Understanding capacity development needs within the NHS Scotland prostate cancer service: A Delphi study

Abstract

Background: The NHS Scotland prostate cancer service has experienced capacity shortage, contributing to the Urological cancer service’s missed government waiting time targets, which have been missed to a greater extent than any other cancer service. This study aims to gain understanding of the capacity development needs of the NHS Scotland prostate cancer service by answering the following research questions: How has usage of the NHS Scotland prostate cancer service changed and how is it predicted to change, (RQ1), Why has the NHS Scotland prostate cancer service been unable to meet demand (RQ2), and how should capacity be developed within the NHS Scotland prostate cancer service to meet demand (RQ3)? Methodology and methods: Informed by ontological holism and epistemological and methodological pragmatism and pluralism, this Delphi study utilised the expertise of carefully selected participants to reach consensus on the capacity development needs of the NHS Scotland prostate cancer service. To do this, three phases of research were used. Firstly, national datasets were used to provide a descriptive analysis of trends in incidence and treatment usage (Phase 1). Then, interviews with healthcare professionals provided context for these trends, specifically to explain trends in treatment usage and predict how they would change, what impact this change would have on service delivery and organisation, and how this could be better planned for (Phase 2). Finally, consensus was facilitated over three rounds of online questionnaires to establish how capacity should be developed within the NHS Scotland prostate cancer service (Phase 3). Results: Phase 1 established that incidence, active surveillance, radiotherapy and chemotherapy usage had increased, and surgery, hormone therapy and watchful waiting had decreased, generally uniformly across Scotland. Phase 2 established that though usage of some treatments had decreased, developments in treatment modalities had led to more lines of treatment. Therefore, capacity shortage was evident across all parts of prostate cancer services in Scotland. When discussing service developments, healthcare professionals dismissed government waiting time targets as a measure of quality care and were developing services in line with their own understanding of quality. And through analysis five issues were identified as hindering service development: lack of cohesion and leadership in prostate cancer care across Scotland, which would relieve capacity shortage at local levels; efficient training of nurse specialists to adopt further roles in prostate cancer care; and lack of clarity on the roles and responsibilities that patients and primary care can reasonably adopt to relieve capacity shortage throughout all parts of services. Finally, healthcare professionals reached consensus that development of national working groups to lead development of quality care and further development of Managed Cancer Networks to lead implementation of quality care, and the development of a multi-faceted specialist nurse training programme, and a national working group to guide development of specialist nurses and allied health professionals roles. Though moving some aspects of prostate cancer care to primary care and supporting patients to have further responsibilities in their own care would substantially reduce pressures within prostate cancer care in Scotland, healthcare professionals were not confident that capabilities existed to enable this. Conclusion: These findings present a clear route forward for development within the NHS Scotland prostate cancer service, and though this study is specific to the NHS Scotland prostate cancer service, evidence indicates that the issues identified are not unique to this service.