Meeting: Cancer Unit Managers - Home - NECN...
Transcript of Meeting: Cancer Unit Managers - Home - NECN...
1
Meeting: Cancer Unit Managers
Date: 1 February 2016
Time: 2:00 – 4:00pm
Venue: Evolve Business Centre
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Lisa Cunningham, Quality Manager, NHS England LC
Alison Featherstone, (Chair) Network Manager, NESCN AF
Carolyn Harper, Cancer Manager, Gateshead CH
Kath Jones, Network Delivery Lead, NESCN KJ
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Claire McNeill, Peer Review Co-ordinator, NESCN CM
Martin O’Callaghan, Lead Cancer Co-ordinator, Northumbria MO
Linda Wintersgill, Information Manager, NESCN LW
Susanna Young, Business Support Assistant, NESCN SY
Apologies: Susan Baxter, Northumbria SB
Jayne Blinco, Cancer Manager, North Cumbria JB
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Anne-Louise Grant, Cancer Services Improvement Mgr, CDDFT AG
Janice Worton, Deputy Cancer Services Manager, JCUH JW
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, apologies as listed above.
1.2 Minutes of the previous meeting
The minutes of the last meeting on 7 December 2015 and the WebEx on the 5 January 2016 were agreed as accurate records with the following amendment on the 5
Enc 1&2
2
January minutes:
Where Newcastle is identified as head and neck for Peer Review it was noted this is for the Local Support Team.
1.3 Matters Arising
Upper GI Breach RCA
The RCA have been received and LW has looked at them, whilst they are not all the same format she feels we can collate all the responses with a larger cohort. LW is looking at a coding system so that a larger collection can be reviewed.
LW suggested that each trust provide 10 breaches. The group discussed how the two sections of the pathway could be collected. CH and MM agreed to consider this. North and South Tees already
LW will contact each manager for these and a report could be turned around quickly.
2 Week Wait Leaflets – Logo
CRUK facilitators are distributing the leaflets on their practice visits. Until the new logo for the network is confirmed the remaining logos are to remain on the leaflets.
The leaflets will be available via a hyperlink on the network’s website for all online referrals.
In addition Newcastle have met with Fiona McQuiston, CRUK Manager and are looking at whether the leaflets could be added to first appointment letters informing them of the importance of attending for appointments.
Dental Referrals
The issue of Head & Neck referrals to Dentists has been discussed at the NSSG and referral to a dental practitioner will not be included on the new network referral proforma. It was agreed this issue would be raised at the next Cancer in the Community Group meeting.
Cancer Waiting Times Draft Protocol
AF/LW agreed to look at this and send a draft proposal out for consideration. It was agreed that this should be
CH/MM
AF/LW
LW
3
done as soon as possible.
AF/LW
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times
Performance
The managers noted the 62 day target is likely to be met for the last quarter.
Self-Assessment/Improvement Plans
AF asked the managers if they have been asked for by CCGs. The Group discussed the differences between CG and Trust performance data.
MM noted that version 9 of the Cancer Waiting Times Guidance was less informative due to attempts to make it concise – lots of scenarios in previous versions have been removed. It was noted that the document contains scope to include new policy directives such as breach reallocation.
Backstop Policy/Long Waiters
The group discussed the policy and how this could be implemented across the region for shared patients.
MM to send through the form of words and AF will discuss this at the steering group meeting tomorrow.
Breach Reallocation Policy
No outputs from the national meeting in December have been received.
2.2 62 Day Event
Service Improvement
A new date has been set for April. A discussion was held regarding what will be discussed/presented on the day.
KJ to take forward the groups suggestions
KJ
4
2.3 NSSG Feedback
Timed Pathways
The timed pathways have been shared with the managers and NSSG’s. JB asked about the date for decision to treat on prostate being before the inter transfer date. The group discussed why this might be. To be checked by NSSG.
AF
Nice Referral Template
The NICE referral templates are now all near completion and will be piloted with Gateshead CCG. Upper GI, Lower GI, Brain and CNS are still to finalise.
The forms will be available on the network website as well as GP Team.net
AF agreed to forward the completed forms.
MM notified the group that the forms are being changed by their Choose and Book team.
AF
2.4 Peer Review
LC gave a presentation (attached) on Peer Review and highlighted the following information:
Peer Review is now known as Quality Surveillance Team
Some Network Group measures will be incorporated within in the MDTs declarations
The process now includes specialised commissioning services as well a cancer. The annual declaration is consistently changing and there has been a delay in the clinical indicators being circulated for consultation. There is a possibility we may have to revert back to the previous peer review measures if the clinical indicators are not circulated within the next 4 weeks.
The Quality Surveillance Team visits for this network are planned for June.
SOP is due in March 2016
CH asked if CQC are visiting a trust will the QST be duplication, it was noted that a CQC visit will look deeper than a QST.
The group acknowledged there could be a significant increase in workload if all sites/groups required validated
Enc 3
5
self-assessment, if the new measures were not in place. Group agreed to start preparing documentation to ensure deadlines could be met.
2.5 Research Action Plans
The group discussed the admin burden of this measure. It was suggested that it might be more beneficial to have one action plan per NSSG and acknowledged that this does not meet the peer review measures.
3. STANDING ITEMS
3.1 Update Reports
Cancer Steering Group Report
The Cancer Steering group report from the meeting on 3 November 2015 was shared with the group (attached).
Enc 4
3.2 Any Other Business
No items to discuss.
Webex
Suggested dates for webex are;
Monday 7 March 2016, 2.00pm
Monday 9 May 2016, 2.00pm
Monday 4 July 2016, 2.00pm
3.3 Next meeting
4 April 2016 2:00pm – 4:00pm at Evolve
6 June 2016 2:00pm – 4:00pm at Evolve
1 August 2016 2:00pm – 4:00pm at Evolve
3 October 2016 2:00pm – 4:00pm at Evolve
12 December 2016 2:00pm – 4:00pm at Evolve
4. MEETING CLOSE
www.england.nhs.uk
The Quality Surveillance
Team / Programme (QST)
(formerly the National Peer
Review Programme)
www.england.nhs.uk
• Aims:
• Improve the quality and outcomes of clinical services
• Embed a quality surveillance programme across all
specialised services and all cancer services
• Reduce duplication of effort / sharing good practice
• Quality Surveillance Team is now governed by the
National Specialised Commissioning Team, NHS
England
• Quality Surveillance Visit Programme to be determined
by local and specialised commissioners
Quality Surveillance Programme
www.england.nhs.uk
Role of the QST
• The establishment & maintenance of an integrated
quality assurance system for specialised services and
all of cancer
• Providing a responsive and flexible review visit
programme in line with national and regional priorities
• Alignment to the specialist services quality
dashboards / NCIN CHI for shared data sources
• Building a quality profile for each specialised service
• Providing a national & regional reporting function
www.england.nhs.uk
Key Stages in Quality Surveillance
Programme: • Quality indicator development for each specialised
service/cancer service by Clinical Reference Group (CRGs)
• Data collection from national data sources
• Quality portal development
• Annual declaration and review
• Quality profile
• Annual meeting with specialised commissioners
• Notification to organisations
• Service review visits
• Feedback to CRGs
www.england.nhs.uk
Quality Indicators will be developed from the service
specification:
• Patient experience
• Clinical outcomes
• Structure and process
Data will be collected on the QST portal
• Data sources
• Self declaration
Quality indicators
www.england.nhs.uk
Information includes:
• Acute and specialised quality dashboards
(provider level)
• Specialised services quality dashboards (service
level)
• Serious incidents
• Patient experience
• Annual declaration
• Complaints
• Information relevant from other service review
reports, such as CQC Inspection
Data Sources
www.england.nhs.uk
QST Portal
• Single web-based portal
• Holds information from a range of sources
• Enables comparison and calibration
• Enables shared use of data
• Allows input from range of stakeholders
• Automatic production of service specific quality profiles
• Permissions for portal under development
• On-line training tool will be available
www.england.nhs.uk
Trust Requirements for Annual Declaration:
• Teams/services to complete self declaration against a
small set of essential structure and function indicators
• Annual declaration completed on quality portal by end of
July 2016 (June for 2017)
• Yes or No compliance required and reason for non
compliance
• No evidence upload required at this stage of process
• No self assessment report required but teams required
to identify any significant issues
• Annual declaration endorsed by CEO or delegated
authority
• Internal validation process to be determined by Trust
www.england.nhs.uk
• Alert criteria to be developed according to an agreed set of pre-determined rules and national parameters
• QST annual assessment of quality profiles flagged as requiring a ‘deep dive’ review completed by end of September
• Findings reported to:
• Specialised Commissioning Hub
• Nurse Director of Local Commissioning Operations
• Chair of Relevant Network
• Annual meeting with regional specialised commissioning October
Validation by QST
www.england.nhs.uk
• Final visit programme agreed regionally and nationally
• Outcomes of annual review process recorded on QST portal
• If not for visit, ongoing monitoring of all other issues identified through annual assessment process is the responsibility of the relevant commissioner
• National summary annual report published late Autumn each year
Validation by QST
www.england.nhs.uk
• Peer review visits will be either risk based or
comprehensive:
• National Priorities
• Regional Priorities
• Rapid Response Reviews
• Trusts notified of visit schedule November
• Visit cycle January to July 2017
Review Visit Cycle
www.england.nhs.uk
Review Visit Cycle for 2016 • National comprehensive visits for :
• Cancer of Unknown Primary
• Heart and Lung Transplant
• Renal/Pancreatic Transplant
• Liver Transplant
• Spinal Injuries
• Transplant Centres in Scotland included
• Regional visit programme:
• Sunderland
• Newcastle
• CDDFT
www.england.nhs.uk
Review Visit Process
• No change in visit process
• Services to be reviewed against quality
measures that underpin the national service
specification
• Evidence to be uploaded to portal to
demonstrate compliance 4 weeks prior to visit
• LRU to analyse evidence and to notify
organisations/reviewers of preliminary findings 2
weeks prior to visit
• Clinically led / peer on peer review visits
www.england.nhs.uk
Rapid Response Visits
• Small number of rapid response reviews requested by
commissioners
• Criteria for visit based on patient safety concerns:
• Serious failings within a provider
• Need to react rapidly to protect patients and/or staff
• A single, material event
• Notification and scope of review by commissioners
• Provider organisations will be given at least 4 weeks
notice
• Quality measures will be developed
• Visits undertaken by QST, peer on peer review
www.england.nhs.uk
IR/SC Process
• Letter to CEO within one week notifying them of
immediate risk or serious concern cc cancer
management team and relevant commissioners
• Action plan in 2 weeks to address immediate risk
to QST
• Action plan in 4 weeks to address serious
concern to QST
• Once action plan ratified by QST, ongoing
monitoring of implementation by relevant
commissioner
www.england.nhs.uk
Support Available
• Training for Trusts on the new process
• Standard Operating Procedure to be published in March
2016
• On-line training tool on use of quality portal
• QM and AQM Local Review Unit
www.england.nhs.uk
Any Other Questions?
Thank You
1
Meeting: Cancer Unit Managers
Date: 07.12.15
Time: 2:00 – 4:00pm
Venue: Evolve Business Centre
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Susan Baxter, Northumbria SB
Anne-Louise Grant, Cancer Services Improvement Mgr, CDDFT AG
Carolyn Harper, Cancer Manager, Gateshead CH
Alison Featherstone, (Chair) Network Manager, NESCN AF
Kath Jones, Network Delivery Lead, NESCN KJ
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Claire McNeill, Peer Review Co-ordinator, NESCN CM
Linda Wintersgill, Information Manager, NESCN LW
Janice Worton, Deputy Cancer Services Manager, JCUH JW
Apologies: Penny Williams, Research Delivery Manager, NIHR PW
Jayne Blinco, Cancer Manager, North Cumbria JB
Lisa Cunningham, Quality Manager, NHS England LC
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, apologies as listed above.
1.2 Minutes of the previous meeting
CH is incorrectly listed as Cancer Unit Manager at Sunderland, this should read as Gateshead. JW - South Tees and not South Tyneside.
Minutes then agreed as a true and accurate record.
Enc 1
1.3 Matters Arising
Cancer Steering Group
2
Cancer Strategy Group held an extended meeting to analyse specific elements of the new Cancer Strategy. The recommendations were reviewed and it was recognise that the strategy needs to be prioritised into manageable pieces before this can be taken forward.
AF discussed the national position – Callie Palmer has just been appointed to NHS England and will lead on the implementation of the strategy with Sean Duffy.
AF also advised task to finish group re cancer dashboard is to be set up and this will feed into the CCGs. Timescales - phase one should be ready by April 2016 a mock-up will be available at the Britain against Cancer.
28 day metric - (4 weeks to diagnostic) a workshop was held 17 November 2015 and work is ongoing. A lot of discussion took place on how this fits in with version 9 CWT. AF also advised there was a need to re-procure open Exeter by 2017.
Multi Diagnostic Centre
AF advised that 6 centres have been chosen to pilot, none from the North East. Those chosen range from rural/urban, large/small.
Breast Services
Sunderland new service not procured and interim measures are still in place. DI advised no timescales has been set.
South Tees also have interim measures in place with N Tees but looking to have a Tees wide MDT. Currently a shared service but activity is still owned by James Cook.
AF updated on discussions at the Breast NSSG- Craig Melrose the Medical Director; NHS England, attended to obtain an understanding of issues across the network.
AF also discussed radiology workforce issues. KJ updated on the HENE task to finish group objectives. AF suggested a system wide piece of work looking at radiology would be beneficial. AF to meet with HENE lead in the new year.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times Guide Version 9
3
MM discussed the issues around the inter provider transfer date and the need to record all steps accurately.
MM gave an example; If Newcastle do the diagnostics then the first date would be correct however if patients are returned to the originating trust it would be the second date (once diagnostics completed) and patient returned to Newcastle. MM suggested the guidance may be the process used to allocate breaches.
Discussions took place re tracking and MDT coordinator roles. AF asked what resource would be needed for an effective tracker system. It was agreed to circulate a template to assess Tracker/MDT Coordinator resource and role across the Network. Nationally there appears to be a wide variation of these roles.
To be discussed at the next meeting.
Group discussed the need to agree a process for the inter provider transfer data.
All to feedback if there is an electronic system available to collect the data and do all have generic email for tracking. All to ensure data is gathered prior to webex being held on the 5 January 2016.
JB discussed the changes to active monitoring;
intervention due to the result of the cancer
nutritional support – must be discussed with the patient
gastrojejunostomy can now be recorded as an enabling treatment.
KJ
All
All
2.2 Cancer Waiting Times
Performance
Octobers report discussed.
November update – members felt performance would be worse; however as a network this is still above the national average.
Enc 2
Self-Assessment / Improvement plans (update)
AF advised the national approach appears to be review month on month, requesting improvement plans if the trusts failed that quarter. CH advised of the considerable amount of work being undertaken at Gateshead Trust.
JB advised of only 20% of 2ww referral patients received by NTH were provided with the patient leaflet which advises of the suspicion of cancer. It was agreed this
4
should be addressed at GP level to reduce the breaches occurring due to patient choice and not being aware of the cancer pathway. KJ to take 2ww referral leaflet to cancer in the community group.
KJ
Capacity Planning
Every failed SS pathway needed to have an improvement plan. All using IST now.
Backstop Policy
Feedback - Gateshead’s policy out for comment
All felt it was difficult to confirm if a patient has come to clinical harm.
Group discussed variation across the network and if this applies to all patients on the pathway or only those confirmed as cancer. For further discussion at next meeting
Group discussed the increase in work involved.
AF
Breach Reallocation Policy
Meeting being held on the 10 December, Monitor is leading on this and issued invitations. AF is attending and requested what the group wanted fed back.
Group agreed that tertiary centre referrals are a concern as the breach allocation is seen as a solution but doesn’t improve the national picture.
Group also agreed for investment into improving pathways between trusts.
AF
PTL Policy Guidance
Patient Tracking log – all have guidance and all working towards this.
2.3 62 Day Event
Lung report
KJ updated on current position. NTH local report to be signed off.
KJ
Urology report
KJ has audited the case notes and assess areas of improvement. Areas noted:
Process of TRUS biopsy and MRI
delays in pathology,
GP 2WW referrals (information given to patient)
5
inter provided transfer forms.
Whilst it was agreed at the 62 day cancer target event to carry out pathway mapping, the group agreed this is not good use of a limited resource from the Network. JB advised the issues have moved on so much since this was agreed. Consideration into how to best progress this work.
AF suggested obtaining Trusts capacity plans to look for shared themes would be more worthwhile.
Group discussed sharing BCA forms for OG patients would be a good starting point.
KJ suggested having a service improvement day and share improvements made and how they have improved the patient’s pathway. KJ/AF to take forward.
KJ/LW
KJ/AF
2.4 NSSG Feedback
Timed Pathways
AF updated on general feedback from the NSSG’s. Lung, Breast, Colorectal, OG, HPB and Urology pathways will be agreed by the end of December.
NICE Referral Template
AF updated on the referral template and advised good progress has been made. Most should be agreed by December. Network will be responsible for updating the forms and these will be available on the website www.nescn.nhs.uk
Sunderland Head and Neck team requested when- dental referrals were started. LW to look into and email reply.
LW
2.5 Peer Review
Group discussed the need for clarification on next year’s process. AF to contract LC.
Network Self-Assessment feedback attached for information. Group discussed the issues and also discussed the Key themes.
AF
Service Configuration
AF advised of trusts making changes to the catchment areas/ population and not discussing them at the NSSG. AF asked all to ensure any changes are notified to the Network and agreed at the appropriate NSSG.
A recent example has been with Head and Neck patients, CDDFT have advised they are seeing North
6
Durham Patients at University Hospital of North Durham. The population flow currently flows to Sunderland and Sunderland still see the majority of North Durham patients. This contradicts the peer review measures which states all patients from a catchment area must be referred to one MDT. Peer review measures also state all 2ww referrals should be seen at a designated hospital. AF to take forward.
Research Action Plans
13 Research action plans outstanding and they are;
Breast – CDDFT & Newcastle
Head and Neck- Newcastle
OG- DMH/Newcastle/North Cumbria/ North Durham/ North Tyneside/ Gateshead/ Sunderland / Wansbeck( (all Unites refer to Newcastle)
Urology- Sunderland
TYA- Urology – Newcastle advised Newcastle Testes MDT needed to complete this.
AF advised she is meeting with Penny Williams, Ann Lenard and Tony Branson to look at a more effective process to increase recruitment.
Regional Peer review update
LC advised via email any additional cancer visits will be notified by the end of next week. However there are only three cancer visits identified for this network requested by commissioners which effects CDDFT, Sunderland and Newcastle.
AF
2.6 Cancer Alliances
AF updated on current discussions on Cancer Alliances. This Network is still meeting and holding NSSGs meetings however some other clinical networks aren’t at this stage. Callie Palmer now in post to take forward Strategy. AF hopes that clarification will soon be produced and will feedback accordingly.
AF
2.7 North East and North Cumbria Regional Genomic Medicine Centre- for information
Received for information.
3. STANDING ITEMS
3.1 Update Reports
Prevention Awareness and Early Diagnosis
7
Group discussed the Blood in Pee campaign
3.2 Any Other Business
Cancer Research Facilitators
AF asked if all have met their facilitators, and advise all facilitators should be attending locality meetings.
2ww Leaflets
AF suggested the facilitators could review the 2ww process.
KJ/JO
Staging Reports
LW provided the group with the staging data. LW confirmed the data is taken from when the patient is diagnosed.
JB advised there is only 4 weeks to validate 5 months of data for the Lung audit, which in reality is shortened further with Christmas. JB discussed the possibility they may be doing the same for the other data and if you are concerned suggested contacting Christine to determine the situation
Webex
Suggested dates for webex are;
Tuesday 5 January 2016, 2.00pm.
Monday 9 May 2016, 2.00pm
Monday 4 July 2016, 2.00pm
3.3 Next meeting
1 February 2016 2:00pm – 4:00pm at Evolve
4 April 2016 2:00pm – 4:00pm at Evolve
6 June 2016 2:00pm – 4:00pm at Evolve
1 August 2016 2:00pm – 4:00pm at Evolve
3 October 2016 2:00pm – 4:00pm at Evolve
12 December 2016 2:00pm – 4:00pm at Evolve
4. MEETING CLOSE
1
Meeting: Cancer Unit Managers
Date: 05/10/15
Time: 2:00 – 4:00pm
Venue: Evolve Business Centre
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Susan Baxter, Northumbria SB
Carolyn Harper, Cancer Manager, Gateshead CH
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Claire McNeill, Peer Review Co-ordinator, NESCN CM
Linda Wintersgill, (Chair) Information Manager, NESCN LW
Janice Worton, Deputy Cancer Services Manager, South Tees JW
In Attendance Susanna Young, Network Administrator, NESCN SY
Apologies: Alison Featherstone, Network Manager, NESCN AF
Lisa Cunnington, Quality Manager, NHS England LC
Penny Williams, Research Delivery Manager, NIHR PW
Anne-Louise Grant, Cancer Services Improvement Mgr, Durham & Darlington AG
MINUTES
1. INTRODUCTION Action Enc
1.1 Welcome and Apologies
LW welcomed the group, introductions were made and apologies were noted.
1.2 Minutes of the previous meeting
Minutes were recorded as accurate from the previous meeting with the amendment of CH being in attendance at the meeting.
Enc 1
1.3 Matters Arising
Capacity & Demand Tool action
There has been no formal notification but LW reported that AF has heard that it is the IST capacity tool that is to be recommended. LW asked if anyone had used it. Link
2
below to the tool.
http://www.nhsimas.nhs.uk/ist/
Cancer Steering Group
The next Cancer Steering Group meeting will be an extraordinary meeting to look at the Cancer Strategy. This is scheduled for 3 November 2.00 – 5.00pm.
The group asked if AF has been in touch with those who she wanted to attend.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times
Cancer Waits
It was noted amongst the group that all trusts are struggling and are likely to fail this quarter. It was also reported that trusts have a large number of breaches.
Self-Assessments
AF has RAG rated the questionnaires, although some have been completed in different ways.
There has been agreement that the existing pathways from the network are to be used until these are updated by each NSSG. MM asked that oncology input is included in the amended pathways.
MM asked if the date will be a review date or if this is to be completed by that date.
LW to confirm a deadline date for the pathways to be completed.
PTL is in place. NTees have agreed to include near misses onto PTL rather than root cause analysis.
Number 7 & 8 were rated as red and LW asked if any managers have used the IST tool. JB confirmed North Tees and Hartlepool Trust has used this before and this is an easy tool to use. It was noted that the deadline to have an indication when the plan will be complete is this week.
Managers have been informed that they do not have to
LW
3
do improvement plans however it was noted that until priority 7 is complete then number 8 will remain red.
Service Improvement Plans
North Tees and North Cumbria have done this however no formal feedback has been provided to date.
Feedback from North Region Meetings
AF attended the Northern Regional Cancer Taskforce and reported that the waiting time targets are the top discussion points. A few other issues were also raised these included:
Breast
Diagnostics
Endoscopy
Nationally the sites more difficult to manage are Lung, Lower GI and Urology.
LW informed the group that the presentation would be emailed to group.
Northern Region Task and Finish Group only looks at the 62 day targets. AF attends as representation of the network as well as the regional team for NHS England. Breach reallocation has been a large discussion point in these meetings and a national reallocation policy is likely to be produced.
JB noted that Alison Dickinson is to meet with her to discuss breach reallocation.
Concerns were raised regarding the reduction in the new guidance as there have been large sections removed.
AF has attended the Quality Surveillance Groups and the CCG forum and will be using these meetings to note the stresses within the system.
LW
Multi Diagnostic Centres
An ACE programme wave 2 has asked for expressions of interest from across the network.
Those who have submitted interest should have a response soon.
4
Julie Owens is taking the lead on this from a network and is working on a version of the Danish model and this will be circulated with the minutes.
Enc 3
2.2 Breast Services
Sunderland services have closed and it has been reported that South Tees are struggling however this is down to radiology capacity issues. Feedback from national meetings is that there are pressures across the country.
Newcastle noted they were struggling but this was down to the volume of patients. Newcastle also have a lack of surgeons due to one leaving and another being off due to an accident.
North Tees are offering 2 sessions of 15 appointments each week for South Tees patients.
Gateshead are managing but it is proving difficult.
2.3 Prevention, Awareness & Early Diagnosis
To be forwarded to the next meeting.
2.4 Research Action Plans
CM informed the group that PW has sent emails to the MDTs for the research action plans however it is not clear who is still outstanding.
CM informed the group she would look through all the NSSG group minutes and update the sheet again and will circulate to managers and asked them to provide any further updates.
AF has been informed of the issues that have been raised.
CM
3. STANDING ITEMS
3.1 Any Other Business
MM informed the group that Newcastle had a visit from Caroline Brook regarding Haematology data. MM noted that they wanted to get the diagnosis codes right. MM to get more feedback on this and will update further. MM asked the group for any quick wins for haematology.
5
MM noted that patients from Northumbria and County Durham are discussed within the MDT however they are not put onto the summerset system. They are all now to be added to summerset for audit purposes and will ask referring trust to complete a proforma.
3.2 Next meeting
7 December 2015 2:00 – 4:00pm (Room 1, Evolve)
4. MEETING CLOSE
1
Meeting: Cancer Unit Managers Date: 03/08/15 Time: 2:00 – 4:00pm Venue: Evolve Business Centre Present: Name: Initials Alison Featherstone, Network Manager, NESCN AF
Audrey Self, MDT Coordinator, Northumbria Healthcare AS
Susan Baxter, Operational Services Manager, Northumbria Healthcare SB
Ellie Merrison, Cancer Data Coordinator, Northumbria Healthcare EM
Martin O’Callaghan, Lead Cancer Coordinator, Northumbria Healthcare MC
Janice Worton, Deputy Cancer Services Manager, South Tyneside JW
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Jayne Blinco, OSM Cancer Services, North Cumbria JBl
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Sarah Danieli, Deputy Director of Performance Mgt, South Tees SD
Fiona Brown, Cancer Implementation Officer, South Tees FB
Anne-Louise Grant, Cancer Services Improvement Mgr, Durham & Darlington AG
Chris Callan, Delivery Manager, NHS England CC
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Leigh-Anne Phillips, Cancer Information Manager, Newcastle Hospitals LP
Linda Wintersgill, Information & Outcomes Manager, NHS England LW
Isobel Finlay, Data Manager, South Tyneside IF
Nicola Lloyd, Cancer Info Manager, South Tyneside NL
Jacky Melrose, Cancer Modernisation Nurse, Gateshead Health JM
Annia Carter, Cancer Pathway Facilitator, Gateshead Health AC
Lisa Cunnington, Quality Manager, National Peer Review Programme LC
Alison Dickinson, Regional Medical Manager, NHS England AD
Katy Legg, Analytical Officer (North), NHS England (via video link) KL
In Attendance Anne Lewis, Network Administrator, NHS England AL
Apologies: Kath Jones, Network Delivery Lead, NESCN KJ
Claire McNeill, Peer Review Coordinator, NESCN CM
Carolyn Harper, Head of Cancer and Palliative Care, Gateshead CH
2
Steven Maxwell, Clinical Coding & Cancer Services & Tracking Mgr, South Tyneside
SM
Rachel Murray, Information Analyst, NHS England RM
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, introductions were made and apologies were noted.
1.2 Minutes of the previous meeting
Minutes were recorded as accurate from the previous meeting.
1.3 Matters Arising
All items arising were discussed on the agenda.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times
i Performance
April showed a lot of red traffic lights but May looked slightly better. A number of trusts are expecting to fail the 62 Day target in Q1, and there is concern for July performance across the region. Monitor has contacted Northumbria re: bowel screening.
ii Analytics Review
There is a Regional Cancer Taskforce Group, now chaired by Dr Mike Prentice, looking at CWT. Sean Duffy and the National Team will be doing a Deep Dive in endoscopy in the coming months. Katy Legg gave a presentation to the group on data available. The group discussed the Cancer Waiting Times Summary from the CUBE. Sean Duffy has confirmed that the information can be shared. Chris Callan sends the information to CCGs already. NESCN will send the information out with the usual CWT report to this group.
AF
LW
3
Cancer Tumour Types Monthly Report – this is available in the North Region Reports Library. Katy will be undertaking piece of work to correlate diagnostics with tumour types. The group expressed an interest in this. The group discussed the previous ability to pause the pathway allowing for patient choice. LW has shared the network data on this with the national team. The group discussed breach reallocations – there is no Network agreement on this subject. Weekly PTLs – Katy will find out next steps. Feedback from teams re 8 key requirements: Trusts currently doing many of the actions as part of current process. Most do not have an operational policy committed to paper but have a process. Some concerns about the impact of doing extra breach analysis for the near misses. South Tees – CWT self - assessment almost ready. Happy to share with group for use as a possible network template. Separate action plans per tumour site are likely to be useful. Northumbria – has capacity issues with radiology and endoscopy. Gateshead – has been able to pull PTL off Dendrite quite easily. South Tyneside – work in progress. Newcastle – Have concerns that producing more detail will affect tracking. Durham – All reports have to be done manually as they do not have a system that does it automatically. North Tees – does not have the time in team to do breach analysis on near misses. Sunderland – self assessment is ready. Improvement Plan per tumour group is a big piece of work. North Cumbria – weekly PTL by tumour group already done, action plans being done. Tracking Systems – Dendrite is used by Gateshead. Infoflex and Somerset are used by lots of trusts across the country. Somerset is developing a 31 days patient diary but there is no date for release. Could any influence be exerted nationally?
KL
SD
AD
2.2 NSSG Representation
4
The list was circulated with the previous minutes and the group agreed the nominations.
2.3 NICE Referral Guidance
The group discussed the letter sent with the agenda. Katie Elliott is leading on this with GP Cancer Leads. The group agreed that a network template per tumour site would be beneficial but were concerned about the timescale.
AF
2.4 Peer Review Update
Team now sit within specialised commissioning. LC updated the group on the potential new process for 16/17 peer review which has not yet been confirmed. This is likely to include an annual declaration. The group agreed that the network should continue as before for the time being. LC congratulated the group for this year’s upload. External verification will be completed by the end of October 2015. It is likely that Cancer of the Unknown Primary will be included on the next round. Visit dates to be notified in September but targeted cancer visits will be notified after the November meeting however the agreed dates will not change.
3. STANDING ITEMS
3.1 Any Other Business
i. Cancer Strategy
The recently published Cancer Strategy was discussed. There is a huge emphasis on diagnostics. The group agreed to hold an extraordinary meeting to look at this in detail.
AF
ii. 62 Day Event
AF tabled an action plan from the 62 Day Event. The report will be sent to the group and it is recognised some of the 8 key requirements may have superseded this work. The group agreed that diagnostics bottlenecks are a key factor.
AF
iii. Staging Data
LW displayed some staging data. This is information that will start to go into the Performance Reports and is extracted from the COSD Reports Portal. Caroline Brook from NCRS had asked that trusts review their data with a view to improving completeness. JB stated
5
that every few months trusts should re-submit all data for the year to capture previously missing items and this might improve staging completeness. It was noted that if a stage is amended without a date attached, it will not be included in the next monthly upload. Staging position at 25 July attached – LW asked trusts to look at and work towards improving completeness in coming months – data will be presented regularly to this group as well as tumour specific data to NSSGs.
Enc 1
3.2 Next meeting
05 Oct 15 2:00 – 4:00pm (Room 1, Evolve)
4. MEETING CLOSE
Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15North of England 26 24 26 28 29 28 30 34 29 32 32 33 34 29 32 32 33City Hospitals Sunderland NHS Foundation Trust (RLN) 41 39 39 44 57 60 63 71 68 61 67 64 71 68 61 67 64County Durham and Darlington NHS Foundation Trust (RX 23 16 23 24 18 24 18 13 14 14 13 18 13 14 14 13 18Gateshead Health NHS Foundation Trust (RR7) 19 14 12 15 20 17 22 32 31 57 33 29 32 31 57 33 29North Cumbria University Hospitals NHS Trust (RNL) 13 12 12 10 13 10 6 10 13 13 13 10 10 13 13 13 10North Tees and Hartlepool NHS Foundation Trust (RVW) 54 45 55 59 58 49 50 52 55 56 54 66 52 55 56 54 66Northumbria Healthcare NHS Foundation Trust (RTF) 19 17 16 15 22 20 24 22 26 26 26 18 22 26 26 26 18South Tees Hospitals NHS Foundation Trust (RTR) 18 21 23 27 23 23 27 44 34 31 33 32 44 34 31 33 32South Tyneside NHS Foundation Trust (RE9) 53 51 57 48 56 48 59 59 50 42 59 50 59 50 42 59 50The Newcastle Upon Tyne Hospitals NHS Foundation Trus 26 24 23 27 25 26 28 28 21 27 28 32 28 21 27 28 32
NCRS - COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 12th, 2015
0
10
20
30
40
50
60
70
80
90
100
Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15
North of England
City Hospitals Sunderland NHS Foundation Trust (RLN)
County Durham and Darlington NHS Foundation Trust (RXP)
Gateshead Health NHS Foundation Trust (RR7)
North Cumbria University Hospitals NHS Trust (RNL)
North Tees and Hartlepool NHS Foundation Trust (RVW)
Northumbria Healthcare NHS Foundation Trust (RTF)
South Tees Hospitals NHS Foundation Trust (RTR)
South Tyneside NHS Foundation Trust (RE9)
The Newcastle Upon Tyne Hospitals NHS Foundation Trust (RTD)
NESCN COSD Level 2.1j staging completion Jan14-May15
Total 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%North East, North Cumbria, And North Yorks 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%North of England 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%City Hospitals Sunderland NHS Foundation Trust (RLN) 57% 41% 40% 39% 45% 58% 61% 63% 72% 69% 62% 68% 64%County Durham and Darlington NHS Foundation Trust (RX 19% 24% 17% 24% 25% 19% 24% 19% 13% 14% 15% 13% 19%Gateshead Health NHS Foundation Trust (RR7) 28% 20% 14% 12% 15% 20% 18% 23% 32% 32% 58% 33% 59%North Cumbria University Hospitals NHS Trust (RNL) 12% 14% 12% 13% 11% 14% 11% 7% 11% 14% 13% 13% 10%North Tees and Hartlepool NHS Foundation Trust (RVW) 55% 54% 46% 56% 60% 58% 49% 50% 53% 55% 56% 54% 66%Northumbria Healthcare NHS Foundation Trust (RTF) 22% 20% 17% 17% 15% 23% 21% 25% 23% 26% 27% 27% 19%South Tees Hospitals NHS Foundation Trust (RTR) 28% 18% 21% 24% 28% 24% 23% 28% 45% 35% 32% 34% 32%South Tyneside NHS Foundation Trust (RE9) 53% 54% 51% 58% 49% 56% 49% 60% 59% 50% 43% 59% 50%The Newcastle Upon Tyne Hospitals NHS Foundation Trus 27% 26% 25% 23% 27% 26% 27% 28% 29% 21% 27% 28% 33%
Total 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%North East, North Cumbria, And North Yorks 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%North of England 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%City Hospitals Sunderland NHS Foundation Trust (RLN) 62% 69% 61% 62% 56% 62% - - - - - - -County Durham and Darlington NHS Foundation Trust (RX 20% 18% 20% 18% 23% 19% - - - - - - -Gateshead Health NHS Foundation Trust (RR7) 52% 50% 53% 34% 71% 56% - - - - - - -North Cumbria University Hospitals NHS Trust (RNL) 12% 8% 10% 14% 10% 16% - 0% - - 100% 0% 0%North Tees and Hartlepool NHS Foundation Trust (RVW) 58% 64% 62% 60% 51% 51% - - - - - - -Northumbria Healthcare NHS Foundation Trust (RTF) 39% 37% 38% 43% 37% 38% - - - - - - -South Tees Hospitals NHS Foundation Trust (RTR) 50% 54% 56% 58% 38% 38% - - - 0% - 0% 0%South Tyneside NHS Foundation Trust (RE9) 44% 60% 33% 49% 45% 32% - - - - - - -The Newcastle Upon Tyne Hospitals NHS Foundation Trus 39% 35% 37% 42% 43% 36% - - - - - - -
COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 25th, 2015
2014Total Jan Feb Mar Apr May
Total Jan Feb Mar Apr
Dec
COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 25th, 2015
2015
Jun Jul Aug Sep Oct Nov
Nov DecMay Jun Jul Aug Sep Oct
1
Cancer Steering Group Meeting:
3rd
November 2015
Achieving World-Class Cancer Outcomes
A Strategy for England
2015-2020
2
Introduction
The Independent Cancer Taskforce published its report, Achieving world-class cancer
outcomes: a strategy for England 2015-2020 in July 2015. The report recommends a
fundamental shift in how we think about cancer services, with a much greater emphasis on
earlier diagnosis and living with and beyond cancer. Six strategic priorities have been identified
made up from 96 recommendations. The strategy will influence our future direction and will
impact on all stakeholders. A link to the strategy can be found here.
The Cancer Steering Group of the 3rd November 2015 was planned to be an extraordinary
extended meeting to enable the group to discuss the Cancer Strategy. The strategy has been
set out to transform outcomes over the next five years by using committed leadership, smart
choices around investing to save and a firm intent to try new approaches and test new models
of care. We therefore extended the membership of the group to a wide range of stakeholders
with attendees representing the views of Providers, Commissioners, Third Sector, Public Health
England, Health Education England and Patient Representation to reflect these ambitions.
In preparation the Cancer Network analysed each individual section of the strategy cross
referencing individual recommendations against existing work plans and work pertinent to
network work streams. Nine recommendations were identified for in depth discussion and
included within the programme. The recommendations to be discussed fell into two interlinking
categories:
Commissioning
Diagnostics
The programme of the day can be found in the appendix 2
Method
The attendees were divided in to groups, each to discuss two separate recommendations, one
from each category. Each group had a designated facilitator with knowledge of the subject.
The question to be answered for each recommendation was: How can we achieve or
influence this as a Network region? Discussions were recorded and the main points shared
with the room.
Summary of discussions
The complete record of the discussions of the day can be found within appendix1
Within the room there was a general consensus of support for the recommendations discussed.
Many of the emerging comments and questions from the discussions related to how they can be
achieved and the barriers to achieving them. The chosen recommendations for discussion
3
where described as being challenging especially in the current climate of financial restraint and
commissioning environment, none the less the group discussions were lively, measured and
constructive.
The main barriers identified included the existing health commissioner/provider architecture and
the need for communication at a wider level incorporating commissioner providers (tertiary,
secondary and primary), HEE and NHS England.
A recurring thread throughout the discussion was the provision of diagnostic services and
workforce availability. The successful planning of both of these was deemed a priority and it
was felt essential to tackle the issues now as they both create a barrier to change, especially for
the development of multi diagnostic centres and time improvements required in achieving a
definitive cancer diagnosis.
Change was accepted as inevitable with the agreement that the development of lead
commissioners to provide services by population was achievable within the region with
comments that the network boundary should be considered as a lead CCG population area. It
was thought that this proposed modelling would set the conditions for service improvement and
effective budget control.
There was resounding agreement for the proposed formation of a Cancer Alliance within the
network region and the value it would bring. In the current environment and the changes
required to achieve the recommendations with the new ‘Cancer Taskforce Strategy’ the
discussions identified the need of a ‘body’ to bring together and ‘broker’ change but also to
have the required level of authority to lead and complete.
Next Steps
The discussions identified the need for the network to position itself nationally to enable the
gathering, analysis and cascading of national intelligence. This is to be achieved with the
engagement of the network cancer manager with the national SCN forum and the role of the
networks associate director on NHS England Internal Cancer Board. The combination of these
will position the network well to lead on the development and forming of a Cancer Alliance
within the region when direction is given. An action plan will be produced from the discussions
and shared with the steering group members.
Identified actions from the initial analysis of the recommendations by the cancer network will be
cascaded for discussion at the relevant network group meetings and included if appropriate into
group work plans.
4
Appendix 1
Record of group discussions
Diagnostics Discussions
The group supported recommendations 21- 23 with a consensus that there is a need to:
share learning from vanguard sites in this country
incorporate education of the general public and primary care regarding cancer
symptoms and cancer pathways.
prioritise education, having the right people getting the right test at the right time
succession planning, needing to plan the training of workforce specialist
Recommendation 21: NHS England should pilot, in up to 5 vanguard sites and in conjunction with Wave 2 of the ACE programme, multidisciplinary diagnostic centres (MDC) for vague or unclear symptoms. These should have the capability to carry out several tests on the same day.
Multi-Diagnostic Centres (MDC): -
• Pilot would have to be in a hospital setting at the moment because that is where the
scanning (medicines) are
• Would people go (distance, off site/community setting)?
Questions to ask: -
• Does having ‘everything there’ to investigate the unknown add benefit?
• Does self-referral add benefit?
Existing projects were discussed from within and out with of the region
1. Discovery Project in Scotland – existing pathway
2. South Tyneside Lung referral - ‘1 stop shop’.
3. Potential to build on recent unsupported ACE bids e.g. Sunderland MDC
Discussions took place around the following -
1. What diagnostics are completed by primary/ secondary care?
2. What are the criteria for MDC?
3. The need to learn more from the Denmark model
4. Who the service is aimed at.
5. Geographical situation – more holistic approach re patient travel etc.
6. Services to be offered need to also include haematology and endoscopy.
Recommendation 22 & 23: NHS England should pilot an approach, through new or existing vanguards, and particularly in areas where GP access is known to be poor, through which patients can self-refer for a first investigative test via a nurse telephone triage, if they have a red flag symptom that would always result in a test. NHS England should pilot the role of a cancer nurse specialist (CNS) in large GP practices to coordinate diagnostic pathways and other aspects of cancer care.
Group tried to formulate the criteria for patients using this service and the advantages and
disadvantages. Advantages included the reaching of those patients who might ignore
symptoms or are avoiding GP visits and giving better access to hard to reach patients.
5
Reducing waiting time to GP appointment was also sighted as long as service planned well.
Disadvantages could be abuse of the system by the ‘worried’ well.
The Clinical Nurses Specialist model adopted within Scotland was sighted as a new model of
working. The role of CNS was discussed with the suggestion that they should be Primary Care
Specialist Nurse rather than a tumour specific CNS. The need for integrated teams and a
recognised pathway of influence from primary to secondary care was discussed
Durham, Darlington, Easington and Sedgefield CCG have appointed 4 Macmillan primary care
nurses and discussed the best ways to use their knowledge and skills and cascade the
outcomes of the project.
Recommendation 24: By the end of 2015, NHS England should develop the rules for a new metric for earlier diagnosis measurable at CCG level. Patients referred for testing by a GP, because of symptoms or clinical judgement, should either be definitively diagnosed with cancer or cancer excluded and this result should be communicated to the patient within four weeks. The ambition should be that CCGs achieve this target for 95% of patients by 2020, with 50% definitively diagnosed or cancer excluded within 2 weeks. Once this new metric is embedded, CCGs and providers should be permitted to phase out the urgent referral (2 week) pathway.
1. Network can influence via personnel on taskforce/national/regional groups 2. The question ‘What is the definitive timing of YES/NO’ was raised and discussed, is it
o When the patient is informed?
o Tissue diagnosis?
o Definitive diagnosis per tumour site?
o Starting point of pathway – test or referral
Discussion and recognised that some tumour sites will be able to establish a definitive point
for Yes/No diagnosis and the need to establish this for all as an uncertainly was recognised.
3. Discussion around the need of GPs to refer through diagnostics prior to 2ww referral,
influencing 4 week target. Points and questions raised -
o Is there capacity within each modality o Reporting times of diagnostic need to be agreed, need to be quicker
Bloods
Imaging
o Can we establish the reporting times across region
o There is a need to identify tests within the 2 week referral form e.g. CT pancreas for suspected pancreatic cancer
o How many trusts providing direct to test and reporting timeframes 4. Individual tumour sites have differing timelines 5. There is a need to increase capacity within the 14 day target
Recommendation 84: Health Education England should support improvements in the earlier diagnosis of cancer by.
HENE have already completed an Investment Plan which addresses needs to 2020. There is a recognised need to consider skill mix e.g. radiographers to read screening films/scans. The future of screening programmes is a universal issue.
6
Commissioning Discussions
Recommendation76 & 77: By the end of 2015 NHS England should set out clear expectations for commissioning of cancer services & NHS England should work with Monitor to pilot the commissioning of the entire cancer pathway in at least one area.
The concept of lead commissioners by population size was deemed achievable with in the
network region, refer to the model in Figure 25 below.
The group thought it would be advantageous to plan regionally having a greater influence on
service improvement and innovation; they would be able to manage a ring fenced budget
balancing improvement against cost savings. It was thought that lead commissioners would be
better place to plan workforce and manage capacity issues. Cost of the model was raised with
an understanding that a fundamental change was required.
The group discussed the present system identifying communication between commissioners
and providers need to change, dialogue to be more focussed on what needs to be provided as
opposed to contractually needs to be delivered, identifying that clinical input is required. Other
points noted
Unclear what the outcomes are to be
The lead commissioner model will not accommodate all patients, some will not be well
enough and patient choice.
Regional commissioner – could do as a network,
Diagnostic service will have to be capable to deliver.
At present CCGs responsible for provision, change required.
Source: Achieving World-Class Cancer Outcomes 2015
7
Recommendation 78: NHS England should set expectations for and establish a new model for integrated Cancer Alliances at sub regional level as owners of local metrics and the main vehicles for local service improvement and accountability in cancer. We advise that Cancer Alliances should be co terminus with the boundaries of Academic Health Science Networks (AHSNs), although in some large AHSN geographies there may be a need for two Alliances. Alliances should be properly resourced and should draw together CCGs and encourage bimonthly dialogue with providers to oversee key metrics, address variation and ensure effective integration and optimisation of treatment and care pathways. Cancer Alliances should include local patients and carers, nurses and Allied Health Professionals.
The discussion for the formation of Cancer Alliances within the region can be divided into 2 sections, how they will be formed and what their role will be. Formation of a Cancer Alliance:
Build on what is in existence and use the experience of previous cancer network board to establish a Cancer Alliance.
Necessary to have chief executive level chairperson and executive level board members
Governance structure with a memorandum of understanding between all stakeholders.
Requirement to build relationships and engage fully with CCGs as they would be required in an alliance
Requirement to have third sector representation
Is there to be additional resources and where will this come from?
Local improvement architecture, a requirement to establish alliance boundaries and population. Would 2 alliances better serve patient pathways
Comments also noted on the differences between the previous cancer network and an Alliance. The Role of a Cancer Alliance
National clarity required
To be the body for establishing a parity of understanding between all stakeholder organisation, commissioners and providers.
Be accountable to a national team having defined terms of reference to ensure remit is achievable.
‘Oversee key metrics’ –this role will need clarification with the provision of milestones/dashboard.
Suggested that performance management will be retained by CCGs
Recommendation 88: NHS England should pilot all secondary/tertiary cancer treatment services provided through a ‘lead provider’ in 2 or 3 new or existing vanguard areas. The lead would manage the entire treatment budget.
Advantages were identified e.g. the reduction of silo working and collaborative working by providers reducing the diagnostic to treatment pathway. The comments recorded highlighted the planning and high level of change required to implement this recommendation, this included:-
Defining the pathway to be commissioned, inclusion of diagnostics
What the ‘entire budget’ incorporates
Would the lead provider subcontract services The need to learn from existing pilots or a vanguard site was identified, with specific reference to the provider/commissioner relationship and decision making process. Again the problem of work force development was raised as a barrier to provision of service with a proposal to work closer with HEE to address this.
8
Appendix 2
Cancer Steering Group
Tuesday 3 November 2015
Achieving World-Class Cancer Outcomes
Programme of the Day
13.30 Registration and Networking
14.00
Welcome and Introduction
Roy McLachlan, Associated Director
14.10
Network Approach to Achieving World-Class Cancer Outcomes
Dr Tony Branson, Medical Director
14.30
Diagnostics
Group Discussion – 3 groups
Recommendation 21 (to include 22 & 23) New approaches to diagnostic pathways and diagnostic metrics
Recommendation 24 Measuring performance on early diagnosis
Recommendation 84 Deficits in diagnostic services
15.00 Group Work Feedback and Next Steps
15.15 Networking Break
15.25
Commissioning
Group Discussion – 3 groups
Recommendation 76 & 77 Commissioning
Recommendation 78 Local improvement metrics
Recommendation 88 Local improvement architecture
15.55 Group Work Feedback and Next Steps
16.25 Open Discussion – Recommendation of Your Choice
16.55
Summary of the Day Alison Featherstone, Network Manager
17.00 Finish
1
Meeting: Cancer Unit Managers - WebEx
Date: 5 January 2016
Time: 2:00 – 3:00pm
Venue: WebEx
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Carolyn Harper, Cancer Manager, Gateshead CH
Alison Featherstone, (Chair) Network Manager, NESCN AF
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Linda Wintersgill, Information Manager, NESCN LW
Janice Worton, Deputy Cancer Services Manager, JCUH JW
Susanna Young, Business Support Assistant, NESCN SY
Apologies: Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Kath Jones, Network Delivery Team Lead, NESCN KJ
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, apologies as listed above.
1.2 Minutes of the previous meeting 07.12.15
The minutes were agreed as an accurate record. Enc 1
1.3 Declaration of interest
None
1.4 Matters Arising
Upper GI Breach RCA
Each Manager has been asked to forward an example
AF/ LW/KJ
2
which AF, LW and KJ will look through to identify what may be helpful across the network prior to agreeing next steps.
The groups had not seen the final lung report. To be shared with members.
KJ
2 Week Wait Leaflets / CRUK Facilitators
Not being used consistently across the patch. AF confirmed that the networks have checked that the content of the leaflets is still valid. MM noted that the logo’s on the leaflets require changing. AF agreed to look at this to ensure the correct logos are included
CRUK Facilitators will be highlighting the leaflets at locality groups and whilst doing GP Practice Visits.
KJ
Service Improvement Day
It was suggested that this be a half day workshop but the content would need to be worthwhile. KJ to contact each manager for suggested content so an agenda can be produced.
In addition JB informed the group that Cumbria were coming to visit North Tees and Hartlepool to see their service improvements and also how Somerset and the MDT’s work.
KJ
Timed Pathways
All the completed timed pathways have now been shared and it was noted these have generated a lot of discussions within the NSSGs and there may be further amends required to the content but not the timeline
AF confirmed these can now be circulated and shared wider.
The remaining pathways will now also be looked at via the NSSG meetings.
Peer Review Visits
It has been confirmed that Cancer of Unknown Primary
3
will be Peer Reviewed this year. Visits will also take place as follows:
Newcastle – Head and Neck
County Durham & Darlington – AOS
Sunderland – Urology
Lisa Cunningham has been invited to the next meeting to update further on peer review.
2. AGENDA ITEMS
2.1 Cancer Waiting Times – Transfer Data
Each site provided an update of where they are with this following the last meeting. It was noted that this will be a larger piece of work than initially thought and the group suggested that the network create a protocol which is to be signed off by all the NSSGs.
AF and LW agreed to look into developing a draft protocol and this will be brought back to the next meeting.
AF/LW
2.2 Breach Reallocation
It was noted that some of the group attended the national event. Feedback was mixed. The slides from the event were shared with the group and attached.
AF noted she will be attending the North Regional Cancer Task Force meeting on 18 January agreed to feedback any further information at the next meeting.
Enc 2
2. STANDING AGENDA ITEMS
3.1 Any Other Business
None
3.2 Dates for Future Meetings
Webex
Monday 9 May 2016, 2.00pm
Monday 4 July 2016, 2.00pm
4
Face to Face Meetings
1 February 2016 2:00pm – 4:00pm at Evolve
4 April 2016 2:00pm – 4:00pm at Evolve
6 June 2016 2:00pm – 4:00pm at Evolve
1 August 2016 2:00pm – 4:00pm at Evolve
3 October 2016 2:00pm – 4:00pm at Evolve
12 December 2016 2:00pm – 4:00pm at Evolve
4. MEETING CLOSE
Welcome and introduction
Chair, Adam Sewell-Jones, Executive Director of Provider
Sustainability, Monitor
Brief introduction to the agenda and
objectives for the day
Prof Sean Duffy, National Clinical Director for Cancer, NHS
England
www.england.nhs.uk
Context
• Breach allocation debate is a longstanding issue
• All committed to the objective of providing timely access to care along seamless patient pathways – but we don’t always succeed.
• What part do the rules around breach allocation play in our collective objective to deliver high quality care to patients?
• How can we set the rules around breach allocation to deliver those objectives more consistently?
www.england.nhs.uk
• Hear from you about how breach allocation affects delivery of timely pathways
• Understand the challenges in capturing IPT data to manage policy
• Hear how some places have tackled the breach allocation locally
• Reflect on what we have heard and work together to consider how we might need to refine existing national policy
Objectives for the day
What are the current issues in breach
allocation?
Alan Gillespie, Associate Medical Director, Sheffield
Teaching Hospitals NHS FT
Alan Gillespie
Associate Medical Director (Cancer)
Sheffield Teaching Hospitals NHSFT
THE CURRENT ISSUES IN BREACH ALLOCATION
THE PROBLEM
• STH is penalised in performance terms as the specialist provider:
• Institution – Monitor Provider License /Risk Assessment Framework
• Cancer Leaders / Managers – Workload
• Cancer Teams – Demotivated by the system
THE REAL PROBLEM
• WE ARE FAILING OUR PATIENTS
• There is an inequitable service to patients across the region caused by delayed diagnostics, staging and onward referral
• Meeting an overall CWT target by “over” performance in one area has masked poor performance elsewhere
TRIPARTITE INTERVENTION
• Very Useful!!!
• “Where there is evidence that poor performance is significantly driven by network-wide issues, we expect you to work with your commissioners and other providers”
• Galvanised Providers and CCGs
• Individual and collective improvement plans – key aim early referral to the specialist provider
ROLE OF BREACH ALLOCATION POLICY
• Apportions responsibility not blame
• All providers should be incentivised to provide more timely diagnostic services and treatments for cancer PATIENTS
• Applied consistently as part of an overall strategy for improved performance for PATIENT benefit
• Consensus challenging to achieve
WHAT NEXT
• “Achieving World Class Cancer Outcomes – A Strategy for England 2015-2020”
• Game changer for cancer PATIENT diagnostic services
• National Guidance using an allocation policy with an improvement trajectory should be considered to drive delivery of the new National Policy/CWT performance targets and improve PATIENT care
LETS TALK…LETS ACT
• Define Goal
• Support Achievement
• Appropriate performance management and accountability
• Continuous service improvement
Challenges to capture data for breach
allocation
Prof Sean Duffy, National Clinical Director for Cancer, NHS
England
www.england.nhs.uk
Background on the Cancer Waiting
Times System (Open Exeter)
• The current Cancer Waiting Times System is over 15 years old and built in old technologies and will be decommissioned by April 2017.
• Because of the age of the system, making changes to it are difficult and carry significant risks to the continued operation of the system, particularly for the reporting end. This is why the system is being decommissioned.
www.england.nhs.uk
Changing the Breach Allocation Rules in
the Cancer Waiting Times System (Open
Exeter)
• Current allocation rule
• New Date Item - “Referral Request Received Date (Inter Provider Transfer)”
• Challenges to updating the pre-specified reports in the Cancer Waiting Times System (Open Exeter)
• Viability of ad-hoc solutions using raw data downloads
• A new Cancer Waiting Times system from April 2017
Examples of good practice
• Guy’s and St Thomas’ NHS FT
• Leeds Teaching Hospitals NHS Trust
• Royal Brompton & Harefield NHS FT
• The Christie NHS FT
Current re-allocation principles
Re-allocation of breaches does not make a difference to patient outcomes, timely care does.
Re-allocation may however allow better focus on where the issues are preventing timely care.
A proportion( over 40%) of patients will receive their care across providers, so good systems to support the transfer of
patients are essential for good patient care.
Timed clinically effective pathways that determine patient flows are the gold standard
Re-allocation feedback
Re-allocation used to identify issues preventing early diagnosis and transfer is helpful.
Re-allocation based on agreed timed pathways or similar (earlier transfer date).
Trust reporting of ITT referrals received and sent to ensure priority given to ITT as much as other cancer KPIs
Analysis of impact of London’s Proposal for 62 day reallocation policy
LCA providers Q2 2015/16
The current proposal and
rationale for breach allocation
will make little or no difference
to performance and therefore to
patients.
A different approach is required
for a breach allocation policy.
55-65%
Come
from
other
trusts
35-45%
come
directly to
GSTT as
2WW
45%
post
42
days
55%
pre 42
days
Referrals 62 day Breaches
≤ 15%
treatments will
breach 62 days
88% of
treatments
will breach 62
days
Approx 10%
breach 62
days
EX
TE
RN
AL
INT
ER
NA
L
We can fully control and influence the
pathway for this group. Small
volumes across most tumour sites.
Work in Urology and H+N to reduce
avoidable breaches.
Internal action plan focussed on
ensuring early access and
diagnostics. Cancer operations
focussed on zero tolerance to
process (avoidable) breaches.
Previous attempts to improve ITT time with
limited success. 70% come from SEL
Acute Trusts. 30% come from South
England. NHSE and CCG support to
improve earlier referral rate.
Improved visibility through weekly joint
PTL meetings and new joint coordinator
posts for SEL.
Translate into Referrals to GSTT
Current process
• GSTT does not utilise a breach allocation process for cancer
waiting times. We report our performance to the Trust board split
by Internal and external performance.
• Agreed timed clinically effective pathways for Lung, Prostate,
H&N, Gynae, LGI and UGI. These indicate the point of referral to
the specialist MDM and transfer
• Funded joint pathway/ Inter Trust coordinators
• Re established forum with local providers( old style Cancer
Network working)
Current process( Contd)
• Use of CIS for Oncology even at satellite clinics with visiting
Oncologists in peripheral hospitals
• Commissioned New Robot (July 2015)
• £20M new endoscopy Unit
• More rapid access diagnostic clinics
• Weekly Shared PTL meetings across Trusts in SEL
• Shared escalation policies.
Questions to consider- Hitting the target but missing the
point
• We have an opportunity after 16 years since these access targets
were published to radically consider what works
• Have we got the model right? 90% of patients on 2 WW pathway
do not have cancer. How do we take them off the list as quickly as
possible to focus resources on the rest?
• Dealing with unintended consequences of any policy change- how
do we ensure the right incentive for best practice is followed by all
to support improvements.
Questions to consider- Hitting the target but missing the
point
• Advancements in treatments for cancer have sped up some
pathways but for some others, waiting for specific tests e.g DNA
mutation testing(BRAF/KRAS) can take time
• The need to focus on what really makes a difference to patient
outcomes e.g. • Direct access to tests MDC (Danish model) approach to the
seriously unwell patient
• Better education/ awareness of patients and GP’s
• More One stop facilities
National Cancer Breach Allocation Summit
Clare Smith
Assistant Director of Operations,
Leeds Teaching Hospitals NHS Trust
National Cancer Breach Allocation Summit
Points to be Covered
• LTHT’s starting point
• LTHT’s recovery methodology
• Inter-provider Transfer (IPT) data
difficulties and sensitivities
• The way forward
National Cancer Breach Allocation Summit – LTHT’s
starting point
• LTHT last achieved overall Quarterly Performance in
Q1 of 2013/14
• Circa 40% of LTHT’s cancer work are referrals from
other Trusts
• Yorkshire Cancer Network Agreement for 85% of Inter
Provider Transfers (IPTs) to be Transferred by Day 38
occur by day 38 in the 62 day pathway
IPT
Apr May Jun Jul Aug Sep Oct Nov Dec
% by Day 38 57.4% 43.1% 51.3% 48.6% 48.0% 53.7% 56.3% 64.3% 62.5%
% after Day 62 20.2% 19.6% 19.5% 18.1% 22.0% 20.6% 22.5% 12.2% 14.3%
2014
National Cancer Breach Allocation Summit – LTHT’s
recovery methodology
Full recognition up to Board level of what was within
LTHT’s gift: Internal and Day 38 performance
Performance
Measures
Cancer: 62 Day:
GP/Dentist
Referrals -
Target >= 85%
Cancer: 62 Day:
Internal Only
Cancer: 62 Day:
IPTs by day 38
Cancer: 62 Day:
Reallocated
position
Apr-14 80.00 82.2 91.43 83.27
May-14 77.69 81.08 75 78.98
Jun-14 79.83 89.22 72.97 85.06
Jul-14 79.28 83.44 88.1 83.47
Aug-14 77.74 84.48 81.08 83.51
Sep-14 71.60 75.81 82.5 76.32
Oct-14 72.61 80.53 76.74 77.98
Nov-14 78.15 83.74 65.79 78.31
Dec-14 74.30 81.17 67.19 74.15
National Cancer Breach Allocation Summit – LTHT’s
recovery methodology
• All 62 Day Breaches reviewed with full clinical team as part of a Root Cause Analysis (including radiologists, Pathologist etc)
• Revised timed pathways that are clinically signed off
• Substantial investment in key posts following systematic review of capacity and demand
• Equal emphasis on internal and pre day 38 referrals and doing our best for late referrals
• Creation of a Cancer Board
• Senior Cross System Oversight and Performance Management
National Cancer Breach Allocation Summit – Leeds
Recovery Methodology
• Significant focus on diagnostics TAT in 7
days e.g. Radiology
Modality
Oct 14
TAT
Oct 15
TAT
CT 13.95 8.47
MRI 12.82 7.82
US 8.73 5.98
National Cancer Breach Allocation Summit – LTHT’s
recovery methodology
• Commitment to deliver internal and pre
day 38 performance by the end of Q2
2015 after a very difficult winter
Performance
Measures
Cancer: 62 Day:
GP/Dentist
Referrals -
Target >= 85%
Cancer: 62 Day:
Internal Only
Cancer: 62 Day:
IPTs by day 38
Jun-15 79.40 84.03 82.93
Jul-15 81.70 86.6 89.47
Aug-15 82.80 89.2 75.61
Sep-15 80.00 86.5 91.18
Oct-15 86.00 91.3 89.5
National Cancer Breach Allocation Summit – IPT data
difficulties and sensitivities
• Once LTHT’s house is in order and using a full breach reallocation LTHT would deliver overall performance
• Tripartite Letter requesting trajectory for overall delivery of 62 day standard
• Data shared with referring Trusts, letters sent from Deputy Chief Executive, Chief Executive, the Board Chair
Performance
Measures
Cancer: 62 Day:
GP/Dentist
Referrals -
Target >= 85%
Cancer: 62 Day:
Internal Only
Cancer: 62 Day:
IPTs by day 38
Cancer: 62 Day:
Reallocated
position
Jun-15 79.40 84.03 82.93 83.52
Jul-15 81.70 86.6 89.47 86.63
Aug-15 82.80 89.2 75.61 86.71
Sep-15 80.00 86.5 91.18 87.21
Oct-15 86.00 91.3 89.5 90.8
National Cancer Breach Allocation Summit – IPT data
difficulties and sensitivities
• Varying responses
• Data discrepancies identified
• Different IT systems
• Local interpretations of IPT date
• Ping – ponging of some IPT referrals due
to diagnostics
National Cancer Breach Allocation Summit – The Way
Forward
• Will await breach reallocation guidance but in the meantime we collectively want to do better for our patients.
• Business Partnership Approach
On-going IPT handover agreement via a weekly Cancer Team VC
Specific pathway and root cause analysis reviews between LTHT and Trusts’ clinical teams in order to approach this as a joint endeavour
Agreed work-up list (to be completed by April 2016)
Royal Brompton & Harefield NHS
Foundation Trust
Mr Richard Connett, MSc HDCR ACIS, Director of
Performance and Trust Secretary
Dr Andrew Menzies-Gow, Clinical Director – Lung Division
Mr John Pearcey, Assistant General Manager – Lung Division
Mr Richard Connett MSc HDCR ACIS; Director of Performance and Trust Secretary
Dr Andrew Menzies-Gow ; Clinical Director – Lung Division
Mr John Pearcey; Assistant General Manager – Lung Division 10th December 2015
National Cancer Breach
Allocation Summit
Harefield Hospital
Telephone: 01895 823 737
Address: Hill End Road, Harefield,
Middlesex, UB9 6JH
Website: http://www.rbht.nhs.uk/
Royal Brompton Hospital
Telephone: 020 7352 8121
Address: Sydney Street, London,
Greater London, SW3 6NP
Website: http://www.rbht.nhs.uk
Surgical Treatment of Lung Cancer Trusts Referring to RBHFT 2015/16
North
South
Midlands and East London Region Harefield Hospital
Royal Brompton Hospital
List of Referring Trusts (2015-16) – 62 Day GP Referral Pathway NHS England
Region Referring Trust
No. of referrals
April – Nov 2015 % of total referrals
Midlands and
East
(52%)
WEST HERTFORDSHIRE HOSPITALS NHS TRUST 13 18%
LUTON AND DUNSTABLE HOSPITAL NHS FOUNDATION TRUST 7 10%
COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST 6 8%
EAST AND NORTH HERTFORDSHIRE NHS TRUST 2 3%
MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST 8 11%
BASILDON AND THURROCK UNIVERSITY HOSPITALS
NHS FOUNDATION TRUST 1 2%
London
(12%)
THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 4 6%
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 2 3%
ROYAL FREE LONDON NHS FOUNDATION TRUST 2 3%
South
(36%)
BUCKINGHAMSHIRE HEALTHCARE NHS TRUST 13 18%
FRIMLEY HEALTH NHS FOUNDATION TRUST 8 11%
GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST 5 7%
Total 71 100%
1. What does the current allocation process look like
and how well is it working?
Q2 2015/16
Cancer Targets Total Treated No. Treated
within time
Reallocation to
Referrer
Reallocation to
RBHT Performance Threshold
14 days – Urgent GP referral 0 0 - 93%
31 day decision to treat to first
definitive treatment 91 90 98.90% 96%
31 day decision to treat to
subsequent treatment (Surgery) 55 55 100.00% 94%
62 day Urgent GP referral to first
definitive treatment (ADJUSTED) 15.5 9 2 0 70.97% 85%
62 day Urgent GP referral to first
definitive treatment
(UNADJUSTED) 15.5 9 - - 58.06%
85%
2. How did you go about designing and agreeing it
with colleagues and partners?
The Trust has implemented the guidance from Monitor,
contained in the Risk Assessment Framework
and the requirements set out in the Standard NHS Contract by
NHS England.
3. Clinical and Operational Challenges Relating to Surgical Treatment of Lung Cancer
Majority present late
Tissue diagnosis and staging can be challenging, but is key to
planning correct treatment
74% of lung cancer patients have at least one co-morbidity at
initial presentation that may impact on performance status:
• 50% have COPD
• 16% have diabetes
• 13% have congestive cardiac failure
4. What benefits have you seen through implementing
an allocated pathway?
• A timed care pathway enables progress during the diagnostic phase to
be tracked and can provide early warning of slippage against timed
milestones
• A clear mechanism for breach reallocation incentivises both referring
and treating trusts to expedite their respective elements of the pathway.
5. Is there an escalation process for when things don’t go
according to the plan?
• Letters written Chief Executive to Chief Executive
• Escalation clinical team to clinical team
• System Leadership; 30th November 2015 - Harefield Hospital hosted an
event for referring trusts where impediments to completion of the
diagnostic phase of the pathway were reviewed
Proposed London Region 62 day Breach Reallocation Process Performance Algorithm
Numerator
Denominator
No. Treated in Time
Total No. Treated + 0.5 per breach case > 20 days x 100
– 0.5 per breach case < 20 days
Application of the London Region Protocol
Quarter 2 - 2015/16
Open Exeter RBHFT Shadow Performance
Period Unadjusted Total
Treated
Unadjusted Non
Breach
Unadjusted
Performance
Breach cases referred
on or before day
42 and not treated in 20
days – full breach to
RBHFT
Breach cases
referred after day
42 and treated
within 20 days – full
breach to referrer
Breaches after day
42 and not treated
in 20 days – breach
share
Treated In Time Adjusted
Performance
Jul-15 6 3.5 58.33% 0 1 1.5 3.5 70.00%
Aug-15 3.5 2 57.14% 0 0.5 1 2 66.67%
Sep-15 6 3.5 58.33% 1 0 1.5 3.5 50.00%
Q2 15.5 9 58.06% 1 1.5 4 9 60.00%
• For the London Region; shadow performance data will be reviewed alongside the current
Open Exeter monthly performance data for the period November 2015 – March 2016.
• It is essential that the diagnostic element of the pathway is completed before referral is
made to the specialist centre
• It should be remembered that the 85% operational standard is intended to be applied
across a number of different tumour types where there will be averaging between shorter
pathways (e.g. breast / skin cancer) and long complex pathways. RBHFT only has long
complex pathways for surgical treatment of lung cancer and a tumour specific standard
may be more appropriate.
• 28 Day CCG Target for completion of diagnostics, recommended by the Cancer Taskforce
in their 2015 – 2020 Strategy; this would help to shorten the diagnostic element of the
pathway and speed up referral to the specialist centre.
• Agreement of a national cancer breach allocation protocol would bring together reporting
for Monitor / TDA and NHS England. Currently, different reporting arrangements are
required for the different bodies leading to inefficiency and confusion.
In Conclusion
The Christie NHS
Foundation Trust
Greater Manchester
3.2 million population
14 CCG’s
14 hospitals
1 tertiary cancer centre
The Christie NHS
Foundation Trust
Actions
• Improvement programme
• Lead clinicians and managers reviewed and determined
optimum clinical pathways for the following priority tumour
groups
• Clinical collaboration to speed up referral process
• Cross Trust management support and capacity sharing
• Sharing of best practice
• Breach reallocation
More patients across GM treated within 62 days
The Christie NHS
Foundation Trust
Breach reallocation policy
• Chief Operating Officers
• Incentive for improvement between providers
• Focus on whole patient pathway
• Underpinned by senior clinical leadership
• Endorsed by GMCCN, NHS GM and Monitor
• Applicable all Trusts
• Automatic reallocation and approval by CEOs
• MoU and commissioner contracts
The Christie NHS
Foundation Trust
Greater Manchester experience
• Contemporary referrals in any month referred to the first definitive
treatment provider = 65%
• Breach analysis, similar in all tumour site pathways, main cause varied
with local pathway arrangements.
• Improvement indictors:
• Deliver 90% of 1st outpatient appointments inside 7 days
• Deliver 90% of CT scans reported within 7 days of requests
• Deliver 90% of conclusive MDT reviews by day 31 of the pathway
• Deliver 70% of referrals to a second provider by day 31
The Christie NHS
Foundation Trust
Maintaining performance
• Monitored/managed at COO’s monthly meeting
• Greater Manchester breach analysis
• Diagnostic Referral Protocol (DRP)
• Validation standard operating procedure
The Christie NHS
Foundation Trust
Regulator
• Unacceptable referral times
• Proposed regulatory action against ALL providers
in the network
• Duty to improve the quality of healthcare
• CF condition 6
• Duty to co-operate
• CF condition 18
• Reflect breach reallocations in Monitor declarations
• Review Q4 2010/11
The Christie NHS
Foundation Trust
Common purpose
“……..it is clear that this target is the collective responsibility of all providers and commissioners
in the Network, and that it is unacceptable that our patients continue to receive treatment
outside the national standard”
The Christie NHS
Foundation Trust
GMCCN Position
• 2009 - Changes to 62 day cancer waiting times targets were
put in place
• 9 consecutive quarters where Greater Manchester failed to
achieve the new target of 85%
• Failure to understand and own pathways within the
network
• Extended diagnostic pathways
• Late referrals to treating trusts
• October 2011 – GMCCN introduced an automatic breach
reallocation policy
The Christie NHS
Foundation Trust
GMCCN 62 Performance 2011/12
Q1 / Q2 pre reallocation
Quarter 1 11/12
Provider Breaches In Target Total % Actual
Performance
Trafford 2 31.5 33.5 94.0%
Wrightington, Wigan
& Leigh 9.5 91 100.5 90.5%
Salford Royal 12 114.5 126.5 90.5%
Tameside 9 82 91 90.1%
South Manchester 17.5 145.5 163 89.3%
East Cheshire 8.5 55 63.5 86.6%
Mid Cheshire 18.5 112.5 131 85.9%
Stockport 19.5 119 138.5 85.9%
Royal Bolton 16.5 100 116.5 85.8%
Pennine Acute 43 198 241 82.2%
Central Manchester 14.5 53 67.5 78.5%
The Christie 67.5 91.5 159 57.5%
Network Total 1431.5 1193.5 238 83.4%
Quarter 2 11/12
Provider Breaches In Target Total % Actual
Performance
Trafford 3 43 46 93.5%
Tameside 10 103 113 91.2%
Salford Royal 12 121.5 133.5 91.0%
South Manchester 18.5 150.5 169 89.1%
Royal Bolton 13.5 89 102.5 86.8%
Wrightington, Wigan
& Leigh 15 91 106 85.8%
Stockport 22 126.5 148.5 85.2%
Mid Cheshire 22.5 127 149.5 84.9%
East Cheshire 20 94 114 82.5%
Pennine Acute 58.5 214 272.5 78.5%
Central Manchester 15.5 51 66.5 76.7%
The Christie 83 94.5 177.5 53.2%
Network Total 293.5 1305 1598.5 81.6%
The Christie NHS
Foundation Trust
GMCCN performance 2011/12
Q3 / Q4 post reallocation
Quarter 3 11/12
Provider Breaches In Target Total % Actual
Performance
Central Manchester 4.5 48 52.5 91.4%
Salford Royal 11 109 120 90.8%
The Christie 16 127 143 88.8%
Wrightington, Wigan
& Leigh 12 92.5 104.5 88.5%
Royal Bolton 14 100.5 114.5 87.8%
Mid Cheshire 15.5 110.5 126 87.7%
South Manchester 20.5 136.5 157 86.9%
Stockport 23 137.5 160.5 85.7%
Tameside 19 101.5 120.5 84.2%
Trafford 6 31.5 37.5 84.0%
East Cheshire 14 71 85 83.5%
Pennine Acute 64.5 207.5 272 76.3%
Other GMCCN 1.5 0 1.5
Network Total 221.5 1273 1494.5 85.2%
Quarter 4 11/12
Provider Breaches In Target Total % Actual
Performance
Wrightington, Wigan
& Leigh 7.5 95 102.5 92.7%
East Cheshire 9.5 84 93.5 89.8%
The Christie 14.5 126.5 141 89.7%
Mid Cheshire 14.5 124 138.5 89.5%
Tameside 12 101 113 89.4%
Royal Bolton 12 99.5 111.5 89.2%
South Manchester 16.5 136 152.5 89.2%
Salford Royal 18.5 116 134.5 86.2%
Central Manchester 10 62.5 72.5 86.2%
Trafford 5.5 26 31.5 82.5%
Pennine Acute 48 209 257 81.3%
Stockport 29.5 119 148.5 80.1%
Other GMCCN 1 0 1 0.0%
Network Total 199 1298.5 1497.5 86.7%
The Christie NHS
Foundation Trust
CaRPs received
• Continued focus on IPTs
Last 4 Quarters
0 - 38 39 - 42 43 - 62 63 + Total
Q3 14/15 274 59 132 65 530 62.8%
Q4 14/15 258 61 125 83 527 60.5%
Q1 15/16 244 66 145 91 546 56.8%
Q2 15/16 310 66 164 82 622 60.5%
Q3 14/15 - Q2 15/16
CaRP receipt time-bandsPercentage by
day 42
The Christie NHS
Foundation Trust
62 day – The Christie Performance
2011/12 to date
Q111/12
Q211/12
Q311/12
Q411/12
Q112/13
Q212/13
Q312/13
Q412/13
Q113/14
Q213/14
Q313/14
Q413/14
Q114/15
Q214/15
Q314/15
Q414/15
Reallocated Position 57.7% 53.4% 88.8% 90.2% 90.5% 88.7% 89.5% 88.4% 88.1% 86.5% 86.6% 87.1% 90.0% 87.1% 86.6% 89.9%
CWT Position 57.7% 53.4% 66.7% 70.6% 71.9% 74.1% 76.7% 76.0% 75.2% 71.9% 68.7% 72.2% 69.6% 66.1% 66.9% 64.7%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
1
Meeting: Cancer Unit Managers
Date: 07.12.15
Time: 2:00 – 4:00pm
Venue: Evolve Business Centre
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Susan Baxter, Northumbria SB
Anne-Louise Grant, Cancer Services Improvement Mgr, CDDFT AG
Carolyn Harper, Cancer Manager, Gateshead CH
Alison Featherstone, (Chair) Network Manager, NESCN AF
Kath Jones, Network Delivery Lead, NESCN KJ
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Claire McNeill, Peer Review Co-ordinator, NESCN CM
Linda Wintersgill, Information Manager, NESCN LW
Janice Worton, Deputy Cancer Services Manager, JCUH JW
Apologies: Penny Williams, Research Delivery Manager, NIHR PW
Jayne Blinco, Cancer Manager, North Cumbria JB
Lisa Cunningham, Quality Manager, NHS England LC
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, apologies as listed above.
1.2 Minutes of the previous meeting
CH is incorrectly listed as Cancer Unit Manager at Sunderland, this should read as Gateshead. JW - South Tees and not South Tyneside.
Minutes then agreed as a true and accurate record.
Enc 1
1.3 Matters Arising
Cancer Steering Group
2
Cancer Strategy Group held an extended meeting to analyse specific elements of the new Cancer Strategy. The recommendations were reviewed and it was recognise that the strategy needs to be prioritised into manageable pieces before this can be taken forward.
AF discussed the national position – Callie Palmer has just been appointed to NHS England and will lead on the implementation of the strategy with Sean Duffy.
AF also advised task to finish group re cancer dashboard is to be set up and this will feed into the CCGs. Timescales - phase one should be ready by April 2016 a mock-up will be available at the Britain against Cancer.
28 day metric - (4 weeks to diagnostic) a workshop was held 17 November 2015 and work is ongoing. A lot of discussion took place on how this fits in with version 9 CWT. AF also advised there was a need to re-procure open Exeter by 2017.
Multi Diagnostic Centre
AF advised that 6 centres have been chosen to pilot, none from the North East. Those chosen range from rural/urban, large/small.
Breast Services
Sunderland new service not procured and interim measures are still in place. DI advised no timescales has been set.
South Tees also have interim measures in place with N Tees but looking to have a Tees wide MDT. Currently a shared service but activity is still owned by James Cook.
AF updated on discussions at the Breast NSSG- Craig Melrose the Medical Director; NHS England, attended to obtain an understanding of issues across the network.
AF also discussed radiology workforce issues. KJ updated on the HENE task to finish group objectives. AF suggested a system wide piece of work looking at radiology would be beneficial. AF to meet with HENE lead in the new year.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times Guide Version 9
3
MM discussed the issues around the inter provider transfer date and the need to record all steps accurately.
MM gave an example; If Newcastle do the diagnostics then the first date would be correct however if patients are returned to the originating trust it would be the second date (once diagnostics completed) and patient returned to Newcastle. MM suggested the guidance may be the process used to allocate breaches.
Discussions took place re tracking and MDT coordinator roles. AF asked what resource would be needed for an effective tracker system. It was agreed to circulate a template to assess Tracker/MDT Coordinator resource and role across the Network. Nationally there appears to be a wide variation of these roles.
To be discussed at the next meeting.
Group discussed the need to agree a process for the inter provider transfer data.
All to feedback if there is an electronic system available to collect the data and do all have generic email for tracking. All to ensure data is gathered prior to webex being held on the 5 January 2016.
JB discussed the changes to active monitoring;
intervention due to the result of the cancer
nutritional support – must be discussed with the patient
gastrojejunostomy can now be recorded as an enabling treatment.
KJ
All
All
2.2 Cancer Waiting Times
Performance
Octobers report discussed.
November update – members felt performance would be worse; however as a network this is still above the national average.
Enc 2
Self-Assessment / Improvement plans (update)
AF advised the national approach appears to be review month on month, requesting improvement plans if the trusts failed that quarter. CH advised of the considerable amount of work being undertaken at Gateshead Trust.
JB advised of only 20% of 2ww referral patients received by NTH were provided with the patient leaflet which advises of the suspicion of cancer. It was agreed this
4
should be addressed at GP level to reduce the breaches occurring due to patient choice and not being aware of the cancer pathway. KJ to take 2ww referral leaflet to cancer in the community group.
KJ
Capacity Planning
Every failed SS pathway needed to have an improvement plan. All using IST now.
Backstop Policy
Feedback - Gateshead’s policy out for comment
All felt it was difficult to confirm if a patient has come to clinical harm.
Group discussed variation across the network and if this applies to all patients on the pathway or only those confirmed as cancer. For further discussion at next meeting
Group discussed the increase in work involved.
AF
Breach Reallocation Policy
Meeting being held on the 10 December, Monitor is leading on this and issued invitations. AF is attending and requested what the group wanted fed back.
Group agreed that tertiary centre referrals are a concern as the breach allocation is seen as a solution but doesn’t improve the national picture.
Group also agreed for investment into improving pathways between trusts.
AF
PTL Policy Guidance
Patient Tracking log – all have guidance and all working towards this.
2.3 62 Day Event
Lung report
KJ updated on current position. NTH local report to be signed off.
KJ
Urology report
KJ has audited the case notes and assess areas of improvement. Areas noted:
Process of TRUS biopsy and MRI
delays in pathology,
GP 2WW referrals (information given to patient)
5
inter provided transfer forms.
Whilst it was agreed at the 62 day cancer target event to carry out pathway mapping, the group agreed this is not good use of a limited resource from the Network. JB advised the issues have moved on so much since this was agreed. Consideration into how to best progress this work.
AF suggested obtaining Trusts capacity plans to look for shared themes would be more worthwhile.
Group discussed sharing BCA forms for OG patients would be a good starting point.
KJ suggested having a service improvement day and share improvements made and how they have improved the patient’s pathway. KJ/AF to take forward.
KJ/LW
KJ/AF
2.4 NSSG Feedback
Timed Pathways
AF updated on general feedback from the NSSG’s. Lung, Breast, Colorectal, OG, HPB and Urology pathways will be agreed by the end of December.
NICE Referral Template
AF updated on the referral template and advised good progress has been made. Most should be agreed by December. Network will be responsible for updating the forms and these will be available on the website www.nescn.nhs.uk
Sunderland Head and Neck team requested when- dental referrals were started. LW to look into and email reply.
LW
2.5 Peer Review
Group discussed the need for clarification on next year’s process. AF to contract LC.
Network Self-Assessment feedback attached for information. Group discussed the issues and also discussed the Key themes.
AF
Service Configuration
AF advised of trusts making changes to the catchment areas/ population and not discussing them at the NSSG. AF asked all to ensure any changes are notified to the Network and agreed at the appropriate NSSG.
A recent example has been with Head and Neck patients, CDDFT have advised they are seeing North
6
Durham Patients at University Hospital of North Durham. The population flow currently flows to Sunderland and Sunderland still see the majority of North Durham patients. This contradicts the peer review measures which states all patients from a catchment area must be referred to one MDT. Peer review measures also state all 2ww referrals should be seen at a designated hospital. AF to take forward.
Research Action Plans
13 Research action plans outstanding and they are;
Breast – CDDFT & Newcastle
Head and Neck- Newcastle
OG- DMH/Newcastle/North Cumbria/ North Durham/ North Tyneside/ Gateshead/ Sunderland / Wansbeck( (all Unites refer to Newcastle)
Urology- Sunderland
TYA- Urology – Newcastle advised Newcastle Testes MDT needed to complete this.
AF advised she is meeting with Penny Williams, Ann Lenard and Tony Branson to look at a more effective process to increase recruitment.
Regional Peer review update
LC advised via email any additional cancer visits will be notified by the end of next week. However there are only three cancer visits identified for this network requested by commissioners which effects CDDFT, Sunderland and Newcastle.
AF
2.6 Cancer Alliances
AF updated on current discussions on Cancer Alliances. This Network is still meeting and holding NSSGs meetings however some other clinical networks aren’t at this stage. Callie Palmer now in post to take forward Strategy. AF hopes that clarification will soon be produced and will feedback accordingly.
AF
2.7 North East and North Cumbria Regional Genomic Medicine Centre- for information
Received for information.
3. STANDING ITEMS
3.1 Update Reports
Prevention Awareness and Early Diagnosis
7
Group discussed the Blood in Pee campaign
3.2 Any Other Business
Cancer Research Facilitators
AF asked if all have met their facilitators, and advise all facilitators should be attending locality meetings.
2ww Leaflets
AF suggested the facilitators could review the 2ww process.
KJ/JO
Staging Reports
LW provided the group with the staging data. LW confirmed the data is taken from when the patient is diagnosed.
JB advised there is only 4 weeks to validate 5 months of data for the Lung audit, which in reality is shortened further with Christmas. JB discussed the possibility they may be doing the same for the other data and if you are concerned suggested contacting Christine to determine the situation
Webex
Suggested dates for webex are;
Tuesday 5 January 2016, 2.00pm.
Monday 9 May 2016, 2.00pm
Monday 4 July 2016, 2.00pm
3.3 Next meeting
1 February 2016 2:00pm – 4:00pm at Evolve
4 April 2016 2:00pm – 4:00pm at Evolve
6 June 2016 2:00pm – 4:00pm at Evolve
1 August 2016 2:00pm – 4:00pm at Evolve
3 October 2016 2:00pm – 4:00pm at Evolve
12 December 2016 2:00pm – 4:00pm at Evolve
4. MEETING CLOSE
1
Meeting: Cancer Unit Managers
Date: 05/10/15
Time: 2:00 – 4:00pm
Venue: Evolve Business Centre
Present: Name: Initials
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Susan Baxter, Northumbria SB
Carolyn Harper, Cancer Manager, Gateshead CH
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Steven Maxwell, Cancer Manager, South Tyneside SM
Claire McNeill, Peer Review Co-ordinator, NESCN CM
Linda Wintersgill, (Chair) Information Manager, NESCN LW
Janice Worton, Deputy Cancer Services Manager, South Tees JW
In Attendance Susanna Young, Network Administrator, NESCN SY
Apologies: Alison Featherstone, Network Manager, NESCN AF
Lisa Cunnington, Quality Manager, NHS England LC
Penny Williams, Research Delivery Manager, NIHR PW
Anne-Louise Grant, Cancer Services Improvement Mgr, Durham & Darlington AG
MINUTES
1. INTRODUCTION Action Enc
1.1 Welcome and Apologies
LW welcomed the group, introductions were made and apologies were noted.
1.2 Minutes of the previous meeting
Minutes were recorded as accurate from the previous meeting with the amendment of CH being in attendance at the meeting.
Enc 1
1.3 Matters Arising
Capacity & Demand Tool action
There has been no formal notification but LW reported that AF has heard that it is the IST capacity tool that is to be recommended. LW asked if anyone had used it. Link
2
below to the tool.
http://www.nhsimas.nhs.uk/ist/
Cancer Steering Group
The next Cancer Steering Group meeting will be an extraordinary meeting to look at the Cancer Strategy. This is scheduled for 3 November 2.00 – 5.00pm.
The group asked if AF has been in touch with those who she wanted to attend.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times
Cancer Waits
It was noted amongst the group that all trusts are struggling and are likely to fail this quarter. It was also reported that trusts have a large number of breaches.
Self-Assessments
AF has RAG rated the questionnaires, although some have been completed in different ways.
There has been agreement that the existing pathways from the network are to be used until these are updated by each NSSG. MM asked that oncology input is included in the amended pathways.
MM asked if the date will be a review date or if this is to be completed by that date.
LW to confirm a deadline date for the pathways to be completed.
PTL is in place. NTees have agreed to include near misses onto PTL rather than root cause analysis.
Number 7 & 8 were rated as red and LW asked if any managers have used the IST tool. JB confirmed North Tees and Hartlepool Trust has used this before and this is an easy tool to use. It was noted that the deadline to have an indication when the plan will be complete is this week.
Managers have been informed that they do not have to
LW
3
do improvement plans however it was noted that until priority 7 is complete then number 8 will remain red.
Service Improvement Plans
North Tees and North Cumbria have done this however no formal feedback has been provided to date.
Feedback from North Region Meetings
AF attended the Northern Regional Cancer Taskforce and reported that the waiting time targets are the top discussion points. A few other issues were also raised these included:
Breast
Diagnostics
Endoscopy
Nationally the sites more difficult to manage are Lung, Lower GI and Urology.
LW informed the group that the presentation would be emailed to group.
Northern Region Task and Finish Group only looks at the 62 day targets. AF attends as representation of the network as well as the regional team for NHS England. Breach reallocation has been a large discussion point in these meetings and a national reallocation policy is likely to be produced.
JB noted that Alison Dickinson is to meet with her to discuss breach reallocation.
Concerns were raised regarding the reduction in the new guidance as there have been large sections removed.
AF has attended the Quality Surveillance Groups and the CCG forum and will be using these meetings to note the stresses within the system.
LW
Multi Diagnostic Centres
An ACE programme wave 2 has asked for expressions of interest from across the network.
Those who have submitted interest should have a response soon.
4
Julie Owens is taking the lead on this from a network and is working on a version of the Danish model and this will be circulated with the minutes.
Enc 3
2.2 Breast Services
Sunderland services have closed and it has been reported that South Tees are struggling however this is down to radiology capacity issues. Feedback from national meetings is that there are pressures across the country.
Newcastle noted they were struggling but this was down to the volume of patients. Newcastle also have a lack of surgeons due to one leaving and another being off due to an accident.
North Tees are offering 2 sessions of 15 appointments each week for South Tees patients.
Gateshead are managing but it is proving difficult.
2.3 Prevention, Awareness & Early Diagnosis
To be forwarded to the next meeting.
2.4 Research Action Plans
CM informed the group that PW has sent emails to the MDTs for the research action plans however it is not clear who is still outstanding.
CM informed the group she would look through all the NSSG group minutes and update the sheet again and will circulate to managers and asked them to provide any further updates.
AF has been informed of the issues that have been raised.
CM
3. STANDING ITEMS
3.1 Any Other Business
MM informed the group that Newcastle had a visit from Caroline Brook regarding Haematology data. MM noted that they wanted to get the diagnosis codes right. MM to get more feedback on this and will update further. MM asked the group for any quick wins for haematology.
5
MM noted that patients from Northumbria and County Durham are discussed within the MDT however they are not put onto the summerset system. They are all now to be added to summerset for audit purposes and will ask referring trust to complete a proforma.
3.2 Next meeting
7 December 2015 2:00 – 4:00pm (Room 1, Evolve)
4. MEETING CLOSE
1
Meeting: Cancer Unit Managers Date: 03/08/15 Time: 2:00 – 4:00pm Venue: Evolve Business Centre Present: Name: Initials Alison Featherstone, Network Manager, NESCN AF
Audrey Self, MDT Coordinator, Northumbria Healthcare AS
Susan Baxter, Operational Services Manager, Northumbria Healthcare SB
Ellie Merrison, Cancer Data Coordinator, Northumbria Healthcare EM
Martin O’Callaghan, Lead Cancer Coordinator, Northumbria Healthcare MC
Janice Worton, Deputy Cancer Services Manager, South Tyneside JW
Jacqueline Brown, Cancer Manager, North Tees & Hartlepool JB
Jayne Blinco, OSM Cancer Services, North Cumbria JBl
Denise Inskip, Cancer Services Manager, City Hospitals Sunderland DI
Sarah Danieli, Deputy Director of Performance Mgt, South Tees SD
Fiona Brown, Cancer Implementation Officer, South Tees FB
Anne-Louise Grant, Cancer Services Improvement Mgr, Durham & Darlington AG
Chris Callan, Delivery Manager, NHS England CC
Michelle Mangan, Cancer Manager, Newcastle Hospitals MM
Leigh-Anne Phillips, Cancer Information Manager, Newcastle Hospitals LP
Linda Wintersgill, Information & Outcomes Manager, NHS England LW
Isobel Finlay, Data Manager, South Tyneside IF
Nicola Lloyd, Cancer Info Manager, South Tyneside NL
Jacky Melrose, Cancer Modernisation Nurse, Gateshead Health JM
Annia Carter, Cancer Pathway Facilitator, Gateshead Health AC
Lisa Cunnington, Quality Manager, National Peer Review Programme LC
Alison Dickinson, Regional Medical Manager, NHS England AD
Katy Legg, Analytical Officer (North), NHS England (via video link) KL
In Attendance Anne Lewis, Network Administrator, NHS England AL
Apologies: Kath Jones, Network Delivery Lead, NESCN KJ
Claire McNeill, Peer Review Coordinator, NESCN CM
Carolyn Harper, Head of Cancer and Palliative Care, Gateshead CH
2
Steven Maxwell, Clinical Coding & Cancer Services & Tracking Mgr, South Tyneside
SM
Rachel Murray, Information Analyst, NHS England RM
MINUTES
1. INTRODUCTION Action Enclosure
1.1 Welcome and Apologies
AF welcomed the group, introductions were made and apologies were noted.
1.2 Minutes of the previous meeting
Minutes were recorded as accurate from the previous meeting.
1.3 Matters Arising
All items arising were discussed on the agenda.
1.4 Declaration of interest
None
2. AGENDA ITEMS
2.1 Cancer Waiting Times
i Performance
April showed a lot of red traffic lights but May looked slightly better. A number of trusts are expecting to fail the 62 Day target in Q1, and there is concern for July performance across the region. Monitor has contacted Northumbria re: bowel screening.
ii Analytics Review
There is a Regional Cancer Taskforce Group, now chaired by Dr Mike Prentice, looking at CWT. Sean Duffy and the National Team will be doing a Deep Dive in endoscopy in the coming months. Katy Legg gave a presentation to the group on data available. The group discussed the Cancer Waiting Times Summary from the CUBE. Sean Duffy has confirmed that the information can be shared. Chris Callan sends the information to CCGs already. NESCN will send the information out with the usual CWT report to this group.
AF
LW
3
Cancer Tumour Types Monthly Report – this is available in the North Region Reports Library. Katy will be undertaking piece of work to correlate diagnostics with tumour types. The group expressed an interest in this. The group discussed the previous ability to pause the pathway allowing for patient choice. LW has shared the network data on this with the national team. The group discussed breach reallocations – there is no Network agreement on this subject. Weekly PTLs – Katy will find out next steps. Feedback from teams re 8 key requirements: Trusts currently doing many of the actions as part of current process. Most do not have an operational policy committed to paper but have a process. Some concerns about the impact of doing extra breach analysis for the near misses. South Tees – CWT self - assessment almost ready. Happy to share with group for use as a possible network template. Separate action plans per tumour site are likely to be useful. Northumbria – has capacity issues with radiology and endoscopy. Gateshead – has been able to pull PTL off Dendrite quite easily. South Tyneside – work in progress. Newcastle – Have concerns that producing more detail will affect tracking. Durham – All reports have to be done manually as they do not have a system that does it automatically. North Tees – does not have the time in team to do breach analysis on near misses. Sunderland – self assessment is ready. Improvement Plan per tumour group is a big piece of work. North Cumbria – weekly PTL by tumour group already done, action plans being done. Tracking Systems – Dendrite is used by Gateshead. Infoflex and Somerset are used by lots of trusts across the country. Somerset is developing a 31 days patient diary but there is no date for release. Could any influence be exerted nationally?
KL
SD
AD
2.2 NSSG Representation
4
The list was circulated with the previous minutes and the group agreed the nominations.
2.3 NICE Referral Guidance
The group discussed the letter sent with the agenda. Katie Elliott is leading on this with GP Cancer Leads. The group agreed that a network template per tumour site would be beneficial but were concerned about the timescale.
AF
2.4 Peer Review Update
Team now sit within specialised commissioning. LC updated the group on the potential new process for 16/17 peer review which has not yet been confirmed. This is likely to include an annual declaration. The group agreed that the network should continue as before for the time being. LC congratulated the group for this year’s upload. External verification will be completed by the end of October 2015. It is likely that Cancer of the Unknown Primary will be included on the next round. Visit dates to be notified in September but targeted cancer visits will be notified after the November meeting however the agreed dates will not change.
3. STANDING ITEMS
3.1 Any Other Business
i. Cancer Strategy
The recently published Cancer Strategy was discussed. There is a huge emphasis on diagnostics. The group agreed to hold an extraordinary meeting to look at this in detail.
AF
ii. 62 Day Event
AF tabled an action plan from the 62 Day Event. The report will be sent to the group and it is recognised some of the 8 key requirements may have superseded this work. The group agreed that diagnostics bottlenecks are a key factor.
AF
iii. Staging Data
LW displayed some staging data. This is information that will start to go into the Performance Reports and is extracted from the COSD Reports Portal. Caroline Brook from NCRS had asked that trusts review their data with a view to improving completeness. JB stated
5
that every few months trusts should re-submit all data for the year to capture previously missing items and this might improve staging completeness. It was noted that if a stage is amended without a date attached, it will not be included in the next monthly upload. Staging position at 25 July attached – LW asked trusts to look at and work towards improving completeness in coming months – data will be presented regularly to this group as well as tumour specific data to NSSGs.
Enc 1
3.2 Next meeting
05 Oct 15 2:00 – 4:00pm (Room 1, Evolve)
4. MEETING CLOSE
Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15North of England 26 24 26 28 29 28 30 34 29 32 32 33 34 29 32 32 33City Hospitals Sunderland NHS Foundation Trust (RLN) 41 39 39 44 57 60 63 71 68 61 67 64 71 68 61 67 64County Durham and Darlington NHS Foundation Trust (RX 23 16 23 24 18 24 18 13 14 14 13 18 13 14 14 13 18Gateshead Health NHS Foundation Trust (RR7) 19 14 12 15 20 17 22 32 31 57 33 29 32 31 57 33 29North Cumbria University Hospitals NHS Trust (RNL) 13 12 12 10 13 10 6 10 13 13 13 10 10 13 13 13 10North Tees and Hartlepool NHS Foundation Trust (RVW) 54 45 55 59 58 49 50 52 55 56 54 66 52 55 56 54 66Northumbria Healthcare NHS Foundation Trust (RTF) 19 17 16 15 22 20 24 22 26 26 26 18 22 26 26 26 18South Tees Hospitals NHS Foundation Trust (RTR) 18 21 23 27 23 23 27 44 34 31 33 32 44 34 31 33 32South Tyneside NHS Foundation Trust (RE9) 53 51 57 48 56 48 59 59 50 42 59 50 59 50 42 59 50The Newcastle Upon Tyne Hospitals NHS Foundation Trus 26 24 23 27 25 26 28 28 21 27 28 32 28 21 27 28 32
NCRS - COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 12th, 2015
0
10
20
30
40
50
60
70
80
90
100
Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15
North of England
City Hospitals Sunderland NHS Foundation Trust (RLN)
County Durham and Darlington NHS Foundation Trust (RXP)
Gateshead Health NHS Foundation Trust (RR7)
North Cumbria University Hospitals NHS Trust (RNL)
North Tees and Hartlepool NHS Foundation Trust (RVW)
Northumbria Healthcare NHS Foundation Trust (RTF)
South Tees Hospitals NHS Foundation Trust (RTR)
South Tyneside NHS Foundation Trust (RE9)
The Newcastle Upon Tyne Hospitals NHS Foundation Trust (RTD)
NESCN COSD Level 2.1j staging completion Jan14-May15
Total 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%North East, North Cumbria, And North Yorks 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%North of England 30% 27% 24% 26% 29% 30% 28% 30% 35% 30% 33% 33% 35%City Hospitals Sunderland NHS Foundation Trust (RLN) 57% 41% 40% 39% 45% 58% 61% 63% 72% 69% 62% 68% 64%County Durham and Darlington NHS Foundation Trust (RX 19% 24% 17% 24% 25% 19% 24% 19% 13% 14% 15% 13% 19%Gateshead Health NHS Foundation Trust (RR7) 28% 20% 14% 12% 15% 20% 18% 23% 32% 32% 58% 33% 59%North Cumbria University Hospitals NHS Trust (RNL) 12% 14% 12% 13% 11% 14% 11% 7% 11% 14% 13% 13% 10%North Tees and Hartlepool NHS Foundation Trust (RVW) 55% 54% 46% 56% 60% 58% 49% 50% 53% 55% 56% 54% 66%Northumbria Healthcare NHS Foundation Trust (RTF) 22% 20% 17% 17% 15% 23% 21% 25% 23% 26% 27% 27% 19%South Tees Hospitals NHS Foundation Trust (RTR) 28% 18% 21% 24% 28% 24% 23% 28% 45% 35% 32% 34% 32%South Tyneside NHS Foundation Trust (RE9) 53% 54% 51% 58% 49% 56% 49% 60% 59% 50% 43% 59% 50%The Newcastle Upon Tyne Hospitals NHS Foundation Trus 27% 26% 25% 23% 27% 26% 27% 28% 29% 21% 27% 28% 33%
Total 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%North East, North Cumbria, And North Yorks 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%North of England 42% 42% 42% 44% 41% 39% - 0% - 0% 100% 0% 0%City Hospitals Sunderland NHS Foundation Trust (RLN) 62% 69% 61% 62% 56% 62% - - - - - - -County Durham and Darlington NHS Foundation Trust (RX 20% 18% 20% 18% 23% 19% - - - - - - -Gateshead Health NHS Foundation Trust (RR7) 52% 50% 53% 34% 71% 56% - - - - - - -North Cumbria University Hospitals NHS Trust (RNL) 12% 8% 10% 14% 10% 16% - 0% - - 100% 0% 0%North Tees and Hartlepool NHS Foundation Trust (RVW) 58% 64% 62% 60% 51% 51% - - - - - - -Northumbria Healthcare NHS Foundation Trust (RTF) 39% 37% 38% 43% 37% 38% - - - - - - -South Tees Hospitals NHS Foundation Trust (RTR) 50% 54% 56% 58% 38% 38% - - - 0% - 0% 0%South Tyneside NHS Foundation Trust (RE9) 44% 60% 33% 49% 45% 32% - - - - - - -The Newcastle Upon Tyne Hospitals NHS Foundation Trus 39% 35% 37% 42% 43% 36% - - - - - - -
COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 25th, 2015
2014Total Jan Feb Mar Apr May
Total Jan Feb Mar Apr
Dec
COSD Conformance Summary Level 2L2.1j - Number of Cancers with a Full Stage at DiagnosisReport Generated: July 25th, 2015
2015
Jun Jul Aug Sep Oct Nov
Nov DecMay Jun Jul Aug Sep Oct