Cancer Services
December 2020
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Introduction
The Western NSW LHD Clinical Services Plan for Cancer Services 2018-2022 articulates the District’s commitment to Cancer Services including, “… as a single service across the District we will provide cancer care services as close to home as possible to reduce the need for people to travel for treatment.” The impending completion of the Western Cancer Care Centre in Dubbo in 2021 provides an opportunity to review the current structure of the cancer services across the District.
Cancer services are currently provided through the Central West Cancer Centre in Orange, Alan Coates Cancer Centre in Dubbo, Daffodil Cottage in Bathurst, Mudgee Health Service, Lachlan Health Service and Cowra Health Service. Outreach and telehealth clinics are currently provided in Coonabarabran, Cobar and Walgett will commence in 2021.
Radiotherapy is currently provided as a District Service at the Central West Cancer Service in Orange with outreach radiation oncology clinics at Bathurst and Dubbo. Completion of the Western Cancer Care Centre in Dubbo in 2021 will include radiation oncology and radiation therapy from a single linac. The Western Cancer Care Centre in Dubbo will include a PET CT as a District Service.
Medical oncology, radiation oncology, chemotherapy and radiation therapy current reporting structure includes four General Managers, two Director of Medical Services, three Directors of Nursing, an Allied Health Manager and the District Director of Cancer services and Innovation.
Principles underpinning the Western NSW LHD Clinical Services Plan for Cancer Services 2018-2022 include:
Services provided will be person-centred, integrated and based on contemporary evidence-based models of care and treatments.
Services will be timely with benchmarks capturing system performance
Services will function as one service across the District
A focus on the needs of Aboriginal people and their families and the cultural appropriateness of services
Anticipating services needed to meet our communities’ needs based on projected increases in cancer incidence
Providing services as close to home as is safe and appropriate for cancer treatments
Current situation
The Western NSW LHD currently have over 130 full time equivalent (FTE) staff working in the various services who provide care to patients with cancer. The completion of the new Western Cancer Care Centre in Dubbo in mid 2021 will result in additional FTE bringing the total for cancer services for the LHD to around 160FTE by 2024.
There is currently a District Director Cancer Services and Innovation with 4 positions (3.6FTE) reporting directly to the position.
Out of scope The Clinical Trials Unit based at Orange Health Service currently focus predominantly on cancer trials. Future scope for this unit would be to include non cancer clinical trials. For this
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reason the LHD have taken the position that the Clinical Trials Unit are out of scope for this proposed restructure. Inpatient care, cancer screening and direct access colonoscopy are also out of scope for this proposed restructure. Volunteers with the exception of Daffodil Cottage. Compassionate drug supply.
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General Manager Bathurst Health
Director Rural Health Services
Alcohol District Manager vCare
Chief Executive
Cancer Information
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Orange Health Service have the largest cancer centre with medical oncology, haematology,
radiation oncology services provided through the Central West Cancer Centre which has two
linear accelerators.
Outreach medical oncology and haematology clinics are delivered in Bathurst, Cowra and Parkes. They provide inpatient care at Orange Health Service for haematology, oncology and palliative care as well as an on call service for the southern network of hospitals. They provide inpatient and outpatient chemotherapy services. The medical staff working in the Central West Cancer Service are a combination of VMO and Staff Specialists and report directly to the Orange Health Service Director of Medical Services (DMS). The Nursing staff report through the Nurse Unit Manager and then to the Director of Nursing and Midwifery (DON&M) at Orange Health Service with the exception of the Rural Cancer Nurse Coordinator who reports directly to the DON&M. The radiation therapists, medical physicists and allied health staff report to the Allied Health Manager Orange Health Service.
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These positions are out of the scope of this restructure
Chief Executive
Medical Oncologists
Centre
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The Alan Coates Cancer Centre at Dubbo provide medical oncology and haematology with additional services provided through fly in services from Sydney and outreach radiation oncology from Orange. Dubbo provides support and services to the central and northern parts of the LHD with Remote Video Assisted Chemotherapy services (RVAC) in Cobar and Coonabarabran currently. It is planned to commence RVAC to Walgett in 2021. The new Western Cancer Centre Dubbo (WCCD) will open in mid 2021 with expanded chemotherapy spaces, a single linear accelerator and a PET CT. The reporting lines at Dubbo are similar to those at Orange where medical staff report via the DMS, nursing and allied health staff report to the Nurse Unit Manager and then through to the DON. The allied health staff have a professional link to the Allied Health Manager but no direct operational reporting line. There are currently no radiation oncology staff at Dubbo however the positions have been approved and are being recruited for commencement in 2021. Current Structure Alan Coates Cancer Centre, Dubbo Health Service
Chief Executive
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Bathurst Health Service provide chemotherapy treatment to the eastern part of the southern sector of the LHD and Lithgow. The outpatient service is supported by medical oncologists and radiation oncologists from Orange. The Bathurst nursing and allied health staff providing care at Daffodil Cottage report through the Nurse Unit Manager to the DON at Bathurst. Oncology Pharmacists located at Bathurst, Dubbo and Orange report through the local Director of Pharmacy. Current Structure Daffodil Cottage, Bathurst Health Service
Chief Executive
Administration Team
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Mudgee Health Service, Parkes Health Service and Cowra Health Service all provide chemotherapy services supported by visiting medical staff from Orange or Dubbo. Staff at Mudgee, Parkes and Cowra all report locally through a Nurse Unit Manager to the local Health Service Manager (HSM). Clinical Governance and outcomes To meet the needs of people with cancer, Cancer Services need to facilitate efficient and effective clinical care. Cancer Services currently has a strategy for planning and service improvement via the Cancer Clinical Stream however the stream has no operational responsibility. A Clinical Director would identify and drive the implementation of clinical safety and quality processes such as clinical audits, integrating outcomes which benefit patients and their families. Effective clinical governance for Cancer Services requires clinicians, managers, and teams across District to take shared responsibility and accountability to improve the quality of care delivered. Clinical leadership from a Clinical Director actively providing cancer care to patients, would achieve improved clinician engagement by acting as an effective role model to inspire and encourage their peers to deliver quality patient care. Measuring, monitoring and improving cancer services is an ongoing challenge given the complexity of cancer care and reliance on point-of-care data entry by all clinicians into MOSAIQ and ARIA, the oncology information systems in use in the LHD. A Clinical Director would drive focused improvements in the provision of data and analysis to clinicians. Focused on Cancer Services, the Clinical Director and District Manager would work as a partnership to shape services to provide care to achieve best patient outcomes. The Clinical Director would focus on clinical leadership, implementing the strategic direction for a multidisciplinary, collaborative cancer care service, liaising with the Cancer Institute NSW, developing strategies to minimise clinical risk, and ensuring quality and safety protocols are maintained. The District Manager for Cancer Services role would have operational responsibility for Cancer Services provided at the hub sites of Bathurst, Dubbo (RVAC sites) and Orange, plus the outreach chemotherapy clinics at Cowra, Mudgee and Parkes, managing the non- clinical functions of the service. Operational responsibility includes performance, budget, models of care, service agreements, workforce recruitment and retention and delivery of WNSWLHD strategic plan, as it relates to cancer services. Proposed changes The commencement of radiotherapy services and district PET CT services at Dubbo in mid 2021 is a driver for proposed changes to the current reporting structure for Cancer Services. It is proposed that all staff working in Cancer Services have an operational reporting line to a full time Cancer Services District Manager. The District Manager is supported clinically by a 0.4FTE Clinical Director with expertise in medical oncology, haematology or radiation oncology. Professional lines to the relevant disciplines of Medical, Nursing and Allied Health will be maintained at local sites. It is proposed that Cancer Services become a discreet business unit within the LHD structure similar to Medical Imaging. All positions currently working in the LHD Cancer Services will have a change to the operational reporting lines. A small number of positions will be affected as per appendix 1. Cancer Services ‘in scope’ of this restructure will complete their own accreditation.
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Director Cancer
Services and
District Manager
Cancer Services
New position
Medical
Oncologists
Radiation
Oncologists
Haematologists Yes Change reporting line to District Manager
Nursing unit
Rural Cancer
Nurse Coordinator
x 2
All other nursing
managers within cancer services.
All administration
managers at relevant sites
Dubbo sites
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Director Medical
Dubbo sites.
Senior systems
analyst ARIA
Biomed Engineer No Remain reporting to Director Medical
Physics.
Pharmacy Orange Hospital.
District Manager.
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These positions are out of the scope of this restructure
Chief Executive
Cancer Information Manager
Rural Cancer Care Coordinator
Lung Cancer Care Coordinator/CTs
Prostate Cancer Specialist Nurse
McGrath Breast Care Nurse
Prostate Cancer Specialist Nurse
FTE
Dubbo
Analyst - Orange and Dubbo
Dubbo and Orange
Oncology Dietitians Psycho-Oncology
Counsellors Oncology Social
FTE
Allied Health Managers Dubbo,
Key Stages and Processes
Stage Stage 1: Initial release of redesign document and first round consultation
Stage 2: Consultation meetings
Date December 2020 February 2021 March 2021
Document distributed to: WNSW LHD ELT WNSW LHD Workforce & Culture team WNSW LHD Director Operations – General Managers, Health Service Managers Health Services Union
Consultation meetings with: Cancer Services Staff
Other staff as appropriate
Consultation feedback to be received by 29 January 2021. Feedback can be sent via email to Julie.dunn@health.nsw.gov.au
Document revised if required
Further discussions with specific teams and union representatives if required
Vocational assessment and EAP services made available to staff
Finalisation of role changes
Where applicable recruitment process to commence
Recruitment processes finalised by 30 March 2021.
An internal recruitment process will be undertaken for affected staff in the first instance
Following this new positions will be advertised through a formal recruitment process
Recruitment phase will adhere to relevant recruitment and EOO policies and procedures
Operations Directorate PO Box 4061 29 Hawthorn Street
Dubbo NSW 2830 Tel (02) 6809 8656 Fax (02) 6841 2236
Website: www.wnswlhd.health.nsw.gov.au
Mr Gerard Hayes Secretary Health Services Union Level 2, 109 Pitt Street Sydney NSW 2000 Via email: secretary@hsu.asn.au Dear Mr Hayes, Re: Proposed realignment of Cancer Services in Western NSW Local Health District I am writing to advise of the intent of Western NSW Local Health District (WNSWLHD) to
undertake structural change within Cancer Services. We formally wish to consult with the Health
Services Union (HSU) and your members due to the potential impact on our employees who
may be members of the union.
In preparation for the completion and opening of the new Western Cancer Centre in Dubbo in
mid-2021, the impending commencement of radiotherapy services and district PET CT services
are the driver for proposed changes to the current reporting structure for Cancer Services. It is
proposed that all staff working in Cancer Services have an operational reporting line to a full
time Cancer Services District Manager. The District Manager will be supported clinically by a
0.4FTE Clinical Director. Professional lines to the relevant disciplines of Medical, Nursing and
Allied Health will be maintained at local sites.
Attached is the Cancer Services Restructure proposal which outlines the proposed changes,
the reasons, scope, timeframes and impact of the proposed changes.
A meeting was held today to present the restructure proposal to staff and open the initial
consultation period seeking staff feedback which will close on 29 January 2021. It is anticipated
feedback will be collated and presented back to staff along with the finalised restructure plan at
a meeting in mid-February and implementation by end of March 2021.
Should you or your industrial team require any further information or have any queries please
do not hesitate to contact myself debra.bickerton@health.nsw.gov.au or Mel Boyle, Human
Resource Partner – Programs and Directorates melanie.boyle@health.nsw.gov.au.
Yours sincerely,