The Good, The Bad and The Patient Choice! Colorectal Patient Pathways Across the Network Presented...

The Good, The Bad and The Patient Choice!

Colorectal Patient Pathways Across the Network

Presented by:Teresa Coombes

Cancer, Oncology, Haematology and Palliative Care Business Unit Manager

Its Not Going Away!

• National slide in Cancer Waits Performance

• Focus on pathways – remove the “muppetry” and identify the real issues

• All SSG’s having discussion

National Position Sliding…….

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

62 Day GP (85%) Screening (90%)

% A

chie

ved

Standard

Dec-14

Jan-15

Feb-15

Local Performance Variable……

Trust Dec’14 Jan’15 Feb’15

UHB 84.6% (81.8%) 80.0% (77.8%) 75.0% (36.4%)

Weston 88.1% (90.0%) 75.4% (100.0%) 90.2% (100.0%)

Yeovil 81.7% (100.0%) 87.95% (80.00%) 89.25% (100.0%)

Taunton 83.2% (57.1%) 79.4% (52.6%) 79.1% (50%)

RUH

NBT

Trust 62day Performance (GP Sus Refs)(Colorectal Specific performance)

The Good:

Weston•First seen day 7

•Completed diagnostic tests and MDT discussion by day 32

•Surgery undertaken on day 43

Yeovil •First seen day 14



The Bad Challenging!

UHB•First seen day 7



Trust Breach ReviewThe delays for both multi-disciplinary team meeting and outpatients caused this pathway to exceed 62 days.

Weston•First seen day 13



Trust Breach Review 48 day admin delay in booking the colonoscopy, (mismatch of access policies)


RUH•General outpatient and inpatient capacity, just due to the increasing number of referrals. •Endoscopy capacity, particularly when our endoscopy unit is used as an inpatient ward when we're in black(!), but also just the general increase in demand.

•Waits for radiology appointments, particularly CT colonograms, and also the delay for radiology reports. •The radiology delays are the main issue for us.

MPH•Our single biggest challenge at Taunton for meeting the 62 day pathway is access to endoscopy. Our waits for colonoscopies are particularly long.

•Also our histopathology staffing shortages can cause delays to reporting the endoscopies which further delays things.

•Some delays to first appointments caused by the need to triage cases and the reluctance of some patients to attend for invasive tests


YDH•First seen day 5



Trust Breach ReviewTreatment plan initially dated in target further imaging requested outside of MDT, previously agreed treatment plan then followed.

Glos

The Patient Choice:

Across all MDT’s•Frequent deferral of first appointment (higher if direct to test?)

•During diagnostic phase (CT / MRI / Endoscopy)

•Deferral of RT if delivered as outpatient

•Nothing we can do about this!

•Deferral of surgery - adjustable

Problem Solving!

• Sharing of best practice and “whose done what”

• Endoscopy capacity solutions?

• Expansion of CNS roles?

Answers on a Postcard Please…………..

The Good, The Bad and The Patient Choice! Colorectal Patient Pathways Across the Network Presented...

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