Annual Report 2009-2010 - Merseyside & Cheshire Cancer Network

Annual Report 2009-2010

Contents 

Foreword 3 

About the Merseyside and Cheshire Cancer Network 4 

Director’s report 5 

Key achievements: 2009/2010 6 

Focus for 2010/2011 7 

Cancer intelligence 8 

Cancer peer review programme 12 

Network groups: Service improvement 13 

Network groups: Development of clinical practice, pathways and guidelines 17 

Network groups: Excellence in clinical audit 20 

Network groups: Education, training and workforce development 22 

Medical Director’s report 24 

Nursing 25 

Research 26 

Patient and public involvement 28 

iVan 30 

Cover image: gates at Warrington town hall 

2 - MCCN Annual Report 2009/2010

Foreword 

Network chair: Kathy Doran 

I am delighted to 

welcome you to the 

eighth annual report 

of the Merseyside 

and Cheshire Cancer 

Network (MCCN). This 

report highlights the 

main achievements and 

collaborations that have helped to develop cancer 

services for local people and their carers during 

2009/2010. 

The network continued to deliver against an 

ambitious programme of work during 2009/2010 

with the overarching aims to reduce cancer 

incidence, to reduce the effects of cancer and 

to reduce mortality across the population. In 

particular work was focused on: 

• ensuring delivery of the recommendations 

from the Cancer Reform Strategy and further 

developed through the North West Cancer Plan 

• ensuring compliance with the national cancer 

peer review programme 

• developing services collaboratively, based on 

evidence, recognised good practice, and clinical 

pathways, for the benefit of all patients in 

Merseyside and Cheshire 

• highlighting where services can become more 

efficient without compromising quality and 

standards 

• continuing to focus on further developing 

services to support patients at the end of 

their life, with partners in other conditions, 

including dementia, heart failure, respiratory 

and renal disease 

• reducing health inequalities in the population, 

by focusing on access to services and reducing 

variations in care 

• informing the commissioning and delivery of 

world class cancer services for local people 

Committed patients, carers, volunteers and staff 

continue to make a significant contribution 

to the collective work of the network and to 

invest time and energy in mature collaboration 

across organisations. The strength of these local 

commitments and relationships forms an excellent 

basis for continued work into 2010/11, when we 

will be collectively challenged to transform care to 

ensure even better outcomes for patients, to take 

further steps to improve quality and productivity 

and to demonstrate that we collectively 

commission and deliver services which represent a 

good investment of resource. 

I would like to formally thank all of our partners, 

in particular all of our clinicians, patient and carers, 

for their continued commitment, time and energy. 

I look forward to continuing collaboration into 

2010/11. 

MCCN Annual Report 2009/2010 - 3

About the Merseyside and Cheshire Cancer 

Network 

The Merseyside & Cheshire 

Cancer Network was formed 

in 2000 and links together the 

organisations that provide care 

for people with cancer across 

Merseyside and Cheshire. 

We work closely with patients, 

carers, health professionals and 

managers to help implement 

the NHS Cancer Reform Strategy 

and North West Cancer 

Plan for the people 

of Merseyside and 

Cheshire. 

The network covers 

a population of 2.3 

million people and 

encompasses one strategic 

health authority, seven primary 

care trusts, twelve hospital trusts, 

ten hospices and a number of 

voluntary organisations. 

The purpose of the network is 

broadly to organise and oversee 

the local implementation of the 

NHS Cancer Reform Strategy, 

which sets out a programme 

of investment and reform. The 

plan also includes a number 

of ambitious targets, with the 

overall aim to save more lives 

and to improve the patient’s 

experience by ensuring that 

people with cancer have access 

to the right professional support 

and access to the best treatment 

throughout their period 

of care. 

The network is managed by 

the Cancer Taskforce who are 

accountable for ensuring that 

the network meets its key 

responsibilities and objectives as 

defined within the Manual of 

Cancer Services Standards. The 

Cancer Taskforce meets quarterly; 

its membership is drawn from 

chief executives of trusts and 

PCTs across the network. 

Clinical network groups (CNGs) 

are the prime focus of the 

network’s activity and work 

alongside the cancer research 

network. 

The CNGs are the source of 

‘expert’ clinical opinion from 

which the Taskforce draws its 

advice on a wide range of 

service issues including 

clinical guidelines and 

treatment options. 

They adopt an evidencebased 

approach, 

adopting the National 

Institute for Health and 

Clinical Excellence (NICE) 

guidance as their reference for 

determining common standards 

and pathways for cancer 

patients. Patients and carers are 

increasingly playing an important 

role in the work of these groups; 

we welcome patient and carer 

members on all CNGs. 

For more information, please see 

our website at www.mccn.nhs.uk. 


Director’s report 

Network director: Pat Higgins 

The Merseyside and 

Cheshire Cancer Network 

works with partners to 

help prevent and tackle 

cancer, and ensure that 

local people can access 

high quality services, 

including end of life 

care. The network supports commissioners to be world 

class, works alongside providers to help translate 

developments and evidence into clinical services and 

engages with patients and their carers to ensure 

that their views influence decisions and inform the 

continued developments and improvements. Cancer 

remains a strategic health priority for Merseyside and 

Cheshire, because of high rates of cancer and high 

rates of death from cancer. The network continues 

to encourage collective work to keep a spotlight on 

the impact that cancer has on the population and to 

promote the continual improvement of services. 

care teams on a range of initiatives to promote learning 

around early detection of cancer and have continued to 

promote cancer screening programmes. 

Increasingly, the network is focusing on the quality 

of services: leading the peer review process, ensuring 

that the experience of patients and carers is reflected 

in strategy and using data to identify priorities for 

improvement and to recognise where services are 

delivering a high quality of care. We have been 

promoting clinical trials and the development of 

research, while developing new models of care in 

order to improve clinical outcomes for patients and to 

develop the cancer workforce to respond to changes 

in clinical practice. We are also developing approaches 

to ensure support for people living with and beyond 

cancer. Over the next few years, this drive to improve 

quality will continue in an increasingly constrained 

financial environment and we will continue to promote 

consistency in care. 

We are particularly proud of the work that has 

developed during 2009/10 to reach out to communities 

and local people to support campaigns to help prevent 

cancer, as well as to raise awareness of the signs and 

symptoms to promote early detection. Through this 

work with local partners, volunteers and communities, 

we have helped people with undiagnosed cancer to 

seek professional help. We have lobbied successfully 

and worked on raising awareness on the dangers 

of sunbeds and exposure to sun, with parliament 

approving legislation in early 2010 on the use of 

sunbeds by children. We have worked with primary 

I would like to thank everybody who made a 

contribution to the network during 2009/2010. The 

network functions well because of the active and 

committed participation of our partners. This report 

acknowledges the collective achievements, work and 

input of patients, carers, staff and clinicians as well 

as the efforts of our partner organisations in shared 

efforts and focus to prevent cancer and minimise its 

impact. I look forward to working with you to address 

the challenges we will face over the forthcoming year, 

to ensure that we continue to serve the interests of our 

population to the very best of our collective ability. 


Key achievements: 2009/2010 

Preventing cancer and diagnosing cancer earlier 

• The network continued to lead lobbying to 

introduce legislation on sun bed usage, and 

supported the further development of smoking 

cessation strategies. 

• The bowel cancer screening programme 

completed its first cycle; we are working with 

communities with lower screening uptake. 

• Work was started to modernise cervical cytology 

laboratory configuration and move towards a two 

week turnaround time for results reporting. 

• Breast units started to plan for the extension of 

the breast screening programme. 

• Education, audit and review of cancer diagnosis 

trends started in all PCTs, with primary care and 

public health active partners in this work. 

• iVan (page 30) engaged with over 14,000 people 

and helped with early diagnosis of cancers. 

Better treatment in the most appropriate settings 

• The network and its partner trusts got to grips 

with the new challenging peer review schedule. 

• Significant service developments during 2009/10 

include the development of the network wide 

sarcoma service. 

• The acute oncology model was developed, 

resulting in the recruitment of an additional five 

clinical oncologists and nursing roles in support 

of the actute oncology model which is now in the 

process of being implemented. 

• A significant programme of work continued to 

promote the use of end of life tools to improve 

choice for people towards the end of their lives. 

• 2009/10 saw the opening of the Liverpool Cancer 

Trials Unit, a partnership with the University of 

Liverpool, Cancer Research UK and Merseyside 

and Cheshire Cancer Research Network to improve 

access to trials and support the development of 

new clinical trials. 

• Sustained and further improvement of cancer 

waiting times targets across the network (page 8). 

• The Anticipatory Care calendar Project received a 

prestigious nomination and commendation at the 

2009 Trustech North West NHS Innovation Awards. 

Living with and beyond cancer 

• The guideline for the key worker role was agreed 

for roll-out across the network. 

• The network continued to ensure that patient 

and carer views influenced the development of 

pathways during and following treatment. 

• Macmillan support was secured to pilot health and 

wellbeing clinics in two hospitals. 

Stronger commissioning 

• An exercise to assess the network against the 

11 world class commissioning competencies 

was undertaken. MCCN was noted to be well 

placed to support PCTs in commissioning quality 

cancer services and was recognised for its work in 

supporting the collection of meaningful clinical 

data real time to help inform strategic planning. 


Focus for 2010/2011 

The network will continue to lead the delivery of the Cancer Reform Strategy and North West Cancer 

Plan across Merseyside and Cheshire. In accordance with our objectives, we aim to: 

1 

Continue to focus on reducing health 

inequalities, working particularly with learning 

disabilities, mental health and prison groups. 

2 

Further embed the network strategy for 

early detection and prevention to improve 

population awareness of the signs and 

symptoms of cancer and to promote earlier 

presentation. 

3 

Work in partnership with the University of 

Liverpool to develop a world class academic 

oncology unit to further increase research 

activity within the network. 

4 

Continue to work with providers and 

commissioners to expand radiotherapy facilities 

to improve access for all patients, reducing 

travel times and developing purpose-built state 

of the art facilities. 

5 

Work with providers and commissioners to 

expand the oncology workforce, to include 

establishing acute oncology teams in all 

hospitals with A&E departments, so that 

patients are cared for where and when is most 

appropriate. 

6 

Implement remedial action arising from peer 

review in conjunction with clinical network 

groups and partner organisations. 

7 

Continue to improve the quality of clinical 

information, building on the successes within 

the staging project in each MDT and adding 

to intelligence regarding cancer presentation, 

treatment and outcomes. 

8 

Support improved access to laparoscopic 

surgery across the network by increasing 

capacity and developing the workforce, 

enabling patients to make an informed choice 

regarding types of treatment. 

9 

Continue the implementation of action plans 

for Improving Outcomes Guidance (IOG) to 

10 

11 

12 

ensure all patients have access to services that 

are delivered to nationally recommended 

standards. 

Continue to develop pathways that meet new 

and extended waiting time targets to further 

reduce referral to treatment times. 

Lead an inpatient improvement programme 

that supports innovative practice and improves 

the quality and efficiency of inpatient services. 

Work with commissioners and providers to 

improve the quality and productivity of cancer 

services to ensure optimal use of resources in 

the delivery of services. 


Cancer intelligence 

The challenge of incidence (new 

cases) and mortality (death rates) 

150 

Figure 1.1: National and network incidence rates (2005-2007) 

is ubiquitous within the whole of 

the North West. Merseyside and 

Cheshire, Lancashire and South 

Cumbria and Greater Manchester 

and Cheshire all experience rates 

that are higher than the national 

average. 

Age-standardised rate (per 100,000 applicable population) 

120 

90 

60 

30 

0 

Urological 

(all persons) 

Breast 

(female) 

Lung 

(all persons) 

Colorectal 

(all persons) 

Upper GI 

(all persons) 

MCCN 

GMCCN 

LSCCN 

England 

New cases diagnosed within 


numbered 11,146 in 2007, which 

represented a 3% increase 

compared to 2006. In contrast, 

the Lancashire and South 

Cumbria, Greater Manchester 

and Cheshire and England 

experienced a decrease in new 

cases. Like the other networks 

in the North West, the most 

common tumour types in 

Merseyside and Cheshire were 

urological, breast, lung, lower 

gastrointestinal and upper 

gastrointestinal respectively. 

Both nationally and within 

the North West, Merseyside 

and Cheshire has the highest 

incidence rate for all cancers 

(2005-2007). Within the most 

common tumour types, the 

network also has the highest 

incidence rates for breast, 

lung, colorectal and upper 

gastrointestinal for the region, 

all of which exceed the national 

rate as well (Figure 1.1). 

Merseyside and Cheshire has 

the highest mortality rates in 

the region and nationally for 

all cancers (2006-2008). Of the 

most common tumour types, 

urological, lung, colorectal 

and upper gastrointestinal all 

demonstrate mortality rates 

higher than the national level. 

In addition to this, urological, 

lung, colorectal and upper 

gastrointestinal cancers have the 

highest mortality rates in the 

region. In contrast, however, the 

mortality rate for breast cancer 

is below the national rate (figure 

1.2). 

With regards to cancer survival, 

one-year survival is used as a 

measurement of early diagnosis, 

as the patients who die within a 

year of diagnosis are more likely 

to have been diagnosed at an 

advanced stage of disease. The 

Merseyside and Cheshire network 

has the lowest one-year survival 

rates (2003-2007) in the North 

West for all cancer types. 

When considered individually, 

urological, colorectal and lung 

cancer one-year survival rates 

exceed the national rate and 

are the highest regionally. In 

contrast, breast and upper 

gastrointestinal cancer one-year 

survival is below the national 

rate, with the latter being the 


Cancer intelligence (continued) 

Age-standardised rate (per 100,000 applicable population) 

60 

50 

40 

30 

20 

10 

0 

Urological 

(all persons) 

Figure 1.2: National and network mortality rates (2006-2008) 

Breast 

(female) 

lowest in the region (figure 1.3). 

Five-year survival rates provide a 

measure of the effectiveness of 

treatments received by patients. 

The latest information (1998- 

2002) has highlighted that 

Lung 

(all persons) 

the Merseyside and Cheshire 

network has the highest fiveyear 

survival in the North West 

for all cancer types, although 

this is lower than the national 

rate. Individual consideration 

of tumour types has shown that 

urological, lung and upper gastro 

intestinal cancer five-year survival 

is the highest in the region and 

higher than the national level. 

Once again, in contrast to this, 

breast and colorectal cancer fiveyear 

survival rates are both lower 

than the national figure, with 

the latter being the lowest in the 

Colorectal 

(all persons) 

region (figure 1.4 overleaf). 

Programme budgeting 

Programme budgeting not only 

enables the network to outline 

spend on cancer services within 

Merseyside and Cheshire, but 

also allows a comparison with the 

other networks within the North 

West and nationally. Intelligence 

surrounding programme 

budgeting enables organisations 

Relative survival (%) 

100 

80 

60 

40 

20 

0 

Upper GI 

(all persons) 

All cancers 

MCCN 

GMCCN 

LSCCN 

England 

to understand current patterns 

of service provision and where 

improvements can be made. 

Cancer spend in Merseyside and 

Cheshire improved dramatically 

from 2004/05 to 2008/09, with 

network expenditure increasing 

from £6 million to £9.7 million 

per 100 000 of the population. 

This expenditure now exceeds 

the national rate and means the 

network is equivalent to other 

cancer network within the North 

West (figure 1.5). 

It is important to note that 

this programme budgeting 

category only covers diseasespecific 

costs and expenditure 

on early detection, prevention, 

screening and cancer awareness 

are addressed within the ‘healthy 

Figure 1.3: National and regional one year survival (2002-2006) 

Urological 

Breast 

Lung 

Colorectal Upper gastrointestinal 

MCCN 

GMCCN 

LSCCN 

England 



individuals’ category (Figure 

1.5). Figure 1.5 illustrates a 68% 

100 

Figure 1.4: National and regional five year survival (1998-2002) 

increases in expenditure with 

regards to this category since 

the Cancer Reform Strategy 

(2007) and the announcement 

of National Awareness and Early 

Detection initiative (NAEDI). 

Relative survival (%) 

80 

60 

40 

20 

MCCN 

GMCCN 

LSCCN 

England 

Cancer waiting times 

0 

All cancers 

Urinary tract 

Breast 

Lung 

Colorectal 

Upper GI 

Reducing the time that a 

patient waits for the beginning 

of treatment from an urgent 

referral plays a fundamental 

role in the efficient and timely 

delivery of services. Intelligence 

surrounding this data enables 

local trusts to assess whether 

delays in waiting times are a 

result of the system of care 

rather than diagnosis or a 

patient’s personal choice. 

Two week wait referrals 

target 

In total, 40829 urgent referrals 

took place from April 2009 to 

March 2010, which, on average, 

meant 3402 patients with 

suspected cancer were seen 

across Merseyside and Cheshire 

per month. The network 

achieved the national standard 

for 11 months out of this period. 

31 day first treatment target 

Expenditure (£million/100,000 population) 

Figure 1.5: Network and national expenditure for Healthy Individuals Programme 

12 

10 

GMCCN Ca 

LSCCN Ca 

8 

6 

MCCN Ca 

National Ca 

GMCCN HI 

4 

2 

LSCCN HI 

MCCN HI 

National HI 

0 

2006/2007 2007/2008 2008/2009 

The network exceeded this target 

from March to December 2009 

by ensuring that 98% patients 

began their first treatment 

within 31 days. 

31 day subsequent treatment 

target 

Following the expansion of 

national standards with regards 



Figure 1.6: 62 day wait for first treatment - urgent GP referral to treatment 


Performance threshold 

even now, these issues are being 

addressed. 

% Performance 

100 

95 

90 

85 

80 

75 

70 

65 

60 

March April May June July 

to cancer waiting times, the 

network has closely monitored 

the progress for this target. 

Surgery 

The network achieved the 

standard required for subsequent 

surgical treatment by achieving 

97% for the ten month period. 

This involved the surgical 

treatment of 4661 patients 

within 31 days. 

Drugs 

The Merseyside and Cheshire 

network has performed very 

well with regards to this type of 

treatment. Of 1933 patients that 

were treated, only six had to wait 

longer than the required 31 days. 

August September October November December 

62 day treatment target 

As well as the expansion of the 

Cancer Waiting Times data set, 

there are now much stricter 

constraints with regards to 

patient pathways. As a result of 

this, there has been an increase 

in performance variability 

compared with 2008 (Figure 

1.6). The network achieved the 

new national standards for five 

months. Constant monitoring of 

the Cancer Waiting Times and 

patient pathways means that, 

The North West Staging 

Project 

The North West Staging Project 

has now come to an end. 

Achieving the aims of the project 

brief, all trusts in the Merseyside 

and Cheshire Cancer Network are 

now submitting PAS, Pathology 

and MDT data to NWCIS. 

Seven trusts have successfully 

implemented our recommended 

solution comprising a 

comprehensive review of process 

and data collection methodology 

and a fully-supported 

deployment of the Somerset 

Cancer Register. A further six 

Trusts and a PCT are due to 

implement the Somerset Cancer 

Register by Christmas 2010. 

The median waiting time from urgent 

GP referral to first treatment in 2009 

was 44 days 


Cancer peer review programme 

The National Cancer Peer Review Programme aims 

to improve care for people with cancer and their 

families by: 

• ensuring services are as safe as possible 

• improving the quality and effectiveness of care 

• improving the patient and carer experience 

• undertaking independent, fair reviews of 

services 

• providing development and learning for all 

involved 

• encouraging the dissemination of good practice 

Cancer networks have delegated responsibility 

from SHAs and PCTs to ensure that services are 

appropriately commissioned and have robust clinical 

governance processes. The process of cancer peer 

review is concerned not only with the review of an 

organisation’s compliance against measures, but 

also with the qualitative assessment of a broad 

set of objectives for the delivery of services. These 

objectives encompass the whole system of quality 

and safety in relation to patient care and patient 

and carer experience. 

2009/10 was the first year of implementing the 

new approach to cancer peer review with the 

introduction of annual self assessment, internal 

validation, external verification & target visits. 

Across the network a number of teams were 

reviewed including: 

• breast 

• lung 

• skin 

• urology 

• gynaecology 

• pancreas 

• oesophago-gastric 

Reviews have now concluded and while the process 

has identified discrete areas of non-compliance 

across the network, overall the results have been 

positive. In particular, the zonal team has applauded 

the robustness of local internal validation processes. 

Following the outcomes from the different stages 

in the peer review process, the cancer network and 

its constituent organisations 

have now agreed 

the actions that 

need to be taken 

within agreed 

timescales, 

building on 

the strengths 

identified 

and addressing 

any aspects in need of 

improvement. 

The schedule of self assessments and targeted visits 

for 2010/11 has been issued and work is already 

underway to prepare for this next round. 


Network groups: Service improvement 

There are 24 clinical network groups (CNGs) across 

the cancer network; all are multi-disciplinary in 

nature. They reflect a focus of local expertise in 

specific cancer types (e.g. lung cancer or breast 

cancer) or a group of experts who work in crosscutting 

services which support care of people 

with cancer (such as chemotherapy, or allied 

health professionals). This is how we engage with 

clinicians across the patch - a key competency 

for PCTs to demonstrate in World Class 

Commissioning. Some of the CNGs’ highlights and 

achievements in 2009/2010 are detailed below. 

Service improvement 

The Allied Health Professionals CNG began 

preparatory work to agree criteria for the four 

level model, undertook a survey of current service 

provision, agreed cancer rehabilitation guidelines 

and started to develop a service specification, 

needs assessment, and training and education 

strategy. Work commenced on developing a 

rehabilitation section for each locality’s cancer 

services directory. This work will continue and be 

subject to peer review assessment in January 2011. 

The Breast CNG helped to prepare units for the 

two week wait for all breast referrals from January 

2010, with the exception of referrals for family 

history services and for reconstructive procedures. 

The Breast CNG acknowledged the excellent 

Professor Emiel Rutgers presents the “People’s Prize”, won by A Farooq, S 

Azmi and M Chandrashekar at the breast Tri-network event in Nov. 2009 

comments about local breast services from 

the 2009 patient survey. The group secured 

100% compliance against the CNG peer review 

measures and the panel noted the enthusiasm and 

commitment of regular group attendees. 

Via the Children and Young Peoples CNG, an 

MDT co-ordinator was appointed at Alder Hey to 

support the Paediatric Oncology MDT and ensure 

that robust arrangements are in place between the 

treatment centre and referring teams. The Teenage 

and Young Adult MDT is now well established and 

is led by Dr Nasim Ali, medical oncologist. During 

its first 12 months the MDT has discussed 95 cases, 

offering supportive care packages to patients in 

Merseyside, Cheshire and North Wales. A peer 

support group for young people aged 16 to 24 

years was established during the year to which all 

patients discussed at the MDT are invited to join. 

The Colorectal CNG continued to monitor and 

support laparoscopic colorectal surgery in line with 



the national guidance; this method of surgery 

is now available in each trust in the network. A 

national baseline assessment was undertaken by 

each colorectal MDT and highlighted an increase 

in the proportion of patients having a laparoscopic 

resection in line with national trends. The group 

also embraced the enhanced recovery programme, 

which improves elective inpatient management by 

ensuring that patients are supported appropriately 

at each stage of treatment. Aintree University 

Hospital Trust was confirmed as an innovation site 

as part of the national programme. 

The End of Life and Palliative Care CNG has 

taken a coordinating role in progressing the 

implementation of the NHS North West End of Life 

Care Clinical Pathway Group recommendations, 

producing and regularly updating a performance 

report on the uptake of end of life care tools 

across the network. 

Dying Matters: “Lets talk about it” is a national 

campaign to raise public awareness on planning 

for end of life. There was a week of events across 

the country, locally led by the End of Life and 

Palliative Care CNG in March 2010 with colleagues 

at local level joining forces for a very successful 

event. The cancer information bus iVan (see page 

30) was dressed in different clothing for the week 

and travelled across the network manned by 

professionals and patient volunteers to deliver 

information around end of life issues. 

Professor Sir Mike Richards with MCCN’s Sandra Rowlands and Gloria 

Payne from the iVan team 

During 2009/2010 the Haematology CNG and 

Pathology CNG continued to work towards a 

solution to the outstanding IOG requirement for 

the Haematological Malignancy Diagnostic Service 

(HMDS). 

The Head and Neck CNG and network team started 

work with Professor Simon Rogers, consultant 

in maxillofacial surgery, to develop a DVD and 

supporting material to raise awareness of the signs 

and symptoms of mouth cancer. Jointly funded by 

the Mersey Deanery and cancer network, this will 

be positioned in dentists and GPs’ practices to be 

launched as part of Mouth Cancer Action Month. 

The Health Inequalities CNG saw good progress on 

most objectives; considerable external investment 

was secured for Merseyside and Cheshire and the 

Early Detection Strategy has been mainstreamed 

into the cancer network’s (and some PCTs’) 

business plans, resulting in good engagement of 

general practice and acute trusts. Relations with 



external partners such as Cancer Research UK and 

Clatterbridge Cancer Research have developed. 

Paul Mackenzie, health inequalities manager for 

the network, continues to be a member of the 

national awareness early detection and national 

equalities committees. 

The Health Inequalities CNG developed a quality 

performance framework/cancer dashboard, 

an information-based tool that enables PCT 

teams to self-assess their effectiveness on cancer 

inequalities. It has three parts: a baseline report 

from the cancer network, a self-assessment group 

exercise lasting a maximum of two hours and a 

round of action and review. Work commenced 

with Liverpool PCT to develop this process, to 

ensure robust evidence for inspections from 

the Care Quality Commission, World Class 

Commissioning panels etc. 

The Health Inequalities CNG continued to 

coordinate activity to improve screening uptake. 

The group identified good practice in report 

formats for GPs and modelling outcomes, 

collaborated work with the National Screening 

Committee to include sentenced prisoners in the 

bowel cancer screening programme, provided 

leadership for change in cervical cytology labs 

and developed a breast screening DVD aimed at 

women with learning disabilities. 

Several social marketing initiatives have been 

developed and implemented across MCCN via the 

Health Inequalities CNG, for example prostate 

cancer insights and awareness raising in two 

deprived wards in Wirral, three wards in an 

affluent area in Cheshire and the Afro-Caribbean 

centre. In April to July 2010 MCCN is rolling out the 

successful malignant melanoma initiative in each 

PCT. This project raises awareness of skin cancer for 

men over 50 years of age. Social marketing insights 

were developed for cancer of the breast, lung, 

bowel, bladder, cervix and skin. 

The Liverpool Heart and Chest Hospital established 

a transbronchial needle aspiration service for the 

network, working alongside the Lung CNG to do 

this. 

The Neuro-oncology CNG and Radiology CNG 

started work across partner trusts in Merseyside 

and Cheshire to develop a network-wide approach 

to the management of metastatic spinal cord 

compression, to ensure delivery of NICE CG 75. 

The Pathology CNG oversaw a number of networkfunded 

trust-based projects which will enable them 

to implement new pathology reporting systems. 

This will subsequently improve data collection 

and assist with various local and national data 

requirements. Work continued on implementation 

of the cervical cytology sector arrangements; the 

laboratories made good progress towards the 

planned consolidation of services. 

During 2009/2010, the Primary Care CNG refocused 



its efforts on engaging with the primary care 

community across Merseyside and Cheshire 

via a regular e-bulletin titled ‘Cancer Matters 

in Primary Care’. The bulletin and associated 

work have enabled engagement with a wider 

group of colleagues, including practice-based 

commissioners, PCT cancer leads and practices with 

an interest in cancer. 

The Sarcoma CNG received confirmation from the 

North West Specialist Commissioning Group that 

the CNG proposal to offer one of the North West 

treatment centres for soft tissue sarcoma at the 

Royal Liverpool University Hospital was accepted. 

The CNG supported the specialist MDT through a 

successful internal peer review. 

The Radiology CNG reviewed and further 

developed the standardised protocols for cancer 

imaging to be applied across the network. The use 

of the protocols maximises imaging capacity whilst 

promoting patient safety by minimising exposure 

to radiation. The CNG has resurrected the PET CT 

operational group with co-opted colleagues to 

plan for a static service beyond 2012 when the 

current national contract concludes. Plans include 

building reporting capability and capacity within 

radiology. 

The Radiology CNG has also been liaising closely 

with the Cheshire and Merseyside PACS managers 

group to resolve some of the issues around the 

transfer of images in a timely manner to support 

MDT discussion. A network audit has revealed that 

there are now no delays in patients being discussed 

at MDT and that the use of CDs to transfer images 

has ceased. The Cardiac and Stroke Clinical 

Network is looking to revise the imaging strategy 

for both disease groups; through collaboration 

between both networks the Radiology CNG has 

representation identified for this work. 

As the Skin CNG prepared for the first peer review 

assessments, a substantial amount of work went 

into the implementation of a number of clinical 

pathways and protocols. The Specialist Skin Cancer 

MDT was formally established at Whiston Hospital 

and the Supranetwork MDT for cutaneous T-Cell 

lymphoma patients was formally established 

at the Royal Liverpool University Hospital. In 

addition, the network Mohs service (a microscopic 

surgical technique for the treatment of some skin 

cancers) became operational at Wirral University 

Hospital. The CNG produced and launched a 

comprehensive melanoma leaflet for local patients 

and also contributed to the development of a 

BBC documentary relating to sunbed use and skin 

cancer. 

The Supportive and Palliative Care CNG 

completed a full stocktake against the IOG in 

May 2009 and March 2010. While there were 

many areas requiring progress earlier in the year, 

significant progress had been made by March. 

Notwithstanding, there remain areas of noncompliance, 

for example rehabilitation, psychology 


Network groups: Development of clinical 

practice, pathways and guidelines 

and 24/7 provision of specialist palliative care, 

which will require intensive performance 

management supported by the SHA. 

The Urology CNG was externally reviewed in 

January and achieved 100% compliance against 

the national measures. Reviewers acknowledged 

strong leadership, improvements in communication 

between the local and specialist MDTs and active 

patient involvement. The report identified a 

number of areas which will need to be reviewed. 

These include a review of the two centre service 

for penile cancer (supra-network MDT), South 

sector renal MDT arrangements and the need 

to ensure consistency in the provision of services 

across the network, for example oncology input 

and joint clinics for patients. 

Development of clinical 

practice, pathways and 

guidelines 

The Allied Health Professionals CNG participated in 

the development of national pathways, to develop 

an evidence base relating to the effectiveness of 

rehabilitation interventions relating to cancer 

in brain and central nervous system, breast, 

colorectal, gynaecology, head and neck, lung, 

upper GI and urology. 

The Chemotherapy CNG received the long-awaited 

final report from the National Chemotherapy 

Advisory Group (NCAG), “Chemotherapy services 

in England, ensuring quality and safety”. The 

group has started to effect fundamental changes 

in the way chemotherapy services operate as 

a consequence of the recommendations. The 

group has completed work on incident reporting 

and off protocol chemotherapy use and has 

planned with partners in the chemotherapy and 

pharmacy groups to deliver end of treatment 

records, standardised network protocols and 

multidisciplinary competencies for prescribing, 

checking, and administering chemotherapy. 

The Children and Young People’s CNG continued 

to develop guidelines and policies with a particular 

focus on clinical and communication arrangements 

between Alder Hey and the shared care units. 

Children’s cancer measures were published in 

2009 and the group has been actively engaged 

in developing the evidence necessary at network, 

principal treatment centre and shared care level 

to ensure consistency across children’s cancer 

services. This work has included the development 

of a key worker policy for children, guidelines for 

psychosocial assessment and clinical management 

protocols. 

The Colorectal CNG reviewed pathways for early 

rectal and anal cancer to ensure that access 

is available to colorectal patients requiring 

specialist input. This work has included a review 

of support available to patients at every stage and 




communication between local and specialist teams. 

The work has also contributed to the development 

of network-wide guidelines for governance and 

communication. 

Referral guidelines across the Colorectal CNG 

and Hepato-pancreato-biliary CNG were finalised 

during the year in light of the NICE guidance 

for Cetuximab for patients with colorectal liver 

metastases. Arrangements for the commissioning 

of specialist pathology (KRAS testing) to test 

patients’ eligibility for this treatment were also 

confirmed. Further work developed to cement the 

links between the associated CNGs, with Mr Hassan 

Malik, liver surgeon, now an active member of 

both groups. 

The Gynaecology CNG undertook a full review of 

all clinical protocols and pathways as preparation 

for the peer review assessments which commenced 

during 2009. 

The Haematology CNG had a productive year, with 

a particular focus on confirming network clinical 

guidelines. Many colleagues actively contributed 

to this work and the resulting guidelines reflect 

this combined effort. The group also regularly 

reviewed access to trials with a view to improving 

uptake and started to develop the network’s 

website to hold up-to-date information about 

open clinical trials. 

The Head and Neck CNG reviewed a number 

Professor Emiel Rutgers presents the prize for best abstract to Dr Joanna 

Coote at the breast Tri-network event in November 2009 

of guidelines and pathways, including imaging 

guidelines for head & neck and thyroid cancer 

and management of neck lumps. Clinical support 

services were also being reviewed within localities 

to ensure that arrangements for aftercare and 

rehabilitation are in place. 

The Hepato-pancreato-biliary CNG wrote 

new guidelines during the course of the year. 

These include guidelines on liver adhesions 

and liver cysts. The network-wide guidance on 

communications and governance between local 

and specialist MDTs has been discussed in depth. 

The liver team has visited referring trusts once 

again this year to strengthen the links across the 

care pathway. 

In anticipation of the publication of IOG measures 

in 2010, the Neuro-oncology CNG continued to 

work on the development of clinical pathways 

and guidelines, with particular focus on a patient 

referral pathway for patients with a newly 




diagnosed brain tumour and the rehabilitation 

pathways/roles of allied health professionals. The 

group also started to review cancer registry data 

and cancer waiting times data to inform the work 

of the group. 

The Oesophago-gastric CNG wrote new guidelines 

for the management of dysplasia; several other 

guidelines and imaging protocols were updated 

to reflect new practices such as the use of PET-CT. 

In January 2010 the CNG underwent peer review. 

The visiting review team confirmed that the CNG 

had complied with 100% of the national measures 

and praised the input of the group’s patient 

representative, Sue Kernaghan, in particular. The 

peer review team noted that a small number of 

surgical procedures had been performed outside 

the designated centres. This matter was raised 

immediately with the trusts concerned and 

appropriate assurance was received. The reviewers 

also stated that a structured plan to decrease the 

number of surgeons performing oesophago-gastric 

cancer resections should be developed. This will 

form a major part of the CNG’s workplan during 

2010. 

A system of formally managing tertiary referrals to 

the Royal Liverpool Hospital laboratory (for MDT 

reporting/second opinions) was established via the 

Pathology CNG so that the financial and workload 

implications can be monitored. In anticipation of 

the NICE appraisal for Iressa for non small cell lung 

cancer patients, an estimated glomerular filtration 

rate (EGFR) testing service has been developed 

at the Royal Liverpool Hospital to enable better 

targeted prescribing of the drug. 

The Pharmacy CNG implemented the first networkwide 

online intervention monitoring tool. 

Results from the first four months of operation 

were presented at the network chemotherapy 

conference poster exhibition. 

Pharmacists routinely make interventions, 

correcting errors on chemotherapy prescriptions. 

Recording and collating these errors provides 

important safety related data and allows 

chemotherapy regimens which cause problems 

to be identified before an actual clinical incident 

occurs. For example, half of all the interventions 

reported concerned regimens containing 

fludarabine or rituximab and fludarabine. The 

interventions included wrong doses and the wrong 

interval between cycles and were judged to have 

prevented serious harm in all cases. Findings have 

been reported back through CNGs with the advice 

to refer to protocols and take extra care in the 

prescribing, dispensing and administering of these 

chemotherapy regimens. 

The Sarcoma CNG developed a policy for genetic 

testing in diagnostic sarcoma referrals, in 

collaboration with the Merseyside and Cheshire 

regional genetics laboratories. Work also started to 

develop referral pathways and cross-MDT working 

across Merseyside & Cheshire and Lancashire & 


Network groups: Excellence in clinical 

audit 

South Cumbria 

The Supportive and Palliative Care CNG developed 

network guidance for bereavement support during 

2009/11 - this was approved by the End Of Life 

and Palliative Care CNG in March 2010. A directory 

of bereavement support services within each 

locality is underway and will be concluded in the 

forthcoming months. 

The Psychological Support Working Group 

continues to meet regularly and has made 

significant inroads in developing a network 

model for holistic needs assessment, which 

incorporates a psychological screening tool. A 

final draft of the guidance was circulated March 

2010. Work continues to develop a training 

programme to support the process. In addition, 

the group has continued to work on a network 

service specification for psychology. This work will 

continue into 2010. 

During the year, the Urology CNG finalised clinical 

and referral guidelines for bladder, prostate, 

renal and testicular cancer and worked with the 

team at The Christie to develop the penile cancer 

guidelines. As part of its work programme, the 

CNG has started to review follow up practice 

and opportunities to explore different models 

of follow up. Dr Steve Connolly, GP, is working 

with the group to look at the interface between 

primary and secondary care supported by clinical 

guidelines. 

Excellence in clinical audit 

The Colorectal CNG reviewed emergency colorectal 

cancer activity in each trust as part of its audit 

programme. Further work is underway to audit 

stenting services as part of the CNG’s review of its 

policy for management of emergencies. 

The Merseyside and Cheshire Palliative care 

Network Audit Group has produced the fourth 

edition of standards and guidelines in palliative 

care. 

In November 2009 the Gynaecology CNG hosted 

a successful audit day with a number of clinical 

and educational presentations relating to local 

projects and areas of current interest. This included 

continuation of the local ovarian cancer audit, 

and an endometrial hyperplasia audit. In addition, 

the development of a local clinical database has 

enabled improved gynaecological data collection 

while trusts prepare for full implementation of the 

Somerset Cancer Register. 

The Head and Neck CNG audited head and neck 

patient pathways to identify any variation against 

the agreed clinical pathway and to address clinical 

and non-clinical delays. Head and neck patients 

often experience complex diagnostic pathways 

involving a number of different trusts and the 

audit highlighted a number of areas for action. 

Submissions to the national clinical dataset for 


Network groups: Excellence in clinical 

audit 

head and neck - DAHNO - have improved and all 

trusts were given a ‘green’ status. Data quality 

is now being addressed. Overall the network 

achieved 74% in staging, a notable increase on the 

last report. 

In addition, an audit of gastrostomy services was 

carried out in order to gather information on the 

availability of local services. The audit highlighted 

some gaps in service leading to increased travel 

for patients and the outcome of the audit is being 

discussed with appropriate localities. 

Survival data for the most common cancers at one 

and five years is now available by PCT or tumour 

type and has been shared in the cancer dashboard, 

led by the Health Inequalities CNG. In addition, 

survival modelling will soon be possible for bowel 

cancers identified through screening. 

Via the Health Inequalities CNG, the PCTs have 

collectively participated in the nationally validated 

Cancer Awareness Measure. This tool is being used 

across the network using appropriate sampling 

methods and is being led by the University of 

Liverpool and Clatterbridge Center for Oncology 

research team. The results will be available in late 

spring 2010. 

The hepato-pancreato-biliary minimum data sets 

for primary liver cancer, metestatic liver cancer, 

pancreas cancer and neuroendocrine tumours have 

been revised so that the majority of data items are 

The cancer dashboard enables PCT teams to self-assess their effectiveness 

on cancer inequalities 

now common across the tumour types. It is hoped 

that this will ensure that better, more consistent 

and relevant data are collected in the future. 

With this in mind, the Hepatobiliary (HPB) CNG 

has decided to hold an annual HPB audit day. In 

January 2010, the CNG was visited by a peer review 

team. The visiting team concluded that the CNG 

was 100% compliant with the national measures 

and singled out the approach taken by Wirral 

Hospitals to track HPB patients for praise. 

The Lung CNG hosted a wide-ranging audit and 

education event in December 2009, which allowed 

a number of colleagues to discuss statistical and 

epidemiological data as well as developments in 

lung cancer care across Merseyside and Cheshire. A 

comprehensive report was presented to the group 

detailing performance against an agreed clinical 

performance indicator (CPI) programme as well 

as the LUCADA dataset. A system for collecting 

data relating to mesothelioma diagnoses was 

implemented to enable a thorough assessment of 


Network groups: Education, training and 

workforce development 

the workload and treatment pathways. 

All trusts contributed data to the national 

oesophago-gastric cancer audit. The 

recommendations from the audit have been 

discussed at length and have been incorporated 

into the Oesophago-gastric CNG’s workplan. In 

July 2009, the CNG held a very successful audit day. 

Twenty five members of the CNG were joined by 

a further 20 colleagues from their MDTs to hear 

audits of patient outcomes and presentations 

on innovative techniques including HALO 

radiofrequency ablation. 

The Primary Care CNG led some local work on the 

national audit of cancer diagnosis in primary care; 

33 practices from seven PCTs submitted full returns 

for this project and analysis was undertaken on the 

main findings. This work generated a significant 

level of interest and engagement from primary 

care and the CNG is considering how to maintain 

momentum and interest. Professor Greg Rubin, 

national lead for this work, visited the network 

in February and led a workshop with over 20 

participants to discuss the audit of cancer diagnosis 

in primary care and learning from the rest of the 

country. 

Skin Electron Beam radiotherapy service (TSEB). 

The Urology CNG Audit Event was held on 

23rd September and was well attended by CNG 

members and wider members of local MDTs. 

Presentations included peer review, organ based 

tumour data and clinical trials. The main focus 

of the meeting related to communication and 

referral arrangements between local and specialist 

MDTs and the information provided to patients at 

different stages of their care. As a result, the CNG 

made a significant contribution to the network 

guidelines for governance and communication 

between local and specialist MDTs. 

Education, training and 


The Allied Health Professionals CNG undertook 

a further local review to quantify rehabilitation 

workforce provision for cancer and palliative care 

patients. This has been a valuable exercise as the 

data will support the development of a network 

specification for cancer rehabilitation. The group 

collaborated with the lead nurses group to focus 

on survivorship. 

The Skin CNG oversaw data collection against 

agreed clinical performance indicators; this 

culminated in an annual report, supporting local 

MDT performance evidence for peer review. A 

successful education event was held in May 2009 

covering a number of topics including the Total 

The Breast CNG organised the annual tri-network 

breast conference in partnership with the 

North West Breast Screening Quality Assurance 

Reference Centre, for the Merseyside and 

Cheshire, Lancashire and South Cumbria and 

Greater Manchester cancer networks. The event 


Network groups: Education, training and 


attracted international speakers and over 150 

local delegates. The clinical debate was lively, 

local research projects were presented and the 

evaluation of the learning from the event was 

extremely positive. 

The Chemotherapy Nurse CNG planned, 

organised and hosted the third annual network 

Chemotherapy Conference, covering a broad 

agenda with topics ranging from acute oncology, 

survivorship and NCAG (National Chemotherapy 

Advisory Group) to cytogenetics, lung and 

haematological clinical updates for the more 

clinically minded in the audience. 

The Education Network Group oversaw the 

sixth Network Development Programme (NDP), 

to enable individuals to be better equipped 

to develop their personal leadership and 

networking skills in relation to their cancer 

role. This has now concluded and the seventh 

programme commenced in March 2010. Work 

also continued on the e-learning programme and 

all three packages (intravenous access care and 

maintenance, chemotherapy and spiritual care) 

are now near completion. The final draft of the 

Network Education Strategy was circulated in 

March 2010 for consultation. Feedback has been 

positive; the strategy recognises the key role of 

training and education in the development of a 

competent cancer workforce. 

annual conference with the National Council 

for Palliative Care, which was well attended and 

successfully evaluated. The next event is scheduled 

for July 2010. 

The Supportive and Palliative Care CNG continued 

to roll out the Advanced Communication Skills 

Training (ACST) programme for senior healthcare 

professionals. A total of 18 ACST courses were 

held in 2009, including three end of life courses. 

So far in 2010, five courses have been held with 

another three dates confirmed and further dates 

to be confirmed for the rest of the year. To date a 

total of 187 MDT core professionals have attended 

for training; a total of 67 have applied but are 

still awaiting a date. In addition there will be 

additional core professionals who need to attend 

training but have not yet applied. Three of our 

trainees were successfully accredited this year: 

Margaret Kendal, Debbie Wyatt and Jan Vickers. 

The group also held a very well attended 

conference in June 2009 titled “Psychological 

Problems: Psychological solutions across the 

lifespan”. 

The End of Life and Palliative Care CNG held its 


Medical director’s report 

Medical director: Ged Corcoran 

Having held this position for almost ten years, 

welcome to my first ever annual report. 

During the last year I was able to increase my 

sessions to the network in order to lead on several 

important strategies: 

• Non-surgical oncology 

• PET-CT 

• Cervical cytology reconfiguration 

• Links with the university 

• Clinical governance 

• Clinical engagement 

• Peer review 

We have made great progress in all of these areas 

and are likely to be among the first networks 

to have acute oncology teams in place. By early 

summer 2010 we will have five out of the seven 

teams in place, having successfully recruited five 

additional medical oncologists. 

With colleagues and the Lung and Radiology 

CNG chairs, we have been working to improve 

the current PET-CT access and are developing a 

strategy for the future. Similarly we are working 

closely with the University of Liverpool to develop 

academic radiology. With the acquisition of a 

Research PET-CT scanner at the Royal, the prospect 

for both these strategies has been significantly 

enhanced. 

ensure that good 

clinical governance is 

in place across patient 

pathways developing in 

the CNGs. I am pleased 

to say that there have 

been no significant 

or serious untoward 

incidents during the 

year. 

Another major focus in my role is maintaining the 

momentum for clinicians to engage with us and 

with each other through our many and varied 

CNGs. Supporting CNG chairs, including chairing 

one CNG (Oesophago-Gastric), has occupied a 

good deal of my time. I know how difficult it 

is to juggle clinical demands with non-clinical 

commitments and am grateful to all of those who 

give generously and freely of their time to ensure 

that we have strong engagement at network level. 

This was formally recognised in the recent peer 

review round. 

I look forward to working with you over the next 

year to further strengthen and develop services for 

all our patients. 

As Medical Director, it is my responsibility to 


Nurse director’s report 

Nurse director: Anita Corrigan 

Having taken up post in March 2009, welcome to my 

first annual report. This has been a busy 12 months, 

both in terms of reviewing the nursing contribution 

to cancer care and in progressing the supportive care 

agenda. I have led on several important work areas, 

including: 

• Nursing Strategy finalised 

• Network Key Worker Guideline finalised 

• Network Bereavement Support Guideline finalised 

• Network Holistic Needs Assessment Guideline 

developed 

• Secured Macmillan funding for an Network AHP 

Lead 

• Network service specifications for psychology and 

rehabilitation commenced 

• E-learning developments 

The network nursing strategy - ‘The pursuit of 

excellence in cancer nursing 2009-2012’ - was 

approved by Taskforce in October 2009. This latest 

strategy aims to set out a vision for cancer nursing to 

respond to the new challenges set out in Modernising 

Nursing Careers (2006), the Cancer Reform Strategy 

(2007), the NHS Next Stage Review (2008) and the 

End of Life Care Strategy (2008) which clearly focus 

on improving the quality of care across the whole 

NHS. Our strategy responds to this challenge, putting 

patients at the heart of our business and our services, 

with the central aim of improving the patient 

experience and outcome. 

The latest network patient experience survey was 

rolled out in July 2009. This was coordinated by lead 

nurses within each organisation. 2010 will focus on 

implementation of remedial action plans. 

A joint-led nurse and AHP meeting was held in 

November 2009 – this was the first joint open meeting 

of lead nurses and allied health professionals; the 

focus of the meeting was ‘survivorship’. The meeting 

was supported by a number of patient and carer 

representatives, whose contribution to the group 

work was greatly appreciated. 

The network key worker guideline was approved in 

October 2009. The guideline specifies the standard 

of care coordination that should be achieved by any 

organisation involved in delivering cancer services and 

the role of the ‘key worker’. It applies to the delivery 

of both supportive and palliative care, covering the 

needs of patients who are expected to be discharged 

from treatment and those requiring end of life care. 

I have also participated in two national work streams: 

modernising cancer nursing careers and nurse sensitive 

outcomes in ambulatory chemotherapy. These will 

continue to inform the work of the group over the 

forthcoming year. 


Research 

Research network 

The aim of the Merseyside and Cheshire Cancer 

Research Network (MCCRN) is to provide the 

cancer network with an infrastructure to support 

randomised prospective trials of cancer treatment. 

These include surgery, radiotherapy, chemotherapy, 

palliative care, newer treatment modalities and 

other well-designed studies that form part of 

the National Institute for Health Research (NIHR) 

portfolio. 

The purpose of the MCCRN is to benefit patients 

by improving the integration, quality and speed 

of cancer research. The MCCRN has developed 

a broad portfolio of approximately 130 studies, 

including 10 NIHR adopted commercial studies. 

The team is working hard to ensure that each 

trust’s portfolio is robust, suitable for the needs 

of the local population and integrated into the 

delivery of cancer services. This means working 

to our own strengths and investing the necessary 

time and resources to develop research in more 

challenging cancer areas, as well as maximising 

patient choice 

Despite a number of workforce challenges 

encountered by the network in 2009/10, 

recruitment to RCTs has been excellent enabling 

us to achieve the 7.5% RCT target. In 2009/10 the 

MCCRN appointed a new clinical lead for research: 

Dr Ernie Marshall, Macmillan consultant in medical 

oncology takes up his new role on 1st June 2010. 

During 2010/11 the MCCRN key priorities are: 

• Performance management of the team and 

their respective portfolios to ensure we meet 

our recruitment targets and provide patients 

with access to a comprehensive portfolio of 

studies 


Research (continued) 

• Identifying new and more cost effective 

ways of working in response to the economic 

downturn and associated financial challenges 

• Continually evaluating skill mix to maximise 

the use of resource 

• To work with our Clinical Network Groups and 

Multidisciplinary Teams to overcome obstacles 

to recruitment into studies and critically 

examine areas where there are poor levels of 

recruitment 

• Continue to provide high quality education 

and training through regional groups 

Research group 

There are currently three research work streams 

addressing diverse topics related to cancer 

experience and awareness: 

1) A study to explore the impact of 

prostate cancer on the daily lives of men. 

This study will explore men’s experiences 

before and following treatment for prostate 

cancer. 

2) A study to explore how language 

impacts on people affected by cancer in 

the period following treatment 

The aims of the Research Group are: 

• To achieve the objectives set within the Cancer 

Nursing Strategy 2008-2012 

• To promote a multi-disciplinary team approach 

to the development and dissemination of 

research findings 

• To develop and sustain partnerships with 

academic staff, lay partners and professional 

bodies 

• To develop and undertake research as defined 

through the priorities and needs of patients, 

carers, professionals and the broader NHS 

• To apply for external funding for research 

proposals 

This study will explore how the language 

that health professionals and members of the 

public use to talk to people affected by cancer 

influences their well-being in the difficult 

period following the completion of a course of 

cancer treatment. 

3) The Cancer Awareness Study 

As part of the MCCN strategy (2008-2010) for 

reducing health inequalities through the early 

detection and prevention of cancer, a study is 

currently underway which has been designed 

to identify the levels of awareness about 

cancer in the seven PCTs within the network. 


Patient and public involvement 

The Cancer Network Partnership 

Group (CNPG) continues to work 

on the priorities set in their 2008- 

2012 strategy: 

• Raising awareness 

• Information 

• Network research 

• Getting involved 

• Support and survivorship 

Raising awareness 

Group members have been 

involved in raising awareness 

of cancer in the community by 

working on iVan, the network’s 

mobile vehicle. 

Doris MacGlashan and Kate 

Jones - both members of locality 

partnership groups - have 

qualified as volunteers on iVan, 

while other members have helped 

in an ad hoc way such as raising 

awareness of prostate cancer with 

the help of the Wirral Prostate 

Cancer Support Group. 

Gloria Payne, patient and public 

involvement lead has also been 

raising awareness of men’s 

cancers in Risley Prison and Thorn 

Cross Youth Offenders Institute, 

Warrington as well as joining the 

Army for a day to raise awareness 

at the Dale Barracks, Chester. 

Information 

Good information is very 

important for people affected 

by cancer and group members 

have been involved in helping 

professionals to devise leaflets 

and booklets for cancer patients. 

Gloria Payne and Ray Murphy, 

chair of the CNPG, have attended 

conferences and workshops 

discussing patient information 

pathways and prescriptions at 

national and regional levels. 

The network’s website continues 

to develop with input and 

comment from group members. 

Yvonne Potter is the patient 

representative on the information 

steering group and inputs at 

network level. 

St Helens and Knowsley Hospitals 

Trust opened an information 

centre; the centre’s manager has 

also joined the partnership locality 

group. 

Network research 

A patient experience survey was 

undertaken in July 2009, involving 

data from nine of the network’s 

hospital trusts. Over 800 surveys 

were returned overall; a report 

on the findings was compiled by 

Gloria Payne and Ian Connolly, 

the network’s performance 


Patient and public involvement (continued) 

improvement manager. This 

report can be found on the 

network website at www.mccn. 

nhs.uk. 

The Network Research Group’s 

developments can be found in the 

‘Research’ section of this report. 

Getting involved 

Gloria Payne has been visiting 

local cancer support groups to 

encourage their members to get 

involved with the work of the 

CNPG, resulting in many new 

people attending events and 

workshops and the recruitment 

of a patient representative to the 

Haematology Clinical Network 

Group. 

In September 2009 the North West 

cancer networks held their annual 

patient partnership conference in 

Wigan, which was well attended 

by all three networks. The keynote 

speaker was Joanne Rule, national 

lead for user involvement in 

commissioning. The event was 

chaired by Derek Stewart. 

by Macmillan Cancer Support was 

held in February 2010. A report on 

the findings of this can be found 

on the MCCN website at www. 

mccn.nhs.uk. 

Support and survivorship 

The fifth course of ‘Living Life 

after Treatment’ (LLaFT) sessions 

started in April 2010. The course 

is for cancer patients who have 

finished their treatment at the 

Countess of Chester hospital. The 

course covers a variety of topics 

such as diet, exercise, information 

and support, physiotherapy and 

anxiety. 

Sue Kernaghan, the patient 

representative on the network’s 

psychological working group, 

became a radio personality when 

she appeared on BBC Woman’s 

Hour with Cieran Devane, chief 

executive of Macmillan Cancer 

Support, where they discussed 

cancer survivorship. 

National Cancer Partnership 

Forum (NCPF) 

representative from Sussex and 

chair of the forum for a number 

of years, tendered his resignation 

at the March event and named 

Ray Murphy as his successor. This 

now means that Ray will chair the 

forum for the next couple of years 

and join Gloria Payne as a member 

of the NCPF planning group. 

Cancer Network Partnership 

Group 

A more detailed report of the 

activities of the CNPG can be 

found in the Cancer Network 

Partnership Group annual report, 

which can be found at www.mccn. 

nhs.uk. The network would like 

to thank Barbara Burkey, who 

is standing down from her role 

as chair of the Liverpool, North 

Cheshire and Wirral Locality 

Group, for her outstanding 

contribution to patient 

involvement. We are pleased 

that she is able to continue as the 

representative for palliative care 

and end of life activities. 

A ‘Rarer Cancers’ event funded 

Mike Vincent, a patient 


iVan 

Following successful visits with the Macmillan cancer 

information and support vehicle in the network, a 

proposal was put together to have a similar vehicle 

with a greater focus on awareness raising and early 

detection. This led to successful bids to the National 

Cancer Action Team and the cancer network for a 

mobile cancer awareness vehicle. We took delivery of 

the vehicle in June 2009. 

The vehicle was intended to support a particular 

emphasis on skin cancer awareness and sun safety, 

due to the rising skin cancer incidence rates within 

England. The vehicle is informally know as iVan, 

which stands for information van. 

iVan’s objectives are detailed below: 

Awareness 

• Utilise a cancer risk assessment tool to increase 

cancer symptom awareness and initiate referral to 

appropriate service if required/ desired. 

• Be responsive to local and national health 

initiatives and campaigns. 

• Raise skin cancer awareness and highlight the 

dangers of sun bed use. 

• Promote cancer screening and self awareness 

programmes. 

• Highlight cancer risk factors such as excessive 

UV exposure, smoking, obesity, frequent alcohol 

consumption and genetic predisposition. 

• Use network and national data intelligence. 

Engaging communities 

• Encourage people to take an active role in the 

maintenance of their health at a preventative 

stage. 

• Promote self awareness checks, such as regularly 

checking skin for significant changes. 

• Provide specific information and support to 

targeted populations. 

• Enable, facilitate and signpost to appropriate 

services. 

• Assess the feasibility and justification for the 

development of a mobile rapid assessment skin 

cancer clinic. 

Since going on the road, iVan has had contact 

with over 14,200 people in 6 months (July 2009 – 


iVan (continued) 

December 2009) with 190 clients being referred to a 

GP because of concerns about symptoms. 

Total figures from July 2009 to end of December 2009 

Level of No. of Description 

intervention contacts 

0 11,160 Leaflet taker, no 

intervention 

1 2,173 Brief intervention 

e.g. brief advice/ 

intervention 

2 433 More in depth, 

specific targeted 

information 

3 245 Psychological 

support, signposting 

4 190 In depth support 

or referral with 

significant symptoms 

Total 14,201 

Follow up of the most complex cases has revealed 

that GPs have fast tracked 16 clients under the urgent 

suspected cancer route. Eight cancers have been 

diagnosed, nine pre cancerous conditions have been 

discovered and there were 43 referrals to services for 

reasons other than cancer. 

Pre cancerous diagnosis 

(n) 

Actinic Keratosis 5 

Bowen’s disease 2 

Bowel polyp 1 

Cervix CIN 3 loop dissection 1 

Total 9 

For those clients referred to a GP from iVan staff, 

nearly 1 in 2 (42%) have resulted in a positive 

intervention, either by treatment by their GP or by 

referral to secondary care. 

Working collaboratively with others 

The iVan team has worked collaboratively with many 

organisations and individuals in order to highlight 

the early detection and prevention of cancer. We 

have actively engaged with the Healthy Communities 

Collaborative projects in Liverpool and Halton & St 

Helens. We have also engaged with groups such 

as the Merseyside Deaf Society, local colleges and 

schools and Liverpool’s Chinese community. We have 

also been working with the Wirral Prostate Cancer 

Support Group. 

Future plans and targets 

Number of cancers diagnosed 

Malignancy diagnosis 

(n) 

Basal cell carcinoma 5 

Squamous cell carcinoma wide excision 1 

Malignant Melanoma wide excision 2 

Total 8 

The iVan project will continue to focus on raising 

awareness of cancer prevention and early detection 

of all cancers, with a particular focus on skin cancer 

during the summer months. We will continue to work 

collaboratively and engage with as many different 

groups as possible. 


Merseyside & Cheshire Cancer Network 

Suite 4 

Woodcourt 

Riverside Park 

Southwood Road 

Bromborough 

Wirral 

CH62 3QX 

Tel: 0151 201 4150 ext. 6200 

Fax: 0151 201 4151 

Web: www.mccn.nhs.uk

Annual Report 2009-2010 - Merseyside & Cheshire Cancer Network

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