cancer diagnostic demand & capacity workshop · data gathering - quantitative data from trusts...

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Cancer

Diagnostic

Demand &

Capacity

Workshop SPH Workshop

Presentation 10th March 2016

www.england.nhs.uk

Identify areas of improvement required across the cancer pathway focussing on cancer diagnostics

Review current diagnostics capacity and infrastructure of 5 cancer specialties

Review demand for diagnostics from patients entering the cancer pathway via the urgent 2WW route, compared with other routes

Develop a model to predict future referrals and tests (to 2021) taking account of demographics and new NICE urgent referral guidance

Run a workshop to share the project findings and explore the significance of the results

Aims of Project

2

www.england.nhs.uk

Elements:

• 12 CCGs – you know who you are….

• 6 Trusts - OUH, BHT, RBH, GWH, MKH, FN

• 5 specialties - Gynaecology, Colorectal, Upper GI,

Lung, Urology

• 11 cancers - ovarian, cervical, vulval, endometrial,

oesophageal, pancreas, stomach, bladder, kidney

prostate, lung

• NICE guidance – 3 scenarios plus baseline

3

Project scope

www.england.nhs.uk 4

www.england.nhs.uk

• Summary of guidance – desk top exercise

• Gather current data from national sources

• Gather Trust qualitative data

• Gather Trust quantitative data

High level plan

5

www.england.nhs.uk

• Achieving world-class cancer outcomes: A strategy for England 2015-2020. Suspected cancer: recognition and referral

• NICE – Suspected cancer urgent referral guidance

• Horizon scanning: An evaluation of imaging capacity across the NHS in England. 2020 Delivery for Cancer Research UK

• Scoping the future: An evaluation of endoscopy capacity across the NHS in England. Cancer Research UK

• Improving outcomes: A strategy for cancer fourth annual report. DH, PHE, NHSE.

• Delivering cancer waiting times – A good practice guide. NHS Interim Management and Support Intensive Support Team Elective Care Guide

6

Data gathering - Guidance

www.england.nhs.uk

• NHS England Cancer Waiting Times Statistics

o CCG and Trust performance against 2WW, 31 day and 62 day targets

• NCIN Cancer Commissioning Toolkit

o 2WW referrals by CCG and Trust over time

o 2WW referrals by CCG and Trust diagnosed with cancer over time

o Non-2WW referrals diagnosed with cancer and treated within 31 days over time

o Routes to Diagnosis data for certain common cancers

o Proportion of cancers diagnosed early (stage 1 or 2) vs late (stage 3 or 4) for Thames Valley CCGs

7

Data gathering - National Data

www.england.nhs.uk

• Southern Bowel Cancer Screening Hub

o Referrals from bowel cancer screening to Thames Valley providers

• Health and Social Care Information Centre

o Referrals from cervical cancer screening to Thames Valley Trusts and number of referrals from cervical cancer screening services for Thames Valley CCGs

• TVSCN

o Incidence data for Thames Valley CCGs/PCTs from

2009 to 2013

o Average decision to treat date for Thames Valley

providers in 2015

• PHE

o Proportion of emergency cancer presentations for Thames Valley CCGs

8

Data gathering - National data continued…

www.england.nhs.uk

• Questionnaire developed for each cancer specialty

• Information requested on:

o Outsourcing of tests

o Number of referrals in 2014/15

o How many clinics, how often these ran, how many slots per clinic

o Equipment used in clinics

o Pathology and radiology turnaround times

o Staffing

• Questionnaires were circulated to providers in early November and return was originally requested by end of November, then by Christmas. The latest return was late February.

9

Data gathering - Questionnaires

www.england.nhs.uk

• We sent a data request to Trusts asking for an

anonymised dataset showing the tests performed for

each suspected cancer referral in 2014/15

o This was to inform our modelling of the future

demand for diagnostic tests

o Our fantasy was ….patient level data of each event

along the pathway – blood test, biopsy, outpatient

appointment, CT scan etc

10

Data gathering - Quantitative data from

Trusts

www.england.nhs.uk

• Cancer managers – face to face interviews

• Telephone interviews with radiology and pathology

managers

• Collated emerging themes from questionnaires and

interviews

• Information presented in a mini-report for each

Thames Valley Trust along with projected referrals

and tests for that Trust

11

Data gathering - Qualitative Data from

Trusts

www.england.nhs.uk

• Returned Questionnaires from Trusts – with some information

12

Data returns from Trusts

• Completed interviews with Cancer, Pathology, Radiology Managers

• Returned data requests and shared modelling work – with some information

Bucks GW HWPH MK OUH RBH

Tests Data Request

Previous Modelling Work


Gynae

Lower GI

Lung

Upper GI

Urology


Cancer Manager

Pathology Manager

Radiology Manager

www.england.nhs.uk

Way too much information for one report

• Purple = Guidance report

• Blue = National data report

• Green = Modelling report – methodology plus

projected referrals and tests by health economy

• Orange = Six Trust reports – qualitative information

plus projected referral and tests by specialty

• To follow….Excel spreadsheet with all modelling

includes approximately 2000 tables…..

13

Outputs - Mini reports


Outputs: Guidance Summary

Mini Report


NICE Guidance: Impact on Referrals

Cancer Specialty Lower Estimate Upper Estimate

Colorectal 5% 15%

Upper GI -40% -80%

Lung 10% 15%

Urological 5% 10%

www.england.nhs.uk

• Upper GI cancer 2WW cancer predicted referrals drop of -40% to -80%

• Assumed primary care will refer to direct access endoscopy so not technically cancer 2WW but urgent 2WW instead.

• Will identify patients unlikely to have cancer.

• A much smaller proportion of patients will therefore require a 2 week wait cancer referral to the hospital Trust.

• The overall number of referrals will not be impacted by this change only whether they are referred as a 2 week wait cancer pathway referral to the hospital Trust or an urgent 2 week wait direct access referral to an endoscopy service.

• The benefit is a significant reduction in the number of outpatient appointments required in the hospital Trust and associated costs.

• Issues around governance and pathway linkage with the independent endoscopy providers and associated pathology laboratories have been raised.

16

Upper GI – NICE predicted 2ww


NICE Guidance – Direct access

X-ray Upper GI

endoscopyCT

Ultra-

sound

Cystos

copyCA125 PSA

Urine

test

Colpos

copy

Lung X

Oesophageal X

Pancreatic X

Stomach X

Colorectal

Ovarian X X

Endometrial X

Cervix

(screened)

Vulva

Prostate X X

Bladder X X

Renal X X

X

Direct access

www.england.nhs.uk

• National diagnostic capacity implementation fund

• Health Education England to focus on accessing and

developing workforce - 60% increase in training

positions - radiology

• Fund by activity not block contract

• Clear national evidence based protocols for follow up

scanning/surveillance

• Better data coding

• PHE/NHSE to plan how to manage pressures from

roll out of Bowel Scope

18

Diagnostics

www.england.nhs.uk

• Delivering cancer waiting times – A good

practice guide. NHS Interim Management and

Support Intensive Support Team Elective Care

• Walk through guide of essential elements of

cancer pathway for capacity planning

• Good practice

• Signposts to tools and practices to smooth

pathway

19

How to guide….


Outputs: Trends in Cancer Data

Mini Report

www.england.nhs.uk

Q1 & Q2

2013/14

Q1 & Q2

2014/15

Q1 & Q2

2015/16

% Change

Q1 & Q2

2013/14 to

Q1 & Q2

2014/15

% Change

Q1 & Q2

2014/15 to

Q1 & Q2

2015/16

% Change

Q1 & Q2

2013/14 to

Q1 & Q2

2015/16

Gynaecological

cancers

2,457 2,514 3,042 2% 21% 24%

Colorectal

cancers

4,562 5,021 5,702 10% 14% 25%

Upper GI cancers 2,376 2,912 3,735 23% 28% 57%

Lung cancer 891 988 1,096 11% 11% 23%

Urological

cancers

3,586 4,053 4,554 13% 12% 27%

Total Thames

Valley

13,872 15,488 18,129 12% 17% 31%

Total England 330,932 371,172 413,965 12% 12% 25%

21

Outputs: Trends in Cancer Data Mini Report

– Two Week Wait Referrals

Number of 2WW referrals for selected cancers in TVSCN increased by 31% between 2013/14

and 2015/16 (Q1 & Q2). This was a greater increase than the England average of 25%.

www.england.nhs.uk

2010/11 2011/12 2012/13 2013/14 2014/15 % Change

from 2010/11

Buckinghamshire

Healthcare

920 809 916 1,599 1,527 +66%

Great Western Hospitals

NHS Foundation Trust

629 615 676 816 806 +28%

Frimley North Hospital 1,424 1,569 1,604 1,675 1,894 +33%

Milton Keynes Hospital 741 686 810 946 1094 +48%

Oxford University

Hospitals

1,293 1,081 1,632 2929 2404 +86%

Royal Berkshire Hospital 946 1,039 1,149 1287 1884 +99%

Thames Valley 5,953 5,799 6,787 9,252 9,609 +61%

England 142,984 147,889 167,394 199,322 198,216 +39%

22

Outputs: Trends in Cancer Data Mini

Report – Cervical Screening Referrals

Number of cervical screening referrals have increased from approx. 6,000 per

annum to approx. 9,500 per annum in TVSCN. This is a 61% increase since

2010/11, compared to a 39% increase for England over the same period.

www.england.nhs.uk

Increasing trend in number of referrals from bowel screening

programme to TV providers

23


Report – Bowel Screening Referrals

0

50

100

150

200

250

300

350

400

450

500

2008 - 2009 2009 - 2010 2010 - 2011 2011 - 2012 2012 - 2013 2013 - 2014 2014 - 2015 2015-2016extrapolated

Buckinghamshire Healthcare

Great Western Hospital

Frimley North Hospital

Milton Keynes Hospital

Oxford University Hospitals

Royal Berkshire Hospital

www.england.nhs.uk

2009 2010 2011 2012 2013 Total Change

between

2009 and

2013

%

Change

between

2009 and

2013

% Change

in England

between

2009 and

2013

(where

data are

available)

Gynaecological

cancers

694 720 679 698 719 3,510 25 4% 7%

Colorectal Cancer 1,433 1,494 1,501 1,567 1,575 7,570 142 10% -

Upper GI cancers 764 801 777 812 861 4,015 97 13% 7%

Lung Cancer 1235 1247 1268 1290 1250 6,290 15 1% 7%

Urological cancers 2,284 2,240 2,320 2,301 2,565 11710 281 12% 13%

Total 11 cancer

sites

6,399 6,490 6,542 6,658 6,960 33,049 561 9% -

24


– Cancer Incidence

Incidence of selected cancers is increasing in TVSCN area, but at a

lower rate than referrals

www.england.nhs.uk

2ww accounts for only 20% to 40% of cancer diagnoses. Emergency presentation

accounted for 44% of pancreatic cancer diagnoses and 34% of lung cancer diagnoses

25

Outputs: Routes to Diagnosis 2006 to 2013

Scre

en

dete

cte

d

Tw

o W

eek W

ait

GP

refe

rral

Oth

er

Ou

tpati

en

t

Inp

ati

en

t E

lecti

ve

Em

erg

en

cy

pre

sen

tati

on

Death

Cert

ific

ate

On

ly

Un

kn

ow

n

Bladder 40% 19% 14% 7% 15% 0% 5%

Bladder (in-situ) 32% 29% 18% 9% 4% 8%

Cervix 28% 10% 34% 10% 3% 9% 0% 6%

Cervix (in-situ) 1% 0% 64% 21% 6% 1% 7%

Colorectal 6% 24% 22% 11% 8% 22% 1% 6%

Kidney 22% 26% 20% 4% 22% 0% 6%

Other and unspecified urinary 20% 30% 25% 7% 12% 5%

Lung 24% 21% 14% 3% 34% 0% 3%

Oesophagus 34% 17% 9% 14% 20% 0% 5%

Ovary 26% 23% 14% 3% 27% 1% 7%

Pancreas 13% 18% 15% 5% 44% 1% 5%

Prostate 37% 34% 12% 3% 7% 0% 7%

Stomach 22% 20% 10% 12% 31% 1% 4%

Uterus 40% 33% 11% 2% 8% 0% 5%

Vulva 33% 37% 15% 2% 6% 7%

Thames Valley SCN

20

06

-20

13

www.england.nhs.uk

England similar to Thames Valley, 47% of Pancreas cancers diagnosed by

emergency presentation and 37% of lung cancers 26

Outputs: Routes to Diagnosis 2006 to 2013

Scre

en

dete

cte

d

Tw

o W

eek W

ait

GP

refe

rral

Oth

er

Ou

tpati

en

t

Inp

ati

en

t E

lecti

ve

Em

erg

en

cy

pre

sen

tati

on

Death

Cert

ific

ate

On

ly

Un

kn

ow

n

Bladder 34% 28% 13% 3% 18% 0% 3%

Bladder (in-situ) 23% 47% 16% 4% 7% 0% 3%

Cervix 23% 18% 32% 10% 2% 11% 0% 4%

Cervix (in-situ) 16% 0% 56% 19% 4% 1% 0% 4%

Colorectal 7% 28% 25% 8% 4% 25% 0% 3%

Kidney 22% 30% 18% 2% 25% 0% 3%

Other and unspecified urinary 17% 37% 22% 3% 18% 0% 3%

Lung 26% 21% 11% 2% 37% 1% 3%

Oesophagus 38% 20% 8% 10% 21% 0% 3%

Ovary 27% 26% 12% 2% 29% 1% 4%

Pancreas 14% 21% 11% 3% 47% 1% 4%

Prostate 33% 41% 11% 2% 9% 0% 4%

Stomach 25% 22% 8% 9% 32% 0% 3%

Uterus 45% 34% 8% 1% 8% 0% 4%

Vulva 36% 40% 12% 1% 7% 0% 3%

England

20

06

-20

13

www.england.nhs.uk

21% of lung cancer

cases diagnosed at

stages 1 and 2 in

TV, similar to 20%

for England in 2013

27


– Stage at Diagnosis

More not recorded data

for TV than England but

% ovarian/uterine cancers

diagnosed at stages 3

and 4 is slightly higher

than for England in 2013 48% 57%

31%30%

21% 13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Thames Valley England

Not Recorded

Stage 3 & 4

Stage 1 & 2

21% 20%

62% 66%

17% 14%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Thames Valley England

Not Recorded

Stage 3 & 4

Stage 1 & 2

www.england.nhs.uk

2ww operational standard being met by TV CCGs apart from West

Berks in Q1 & Q2 2015/16

28


– 2ww for CCGs

CCG

2013/14

Q1

2013/14

Q2

2013/14

Q3

2013/14

Q4

2014/15

Q1

2014/15

Q2

2014/15

Q3

2014/15

Q4

2015/16

Q1

2015/16

Q2

NHS Bracknell and Ascot CCG 94.7% 94.2% 96.2% 96.7% 93.2% 93.6% 95.9% 94.5% 94.0% 94.2%

NHS Slough CCG 94.7% 95.5% 97.7% 96.7% 94.4% 96.1% 95.1% 94.8% 94.1% 94.1%

NHS Windsor, Ascot and Maidenhead CCG 94.7% 95.5% 97.2% 96.1% 92.9% 94.7% 95.3% 95.3% 95.1% 94.3%

NHS Newbury and District CCG 93.2% 93.4% 95.4% 94.3% 90.9% 88.5% 91.2% 93.8% 89.3% 75.9%

NHS North & West Reading CCG 92.6% 94.1% 95.1% 93.9% 90.9% 88.0% 91.8% 92.9% 88.2% 71.6%

NHS South Reading CCG 93.7% 94.6% 94.6% 93.8% 90.4% 90.1% 91.5% 94.8% 88.3% 72.4%

NHS Wokingham CCG 93.8% 94.3% 94.2% 93.4% 91.0% 90.2% 93.4% 94.5% 88.8% 71.5%

NHS Aylesbury Vale CCG 99.1% 98.8% 98.5% 96.7% 94.0% 94.3% 94.4% 96.2% 95.1% 95.9%

NHS Chiltern CCG 98.6% 97.8% 97.6% 96.0% 91.8% 93.9% 93.9% 94.4% 94.0% 94.6%

NHS Milton Keynes CCG 98.6% 96.9% 96.8% 96.5% 94.7% 93.9% 96.0% 95.1% 95.8% 94.8%

NHS Oxfordshire CCG 95.4% 93.6% 95.6% 96.5% 93.0% 93.1% 94.1% 97.1% 94.1% 93.1%

NHS Swindon CCG 94.6% 94.1% 95.6% 93.5% 94.2% 93.8% 94.1% 95.1% 94.8% 95.1%

Operational Standard 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

England 95.5% 95.2% 95.6% 95.0% 93.5% 93.6% 94.7% 94.7% 93.6% 93.5%



Report – 2ww for CCGs

70%

75%

80%

85%

90%

95%

100%

Q12013/14

Q22013/14

Q32013/14

Q42013/14

Q12014/15

Q22014/15

Q32014/15

Q42014/15

Q12015/16

Q22015/16

Buckinghamshire Healthcare NHS Trust

Great Western Hospitals NHS Foundation Trust

Frimley Healthcare NHS Foundation Trust(Frimley North only)

Milton Keynes Hospital NHS Foundation Trust

Oxford University Hospitals NHS FoundationTrust

Royal Berkshire NHS Foundation Trust

Operational Standard

2ww operational standard being met by TV providers apart

from RBH in 2015/16

www.england.nhs.uk

Q1 Q2 Q3 Q4

Gynaecological Buckinghamshire Healthcare NHS Trust 5.6 25 0 0

Frimley North Hospital 12.5 28.6 7.7 0

Oxford University Hospitals NHS Foundation

Trust

13.4 22.2 13.8 23.4

Royal Berkshire NHS Foundation Trust 8.3 20 6.1 11.1

Colorectal Buckinghamshire Healthcare NHS Trust 24 18.5 38.3 20.7



Trust

15 16.1 33.3 21

Royal Berkshire NHS Foundation Trust 4.4 10.7 3.8 8

Lung Buckinghamshire Healthcare NHS Trust 21.2 15.1 17.2 12.5

Frimley North Hospital 33.3 28.6 38.5


Trust

13.6 10.7 12.2 13.6

Royal Berkshire NHS Foundation Trust 6.5 25 22.7 21.3

Upper GI Buckinghamshire Healthcare NHS Trust 37.9 31.6 42.9 25.7

Frimley North Hospital 35.3 32.3 25 0


Trust

8.3 13.9 15.7 38.8

Royal Berkshire NHS Foundation Trust 19 26.1 7.1 15.4

Urological Buckinghamshire Healthcare NHS Trust 30.4 20.9 27.9 30.5



Trust

20.4 29.5 21.6 26.1

Royal Berkshire NHS Foundation Trust 22.3 28.4 29.7 23.3

30

Outputs: Average Decision to Treat Date 2015


Outputs: Modelling Future Demand

for Cancer Diagnostics Mini Report

www.england.nhs.uk

Populations (Aged 20+)

• CCG populations

o Current and past years we used ONS mid year estimates

o Future years we used ONS 2012-based sub national population projections for CCGs

o CCG populations grouped into health economies for modelling e.g. East Berks

• Trust catchment populations

o Published APHO/PHE Trust catchment populations for 2011, 2012, 2013

o Estimated forwards and backwards using year on year increase in CCG population from ONS projections using CCG in which Trust is sited e.g. for Milton Keynes Hospital applied % change from MK CCG

32

Modelling Methodology Data Sources

www.england.nhs.uk

NICE Guidance estimates of changes in numbers of

referrals

33

Modelling Methodology: Data Sources

Baseline

Scenario

Scenario

1

Scenario

2

Scenario

3

Cancer

Specialty

No Impact Lower

Estimate

Mid-Point

Estimate

Upper

Estimate

Colorectal 0% 5% 7.5% 15%

Upper GI 0% -40% -60% -80%

Lung 0% 10% 12.5% 15%

Urological 0% 5% 7.5% 10%

www.england.nhs.uk

2ww Referrals


• Pre-2013 PCT data calculated for CCGs using ONS

percentages

Non-2ww Referrals


• Number of cancers diagnosed and treated within 31

days from routes other than 2WW

34


www.england.nhs.uk

Screening Referrals

• Bowel screening data provided by the Southern

Bowel Cancer Screening Hub

• Cervical Screening obtained from HSCIC by provider

- commissioner figures estimated based on provider

proportions

35


www.england.nhs.uk

Milton Keynes Test Data

• Milton Keynes provide detailed referral and test data

for 2014/15

• Used to derive a ratio of tests per referral, by type of

test

• Applied to the referral numbers to estimate numbers

of tests

36


www.england.nhs.uk

• Chart 2009-2014 rates of referrals for each health

economy, provider and speciality, separately for 2WW,

non-2WW and screening

• Add a log trend for each organisation

• Forecast forward 7 years

• Apply co-efficients from log trend to derive projected rates

• Apply these rates to projected populations to get projected

referral numbers

• Apply NICE estimated changes to 2WW referral numbers

• Apply the Milton Keynes ratios of referrals to test to these

referral numbers to get projected test numbers

37

Basis of Modelling

www.england.nhs.uk

For example (2ww referrals, colorectal, Oxfordshire)

Add log trend to historic referrals

38

Basis of Modelling

www.england.nhs.uk

For example (con’td)

Apply calculated forecast rate to projected population to get projected number of 2WW referrals

39

Basis of Modelling

www.england.nhs.uk

Then add NICE Guidance estimated changes to this

Baseline, to create 3 scenarios, based on:

Scenario 1 – Minimum level estimated by NICE

Scenario 2 - Mid-point between minimum and maximum

level estimated by NICE

Scenario 3 - Maximum level estimated by NICE

40

Basis of Modelling

www.england.nhs.uk

For example (con’td)

Add NICE Guidance estimated % changes to 2WW referrals, and add these adjusted 2WW

figures to the non-2WW and screening (where appropriate) projections

41

Basis of Modelling

www.england.nhs.uk

Bear in mind that Upper GI is different…. If the NICE Guidance limits are applied, the results look like this. However, the Guidance is likely to result in changes in

referral paths and routes to testing, rather than changes in the numbers of referrals and tests. Therefore, only the

Baseline is used in the SPH modelling. More details are given in the separate Modelling Data Excel file, and Modelling

Report

42

Basis of Modelling

Note – NICE

changes are

assumed to be

implemented

evenly over the

5 years 2016 -

2020

www.england.nhs.uk

Back in 10 mins please

43

Break – phew!

www.england.nhs.uk

The model calculates future numbers of referrals and tests for multiple combinations:

Organisations (6 providers + TV total, 6 health economies + TV total) 14

Specialties 5

Scenarios (Baseline + Scenarios 1,2 and 3) 4

Referral types (2ww, non-2ww, screening and total) 4 x each for referrals and tests 2 x

Total 2,240

Key results are included in your packs

44

Modelling Results

www.england.nhs.uk

Population changes underlie all other changes

45

Modelling Results: Main Drivers

www.england.nhs.uk

Between 2009 and 2014, Referrals steadily increased

46

Modelling Results: Main Drivers

Health Economy View

Provider View

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2009 2010 2011 2012 2013 2014

Bucks

East Berks

Milton Keynes

Oxfordshire

Swindon

West Berks

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2009 2010 2011 2012 2013 2014

BuckinghamshireHealthcare NHS Trust

Great Western HospitalsNHS Foundation Trust

Milton Keynes HospitalNHS Foundation Trust

Oxford UniversityHospitals NHS Trust

Royal Berkshire NHSFoundation Trust

Wexham Park Hospital


Modelling Results: Colorectal, Baseline Referrals

Change between

2014 and 2021: 17%

Number of Referrals - BaselineTrust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,343 1,712 2,090 1,896 1,850 2,253 2,063 2,077 2,126 2,178 2,224 2,268 2,308 Great Western Hospitals NHS Foundation Trust 950 1,133 1,344 1,587 1,557 1,879 1,889 1,928 1,991 2,048 2,101 2,152 2,199 Milton Keynes Hospital NHS Foundation Trust 789 923 1,122 1,087 1,201 1,454 1,352 1,422 1,472 1,518 1,563 1,604 1,645 Oxford University Hospitals NHS Trust 1,510 2,080 2,674 3,398 3,032 3,341 3,551 3,670 3,791 3,900 4,000 4,096 4,183 Royal Berkshire NHS Foundation Trust 1,519 1,792 1,978 2,386 2,432 2,554 2,598 2,688 2,772 2,846 2,914 2,978 3,038 Wexham Park Hospital 1,202 1,410 1,712 2,090 1,962 2,233 2,241 2,342 2,418 2,490 2,561 2,626 2,690 Total 7,313 9,050 10,920 12,444 12,034 13,714 13,695 14,126 14,570 14,980 15,363 15,725 16,063

Actual Projected


Modelling Results: Colorectal, Scenario 3 Referrals Number of Referrals - Scenario 3

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,343 1,712 2,090 1,896 1,850 2,253 2,063 2,125 2,226 2,331 2,433 2,535 2,581 Great Western Hospitals NHS Foundation Trust 950 1,133 1,344 1,587 1,557 1,879 1,889 1,973 2,084 2,193 2,300 2,407 2,460 Milton Keynes Hospital NHS Foundation Trust 789 923 1,122 1,087 1,201 1,454 1,352 1,456 1,544 1,629 1,715 1,800 1,847 Oxford University Hospitals NHS Trust 1,510 2,080 2,674 3,398 3,032 3,341 3,551 3,766 3,990 4,210 4,425 4,642 4,743 Royal Berkshire NHS Foundation Trust 1,519 1,792 1,978 2,386 2,432 2,554 2,598 2,750 2,900 3,044 3,186 3,326 3,393 Wexham Park Hospital 1,202 1,410 1,712 2,090 1,962 2,233 2,241 2,396 2,530 2,664 2,800 2,934 3,006 Total 7,313 9,050 10,920 12,444 12,034 13,714 13,695 14,466 15,274 16,070 16,859 17,645 18,031

Actual Projected

Total Change by

2021 - Baseline to

Scenario 3: 12%

Change between

2014 and 2021: 31%

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Buckinghamshire HealthcareNHS Trust

Great Western Hospitals NHSFoundation Trust

Milton Keynes Hospital NHSFoundation Trust

Oxford University HospitalsNHS Trust




Modelling Results: Colorectal, Baseline Tests Number of Tests - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Buckinghamshire Healthcare NHS Trust 1,826 2,327 2,841 2,578 2,515 3,063 2,805 2,823 2,891 2,961 3,023 3,084 3,138

Great Western Hospitals NHS Foundation Trust 1,292 1,540 1,827 2,158 2,117 2,555 2,568 2,621 2,706 2,785 2,856 2,925 2,990

Milton Keynes Hospital NHS Foundation Trust 1,073 1,255 1,525 1,478 1,633 1,977 1,838 1,933 2,002 2,064 2,124 2,181 2,236

Oxford University Hospitals NHS Trust 2,053 2,828 3,635 4,620 4,122 4,542 4,828 4,989 5,154 5,302 5,438 5,569 5,687

Royal Berkshire NHS Foundation Trust 2,065 2,436 2,689 3,244 3,306 3,472 3,532 3,654 3,768 3,869 3,962 4,049 4,130

Wexham Park Hospital 1,634 1,917 2,327 2,841 2,667 3,036 3,047 3,184 3,288 3,386 3,482 3,570 3,657

Total 9,942 12,304 14,846 16,918 16,360 18,644 18,619 19,205 19,808 20,366 20,887 21,378 21,838

Estimated Projected


Modelling Results: Colorectal, Scenario 3 Tests Number of Tests - Scenario 3

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,826 2,327 2,841 2,578 2,515 3,063 2,805 2,889 3,026 3,169 3,307 3,447 3,509 Great Western Hospitals NHS Foundation Trust 1,292 1,540 1,827 2,158 2,117 2,555 2,568 2,682 2,833 2,981 3,127 3,272 3,345 Milton Keynes Hospital NHS Foundation Trust 1,073 1,255 1,525 1,478 1,633 1,977 1,838 1,980 2,099 2,214 2,332 2,447 2,510 Oxford University Hospitals NHS Trust 2,053 2,828 3,635 4,620 4,122 4,542 4,828 5,120 5,425 5,723 6,016 6,312 6,448 Royal Berkshire NHS Foundation Trust 2,065 2,436 2,689 3,244 3,306 3,472 3,532 3,739 3,943 4,139 4,332 4,522 4,613 Wexham Park Hospital 1,634 1,917 2,327 2,841 2,667 3,036 3,047 3,258 3,440 3,621 3,807 3,989 4,087 Total 9,942 12,304 14,846 16,918 16,360 18,644 18,619 19,667 20,765 21,848 22,921 23,989 24,513

Estimated Projected

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000








Modelling Results: Lung, Baseline Referrals Number of Referrals - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 287 306 398 376 337 368 390 399 408 417 425 433 440 Great Western Hospitals NHS Foundation Trust 219 207 270 275 269 327 274 280 287 292 298 303 308 Milton Keynes Hospital NHS Foundation Trust 162 151 172 219 249 336 275 289 303 315 327 338 349 Oxford University Hospitals NHS Trust 507 516 626 755 746 928 815 844 870 894 916 937 957 Royal Berkshire NHS Foundation Trust 380 461 343 456 446 478 507 517 527 536 544 552 559 Wexham Park Hospital 132 122 183 183 164 209 187 194 200 206 212 217 222 Total 1,687 1,763 1,992 2,264 2,211 2,646 2,447 2,523 2,595 2,661 2,722 2,780 2,834

Actual Projected

Change between

2014 and 2021: 7%

-

200

400

600

800

1,000

1,200

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

20

19

20

20

20

21BuckinghamshireHealthcare NHS Trust







Modelling Results: Lung, Scenario 3 Referrals Number of Referrals - Scenario 3

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 287 306 398 376 337 368 390 410 431 452 473 494 502 Great Western Hospitals NHS Foundation Trust 219 207 270 275 269 327 274 288 302 316 330 343 349 Milton Keynes Hospital NHS Foundation Trust 162 151 172 219 249 336 275 297 320 342 365 387 399 Oxford University Hospitals NHS Trust 507 516 626 755 746 928 815 867 918 968 1,018 1,067 1,090 Royal Berkshire NHS Foundation Trust 380 461 343 456 446 478 507 529 553 576 599 622 630 Wexham Park Hospital 132 122 183 183 164 209 187 198 208 219 229 239 245 Total 1,687 1,763 1,992 2,264 2,211 2,646 2,447 2,590 2,732 2,873 3,012 3,153 3,215

Actual Projected

Total Change by

2021 - Baseline to

Scenario 3: 13%

Change between

2014 and 2021: 22%

-

200

400

600

800

1,000

1,200

20

09

20

10

20

11

20

12

20

13

20

14

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20

21BuckinghamshireHealthcare NHS Trust







Modelling Results: Lung, Baseline Tests


Modelling Results: Lung, Scenario 3 Tests

Number of Tests - Scenario 3Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Buckinghamshire Healthcare NHS Trust 383 409 532 502 450 492 520 548 575 604 631 660 670

Great Western Hospitals NHS Foundation Trust 293 276 361 367 359 437 365 384 403 422 440 459 466

Milton Keynes Hospital NHS Foundation Trust 216 202 230 293 333 449 367 397 428 457 487 517 533

Oxford University Hospitals NHS Trust 677 689 836 1,008 996 1,239 1,089 1,158 1,226 1,293 1,359 1,426 1,455

Royal Berkshire NHS Foundation Trust 508 616 458 609 596 638 677 707 739 769 800 830 842

Wexham Park Hospital 176 163 244 244 219 279 249 264 278 292 306 320 328

Total 2,253 2,355 2,661 3,024 2,953 3,534 3,268 3,459 3,649 3,837 4,023 4,211 4,294

Estimated Projected

www.england.nhs.uk

• Upper GI cancer 2WW cancer predicted referrals drop of -40% to -80%

• Assumed primary care will refer to direct access endoscopy so not technically cancer 2 week wait but urgent 2 week wait instead.

• Will identify patients unlikely to have cancer.

• A much smaller proportion of patients will therefore require a 2 week wait cancer referral to the hospital Trust.

• The overall number of referrals will not be impacted by this change only whether they are referred as a 2 week wait cancer pathway referral to the hospital Trust or an urgent 2 week wait direct access referral to an endoscopy service.

• The benefit is a significant reduction in the number of outpatient appointments required in the hospital Trust and associated costs.

• Issues around governance and pathway linkage with the independent endoscopy providers and associated pathology laboratories have been raised.

• In this modelling, only the Baseline is calculated. Further details about this are available in associated the Modelling Data excel spreadsheet and Modelling Report.

55

Upper GI – NICE predicted 2ww


Modelling Results: Upper GI, Baseline Referrals Number of Referrals - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 631 723 776 938 927 1,133 1,091 1,135 1,173 1,212 1,246 1,280 1,310 Great Western Hospitals NHS Foundation Trust 571 678 728 876 932 1,033 1,002 1,039 1,073 1,104 1,132 1,159 1,185 Milton Keynes Hospital NHS Foundation Trust 414 339 340 447 514 607 544 565 585 604 622 638 655 Oxford University Hospitals NHS Trust 1,172 1,169 1,022 1,334 1,388 1,754 1,544 1,581 1,615 1,647 1,675 1,703 1,728 Royal Berkshire NHS Foundation Trust 629 701 759 924 1,028 1,282 1,225 1,278 1,330 1,376 1,418 1,458 1,494 Wexham Park Hospital 661 694 771 805 850 999 943 974 1,001 1,027 1,053 1,077 1,100 Total 4,078 4,304 4,396 5,324 5,639 6,808 6,349 6,572 6,778 6,969 7,147 7,315 7,472

Actual Projected

Change between

2014 and 2021: 10%

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000








Modelling Results: Upper GI, Baseline Tests Number of Tests - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 890 1,020 1,095 1,323 1,308 1,598 1,539 1,601 1,655 1,709 1,758 1,805 1,848 Great Western Hospitals NHS Foundation Trust 806 957 1,027 1,236 1,315 1,457 1,414 1,466 1,513 1,557 1,597 1,635 1,672 Milton Keynes Hospital NHS Foundation Trust 584 478 480 631 725 856 767 797 826 852 877 900 924 Oxford University Hospitals NHS Trust 1,653 1,649 1,442 1,882 1,958 2,475 2,179 2,230 2,279 2,323 2,363 2,403 2,438 Royal Berkshire NHS Foundation Trust 887 989 1,071 1,304 1,450 1,809 1,728 1,803 1,876 1,941 2,001 2,057 2,108 Wexham Park Hospital 933 979 1,088 1,136 1,199 1,409 1,330 1,374 1,413 1,449 1,486 1,519 1,552 Total 5,753 6,072 6,202 7,511 7,955 9,605 8,956 9,272 9,562 9,832 10,082 10,319 10,541

Estimated Projected

-

500

1,000

1,500

2,000

2,500

3,000








Modelling Results: Urology, Baseline Referrals Number of Referrals - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,263 1,482 1,593 1,661 1,890 2,128 2,048 2,125 2,193 2,261 2,323 2,382 2,435 Great Western Hospitals NHS Foundation Trust 755 852 884 1,044 1,278 1,321 1,325 1,374 1,420 1,461 1,500 1,536 1,571 Milton Keynes Hospital NHS Foundation Trust 691 609 688 667 739 854 792 813 832 850 868 885 901 Oxford University Hospitals NHS Trust 1,345 1,437 1,762 2,173 2,365 2,566 2,535 2,636 2,730 2,815 2,893 2,967 3,035 Royal Berkshire NHS Foundation Trust 907 1,082 1,203 1,209 1,566 1,931 1,728 1,802 1,873 1,936 1,994 2,048 2,099 Wexham Park Hospital 705 772 899 1,006 1,283 1,347 1,361 1,427 1,484 1,537 1,590 1,638 1,684 Total 5,666 6,234 7,029 7,760 9,121 10,147 9,789 10,177 10,532 10,861 11,167 11,456 11,725

Actual Projected

Change between

2014 and 2021: 16%

-

500

1,000

1,500

2,000

2,500

3,000

3,500

20

09

20

10

20

11

20

12

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13

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21








Modelling Results: Urology, Scenario 3 Referrals Number of Referrals - Scenario 3

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,263 1,482 1,593 1,661 1,890 2,128 2,048 2,165 2,275 2,389 2,497 2,605 2,664 Great Western Hospitals NHS Foundation Trust 755 852 884 1,044 1,278 1,321 1,325 1,399 1,470 1,540 1,607 1,674 1,712 Milton Keynes Hospital NHS Foundation Trust 691 609 688 667 739 854 792 828 864 899 935 970 988 Oxford University Hospitals NHS Trust 1,345 1,437 1,762 2,173 2,365 2,566 2,535 2,682 2,825 2,963 3,095 3,227 3,301 Royal Berkshire NHS Foundation Trust 907 1,082 1,203 1,209 1,566 1,931 1,728 1,835 1,942 2,043 2,141 2,238 2,293 Wexham Park Hospital 705 772 899 1,006 1,283 1,347 1,361 1,452 1,536 1,618 1,701 1,782 1,833 Total 5,666 6,234 7,029 7,760 9,121 10,147 9,789 10,361 10,913 11,452 11,978 12,496 12,791

Actual Projected

Total Change by 2021 -

Baseline to Scenario 3: 9%

Change between

2014 and 2021: 26%

-

500

1,000

1,500

2,000

2,500

3,000

3,500

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

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20

17

20

18

20

19

20

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20

21








Modelling Results: Urology, Baseline Tests Number of Tests - Baseline

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Buckinghamshire Healthcare NHS Trust 1,725 2,025 2,176 2,269 2,582 2,907 2,798 2,904 2,997 3,090 3,173 3,254 3,326

Great Western Hospitals NHS Foundation Trust 1,031 1,164 1,208 1,426 1,746 1,805 1,810 1,878 1,940 1,997 2,049 2,099 2,146

Milton Keynes Hospital NHS Foundation Trust 944 832 940 911 1,010 1,167 1,082 1,110 1,137 1,162 1,186 1,209 1,232

Oxford University Hospitals NHS Trust 1,837 1,963 2,407 2,969 3,231 3,506 3,463 3,601 3,730 3,846 3,952 4,053 4,146

Royal Berkshire NHS Foundation Trust 1,239 1,478 1,643 1,652 2,139 2,638 2,361 2,462 2,559 2,645 2,724 2,798 2,867

Wexham Park Hospital 963 1,055 1,228 1,374 1,753 1,840 1,859 1,949 2,027 2,100 2,172 2,237 2,301

Total 7,741 8,517 9,603 10,601 12,461 13,862 13,374 13,903 14,389 14,838 15,256 15,650 16,018

Estimated Projected


Modelling Results: Urology, Scenario 3 Tests Number of Tests - Scenario 3

Trust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,725 2,025 2,176 2,269 2,582 2,907 2,798 2,958 3,109 3,263 3,411 3,559 3,639 Great Western Hospitals NHS Foundation Trust 1,031 1,164 1,208 1,426 1,746 1,805 1,810 1,911 2,009 2,104 2,196 2,287 2,339 Milton Keynes Hospital NHS Foundation Trust 944 832 940 911 1,010 1,167 1,082 1,131 1,181 1,229 1,277 1,325 1,350 Oxford University Hospitals NHS Trust 1,837 1,963 2,407 2,969 3,231 3,506 3,463 3,664 3,860 4,047 4,229 4,409 4,510 Royal Berkshire NHS Foundation Trust 1,239 1,478 1,643 1,652 2,139 2,638 2,361 2,507 2,653 2,791 2,925 3,057 3,132 Wexham Park Hospital 963 1,055 1,228 1,374 1,753 1,840 1,859 1,983 2,098 2,211 2,324 2,434 2,504 Total 7,741 8,517 9,603 10,601 12,461 13,862 13,374 14,154 14,909 15,645 16,363 17,072 17,474

Estimated Projected

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

20

19

20

20

20

21








Modelling Results: Gynae, Baseline Referrals

Change between

2014 and 2021: 10%

Number of Referrals - BaselineTrust 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Buckinghamshire Healthcare NHS Trust 1,733 1,610 1,446 1,664 2,272 2,275 2,127 2,190 2,246 2,302 2,353 2,402 2,446 Great Western Hospitals NHS Foundation Trust 1,204 1,324 1,398 1,500 1,713 1,778 1,784 1,833 1,879 1,922 1,960 1,998 2,033 Milton Keynes Hospital NHS Foundation Trust 1,332 1,283 1,334 1,494 1,688 1,902 1,776 1,837 1,895 1,948 2,000 2,048 2,096 Oxford University Hospitals NHS Trust 2,344 2,286 2,120 2,658 4,262 3,730 3,688 3,820 3,943 4,054 4,155 4,253 4,341 Royal Berkshire NHS Foundation Trust 1,735 1,682 1,857 2,002 2,272 2,978 2,563 2,653 2,741 2,819 2,891 2,958 3,021 Wexham Park Hospital 2,066 1,971 2,182 2,303 2,446 2,693 2,618 2,689 2,748 2,806 2,864 2,917 2,970 Total 10,414 10,156 10,337 11,621 14,653 15,356 14,557 15,023 15,453 15,851 16,224 16,576 16,907

Actual Projected

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000








Modelling Results: Gynae, Scenario 3 Referrals Number of Referrals - Scenario 3


Actual Projected

Total Change by

2021 - Baseline to

Scenario 3: 0%

Change between

2014 and 2021: 10%

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000








Modelling Results: Gynae, Baseline Tests Number of Tests - Baseline


Estimated Projected

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000








Modelling Results: Gynae, Scenario 3 Tests Number of Tests - Scenario 3


Estimated Projected

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000








Modelling Results: A view of tests - baseline Number of tests – top 10 by volume (in 2021)

Estimated and Projected Number of Tests: All 5 Specialties Baseline

All Thames Valley 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Hysteroscopy 8,837 8,618 8,772 9,861 12,434 13,031 12,353 12,748 13,113 13,451 13,767 14,066 14,347

Colonoscopy 5,728 7,088 8,553 9,747 9,425 10,741 10,726 11,153 11,596 12,018 12,424 12,817 13,095

CT Scan 5,978 6,655 7,505 8,609 8,871 10,222 9,826 10,230 10,627 11,006 11,369 11,722 11,972

Cystoscopy 3,631 3,994 4,504 4,972 5,844 6,502 6,273 6,580 6,871 7,149 7,415 7,674 7,854

Ultrasound 4,464 4,452 4,623 5,184 6,433 6,831 6,497 6,727 6,942 7,142 7,331 7,510 7,666

Other 2,930 3,303 3,746 4,236 4,603 5,192 5,041 5,257 5,468 5,667 5,859 6,044 6,179

OGD 3,222 3,401 3,473 4,207 4,455 5,379 5,016 5,193 5,355 5,506 5,647 5,779 5,903

MRI Scan 2,777 2,989 3,282 3,703 4,228 4,703 4,519 4,707 4,887 5,057 5,219 5,376 5,494

Ultrasound - Transvaginal 1,421 1,386 1,410 1,586 1,999 2,095 1,986 2,050 2,108 2,163 2,214 2,262 2,307

Flexi-Sigmoidoscopy 696 861 1,039 1,184 1,145 1,305 1,303 1,355 1,409 1,460 1,510 1,557 1,591


Modelling Results: A view of tests – Scenario 3 Number of tests – top 10 by volume (in 2021)

Estimated and Projected Number of Tests: All 5 Specialties Scenario 3

All Thames Valley 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Hysteroscopy 8,837 8,618 8,772 9,861 12,434 13,031 12,353 12,748 13,113 13,451 13,767 14,066 14,347

Colonoscopy 5,728 7,088 8,553 9,747 9,425 10,741 10,726 11,330 11,963 12,587 13,205 13,820 14,122

CT Scan 5,978 6,655 7,505 8,609 8,871 10,222 9,826 10,323 10,820 11,304 11,779 12,248 12,510

Cystoscopy 3,631 3,994 4,504 4,972 5,844 6,502 6,273 6,639 6,993 7,338 7,675 8,007 8,196

Ultrasound 4,464 4,452 4,623 5,184 6,433 6,831 6,497 6,740 6,967 7,181 7,385 7,580 7,737

Other 2,930 3,303 3,746 4,236 4,603 5,192 5,041 5,308 5,573 5,831 6,083 6,332 6,474

OGD 3,222 3,401 3,473 4,207 4,455 5,379 5,016 5,193 5,355 5,506 5,647 5,779 5,903

MRI Scan 2,777 2,989 3,282 3,703 4,228 4,703 4,519 4,739 4,952 5,159 5,359 5,555 5,678

Ultrasound - Transvaginal 1,421 1,386 1,410 1,586 1,999 2,095 1,986 2,050 2,108 2,163 2,214 2,262 2,307

Flexi-Sigmoidoscopy 696 861 1,039 1,184 1,145 1,305 1,303 1,377 1,454 1,529 1,604 1,679 1,716


Any Questions?

www.england.nhs.uk

Yay!

69

Lunch


Outputs: Individual Trust Data

Mini Reports

www.england.nhs.uk

• Quality of referrals from primary care

• Primary care carrying out all available direct access testing?

• Difficult to keep within targets if a tertiary centre involved

• Patient choice is a significant reason for breach

• Sequential diagnostics pathway rather than parallel

71

Qualitative data: Cancer managers

www.england.nhs.uk

• Pathology requests increasing year on year

• Trend of more complex drugs and tailored treatment which typically all need a new test

• Service not always included in planning

• Workforce recruitment and retention – national issue

• Local solutions include outsourcing of routine samples, overtime, agency staff, incentivising posts, but no solution is sustainable

72

Qualitative Feedback: Pathology

www.england.nhs.uk

• Increasing complexity of tests

• Recruitment and retention at all levels – national issue

• Local solutions, outsourcing, agency staff, shift work, extending working day (7 days 8am-8pm)

• Capital equipment overdue for replacement – localise

• Always playing ‘catch up’ - unsustainable

73

Qualitative Feedback: Radiology

www.england.nhs.uk

• Lung – PET scans, direct access results from CT and

chest x-ray from GP, complex work up and late stage

presentation

• Gynae – direct access hysteroscopy, CA125 result

from GP, hysteroscopy capacity generally, staffing

• Colorectal – Patients unprepared for procedure, lack

of nurse endoscopists, single sex clinics

• Upper GI – complex work up, tertiary centre involved

and late stage presentation

• Urology – Primary care don’t always undertake

baseline investigations, single sex clinics, thinking

time for treatment options and complex range of tests.

74

Qualitative Feedback: Specialty

www.england.nhs.uk

• Thames Valley 14% increase in referrals between 2014 and 2021

• Diagnostics are becoming more numerous, complex and time consuming per referral

• Currently no one meeting 28 day referral to confirmed diagnosis - range 0-60%

• Overall radiology and pathology services are unsustainable in the long term

o workforce,

o year on year cut to budgets,

o diagnostics not included in service planning,

o equipment falling over.

75

Highlights….

www.england.nhs.uk

‘Essentially all models are

wrong but some are useful.’

George Box

76

www.england.nhs.uk

• Go through reports – is there anything you don’t know

already?

• Use excel spreadsheet we will send to you to identify

figures most important to your organisation

• Fine tune the model – use our methodology and

referral information in the report with your own

diagnostic data

• Feedback comments if there is anything wrong or that

you want to add to [email protected]

• Come and talk to us….

77

Using what we’ve done

mailto:[email protected]

cancer diagnostic demand & capacity workshop · data gathering - quantitative data from trusts...

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