Supporting Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Alliance to establish a targeted lung health check pilot programme. The Alliance-wide service model has helped to set the blueprint for national rollout. Detecting and treating lung cancer cases sooner, saving lives and shrinking health inequalities among outcomes.
The NHS Long Term Plan is committed to diagnosing 75% of cancers at stages 1 or 2 when they are more amenable to curative treatment. Lung cancer is often diagnosed at stage 3 or 4 with subsequent high levels of mortality.
In April 2020, the National Cancer Programme introduced a Targeted Lung Health Checks Pilot Programme (TLHC). This aimed to provide a screening pathway to increase the diagnosis of early-stage lung cancer and provide more treatment options and increase survival rates.
Broader objectives included challenging the narrative surrounding lung cancer outcomes more generally, spotlighting the treatment options available and preventative measures that can be taken to look after our lungs. The approach is embedded in the health inequalities strategy, with participating locations being selected for their lung cancer incidences, smoking prevalence, and deprivation. Indeed, as part of the programme, many local pilot projects chose to take their diagnostics to community locations via mobile units.
Data from the Phase 1 Manchester TLHC pilot showed that 65% of lung cancers were diagnosed at stage 1 and 13% at stage 4, compared to 18% at stage 1 and 48% at stage 4 before the pilot. The Phase 1 pilot programme has, as of the end of 2021, diagnosed 400 cancers – 73% at stage 1, and 10% at stage 2.
SWAG Cancer Alliance has a higher proportion of the population aged 55-74 than the England average. Although the smoking prevalence overall for SWAG is lower than that of England's national average, it has a significantly higher rate of ex-smokers – with all ICS areas reporting higher numbers than England as a whole. SWAG has a similar Index of Multiple Deprivation (IMD) rate to the national England average, with Bristol, North Somerset and South Gloucestershire (BNSSG) scoring the highest across the whole alliance footprint (19.7).
In Autumn 2021, it was confirmed that SWAG Cancer Alliance would join Phase 3 of the trial to commence in Q2 2022. They received funding to deliver lung health checks to 27,000 eligible individuals.
The challenge for SWAG was to understand who that 27,000 should be. Which populations across their footprint would stand to gain the most from this programme? What service model and pathway should they introduce, and who is required as part of the team to deliver such a programme? These questions and more needed to be considered so that they could start inviting individuals to lung health checks during 2022/2023.
We acted as a single point of contact (SPOC) on behalf of the project, engaging with ICS/CCG Cancer and GP Leads, PCN Clinical Directors, Cancer Leads, and Practice Managers; Trust IT, IG, PACS, Radiology, Cancer Service Managers, Lung Cancer Nurse Specialists; Local Stop Smoking Commissioners and Service leads to partner with, local Healthwatch and community groups such as C’aafi Health.
Project Management and admin support were provided to establish and lead a delivery group through the key milestones and towards the development of a SWAG TLHC service model. Areas of support included:
- Risk management and escalation, action tracking, process mapping and design to maintain project momentum.
- Designing the governance group meeting format and Terms of Reference and supporting recruitment into its key clinical lead positions.
- Data analysis, BI support and Geospatial mapping, providing data about SWAG’s populations to inform the identification of priority populations, postcodes and communities and shape the final delivery plan. This analysis has underpinned the entire SWAG TLHC service model and roll-out plan.
- Information Governance insight to quality assure documentation shared by suppliers prior to sign-off from regional Trust and GP Data Protection Officers.
- Contract and supplier relationship management, including driving the procurement process via NHS Supply Chain; helping to shape the service specification with our third-party delivery partners, InHealth, and managing this relationship on an ongoing basis to help shape the roll-out plan.
- Communications and engagement support including establishing and leading a comms and engagement subgroup; developing mandatory and additional resources for patients and systems, including posters, leaflets, website and press release copy, GP information packs and comms toolkits for all organisations. Also included setting up and leading a range of engagement events with targeted stakeholder groups such as PCN leads and Stop Smoking commissioners across the SWAG footprint to shape a strategic comms and engagement plan moving forward.
- SWAG launched the first cancer alliance-wide programme for the TLHC. Previous service models had been limited to a single CCG or ICS. This ensured the benefits would be felt by those with greatest need across the alliance area. It also served to spread expertise and support preparation for the national roll-out of this programme in 2023.
Our involvement in the project resulted in:
- The successful appointment of a SWAG TLHC Clinical Director, Responsible Radiologist and Clinician (Responsible Assessor/Lead Nurse and SRM (MDT) Coordinator recruited via InHealth). And the successful procurement of InHealth – subcontracting to Heart & Lung Health – for the delivery of an end-to-end TLHC service with one organisation responsible for and delivering all elements.
- The comprehensive analysis of local population data and visualisation to support decision-making was conducted by our business intelligence team. This involved identifying Primary Care Networks in postcode districts with the highest incidences of lung cancer along with IMD (index of multi deprivation) scores.
- Development of the SWAG TLHC Service Model and roll-out plan including the identification of participating PCNs, GP practices and Trusts, cementing support and buy-in from all systems and stakeholders, including the successful sign-up of all 34 identified GP practices.
- Development of an incidental findings protocol for GP and Acute partners.
- Development of all necessary documentation for launch, including SWAG letters, press releases and patient and system resources as well as additional resources unique to SWAG’s pathway.
- Establishing new relationships for SWAG, such as local stop smoking services and partners, community pharmacy, PCN leads, leading to the exploration of future opportunities for collaboration.
- SWAG TLHC launched in July 2022. Those with potential lung cancer will be diagnosed earlier and have more treatment options which leads to better outcomes for patients. It also saves money for providers. Earlier diagnosis means earlier and potentially less invasive and intensive treatment
Thank you, for all you’ve done; your approach has always been focused, clear and collaborative - Commissioning Cancer Manager
The SCW Project Manager was very organised with a comprehensive understanding of the project and the many complex relationships and partners involved - Dr Anna Bibby, SWAG TLHC Clinical Director and Respiratory Consultant, North Bristol Trust
SCW’s THLC project manager brings organisation and structure to a team and is always able to bring humour and is highly personable. Leads as a role model - SWAG TLHC Delivery Group Member
To find out more about SWAG Cancer Alliance’s Targeted Lung Health Check Programme