1. Non-surgical Cancer Treatment Services

2. Medical Oncology Models of Care Overview of the three implementation programmes 1.Service configuration - To help improve and reconfigure services and to increase treatment capacity in the appropriate facilities 2.Workforce - To develop and support workforce models that increase clinical capacity 3. Service quality - To improve clinical quality and service efficiency so that patient care is equitable nationwide

3. Medical Oncology Models of Care Developments to date include: development, distribution and analysis of a service assessment tool for DHBs development of regional oncology service plans appointment of a project team, including two Senior Medical Officers (SMOs), to develop guidance on alternative clinical and non-clinical roles in medical oncology appointment of a clinical nurse lead to develop a Knowledge and Skills Framework for Cancer Nursing

4. Medical Oncology Models of Care 2013/14 activities: 1. The service configuration programme Develop national standards for the delivery of medical oncology services to support a four level service centre model of care. 2. The workforce programme Develop guidance on alternative clinical and non-clinical roles in medical oncology. Develop a Knowledge and Skills Framework for Cancer Nurses that will include: – specific nursing activities/tasks and competencies at each stage of the patient care pathway – an education programme for cancer nursing. Begin implementation of the Knowledge and Skills Framework for Cancer Nurses.

5. Medical Oncology Models of Care 2013/14 activities: 3. The service quality programme Support the implementation of the national standards for tumour specific treatment. Support quality improvement initiatives such as multidisciplinary meetings. Support the regional cancer networks to implement their regional service plans. Support the sector to implement and share service innovations.

6. Chemotherapy E-Prescribing Project Project purpose To progress the development of e- prescribing for chemotherapy in the CCN region as an enabler to support the Medical Oncology Models of Care implementation.

7. Chemotherapy E-Prescribing Project Objectives: Regional Cancer Treatment Service (RCTS) development of a business case and implementation plan to enable chemotherapy e-prescribing, via MOSAIQ, with its catchment DHBs Wellington Blood and Cancer Centre (WBCC) completing a feasibility study to identify an electronic patient management system to support their medical oncology and clinical haematology services, taking into account the wider context of the cancer centre and DHB existing Information System infrastructure

8. Chemotherapy E-Prescribing Project RCTS A joint project MO and CH Business case in development for Mosaiq chemotherapy prescribing Awaiting a wireless environment and Mosaiq mobile Phased implementation but planned for all RCTS sites Working closely with SCN

9. Chemotherapy E-Prescribing Project WBCC Identified as a strategic goal some years ago Aligns well with the national momentum Locally we want to identify the solution that – Performs the key tasks to the highest level – Allows us to interface with Radiation Oncology appropriately – Allows us to work regionally as effectively as possible – Allows us to report to National Projects to the standards required.

10. Chemotherapy E-Prescribing Project WBCC 1.Site visits from the 3 vendors in the mix: Aria; Mosaiq (Elekta); Charm Served to orientate staff to the project and the questions to ask 2.Project Team – Representing all the disciplines 3.Drafting a document that tries to ask all the relevant questions of a product – so the preferred candidate can be identified ( “ RFP phase ” ) 4.Move this out to the Vendors 5.Review the Result with the teams 6.Select and justify the preferred solution – writing the Business Case.

11. Chemotherapy E-Prescribing Project MilestonesCompleted by Project /Communication Plan and Feasibility Study CriteriaJuly2013 Regional Steering group and RCTS / WBCC Project Groups established July 2013 RCTS pre-implementation activities identified and commencedJuly 2013 WBCC feasibility study completedSep 2013 MDHB HAC endorsement RCTS Business case and implementation plan Oct 2013 C&CDHB executives decision re WBCC feasibility study recommendations Oct 2013 Phase 1 activities complete and Phase 2 activities identifiedOct/Nov 2013

12. WBCC / RCTS service developments WBCC Ambulatory Model of Care and expansion of services 5 North additional beds Outreach services

13. WBCC / RCTS service developments RCTS Improving outpatient clinic facilities Continue to develop 2 CNS roles for MO Standardisation and control of protocols Planning for future staffing numbers Consideration of an outreach chemotherapy model for Whanganui

14. Proposed Regional Activities 2013/14 Complete Chemotherapy E-prescribing Project Phase 1 activity by October 2013 (timing of Phase 2 activities dependant on MDHB and C&CDHB decisions at this point). Complete a short term Medical Oncology Regional Service Plan to support the implementation of MOMOC (under consideration by the E-prescribing Regional Steering Group)

15. Proposed Regional Activities 2013/14 Continue to contribute to the MOMOC National Implementation Plan activities, including: – development of national standards for the delivery of medical oncology services – development of guidance on alternative clinical and non-clinical roles in medical oncology – development of a Knowledge and Skills framework for cancer nurses and commencing implementation activities

16. National Radiation Oncology Plan Project Purpose To develop a robust National Plan that will inform national-level decision making, and provide guidance for further more detailed capacity and operational planning, and the parameters and tools to assist DHBs’ local and regional planning processes for radiation oncology services in NZ over the next 10 years.

17. National Radiation Oncology Plan Involves drawing together: existing detailed planning of radiation oncology services forecasting models for cancer prevalence and regional linear accelerator capacity needs additional workforce and cost modelling to be undertaken

18. National Radiation Oncology Plan MilestoneCompleted by (2013) Development and testing of modelling assumptions and parameters 30 April Report on modelling (linear accelerators, workforce, cost) 31 May Stakeholder engagement on draft plan26 August – 13 September Final Plan completed31 October Ministry of Health publication of Final PlanDecember

19. WBCC / RCTS service developments WBCC 2012 regional LINAC requirements were reviewed in conjunction with Mid-Central 2011 as base yr and modelled to 2020 population, intervention rates, retreatment rates Average number of fractions, linac available hours, built in coping with peak demand and still meeting 4 week target Modelled change in complexity on linac throughput

20. WBCC / RCTS service developments WBCC need 4 th LINAC 2014 and a second in 2019/20 National Service Plan – using a similar approach (but not building in a change to average treatment times for complexity) yet to be released - due later this year and therefore likely to stall 4 th LINAC and associated facilities along with the fiscal constraints of the hospital and the complexity of a North End development

21. WBCC / RCTS service developments WBCC service developments for 2013/14: Facilities and Equipment: Replacement LINAC 1 business case 4 th LINAC and facilities expansion Utilisation of old simulator room Participation in dept wide review of ambulatory care and e prescription ARIA upgrade

22. WBCC / RCTS service developments WBCC – Brachytherapy service U/S based planning for HDR prostate Interstitial needle use for some cervical carcinomas Interstitial breast HDR (Endoluminal service)

23. WBCC / RCTS service developments WBCC continue to extend our review of patient immobilisation and imaging. numerous physics projects – acuros dose calcs, safety plans, in vivo dosimetry, new TBI protocol Radiation therapist projects focused on patient education/care, quality/process improvement,IT supported oncology care

24. WBCC / RCTS service developments RCTS Replacement of simulation CT scanner Optimising the work flow area Stereotactic body radiotherapy program Initial work on linac vendor change

25. Proposed Regional Activities 2013/14 Participation on National Radiation Oncology Plan Steering Group and Expert Advisory Group through to October 13. Development of a Regional Radiation Oncology Services Implementation Plan by June 2014.