Tayside Breast Cancer Independent Advisory Group: final report

The report on how best to implement changes to breast cancer management in NHS Tayside.

Summary of recommendations

Table 1

A summary of all 19 recommendations appears below. The preceding discussion section explains the reasoning behind each.

Number Recommendation Timescale Lead Responsibility
1 A separate longer life group should be created to ensure the implementation of this report's recommendations, particularly those relating to long term changes in organisational culture across cancer networks in NHS Scotland. This new group should report to the Scottish Cancer Taskforce. Short term Scottish Government
2 Sufficient resource should be provided to the Regional Cancer Networks to ensure that this report's recommendations are delivered in full. Short term NHS Boards
3 The three Regional Cancer Networks should undertake a mapping review of the terminology being used in governance structures, with the aim of achieving, where feasible, more consistency across NHS Scotland. Medium term Regional Cancer Networks
4 All NHS Scotland staff (particularly clinical staff) should be reminded of the requirements of MEL (1999) 10, and the need to engage with the governance arrangements covered in section 8. See Annex C1 for the relevant extract. Short term Scottish Government
5 In the case of consultant staff, delivery of Recommendation 4 includes attendance at relevant advisory groups e.g. tumour specific meetings. Such attendance should be included in the individual's job plan, in consultation with the relevant Medical Director. Short term NHS Boards/Regional Cancer Networks
6 Consideration should be given to whether para 1.43 of CEL 30 (2012) requires clarification regarding where the balance of governance lies, locally and regionally. The need for revision of the CEL has already been agreed by the Scottish Cancer Taskforce. See Annex C2 for the relevant extract. Short term Scottish Government
7 The Scottish Association of Medical Directors should be used to raise awareness of this report and provide direction and leadership to ensure implementation of the recommendations in this report. Short term Medical Directors
8 To ensure consistency across NHS Scotland, a properly resourced multi-professional National Clinical Management Guidelines (CMG) Oversight Group should be set up for the development of and monitoring of compliance with cancer CMGs. Medium term Scottish Government
9 The Regional Cancer Networks should formalise the current informal process of sharing CMGs across NHS Scotland in the interests of national consistency and shared learning. Short term Regional Cancer Networks
10 A review of all existing CMGs and associated Systemic Anti-Cancer Therapy (SACT) protocols against extant central reference material e.g. relevant Scottish Medicines Consortium (SMC) guidelines and Scottish Intercollegiate Guidelines Network (SIGN) guidelines, should be undertaken in all three regions. The process must include escalation procedures where consensus is not reached. If variation exists, this needs to be explained and justified. Long term Regional Cancer Networks
11 The National CMG Oversight Group should hold an annual consensus conference to facilitate and embed a "Once for Scotland" approach that encompasses cancer CMGs. There would be benefit in involving patients in the planning and delivery of the national conference. Medium term Scottish Government
12 New arrangements for cancer CMG development and monitoring should be communicated to NHS Scotland through a new CEL. Medium term Scottish Government
13 Regional Cancer Networks along with constituent Board representatives should attend regional tumour specific meetings to consider Quality Performance Indicators (QPI) data. Short term Regional Cancer Networks
14 Adequate resources should be allocated to the Regional Networks from Boards to hold regional tumour group meetings to consider QPI data and complete the audit loop. Medium term NHS Boards
15 Officials in all 3 Regional Cancer Networks (NCA, SCAN and WoSCAN) should take the opportunity to observe the operation of each other's networks, including patient involvement processes. Short term Regional Cancer Networks
16 The current upgrade of Chemocare ®should be delivered as quickly as is safely possible, to ensure resilience of the service and allow the development and delivery of national reports capable of monitoring prescribing practice. The Chief Executives Group and the Scottish Cancer Taskforce have a role in assessing whether sufficient priority is being given to achieving measurable progress in this area. Medium term NSS/Regional Networks/Chief Executives/ Scottish Cancer Taskforce
17 Patients must be explicitly informed of any variance from generally accepted standard SACT clinical practice, for informed consent to take place. The risks of treatment should also be discussed and this discussion recorded in the patient's record. Short term NHS Boards
18 All Boards must adopt the standardised approach to SACT consent once guidance is available to ensure national consistency in documentation of informed consent across Scotland. Short term NHS Boards
19 NHS Tayside should continue to offer extended support for patients & families including wellbeing support and the offer of enhanced health monitoring to affected patients. Short term NHS Tayside


Email: marianne.barker@gov.scot

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