Monitoring the National Cancer Standards for dummies……

……….by dummies

Louise Carrington. Programme Co-ordinator CSCG

Andrew Graham. HSW

Today

• Quick summary of the target

• Run through the software from log-in to reporting– Changes and definitions– Key messages and top tips

• Q&A session

• lastly one-to-one tuition on specifics if anyone is interested

Standards? What standards?

• Published August 2005

• WHC (051) 2005 expectation of full compliance by March 2009….

……Which is now

Yeah, but……?

Which standards are

the critical ones?

What does “comply

with” mean?

“by March 2009”, is that:• the beginning of

March?• the end of March? • from the first of

April?

Will we get more money if we’re

seen to be doing badly or doing

well?

Which standards are the critical ones?

All Cancer Standards are created equal: none are more equal than others.

(Sorry George)

What does “compliance” mean?

Compliance = 100% at the level of each standard.

Each is pass or fail

Advisable to complete full data entry even if you think you’re only a little way there:

a. You might complyb. Assessment of partial compliance may be used to trigger further

phases in the monitoring process

What does “by March 2009” mean?

The end of March 2009

But …

must be able to demonstrate that you are compliant by the end of March 2009

Example A

e.g. people, services and things

– do you have a policy in place? – do you have 2 breast surgeons?

» Can be implemented on the 31st March 2009 and be compliant.

Example B

e.g. activity and whole year data

– Have each of your breast surgeons seen 50 patients in the last year?

– Has your Head and Neck MDT managed at least 80 patients during the year?

» Will need activity data from the entire period April 1st 2008 to March 31st 2009 to demonstrate compliance

Example C

Analysis of how things are working

– Audits (of policies, referral pathways)– Have your core MDT members attended more than

50% of the MDTMs?

» Will need to have been in place long enough to assess/audit and report on

Will we get more money if we are seen to be doing badly or doing well?

Accurate data ……

Getting started

What sort of MDT are we?

Cancer site and level

A: Breast, colorectal, gynaecological, haematological etc

B: Local/Network/SupraNetwork level

Full list of expected MDTs is published on the CSCG webpage, with

– their specialty

– level

– MDT lead clinician

What does the level mean?

• Specialisation, rare, complex and patient flow

• Defined by NICE/IOG

• Designated and agreed by the Network Central Team

Local MDTs

May

• refer patients on to a Network or supranetwork MDT

• act as purely diagnostic services

• manage local patients only

• manage patients from further afield

• be many or few within a network

• Be more than one in a single health organisation

Local MDT

1° Care1° Care Emergencies

Screening

Network MDTs

Will • receive patients referred on from local MDTs• Be more specialised than local MDTs: treatments, cancer types• be only one per network (for most cancer types)

May also act as a local MDT for their local patients

Network MDT

1° Care 1° Care Emergencies Screening

Local MDTLocal MDT

1° Care 1° Care Emergencies Screening

More specialised than Network MDTs

Cover more than 1 Network

May • receive referrals from network and local MDTs• be only one in Wales for their cancer type (or cancer sub-type)• act as local MDT for their local population• act as a Network MDT for their Network

SupraNetwork MDTs

Network MDT

1° Care1° CareEmergencies

Local MDTLocal MDT

1° Care1° CareEmergenciesScreening

Supranetwork MDT

Network MDT

1° Care1° CareEmergencies

Local MDT Local MDT

1° Care1° CareEmergenciesScreeningScreening

– Doing Network level work (e.g complex surgeries)

– Working in more than one Trust/Health organisation/network

– Having MDT members from more than one Trust/Health organisation/network

– Holding joint MDTMs with other MDTs

If in doubt ask your central Network Team

X

But……

If you are carrying out the functions of a network MDT (i.e. the complex surgeries, treating the rare cancers etc) make sure this information is recorded in the database.

The following Cancer sites only have MDTs/SPCTs operating at one level (“local” level)

• breast, • lung, • head and neck, • thyroid, • specialist palliative care,

MDTs in these cancer sites:

do not refer on to more specialist MDTs.

may have patients referred to them from the entire Network (& other areas) in order to fulfil activity criteria

The remainder have tiers of MDT levels

Top tips for data entry

• Classic exam technique tips:

– Read the questions– Enter the data in enough detail

• CSCG central team• External validation team• Don’t assume knowledge but don’t overwhelm

– Check your answers • follow logically?• Identical in different parts of the database

– Validate the data (71387 lung cancers)

• Press “submit” frequently to prevent data loss

If the answer is 0, put 0, don’t leave blank.

Whole year data or sample data

This year or minimum three year cycle

Answer all parts of the question don’t just give the numbers

Activity data, audits and other numbers asked for

All, most, some, zero, fifty, 50-60, roughly half, c.99%, n/a, not known, we don’t have the resources to find this…..

Am I a core/non-core/associate member of the MDT?

different scoring rules apply to core and non-core members of the MDT.

MDT assigns those who are core and those who aren’t

Must have the required number of core individuals from each profession in the list

Core individuals must attend more than 50% of MDTMs

Looking at the number of MDTMs running without a specialty present or postponed/cancelled because a specialty wasn’t present.

Additional MDT professions

• Additional professions that are not in the standards list

• Essential/occasional • Won’t be scored against the standards• Markers of quality (research nurses etc)• Best practice

Changes

Summary of all substantive changes on website

– The MDT membership– New NHS Wales structure– Help buttons– MDT summary/pathway pages– Audit timings– All Wales dataset completion– Surgical standards– SPC standards– Skin standards– Specialist pathologists and radiologists– Sign-off mechanism

Specialist pathologists and radiologists

• Not those listed as MDT members in section 4.

• second opinion,

• May be extremely rare

• For UK and International-level specialists, the person/s to whom they refer for a second opinion, may be no more specialist than themselves, and be called upon very infrequently.

MDT summary page

Sign off

Reporting

Data, data, everywhere

Agreed in outline with the Minister, tight deadline for reporting.

Current plan:• no central validation prior to reporting to the Assembly• accepting all data at face value• Won’t be using any occult knowledge to

enhance/interpret your answers• Presenting pass-fail situation to the assemblyAssembly final decision

• HSW (technical) RFW-Web@HSW.Wales.NHS.UK

• Network advisors• CSCG website http://howis.wales.nhs.uk/sites3/page.cfm?orgid=322&pid=14275

• Workshops• CSCG Louise.Carrington@cscg.wales.nhs.uk, 02920196163

• Query log• Help files• FAQs• Changes document• Top tips etcClinical advisory

structureAssemblyNetworks

Summary

• Use the help resources• Read the questions• Enter as much detail as asked for in the correct

format• Assume nothing• Check the data• Obtain clinical and managerial sign-off• If in doubt ask• And finally…….

Feedback from users