Cancer Control in New Zealand Cancer Connections Newsletter, Autumn 2008 Welcome to the first edition of Cancer Connections, which aims to link together the thousands of professionals working within the cancer community. To paraphrase the Cancer Control Council, successful implementation of the Cancer Control Strategy relies on that entire community working together. We aim to celebrate the work of so many committed people throughout the country, focusing on the positive, innovative work being done, and on spreading the good word. You can read this newsletter online on this page (see menu on the right) or download the PDF version below: Cancer Connections Newsletter, Autumn 2008 (PDF, 183 KB) The power of networks ‘The power of networks will come from how well they collaborate and share with each other.’ Creating connections at local, regional and national levels in the community fight against cancer is a passion for Ministry of Health National Clinical Director John Childs. He sees enhanced communication as the conduit to share the knowledge being accumulated in New Zealand’s small towns and cities. ‘Sometimes there were great local innovations, but that’s where they ended.’ Now, he sees Networks as the key element of cancer communication, where those great and innovative ideas can be shared more widely. ‘It’s about recognising good ideas regionally, but then it’s what we then see nationally. So a measure of whether networks are actually working is not only what people see on the ground in the regions, it’s actually what we then see happening right around the country.’ Four networks are now running, in varying stages of development, and John Childs concedes there have been teething problems – not the least being the distances involved in some of the networks. Southern, for instance, stretches to encompass the entire South Island. But generally each network is quickly extending its reach to involve all the community networks that blossom around the need to fight cancer. John has no time for silos. ‘Silos may contain passionate little groups that are working well, but they should be talking to others, sharing their developing knowledge and experience.’ Even big silos like the DHB funding and planning services, and the implementers – the operators – each bring to the table the knowledge and sets of skills that complement each other but you’re not actually going to get a good outcome until you provide a process that enables them to get together and properly support one another. Each has to understand their silos must be properly aligned, that they must be communicating effectively, making certain they do their bit to get the best possible patient outcome. John’s own experience as a specialist radiation oncologist, first as clinical director for radiation oncology in Auckland, then clinical director for all medical services in Auckland gave him the broad understanding and the abilities he brought to the Ministry. He commutes from his home in Whangarei, where his involvement with family and the many groups that make up the Northland networks enables him to keep his feet on the ground. ‘I serve a community that still has high inequalities, but has a network in place that is making a difference. After communication, now we have Southland working on establishing the same system.’ Key to so many of the improvements he seeks is the engagement with Māori and with Pacific Islanders and other ethnicities, and providing support for all these groups. ‘The pilot project in Rotorua (page 6) is a brilliant example and has clearly shown that to provide support is to encourage better access. If properly supported, these groups find it easier to access the services.’ . . . you’re not actually going to get a good outcome until you provide a process that enables them to get together and properly support one another. John Childs National Clinical Director Back to top ‘So much learning, so much planning required’ The power of networking is co-ordinating the fight against cancer throughout the country. Suggested in the Cancer Action plan 2005-2010 as a vehicle for achieving a number of the objectives, four regional networks are rolling, but they’re probably still only in second gear. The very size of the networks can be intimidating, with Central network manager Jo Anson – based at Mid-Central DHB in Palmerston North – co-ordinating Taranaki, Whanganui, Mid-Central, Hawke’s Bay, Tairawhiti, Wairarapa, Hutt Valley, Capital & Coast and Nelson Marlborough. The recently appointed Canterbury-based southern network manager has the whole of the South Island for a territory. The brake was let off by the Ministry framework and funding in mid 2007, but only the appointment of the network managers has got the vehicle into second gear. ‘There is so much learning, and so much planning required,’ says Jo Anson. ‘We had first to work out just what and who we are.’ Then initial targets had to be identified. The basic objectives set out by Ministry principal advisor John Childs included: improving the pathway of care for cancer patients, families and whanau by improving quality and access to appropriate care organising a structure to manage and lead coordination of activities and actions throughout the network’s region being accountable to their constituent DHBs through regular reporting against agreed outputs the networks would also provide collaborative advice to support existing decision making within DHBs Building the current work programme for the Central region - developed within the existing strands of the Cancer Control strategy, Jo Anson felt the basic “headings” if you like, were fairly obvious, but had to be set down to provide structure around the initial work. The synergy of the other networks meant there was no need to reinvent the wheel. Jo salutes Jan Hewitt in Midlands for her early work that helped the other networks speed into action. While each Network must identify and engage with regional service providers and existing networks, also important are guidelines for the establishment of local cancer networks among Māori and Pacific people. The four regional networks strongly collaborate, yet each must focus on regional priorities. Central Network manager Jo Anson. Ph: (06) 350 8622 Back to top MidCentral sets new course for fighting cancer with whanau Four Cancer navigators set a new course for fighting cancer when introduced to their whanau recently. The four, employed by Māori providers within the Mid-Central DHB will work throughout the district to improve Māori access to cancer services in the district. ‘This could be one of the most important initiatives we have yet seen in the fight against cancer, particularly for Māori,’ said Mid-Central DHB clinical director for Cancer services, Dr Simon Allan. ‘This has real potential.’ The navigators will work to ensure their Māori people benefit from every support service available. ‘The future,’ said Dr Allan, ‘is about preventing Cancer.’ Pointing out to that future, he said: ‘Cigarette smoking is top of the danger list.’ Before being introduced, the four were welcomed by former associate Minister of Health, Māori Party co-leader Tariana Turia, who herself gave up work to reconnect with her mother, who had not raised her, on her final journey. ‘For all that others may help and support, only we can care and support and prepare them for this final journey.’ Māori, she had said earlier, faced an even bigger cancer. ‘The cancer of family violence against our tamariki is the worst type of cancer affecting us right now. ‘Have we no time to spend to look after our own? Violence has simply become part of our lives.’ Māori patient advocates are one way for Māori to gain access to and navigate through the multitude of services associated with one’s cancer journey. The service will work across the cancer control continuum with health promotion/education, service coordination and advocacy on behalf of the diagnosed patient and their whanau. A key objective of the service is to ensure that the activities of existing health professionals are co-ordinated and effectively targeted for Māori, and that Māori are assisted to better utilise those services, but the services will be available to the whole community. Clinical director of the Mid Central section of the Central Cancer Network, Dr Simon Allen lays down the challenge on the Marae: ‘Forget all the environmental toxins, forget other trendy causes celebre; cigarette smoking is top of the danger list.’ Former associate Minister of Health, and now Māori Party co-leader Tariana Turia is greeted at the Motuihi Marae launch of the Cancer Navigators programme by the CEO of the host PHO, Ellen Kauri David. Behind the pair is Genny Gerrard. Back to top Stop Press - Appointment to Southern network Former acting South Island Network manager Barbara Rebbolini has been appointed to the permanent role. Her appointment completes the quartet with managers now appointed to all four networks. Initial Southern appointment Chris Taylor accepted another position. Back to top Rotorua pilot produces results Working from Rotorua Hospital and branching out into all areas of the Rotorua cancer community, the Te Kahui Hauora Trust and Hunga Manaaki Cancer Care service is creating positive feedback.. The three-year pilot is concentrating on reducing the inequalities and improving access to all cancer services for the Rotorua community. TKHT CEO Ray Morrison reported to last year’s networks forum about this extension that stands alongside the trust’s existing contracts; problem gambling, smokefree co-ordination, traditional Māori healing, Māori non-attendance at outpatients clinics and cultural safety training. Key features of Hunga Manaaki are the support given to turoro (patient) and whanau through the whole cancer journey, both inside and outside the clinical process, with access to both financial and transport services, leading to A non-attendance rates drop for all clinics Information services readily available Turoro and Whanau benefiting from the health promotion and education available within the community support. Being involved across the journey enables patient and whanau advocacy, both in the planning for discharge planning process, but also in the continued communication and care required in the community. During his presentation to the networks forum, Te Kahui Hauora Trust CEO Ray Morrison points to the communications circles within the Hunga Manaaki service that are already generating positive feedback, and follow-on interest. Back to top Canterbury pilot goes national A Canterbury pilot study that increased the retention potential of radiotherapist recruits has won national funding. One of 23 implementation projects funded by the Ministry of Health in 2006, Canterbury has formally allocated a senior radiation therapist’s time to mentor new graduate MRTs through their transition from student to professional. That mentoring input increased the retention potential of new recruits, hardly rocket science, but definitely commonsense, says Simon Bidwell, a senior analyst in the Ministry’s cancer team. Funding has been allocated to each of the six cancer centres according to how many new recruits they will have. MOH contact: Simon Bidwell Ph: 04 496 2442 Back to top Framework for nursing education being developed A nursing advisory group is working with the Ministry of Health to develop a framework for nursing education in cancer and palliative care. Early work for the group includes analysing a detailed study of the current nursing workforce and an assessment of the gaps in access to appropriate education. Workforce development for nurses is a priority in both the Palliative Care and Cancer Control strategies. Nurses are integral to the care of cancer and palliative care patients in many different settings, whether inpatient or outpatient, in hospice or rest homes, or in community health centres; even in their own homes. They can therefore better understand the needs of patients and their families and whanau as they negotiate the health care system. Experience has shown nurses are likely to fill many of the ‘care coordinator’ and ‘patient navigator’ roles being developed in a number of DHBs. The Cancer Control Workforce Stocktake and Needs Assessment, recently published by the Ministry, identified imbalances in skill mix, inconsistent access to education and career development, and inconsistent definition of roles and responsibilities. In response, the Ministry tendered for a research provider, Auckland UniServices, to undertake a more detailed study of the nursing workforce and recommend specific actions. The Cancer & Palliative Care Nursing Advisory Group has 12 members who bring a range of nursing perspectives including cancer, palliative care, academic, acute hospital, hospice, community, rural, M¯aori and Pacific. The group will oversee this work and make some recommendations to DHB Directors of Nursing, who are responsible for planning nurse training and education throughout their districts. One of the group’s current tasks is to develop some agreed competencies for cancer and palliative care nurses at different levels of practice. MOH contact: Nick Polaschek Ph: 04 496 2452 Back to top The Regional Cancer Networks Forum The Regional Cancer Networks Forum in November 2007 was the first major group to receive input from new Minister of Health David Cunliffe. Just days after his appointment, and still submerged by the paper mountain of briefings and submissions, Minister Cunliffe took time to speak briefly and give careful answers to frank questions. The forum was an opportunity to share initiatives and perspectives, mostly about consumer involvement and patient pathways co-ordination, and reducing inequalities in cancer outcomes. Most of the presentations to the forum are available below: Regional Cancer Networks Forum, 7-8 November 2007 Back to top The Ministry of Health Team John Childs - National Clinical Director Deborah Woodley - Manager Simon Bidwell - Senior Analyst Andrea Bland - Administrator Nancy Harp - Project Manager Emma Hindson - Senior Analyst Pam Lee - Senior Analyst Jane Lyon - Clinical Advisor Kirstin Pereira - Project Manager Nick Polaschek - Senior Project Manager Ricarda Vandervorst - Senior Analyst Marjan van Waardenberg - Senior Analyst Back to top

In this issue The power of networks So much learning, planning required MidCentral sets new course for fighting cancer with whanau Stop Press - Appointment to Southern network Rotorua pilot produces results Canterbury pilot goes national Framework for nursing education being developed Regional Cancer Networks Forum The Ministry of Health Team