Report of the Cancer Services Implementation Committee
In July 2001, the Cancer Services Implementation Committee was struck in response to public concerns about waiting lists for radiation therapy and the ability of the current system to meet the growing need for cancer services of all kinds. The focus of the Committee was to recommend ways to improve the integration of cancer services at the local and regional levels, the quality of patient care, and the productivity and efficiency in the cancer service component of the Ontario health system. The Committee considered a broad range of information including the results of widespread consultations.
Cancer care in Ontario is becoming increasingly important. The proportion of disease and deaths from cancer is dramatically increasing, and there is a growing awareness of the broad continuum of cancer care. Currently, Ontario spends about $1.5 billion on cancer care with increasing pressures to invest more.
Over the course of its review, the Committee found that :
- Cancer care is fragmented and needs to be better co-ordinated.
- Information systems are fragmented and unable to support and monitor improvements in access, care and outcomes at the provincial, regional and local levels.
- A quality bar needs to be set and supported by standards to ensure that all patients receive the same quality care no matter where they live in the province.
- Funding approaches are inadequate to ensure appropriate cancer funding in hospitals (currently hospitals can allocate their budgets according to their individual priorities).
- Although a complex array of cancer services is provided by many individuals, most of whom also care for non-cancer patients, a comprehensive picture of who these individuals are, what they do, how much they do and what their outcomes are, does not exist. The cancer services system is characterised by many governors and managers who only oversee pieces of the system.
These factors all result in a cancer services system that lacks integration and coordination. The Committee made a number of recommendations that address this fundamental issue.
- After exploring a number of options, the Committee recommended that the role of Cancer Care Ontario (CCO), as principal advisor to the Minister of Health and Long-Term Care on all matters related to the cancer control system and cancer control services, should be strengthened. This includes health promotion and disease prevention, screening, primary care, diagnostics, treatment, rehabilitation, home/ community care, supportive and palliative care. CCO should focus on and be accountable for providing strategic direction for the cancer services system, developing standards and guidelines to support quality cancer care across the continuum, monitoring system performance, addressing problem areas, ensuring timely and equitable access to care, and ensuring the effective use of resources to support the full continuum of cancer services.
- CCO should establish Regional Cancer Advisory Bodies, made up of a broad range of stakeholders, to plan and oversee the integration of all regional cancer services. Activities at the regional level will be pivotal for bringing cancer providers together, and improving the quality and integration of cancer services in the regions. These bodies should co-ordinate services at the regional level, be accountable to the CCO board, and provide reports to stakeholders including the public. The key focus of activity to develop integrated care should be at the regional level. Indeed, the regional bodies will make up the Cancer Care Ontario System.
- CCO's new and existing regional cancer centres should move towards greater integration of cancer services into one program with host hospitals. This includes a joint oncology program, single leadership for the integrated oncology program, joint support staff and an annual joint operating plan for the integrated program.
- CCO and other cancer system stakeholders should work with the Ministry of Health and Long-Term Care (Ministry) to develop and implement a cancer information strategy that will be the backbone for an integrated cancer services system. The strategy should address management and clinical information, an integrated patient record and a fully-linked comprehensive database that will support research. A focus on staging cancer patients consistently and developing uniform pathology reporting will strengthen the quality of, and access to, care.
- CCO should establish a Cancer Quality Council to monitor, assess and improve clinical and health system performance of all cancer services in Ontario. The Council will have strong positive impacts on quality of care by overseeing the development of evidence-based tools, monitoring their use and targeting performance improvements.
- The Ministry, on the advice of CCO and other stakeholders, should develop a comprehensive and consistent funding approach for cancer services in the province that includes an envelope of funds that are protected for cancer and allocated using volume, complexity and quality considerations. The envelope will gradually encompass the whole continuum of cancer services in the province as part of an integrated approach to care.
- CCO should continue to develop a provincial cancer human resources strategy to support the training, recruitment and retention of a sufficient number of professionals to provide cancer services. To ensure there is an adequate supply of human resources to provide the full range of cancer services, the Ministry must move quickly to create additional training positions in key areas.
- CCO should work with stakeholders to develop strategies to support the professional development of, and advance communication between, providers. This will improve timely access to care and result in more co-ordinated patient care.
The Committee recognises that cancer is one of a number of competing priorities for limited health care resources. Its recommendations attempt to make the most effective and efficient use of resources while focusing on the patient and the need to provide quality, integrated care. The Committee's recommendations also take into account the system's capacity for change, and are sensitive to the need for appropriate conditions and timing to support and sustain system change.
The Committee believes that its recommendations are a key transition step that will facilitate the move to the full integration of cancer services in the province and position the system to meet the challenges of the future.