Part 4: Is regional services planning integrated with regional cancer-services planning?

4.1
In this Part, we look at what the introduction of regional services planning has meant to regional cancer-services networks – a long-established workstream, with its own regional funding and lines of accountability.

4.2
The planning for cancer services is contributing to achieving the intended effects of regional services planning. This is partly because regional planning for cancer treatment has been working successfully since well before regional services planning was set up.

Regional networks to treat cancer

4.3
Regional networks to treat cancer were set up in 2006 and 2007. The networks have separate funding dedicated to achieving their co-ordination and improvement functions throughout the health sector as a whole, not just with DHBs. They also get dedicated funding to carry out projects that are in line with the national cancer work plan. The strong relationship between the networks and the Ministry is characterised by regular communication, clear lines of responsibility, and a co-operative working relationship. This is an important contributor to having effective cancer-services networks.

4.4
The regional cancer-services networks lead service improvement and planning, support the achievement of health targets and policy priorities, and link to national and regional governance structures. The networks' governance arrangements were expected to be in line with regional services planning before July 2012. At the time of our fieldwork (early 2013), this had been done in the Northern region, but not in the South Island.

4.5
In the South Island, we saw the potential for inconsistency between regional services planning and how regional cancer-service planning works. For example, separate accountability and governance for cancer-services planning was apparent. By contrast, integrating the Northern regional cancer-services network into regional services planning avoided these problems.

4.6
The problems in the South Island reinforced a message repeated to us - that setting up successful relationships is an important part of improving regional service delivery, whether through regional services planning or some other mechanism.

4.7
In our view, the regional cancer-services networks and DHBs are planning for cancer services in a way that is in line with the intended effects of regional services planning. Examples include devising consistent clinical protocols for access to services and increasing use of multidisciplinary meetings to decide on treatment for patients suspected of having cancer.⁶ Multidisciplinary meetings are known to improve the survival rates of patients, and using these meetings more is part of the national cancer work plan.

4.8
Although these efforts contribute to achieving the intended effects of regional services planning, in our view, they did not happen because of regional services planning. Instead, these efforts are part of a workstream that was set up and put in place well before the introduction of regional services planning.

Integrating regional information services and information technology

4.9
Information technology is crucial for the regional delivery of services and improving the quality of care. It enables changes in working practices and the use of buildings. We expected that the information technology workstream would use regional clinical priorities as the basis of work priorities. We found that, although information technology initiatives are under way to improve regional delivery of cancer services, there are difficulties. In the South Island and Northern regions, these difficulties are mostly to do with integrating cancer-services network information technology requirements with regional information technology work.

4.10
The cancer-services network staff and regional information technology staff spoke of problems with setting priorities and a lack of communication. Cancer-services networks had information technology projects outside the regional information technology workstream. Cancer-services network staff and regional information staff told us that the problems would be addressed by having one system. The Ministry later told us that it expected there would be a national contract by 2014, although consultation had not started. This highlights the potential for discord when accountability is divided and communication is lacking.

Data for planning

4.11
To help prepare good-quality plans for cancer services, the cancer-services networks have put a lot of effort into collecting and analysing data and carrying out research to set up a good information base. Our audit confirmed problems with data completeness in some DHBs. In Part 5, we discuss those problems.

Progress

4.12
Regional services planning and cancer-services planning are becoming more in line. Getting them in line is relatively straightforward because these two types of planning have similar intentions.

4.13
Within regional services plans generally, the cancer workstream is more in line with the intended effects of regional services planning than other clinical workstreams. Many measures focus on quality of care. However, the cancer-services sections of the regional services plans say nothing about the effect on costs. This means that we could not see evidence of any plans for reducing costs or getting greater efficiency for the same money.

6: A multidisciplinary team meeting is a deliberate, regular, face-to-face (or videoconference) meeting involving a range of health professionals with expertise in a range of different specialties to discuss the options for patients' treatment in real time.