Tumour specific service standards are the building blocks for quality care when used as a quality improvement tool. They ensure patients receive timely, good quality care along the cancer pathway. They describe the level of service that a person with cancer should have access to, thereby reducing the risk of patients receiving poor quality care.
The national tumour standards describe the level of service that a person with cancer should have access to in New Zealand. They are used by the DHBs as the benchmarks for high quality care for different types of cancer and help ensure patients receive timely, good quality care along the cancer pathway.
The first tumour specific standards to be developed were the Standards of Service Provision for Lung Cancer Patients in New Zealand, published in 2011.
Subsequently, in December 2013, the Ministry of Health published 10 sets of provisional tumour standards for bowel, breast, gynaecological, lymphoma, myeloma, head and neck, thyroid, melanoma, sarcoma and upper gastrointestinal cancer.
The standards were developed by tumour standards working groups of clinical staff and consumer representatives for each tumour type.
Since their publication DHBs have been reviewing the services they provide against these standards. They have also begun implementing improvement strategies where equity issues have been identified during their reviews.
The tumour standards working groups have now begun work on identifying a core dataset for each tumour type and developing definitions for ‘high suspicion of cancer.’
On this page:
- What are tumour standards?
- What are the components of a tumour standard?
- How were the provisional standards developed?
- What do the provisional standards cover?
- How will the provisional tumour standards be used?
- Why are the tumour standards provisional?
- How will the tumour standards be kept current?
What are tumour standards?
Tumour standards describe the level of service that a person with cancer should have access to. All of the recently developed provisional tumour standards include a number of standard statements that are generic across most cancers; they apply to all people with cancer and to all cancer types. These common standard statements are captured in a separate document.
What are the components of a tumour standard?
The provisional tumour standards all follow the same format.
The standards are grouped in clusters, each describing a priority element of quality cancer care. Each cluster of standards has a title that summarises the step of the patient journey or area on which the standard focuses for example, Timely access to services.
This is followed by a standard which explains the level of care or service required. Each standard is expressed as a short statement that outlines why or how the standard will make a difference for patients. The standards are not intended to be at the level of detail found in clinical protocols or guidelines.
The rationale section provides the reasons why the standard(s) and related good practice points are considered important.
Each cluster of standards contains good practice points. Good practice points are either supported by the international literature, the expert opinion of the working group or the consensus of feedback from consultation with New Zealand clinicians involved in providing care to cancer patients.
The monitoring requirements are measures used to assess the delivery of the standard(s). The majority of measures will be process measures because few outcome measures can be attributed to a single standard statement.
How were the provisional standards developed?
The provisional tumour standards were developed by clinical working groups managed by a lead regional cancer network, with funding from the Ministry. The working groups were made up of doctors, nurses and allied health professionals from across the cancer pathway.
The provisional standards are based on established national and international evidence-based guidelines, or expert opinion. The tumour standard working groups had access to expert advisors including Māori and consumer health representatives. The provisional tumour standards were also informed by wider consultation from key sector stakeholders and relevant professional organisations. Draft standards were circulated for feedback in April and May 2013 and more than 160 submissions were received.
The tumour standard working groups did not include cost-effectiveness review.
What do the provisional standards cover?
The standards include:
- timely access to services
- communication and referral
- data collection
- investigations, staging and diagnosis
- multidisciplinary care
- lifestyle factors and recommendations
- care coordination
- palliative care
- anti-cancer treatment
How will the provisional tumour standards be used?
The tumour standards are not mandatory. Over the coming years DHBs will be expected to work with their regional cancer network and other local service providers involved in cancer services to use the tumour standards to review existing services and make improvements. It is likely that the areas of service improvement will include some standards that are aspirational, needing both time and resource in order to be implemented.
The 2014/15 Annual and Regional Planning Guidance for DHBs included the expectation that all DHBs complete an audit against at least two tumour standards. In this context, an audit is defined as a review of a DHB’s current service delivery in relation to the tumour standard. The regional cancer networks are facilitating this work including identifying where high-quality care or services are being provided and highlighting areas for improvement.
Why are the tumour standards provisional?
The tumour standards have provisional status so they can be updated once regions have completed reviews against the tumour standards. In particular, the reviews will help assess whether the standards:
- are focused on an area where quality can be improved to deliver high-quality care or service provision
- will improve effectiveness, patient experience, patient safety, equity
- are cost-effective and make good use of existing resources
- are measureable.
How will the tumour standards be kept current?
The provisional tumour standards will undergo a formal review five years after publication.