The idea

The West Yorkshire and Harrogate (WY&H) Cancer Alliance is a collaborative organisation involving the NHS, local councils, the voluntary sector and the people of West Yorkshire, with its main purpose being to improve the outcomes for cancer on behalf of the population.

Lung Cancer is the biggest cancer killer in West Yorkshire and Harrogate (Cancer in Yorkshire, 2016), with variation in route to diagnosis, stage at diagnosis and one-year survival rates. Table one summarises the Alliance’s respective outcomes by ‘Place’ and shows how outcomes vary. One-year survival is as good as the England “average” but could be much better if all ‘Places’ had one-year survival similar to that of Harrogate.

The service model

Lung cancer incidence is directly related to smoking and tobacco use is the most important preventable cause of lung cancer in the UK. It is estimated that tobacco addiction caused over 2,300 cancers in the WY&H area in 2010. In WY&H, 18.6% of the adult population are smokers, higher than the national average of 15.5% and equating to around 350,982 smokers in the WY&H Cancer Alliance.

The Alliance is implementing an integrated system-wide sequence of four interventions. 

1. Optimising smoking cessation support Using the acute sector of the NHS to promote smoking cessation through an ‘Every Contact Counts’ approach – eg signposting in the acute sector, carbon monoxide monitoring for every elective admission and initiating nicotine replacement prescribing (the Ottawa model)

Impact:  reduction in: smoking prevalence, re-admission rates and hospital mortality 

2. “Push and pull” symptom awareness campaigns and community engagement events

Potential adoption of the national, ‘Be Clear on Cancer’ and South-East Leeds, ‘Cough Campaign’ resources.

Impact Reduction in cancers diagnosed as an emergency presentation, more cancer diagnosed overall and more people offered curative surgery (earlier stage diagnosis).

3. Risk identification in Primary Care to promote direct access to Low Dose CT (LDCT) scanning

Implementing the Manchester Cancer Improvement Partnership community based ‘Lung Health Check’ model, the introduction of Lung Health Checks will be phased and across Mid Yorkshire, Bradford and an existing Leeds-based research programme which is also introducing lung health checks.

Impact More lung cancers diagnosed overall and at an earlier stage offering surgical treatment.

4. Optimising the lung cancer pathway to ensure people are speedily and optimally managed, in tandem with the system wide approach to all cancer management across the Alliance.
   • Impact improvement in 62-day pathway overall. 

Key progress:

• Programme team appointed, comprising a Programme Manager and two Project Managers aligned to each locality.
• The Tackling Lung Cancer Programme team took over the progress already made on the implementation of the National Optimal Lung Cancer Pathway at the Lung Cancer Pathway Event on  6 July 2018.
• Presentations delivered to the Health and Wellbeing Boards in the Bradford and Mid Yorkshire districts, ensured the engagement and support of local system leaders.
• The Tackling Lung Cancer Programme is now a priority in Wakefield’s CCG annual plan.
• Baseline information on smoking cessation approaches and good practice has been collected from every acute provider in West Yorkshire, while raising awareness of the Tackling Lung Cancer Programme.
• Intelligence from both the Manchester and Nottingham pilots fed into the modelling of the proposed Lung Health Check and Low Dose CT element of the programme. This will help to predict the likely number of new cancer referrals generated via the Lung Health Check programme.

Patient benefits:

The ‘every contact counts’ approach will ensure that all the needs of patients are met from smoking cessation support through to cardiovascular checks.

Patients with suspected lung cancer will benefit from a faster pathway taking them from first referral to diagnosis and beyond.

Community low dose CT scanner allow for opportunistic scans, enabling more lung cancers (and other serious lung conditions) to be diagnosed sooner and at an earlier stage.

Heightened awareness of the dangers posed by smoking and how to access smoking cessation support and investigations for worrying lung symptoms across the Alliance.

Wider system benefits

Mobile Low Dose CT capacity and reporting will support WY&H in its efforts around the 62-day target.

Quotes

“Traditionally, activities aimed at improving outcomes in lung cancer, have been undertaken as single interventions, whether symptom awareness raising or optimisation of pathways of care.

“On their own, single interventions can be of benefit to people but if combined in a systematic way, together there may well be a greater impact on improving outcomes overall. Our aim, therefore, is to use a number of interventions designed to reduce lung cancer incidence, improve the stage at diagnosis and increase one-year survival.” Carol Ferguson, Macmillan Programme Director, West Yorkshire and Harrogate Cancer Alliance.

Implementation tips

• Implement best practice from the Manchester Lung Health Check Pilot team.
• Utilise existing data to inform and improve your system modelling.
• Consider the impact of any-and-all elements of this approach on your local system and how to mitigate any potential issues. WY&H is a very challenged system in terms of achieving the 62-day target, in view of this and system modelling, the introduction of Lung Health Checks will be phased and across Mid Yorkshire and Bradford.
• Engage early with local system leaders, commissioning managers, public health, clinical leaders from primary and secondary care, smoking cessation providers and the voluntary sector to secure their buy-in, baseline data and harness current and best practice

Table 1: Outcomes for lung cancer in West Yorkshire and Harrogate