1.3 A focus on equity The NZ Cancer Plan aims to improve cancer outcomes for all New Zealanders. This means that people, irrespective of their ethnicity, gender, locality or socio-economic status, must be able to have every opportunity to access services that will reduce their risk of developing cancer, enable their cancer to be detected earlier as well as getting high-quality cancer treatment quickly. The impact of cancer is much higher for Māori than the general population. To improve cancer outcomes for Māori, the NZ Cancer Plan is guided by the overarching framework and aspirations in the Māori Health Strategy, He Korowai Oranga (Ministry of Health 2014). A useful framework has also been developed alongside He Korowai Oranga to improved equity in health care. This equity framework can be applied to all existing and new approaches that aim to improve cancer outcomes for Māori. 1.4 Expectations Within three years the Ministry expects to see the following improvements across the cancer pathway which will contribute to better overall cancer outcomes. By 2018 New Zealanders can expect to have: a greater opportunity to be well and a lower chance of prematurely developing or dying from cancer good access to primary care services if they feel unwell or are experiencing cancer symptoms good access to population screening services in their region quick referral to specialist cancer services if cancer is suspected good access to palliative care in their place of choice. By 2018 patients can expect to: be well informed about their cancer and the treatment and support options available to them receive their first cancer treatment within 62 days of referral with a high suspicion of cancer be consistently well cared for regardless of where they live. By 2018 health professionals can expect to: have the right technologies and equipment to do their jobs have appropriate training and educational opportunities be part of a high-functioning multidisciplinary team be performing at the top of scope of practice. 2 The New Zealand context
We will promote eating well and keeping active The Ministry of Health will implement the Healthy Families New Zealand initiative. The initiative will support communities to strengthen existing health promotion efforts to encourage families to live healthy and active lives Ministry of Health, DHBs, NGOs More people will have access to easily understood and nationally consistent information resources More people will be making healthy food and activity choices and sustaining healthy weights More people will be aware of cancer risks and will be doing something about them We will implement smoking cessation initiatives in hospitals and in primary care Health professionals working in hospitals and primary care will advice and support to quit smoking to their patients who smoke Health professionals will also offer pregnant women who smoke advice and support to quit smoking DHBs, primary health organisations, lead maternity carers Fewer people will be smoking We will implement a prostate cancer awareness and quality improvement programme The Ministry of Health, with DHBs and primary care organisations, will develop and distribute high-quality prostate cancer information resources The Ministry of Health will develop prostate cancer standards and draft guidelines Ministry of Health, DHBs, primary health organisations More people will have access to easily understood and nationally consistent information resources We will improve coverage and service delivery of bowel, breast and cervical screening programmes and reduce barriers to access Bowel screening The Ministry of Health will monitor the Bowel Screening Pilot on a quarterly basis against agreed performance indicators An independent evaluation will assess the success of the Screening Pilot and provide information on the viability of a national bowel screening programme Ministry of Health, service providers, Waitemata DHB, BreastScreen Aotearoa lead providers More people across all population groups will be screened for breast and cervical cancer
Breast screening The Ministry of Health will monitor BreastScreen Aotearoa three yearly against national standards, and annually against indicators and targets All BreastScreen Aotearoa lead providers will have access to mammography technology The Ministry of Health will review the BreastScreen Aotearoa service delivery and funding model to make improvements to the programme in the context of changing technology Cervical screening The Ministry of Health will monitor the National Cervical Screening Programme three yearly against national standards, and six monthly against indicators and targets The Ministry of Health will implement the 2013/14 priority recommendations of the Report of the Parliamentary Review Committee regarding the New Zealand Cervical Screening Programme (Tan et al 2011) We will improve the early detection of lung cancer The Ministry of Health will develop guidance for the early detection of lung cancer Ministry of Health, DHBs, primary health organisations, NGOs More people will be aware of cancer risks and will be doing something about them Diagnosis and treatment What How Who By 2018 the Government expects: We will improve the quality and consistency of care DHBs will use the tumour standards to improve quality by reviewing their current service delivery against the provisional tumour standards and identifying areas for service improvement DHBs Services will have been reviewed and improved using the tumour standards Diagnostic and treatment processes will be streamlined, faster and more standardised
We will improve the collection of and access to clinical information to support service improvement DHBs will report against the faster cancer treatment pathway indicators: 62-day target – all patients referred urgently with a high suspicion of cancer receive first cancer treatment (or other management) within 62 days 31-day indicator – all patients with a confirmed diagnosis of cancer receive their first cancer treatment (or other management) within 31 days of the decision to treat DHBs Patients will receive first cancer treatment within 62 days of urgent referral with a high suspicion of cancer DHBs will report against the colonoscopy waiting time indicator: Diagnostic colonoscopy: an increasing percentage of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 days) an increasing percentage of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days) Surveillance colonoscopy: an increasing percentage of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date DHBs will implement Phase One of the National Patient Flow project, which will start to capture relevant patient information at each point of the patient pathway
We will support high quality clinical through good care DHBs will implement regionally agreed activities that will improve the functionality of cancer multidisciplinary meetings (MDMs), including: using the Ministry of Health’s (2012) MDM guidance document Guidance for Implementing High-quality Multidisciplinary Meetings: Achieving best practice cancer care establishing processes for linking secondary services into tertiary service MDMs implementing electronic MDM pro formas purchasing videoconferencing technology appointing MDM coordinators The Ministry of Health will monitor DHBs’ activity to improve the coverage and functionality of MDMs DHBs, Ministry of Health Diagnostic and treatment processes will be streamlined, faster and more standardised We will improve patient outcomes by coordinating care for patients with cancer and facilitating timely diagnosis and initiation of treatment DHBs will implement the cancer nurse coordinator initiative The Ministry of Health will monitor implementation progress through service reporting, evaluation and faster cancer treatment indicator data DHBs will continue to provide adolescent and young adult (AYA) coordination services. The AYA clinical network will support this service area DHBs, Ministry of Health Diagnostic and treatment processes will be streamlined, faster and more standardised A cancer nurse coordinator workforce will have been established People will be better informed and more confident about their treatment
We will improve surveillance and follow-up practice in all health settings The Ministry of Health will scope the development of follow-up and surveillance guidance Ministry of Health Patients will receive consistent follow-up and surveillance from all clinicians (eg, general physicians, primary care providers, senior nurses)