NHS Direct Wales
Background and Policy Context
The application of these principles in Wales was set out in the Cameron Report, 'Cancer Services in Wales' which laid down the foundation for the development of cancer services in Wales, with services based on three cancer centres. The report also stressed the pivotal role of specialist Multidisciplinary Teams (MDTs) in cancer care.
Over the coming years, around 1 in 3 people will be diagnosed with cancer before age 75 and around 4 in 10 at some stage during their lifetime. The Delivery Plan below sets out the Welsh Government’s vision and what this means for NHS cancer services.
The development of the National Cancer Standards (2005) helped to define the core aspects of the service that should be provided for cancer patients in Wales. These National Cancer Standards take account of the evidence-based Improving Outcomes Guidance series published by National Institute of Health and Clinical Excellence (NICE).
The services provided by the NHS and its partners must shift their emphasis now to one of promoting and protecting people’s health throughout their lives instead of focusing largely on treating a specific illness. Source: WHC (2006) 080
What is the NHS in Wales doing about cancer?
It is one of the Government’s key aims to reduce the incidence of cancer in Wales through primary prevention. In particular, to have comparable cancer incidence rates with the lowest European quartile by 2015. It is estimated that changes in diet and factors related to diet (including body mass and levels of physical activity) could reduce cancer incidence and mortality by between 30 and 40 per cent.
The main ways we prevent and reduce the impact of cancer include:
Changing those things that have been shown to have a direct causal effect on cancer rates and occurrence.
Detecting cancers as early as possible through improved public and professional awareness of symptoms.
Detecting cancers through cancer screening programmes
Health promotion & prevention are the responsibility of the Local Health Boards supported by the National Public Health Service. Preventative measures are relevant to a number of cancers including lung cancer, head & neck cancers and colorectal cancers. The major focus for health promotion in the community remains smoking cessation, which directly influences the incidence of a number of cancers, as well as other illnesses such as coronary heart disease and stroke. A key cancer-specific initiative is the Sun Awareness campaign.
- Health Challenge Wales - Cancer reduce the risk
- Health Challenge Wales - Smoking
- Stop Smoking Wales
- Sun Smart - the UK wide Sun Awareness and Skin Cancer prevention campaign run for the UK health departments by Cancer Research UK
- Cancer Awareness - Welsh Assembly Government website
Current health promotion strategies are more closely associated with Coronary Heart Disease prevention than cancer, however all the existing initiatives designed to promote healthy eating and exercise are relevant for cancer prevention and these links are being strengthened and highlighted.
The three screening programmes relating to cancer in Wales, Breast Test Wales, Cervical Screening Wales and Bowel Screening Wales are managed by Public Health Wales.
The National Audit Office recommended that the NICE Referral Guidelines for Suspected Cancer should be widely disseminated and acted upon, and that stronger joint working relationships between general practitioners and hospitals should be encouraged through the continued development of standardised referral procedures with feedback to general practitioners on appropriateness of referrals.
In order to improve survival, NHS Wales help to develop and support initiatives to promote the public’s awareness of significant signs and symptoms, so that patients present earlier to their GP. Some examples are:
- Bowel Cancer "Don't die of embarrassment" campaign
- Detecting skin cancer - how to spot the changes early
- Mouth Cancer Awareness campaign
Primary Care also plays a major role in the support and care of cancer patients including palliative care, and increasingly the move to longer term-survival, often termed as ‘living with your cancer’ .
Here the aim is to provide diagnosis, treatment, and rehabilitation and palliative care services for people with cancer that match or surpass the best in Europe in terms of quality.
Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. The Healthcare Standards for Wales underpin clinical governance by ensuring that quality services are provided equitably, robustly and ethically across all settings. Clinical audit is at the heart of clinical governance. It addresses quality issues systematically and explicitly, by providing reliable information. It can, importantly,
confirm the quality of clinical services and highlight the need for improvement.
Successful clinical audit involves changing practice to meet the standards. Highlighting the need for improvement and changing practice to meet the standards is integral to improving healthcare.The roll out across Wales of the Cancer Information System Cymru (CaNISC) supports and enhances clinical audit.
The National Cancer Standards cover a number of cancers and also include standards for Specialist Palliative Care in relation to Cancer Services. They also detail the key elements of the diagnostic and treatment process that patients should expect to receive. These include requirements for patient centred care, the formation and work of local, network and supra-network level multidisciplinary teams (MDTs) as advised by NICE service guidance and clinical guidelines, adherence to and audit against nationally agreed clinical guidelines, and waiting times from referral or diagnosis to start of definitive treatment.
The regional Cancer Networks lead the process of mapping and assessing current services against the Standards and developing and implementing action plans to deliver the shape of future service organisation.
- North Wales Cancer Network
- South Wales Cancer Network
- South East Wales Cancer Network
- South West Wales Cancer Network
Cancer research is a fundamental part of improving the quality of our services. The Wales Cancer Bank collects and stores cancer tumour, tissue and blood samples from all consenting patients with possible or confirmed cancer as a basis for future scientific studies. These studies will help to establish the causes of cancer, and help to identify new areas for treatment and selection of the best treatments for individual patients.
The Cancer Genetics Service for Wales (CGSW) is part of the All Wales Medical Genetics Service (AWMGS). Its remit is to assess the risk of cancer based on a patient's reported family history and to work with the relevant specialists to recommend further screening strategies where appropriate.
The Wales Gene Park undertakes research for a better understanding of the role of genes in the development of cancer, as well as new methods of diagnosis
and treatment of the disease.
The Wales Cancer Trials Network also aims to make research a routine part of cancer services and to ensure that every patient who is eligible has an equal opportunity to take part in a research trial.
The report highlights the progress we have made in cancer services in Wales.
Cancer statistics sources
- Welsh Cancer Intelligence and Surveillance Unit
- Cancer in Wales, 1995-2009: A Comprehensive Report
- Patient Episode Database Wales (Intranet site available to NHS staff only)
- Health Maps Wales (Intranet site available to NHS staff only)
- Primary Care - Quality and Outcome Framework Achievement Data (Intranet only)
- Office of National Statistics Cancer Atlas
- NHS Cancer Waiting Times, Quarter ending June 2012
- NHS Cancer Waiting Times: Quarter Ending 31 March 2010