Better Health ‘after’ Cancer

Dr Aileen Keel, CBE Deputy Chief Medical Officer, Scottish

Government

Policy Context - 2020 Vision (1)

• By 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that we will have a healthcare system where:

• We have integrated health and social care • There is a focus on prevention, anticipation and

supported self-management • Where hospital treatment is required, and cannot be

provided in a community setting, day case treatment will be the norm

Policy Context - 2020 Vision (2)

• Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions

• There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission

Why the 2020 Route Map?

• Proportion of over-75s up 25% by 2023 • Demography could increase spend by >70% by 2033 • Seemingly entrenched health inequalities • Disease pattern shift to chronic & multiple conditions • Dementia cases +75% by 2033

Key Features of 2020 Route Map

• Public service reform • Improving quality at scale • Targeted / accelerated improvement • Cross-sectoral • Transformational innovation & economic growth • Shifting power to individuals and communities • Community Planning Partnerships • Engaging and empowering the workforce • Our approach to the Francis Inquiry

ROUTE MAP TO THE 20:20 VISION

20:20 Vision / Quality AmbitionsPerson Centred, Safe and Effective Care which supports people to live as

long as possible at home or in a homely setting.

Quality of Care Health of the Population

Value & Financial

SustainabilityIndependent livingServices are safe

Engaged workforcePositive experiences

Triple Aim

20:20 Vision

12 Priority Areas for Action

11/02/13

Quality Outcomes Healthier living Effective resource use

Triple Aim Quality Ambitions 12 Priority Areas for Improvement

Person Centered Person Centered Care

Safe Safe Care

Primary Care

Unscheduled and Emergency Care

Integrated Care

Care for Multiple and Chronic Illnesses

Early Years

Health Inequalities

Prevention

Workforce

Innovation

Efficiency and Productivity

Effective

ROUTE MAP TO THE 2020 HEALTH AND SOCIAL CARE VISION FOR SCOTLAND

Health of the Population

Value and Sustainability

Quality of Care

Triple Aim 12 Priority Areas for Improvement

1 Person-Centred Health and Care Collaborative implemented

2 Information and support to enable people at home and during times of transition

3 Further increase in safety in Scottish Hospitals 4 New broader measure of safety developed (SPSI)

5 Maternity, mental health and primary care safety programmes

6 Implementation of new GP contract7 2020 Vision for expanded primary care8 New Models of ‘place-based’ primary care9 Out of hospital care action plan10 Sustainable performance on 4 hour A&E waits11 Increase flow through the system12 New Bill

13Preparatory work with Health Boards, Local Authorities, third and independent sector and the building of effective CPPs

14Key pressure points in the entire patient pathway for most common multiple illnesses will be identified and actions agreed

15Through more detailed analysis of existing data, people will be identified as ‘at risk’ and anticipatory plans will be agreed

Early Years 16The world’s first national multiagency quality improvement programme will be implemented across partner organisations

17 New focus on most deprived areas

18 ‘Deep-end’ GP practices approach rolled out more widely across relevant areas

19 Early detection of cancer20 New restrictions on tobacco advertising21 2020 Vision for NHSScotland workforce

22 Detailed action plan agreed to deliver 2020 Workforce vision

23 A new fund to provide pump-priming for innovative approaches in healthcare

24 A new procurement portal will be established to encourageworking with SMEs and Third Sector

Efficiency and Productivity 25 Recommendations to increase shared services

Prevention

25 Key Deliverables for 2013/14

Person Centered Care

Safe Care

Health Inequalities

Care for Multiple and Chronic Illnesses

Workforce

Innovation

Health of the Population

Value and Sustainability

Quality of Care

Primary Care

Integrated Care

Unscheduled and Emergency Care

Better Health ‘after’ cancer

Scottish Cancer Taskforce workstreams

– Acute oncology – Radiotherapy service provision – Surgical oncology – Detecting Cancer Early – Quality Performance Indicators Programme – Transforming Care after Treatment

Transforming Care after Treatment -TCAT

• by 2030 there are likely to be around 360,000 people living with or after cancer treatment in Scotland

• how should care and support be delivered after the initial management of cancer?

• TCAT aims to:- – Enable patients to play a more active role in managing

their own care – Provide services which are more tailored to the needs and

preferences of the patient – Give patients more support in dealing with the physical,

emotional and financial consequences of cancer treatment – Improve integration between different service providers

and provide more care locally

How will the TCAT aims be achieved?

• A cancer workforce skilled in managing patients following cancer treatment

• Attitudinal and behavioural changes among people affected by cancer and professionals – particularly around the health and well-being of people living with cancer

• A fully integrated and joined-up approach to care that incorporates rehabilitation and self-management into pathways

• Discontinuation of ineffective follow-up practices, whilst achieving secondary prevention and earlier detection of new/recurrent cancer through increased rehabilitation and health promoting behaviour changes

Impact of physical activity on cancer outcomes

Prevent or mitigate some of the consequences of cancer treatment Prevent or help manage other long term conditions Emerging evidence that being more active may help reduce relative risk of recurrence and disease progression

Physical activity and primary prevention

•Physical activity is an independent risk factor for cancer. Being active reduces relative risk by:

• 30-50% for colon cancer • 20-40% for breast cancer

•Physical inactivity is estimated to cause around 21–25% of breast cancer burden.

Physical activity in people with advanced cancer

•Prevents decline in quality of life

•Improves fitness

•Improves functional ability

•Improves emotional well-being

•Improves fatigue levels

Being active is safe!

•‘Exercise is safe both during and after most types of cancer treatment ... Patients are advised to avoid inactivity and return to normal daily activities as soon as possible after surgery, and during adjuvant cancer treatments. The standard age appropriate guidelines are also appropriate for cancer patients.’

(British Association of Sport and Exercise Sciences Expert Statement on Exercise and Cancer Survivorship)

Recommendations - Older Adults UK Physical Activity Guidelines by four Chief Medical Officers. • Be active every day aiming to accumulate at least 150 minutes moderate intensity physical activity in bouts of 10 minutes or more.

• Exercise to improve muscle strength on at least two days of the week.

• If at risk of falling use exercises to improve balance and co-ordination.

• Avoid sedentary behaviour.

Physical Activity and TCAT go hand in glove

• Secondary prevention means promoting the same messages as

those for primary prevention …..and means promoting the same behaviours that aid recovery

after cancer treatment • Needs societal change in the attitude (patients, carers,

professionals and the general public) about the benefits of healthy living, even after a cancer diagnosis

……and particularly about the benefits of promoting physical

activity

Scale of the challenge

• About 80% of people living with and beyond cancer are not physically active to the recommended levels

• 72% of GPs & 60% of oncologists don’t talk to cancer

patients about moving more – Benefits of physical activity are not fully understood – Only 57% are aware activity reduces the risk of recurrence

and mortality – Only 72% are aware side effects are reduced – 10% are unaware of fatigue reduction – 3% are unaware of stress reduction

Supporting cancer survivors to become more active

Survivors

•want support in becoming more active •want this support to be personalised and tailored to their needs

•want being active to be their choice

Motivations for becoming more active

•“I want to do it so that I can go walking with friends without feeling like I am a burden”

•“I want to do it for my family because they were there for me when I was going through treatment”