs to be taken into consideration, although the Role Delineation only takes into account treatment within the acute healthcare setting. A benefit would come from integration of screening services with General Practice. GP's are trusted providers who can remind, encourage and promote use of government funded screening and achieve better take up rates, in particular FOB (bowel cancer screening) and mammography. Care coordination and identification of blockages in the system process - this could identify if there are delays in critical treatment or surgery or referral between specialities or access to diagnostic services from certain areas. Outreach clinics have been a valuable tool for access in the North and for significant population areas with low referral rate, this remains a viable option to improve access. Sustainable partnerships with private and non-government organisations that combine with the Government activities will support improved access to services. Where are the areas of service duplication in your discipline? NWRH and MCH have unnecessary duplication of staff (nursing, pharmacy, admin) and facilities/resources (chemotherapy chairs, IT systems, other equipment) which has led to a shortage of specialist staff (chemotherapy nurses, etc.) and resources (finances for equipment etc.) in the NWRH where the new regional cancer centre will be based in There is transport costs associated with transporting blood cells to the RHH, but this cost would be greater if patients were required to travel to a single centre. Where are the gaps? There are potential gaps in transport and housing infrastructure as public transport services are Page 5 of 7

6 variable across the state. Provision of survivorship services for Bone Marrow Transplant patients and the broader cancer population is scant, as there is currently only a small survivorship clinic at the RHH. The provision of specific care coordination for Adolescents and Young Adults is currently non-existent, and appropriate palliative care for haematology patients requiring blood products in the palliative setting is non-existent. Rehabilitation services for cancer patients are lacking along with access to allied health professionals, and there is no recognition or emphasis on cancer prevention actions/activities or early detection through screening or other means. Are there any services being inappropriately provided, or planned, at your facility? Ambulatory/chemotherapy day unit in MCH and duplication of services given that the NWRH cancer centre will be operational in 2015, together with acute inpatient care in MCH. Very uncommonly, complex surgery e.g. head and neck surgery in NWRH. The Role Delineation Framework does not incorporate the utilisation of non-clinical organisations. How do we promote and maintain safe primary and community care to consumers and communities such that they seek out these services rather than attend Emergency Departments when their conditions are more advanced? Investing in public health and primary care with the upskilling of healthcare workers, clear and transparent communication lines, and referral pathways properly disseminated. Patients need access to care coordinators who can assist with navigation of the health system, streamline and target care. The service needs to be available, accessible and affordable for both recipients and providers. The community needs to be well educated as to how to access services appropriately. Health professionals need to be well educated and trained as well as the staff employed in community centres, and to promote the use and development of PCEHR. How do we determine which services to focus on to expand the role of primary and community care? We need to expand the role of primary and community care within the palliative/ chronic disease setting, rehabilitation after cancer treatments, survivorship, and long term effects including psychosocial care. General Practice care of patients post-acute treatment and knowledge or protocols on when the patient needs to be referred back to the acute service. This will allow confidence when discharging care back to the GP s and potentially reduce the workload attached to continued long term follow up at the acute service. (This is the subject of a research project in Western Australia that may be useful). Ongoing non cancer health prevention and disease management (from usual community provider) must not also be overlooked. What services do not have sufficient volume or activity in Tasmania to maintain a safe, high quality service? CCAG has put forward under Principle 3 of Appendix 2: Tasmanian Cancer Services Summary of planned principles and objectives a number of objectives for best practice arrangements, access and equity of access to highly specialised services/treatments, service integration, and alignment with demand. Page 6 of 7

7 What additional areas should we be considering for interstate partnerships in order to improve service within Tasmania? Tasmania currently has sole person dependency for the provision of paediatric oncology services. The current incumbent has signalled his intention to retire in the next couple of years and it is highly unlikely that a replacement will be found due to the small patient numbers and lack of professional peer support for a dedicated paediatric oncologist. An interstate partnership with the Royal Children s Hospital in Melbourne has been proposed as a viable succession planning strategy. Adolescent and Paediatric cancer care, Sarcomas and Germ cell tumours require multidisciplinary discussion and management including survivorship/ long term treatment and follow up with psychosocial care. A continuing and strengthened relationship with the ontrac Program will support this cohort of patients. What services, despite comparatively low volumes, should we continue or invest in in Tasmania, and what interstate supports may be required to maintain them? Clinical trials: The role delineation proposal will see many patients in the North West missing out on clinical trials. A suggestion to create a single state-wide clinical trials service which allows all Tasmanian patients to access trials whether it be in the North West, North or South. Trials will be registered under this state-wide service rather than individual hospitals but patients will be able to attend individual hospitals for the trial treatment and follow-up. We should invest in complex surgery such as head and neck, neurosurgery, thoracic, upper GI and also Familial Cancer Services with rising cancer incidence and genetic findings playing an increasing role in therapeutic decisions. It is essential to continue to foster the existing relationship with the Royal Melbourne Hospital for bone marrow transplantation, and ongoing relationship with Royal Children s Hospital for paediatric cancers, alongside establishing links with specialist cancer centres for rare and complex cancers. Is the Tasmanian health system all it should be, or should we be open to change in order to improve outcomes for all Tasmanians regardless of where they live? We should be open to change that promotes health service delivery which is based on providing equity of access to quality care for all Tasmanians rather than focussing on providing local access to specialised services. The focus on providing some specialised services at all major locations with the inherent risks of decreased quality and lack of appropriate clinical support services is not an efficient use of expensive resources. General Comments There has been a significant step made in breaking down the combined service levels into the major subcategories, however there is more work that needs to done to develop service level descriptors which are relevant for Tasmania in the context of a statewide service model for cancer services. The concept of the framework as developed in other states is a good one, but the service level descriptors developed in the larger states may not be applicable for our Tasmanian model. This is obviously something that can t be done as part of this current response but rather highlighting the need for it and CCAG willingness to lead it. If there any specific issues you would like to address please contact the Cancer Clinical Advisory Group (CCAG) via the Convenor, Dr Rosie Harrup. Page 7 of 7

8 Appendix 1 The table below highlights the evidence based optimal referral rates for various cancers that have been grouped into tumour streams. It is a compilation of optimal rates for Medical Oncology from and optimal rates for Radiation Therapy from that also included HDR Brachytherapy and Synchronous Chemo-Radiation Therapy. For a tumour groups such as upper GI, Neurology, Lung, Head and Neck, Rectum, where a significant number of patients require synchronous Chemo-Radiotherapy it seems logical for those treatments to have a referral pathway to a level 5 centre with combined Chemotherapy and Radiation Therapy Services. For Gynae services where a significant number of patients would benefit from HDR Brachytherapy the referral pathway needs to include that service. Currently HDR Brachytherapy is available in Launceston and there are good referral pathways currently in place. (see table 2) For Haematology, Colorectal and Neurology streams there are no indications for HDR Brachytherapy and the Radiation Therapy services in Launceston and Hobart have the similarly optioned linear accelerators and treat with a wide range of treatment techniques so there is no need for a referral pathway outside these regions to a statewide radiation therapy service. There is a need to have referral to a statewide bone marrow transplant service of interstate depending on the complexity involved. Other tumour streams such as Genito-Urinary are not so straight forward where the referral pathways will vary for Bladder with some synchronous Chemo-Radiotherapy, Prostate with HDR or seed Brachytherapy indications. The private sector in Hobart has a Prostate seed program in place and sees around 40 to 50 cases per year. Breast is a case where chemotherapy and radiation therapy are used in the management of the disease but not required to be delivered synchronously so can be managed with referrals between centres as required. There are some patients with close or positive surgical margins where HDR Brachytherapy has some indications and can also be used for accelerated partial breast irradiation for early stage disease. Table 1 Optimal Cancer treatment rates Tumour Group/Site Medical Oncology Chemotherapy Indication (%) Haematology Chemotherapy Indication (%) Radiation Oncology Indication (%) % of cancer that require Synchronous Chemoradiotherapy HDR Brachytherapy Indication Genito- Urinary Bladder Prostate Kidney Testis 70 7 Neurology Brain I131 Isotope Therapy Indication Breast Breast Yes* 1 CCORE Chemotherapy in Cancer Care: Estimating the optimal Chemotherapy utilisation rate, Barton, Delaney and others, Aug CCORE Radiotherapy Utilisation rates, Barton, Delaney and others, March 2014

9 Upper GI Gallbladder Liver 27 0 Oesophagus Yes* Pancreas Stomach Head and Neck Head and Neck Thyroid 13 4 Yes Lung Lung Yes* Haematology Leukaemia 85 4 Lymphoma Myeloma Skin Melanoma Colo- Rectal Colon 55 4 Rectum Gynae Cervix Ovary 84 4 Uterus Vagina Vulva Not available 39 Unknown Primary Other equates to 43% equates to 7.8% equates to 48.3 % equates to 8.9 % equates to 3.3 % <1% of all cancers Available * local indications of all cancers RHH, LGH, NWRH, MCH NW patients referred to LGH especially IP treatment of all cancers of all cancers of all cancers of all cancers RHH, LGH RHH, LGH RHH, LGH LGH RHH Bone Marrow Transplants at RHH, NW haematology patients referred to LGH NW patients referred to LGH predominately NW patients referred to LGH HDR Brachytherapy at LGH Patients referred to RHH

10 The actual referral levels for the HDR Brachytherapy service in Launceston form the three regions over the past 4 years have been captured in the following table Table 2 Referral Rates to HDR Brachytherapy Service in Launceston Brachytherapy referrals by source area code (2011 to 2014) Total Percentage Gynae % Breast % Prostate % Lung % Oesophagus % H& Neck % Skin (Melanoma) % Total The table above shows the referral patterns to the HDR unit in Launceston excluding non-melanoma skin treatments. The vast majority from Hobart are Gynae cases as you would expect.

11 Department of Health and Human Services and Tasmanian Health Organisations Tasmanian Cancer Services Summary of planned principles and objectives Objectives Principle 1 Improving Cancer Prevention Prevention offers the most cost effective long term strategy for the control of cancer Assess effectiveness of all interventions designed to reduce the impact of cancer on Tasmanians Encourage healthy behaviours and physical activity Promote and support effective communication plans Principle 2 Effective Cancer Screening and Early Detection Screening can detect cancer at an earlier stage and early detection provides the best chance of cure Objectives Promote and support effective screening programs Promote public awareness and recognition of early symptoms and signs of concern Ensure timely access to diagnostic procedures Principle 3 Creating a Quality, Integrated and Sustainable Cancer Care System Quality and sustainable care will be provided by a functionally integrated cancer care system Objectives Implement best practice arrangements for cancer care and treatment services for all Tasmanians Support equity of access for people within Tasmania to all modalities of cancer care Improve equity of access to highly specialised services/treatments for defined cancers Support service integration across professional and geographic boundaries Ensure alignment of system capacity with demand Strengthen sustainable partnerships with the private and non-government sectors Recruit and retain a sustainable and high quality workforce Page 1 of 2

12 Principle 4 Research and Innovation Drive efficiency and effectiveness through research and innovation Objectives Promote clinical cancer research Promote clinical trials participation Implement state wide technology and information systems Support initiatives that provide cost benefits for the health system Principle 5 Providing a Patient Centred Continuum of Care The patient is at the centre of their care throughout their care pathway Objectives Cancer care is planned and delivered as a seamless service system across Tasmania using best practice shared cancer care models Monitor outcomes of cancer care in Tasmania Enhance supportive and palliative care Promote recognition of Survivorship needs Objectives Principle 6 Ensuring a well Governed Statewide System Effective governance will support and enable planning and delivery of excellent care A Robust and well Governed system Communicate the cancer care system to the community and health professionals Page 2 of 2

13 Appendix 3: CCAG response to Green Paper & Role Delineation Framework Re: Cancer Screening and Control Services Cancer is a major cause of illness in Tasmania and has a substantial social and economic impact on individuals, families and the community. The major opportunity for reducing incidence and mortality from cancer as well as reducing the burden of the disease on the community is through prevention, screening and the detection of early-stage cancers; while late-stage diagnosis, treatment and palliation of people with cancer consume significant health care resources, and does not reduce the burden of cancer on the community. Cancer kills more Tasmanians than any other single cause. Moreover, it is predominantly a disease of older people, therefore presenting an enormous challenge to health resources as Tasmania s population continues to age. Greater investment in the organised screening programs (breast, cervical and bowel) will deliver improved outcomes for Tasmanians whose cancers can be diagnosed in the earliest stages, when treatment is most effective. Successful population based cancer screening programs encourage participation by the target population (those at highest risk) in order to achieve reductions in morbidity and mortality that will realise benefits to the community and reduce the burden of late-stage disease on health care services. The population based approach encourages asymptomatic individuals in the target population to have regular screening. It is distinctly different from diagnostic tests to investigate symptoms in individuals. Screening programs - in particular the BreastScreen program - currently operate under a capped funding model, with no concomitant growth in funding to accommodate the increasingly ageing population. This is a significant gap in health care funding arrangements that significantly limit the realisation of benefits from screening. Cancer Screening & Control Services (CSCS), in providing population based screening programs 1 for the asymptomatic, well population, is uniquely different to the acute health sector, where people who are sick, seek treatment to manage their illness, or become well again. It is a different paradigm. Cancer Screening and Control Services work plays a critical role in Tasmania achieving the objective of the Healthiest State status, by investing in the future health of the state through strategies and initiatives that will reduce morbidity and mortality attributable to cancers that are largely preventable. Cancer screening interventions, risk identification, prevention and early detection initiatives can achieve substantial control over the burden of the many cancers impacting Tasmanians. One State, One Health System, Better Outcomes, Tasmanian Role Delineation Framework states that services for screening and prevention of cancer are outside the scope of the Framework and are described in the Tasmanian State Cancer Plan 2. However, the West Australian Clinical Services Framework , one of the frameworks upon which the Tasmanian Role Delineation Framework is based, clearly maps cancer screening services from Level 1 through to Level 6. 3 A self-assessment undertaken by Cancer 1 Australian Population Health Development Principal Committee. Screening Subcommittee. The Australian Population Based Screening Framework Tasmanian Department of Health & Human Services. One State, One Health System, Better Outcomes. Tasmanian Role Delineation Framework. December Page 45 3 Department of Health, Western Australia. WA Health Clinical Services Framework Page 71

14 Screening & Control Services against the West Australian model also clearly places CSCS at a Level 6 in the Tasmanian framework. Program design and delivery in Tasmania is identical to that of West Australia with coverage of the service extending from prevention and community engagement and recruitment activity, early detection, screening, research and teaching to provision of psychosocial care into survivorship. Cancer Screening and Control Services, through sustained excellence according to national standards, meet all criteria within the Role Delineation Framework. Through the three established national screening programs, CSCS delivers quality care and services on a statewide basis. Tasmania s population is the oldest in Australia and cancer is predominantly a disease of ageing. Demand for Cancer Screening and Control Services will continue to grow with the ageing population. The effectiveness of these programs in delivering long term improved health outcomes depends on the provision of quality, sustainable integrated screening services.

15 APPENDIX 4 - CANCER COUNCIL TASMANIA ADDITIONAL INFORMATION TO SUPPORT THE RESPONSE FROM THE CANCER CLINICAL ADVISORY GROUP (CCAG) Background Cancer Council Tasmania (CCT) is an incorporated association and was established in It is a not-for-profit organisation that works to minimise the incidence and impact of cancer on all Tasmanians. The organisation is 90% funded from fundraising and donations, with each dollar raised staying in Tasmania and invested back into the Tasmanian community. CCT covers all cancers, all ages with a mission to reduce the impact and incidence of cancer in Tasmania, Cancer Council Tasmania: Provides high quality support services for people affected by cancer being cancer patients, their families, carers; Invests in cancer prevention programs which educate the community about lifestyle factors that can decrease the risk of cancer; Advocates and lobbies for effective public and or legislative change related to cancer prevention and health promotion; Provides a respected voice for the needs of people affected by cancer; and Funds local cancer-related research projects. Response CCT is represented on the CCAG. CCT provides services that include practical, financial, educational and emotional support at all stages of the patient s cancer journey. CCT does not provide clinical support, counseling or case management and although not physically working in the clinical space it seeks to ensure a collaborative relationship with the three major public hospitals in the state, private sector hospitals and other aligned not for profit organisations. Health promotion, cancer prevention and early detection are areas of advocacy and promotion that CCT continues to pursue. The numbers of people being diagnosed with cancer continue to rise, mortality rates are decreasing and people are living with cancer longer. Over 8 people per day are diagnosed with cancer in Tasmania. A coordinated approach with public, private and not for profit partnerships is needed to ensure better outcomes from one state and one health system. CCT seeks to work across all sectors. The client is our focus with the emphasis on ensuring that the numbers of future clients are minimised through the activities progressed related to cancer prevention and early detection. The ability to connect with rural and remote areas to deliver the messaging, ensure that they have access for diagnosis and an efficient system to ensure treatment if needed, are fundamental to reducing health costs now and into the future.access to better services is vital. The impact on our clinical systems and the ongoing costs will become an additional burden on the health system if funding related to cancer prevention and screening is reduced and the activities are not included in One Health System. There must be a whole of system approach to improving health outcomes and reducing the increasing cost impost on our system. 1

16 As documented in the Green Paper, the need to shift the discussion from better access to services and instead strive towards access to better services is commendable. However the access comes at a cost. Cancer Council Tasmania provides a transport2treatment service at no cost to Government. In the service transported 305 individual clients to over 4,800 treatment appointments at the Holman Clinics in Launceston and Hobart. People need access to services and CCT supports Government to determine the best profile of services across the state to ensure equal access to quality services for all Tasmanians, regardless of where they live. Government must continue to support organisations such as CCT and ensure that they continue to have the capability and capacity to sustainably deliver the service, which can be delivered at a considerably lesser cost than Government can provide. 2