hywel dda health board cancer annual report 2012/13 annual report 20… · hywel dda health board...

Hywel Dda Health Board Cancer Annual Report

2012/13

October 2013


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CONTENTS

INTRODUCTION ...............................................................................................................2

NOTE REGARDING INTERPRETATION OF DATA AND INFORMATION CONTAINED WITHIN THIS DOCUMENT ...............................................................................................3

1 CANCER IN HYWEL DDA; 2012/13 SUMMARY .....................................................4 1.1 During 2012/13: ................................................................................................4 1.2 In 2013/14, we must:.........................................................................................4

2 THE CANCER CHALLENGE IN HYWEL DDA HEALTH BOARD...........................5 2.1 Incidence of cancer is increasing ......................................................................5 2.2 Mortality from cancer is decreasing ..................................................................5 2.3 Survival following cancer is improving ..............................................................6

3 OUR APPROACH TO TACKLING CANCER ...........................................................7

4 PREVENTING CANCER...........................................................................................8 4.1 Preventing Cancer ............................................................................................8 4.2 Health and Lifestyle ..........................................................................................8

5 DETECTING CANCER QUICKLY ..........................................................................10 5.1 Screening........................................................................................................10 5.2 Early Diagnosis ...............................................................................................12

6 DELIVERING FAST, EFFECTIVE TREATMENT AND CARE................................13 6.1 Referrals to Our Service .................................................................................13 6.2 Patients Diagnosed with Cancer .....................................................................13 6.3 Patients Treated..............................................................................................13 6.4 Access and cancer waiting times....................................................................14 6.5 National Cancer Standards.............................................................................15 6.6 Progress in 2012/13........................................................................................15

7 MEETING PEOPLE’S NEEDS................................................................................16 7.1 Meeting People’s Needs .................................................................................16 7.2 Key Workers ...................................................................................................16 7.3 Care Plans ......................................................................................................16 7.4 Patients Reviewed in Primary Care within 6 months of Cancer Diagnosis .....17 7.5 Progress in 2012/13........................................................................................17

8 CARING AT THE END OF LIFE .............................................................................17

9 IMPROVING INFORMATION..................................................................................18 9.1 Progress in 2012/13........................................................................................18

10 TARGETING RESEARCH ......................................................................................18 10.1 Develop cutting edge cancer services ............................................................19 10.2 Progress in 2012/13........................................................................................19

REFERENCES: ...............................................................................................................20


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INTRODUCTION

This is the second annual report of cancer services in Hywel Dda and presents updated information against a range of indicators that can be used as actual and proxy indicators of change in service.

As with last year’s report, we present our progress against the key indicators and the priority areas identified in the National Cancer Plan. We are pleased to be able to present more information this year on the referrals received, diagnosis and treatments provided, by our services in 2012/13.

In July 2013 we published our interim Cancer Delivery Plan which reflected a number of developments in the Health Board including completion of the clinical strategy consultation and launch of the Population Health Groups. These developments will be incorporated into the full delivery plan to be published in late Autumn.

Signed

Trevor Purt

Chief Executive


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NOTE REGARDING INTERPRETATION OF DATA AND INFORMATION CONTAINED WITHIN THIS DOCUMENT

Some information presented in this document is based upon relatively small numbers which can be volatile.

Caution must be taken when interpreting any change from one year to another as being better or worse because the change might not be significant. Readers are encouraged to look at the general direction over a longer period of time which will give a better indication of progress.


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1 CANCER IN HYWEL DDA; 2012/13 SUMMARY

1.1 During 2012/13:

• Incidence of cancer fell

• Deaths due to cancer increased slightly

• Survival after diagnosis increased

• The proportion of people who smoked reduced, and is less than for Wales

• The proportion of people who are physically active reduced, but is more than for Wales

• The proportion people who are obese increased and is more than for Wales

• Rates of access to screening remained steady

• The recording of Stage of Cancer at Diagnosis improved

• 6,700 patients were seen in outpatients on an urgent suspected cancer pathway

• 2,660 patients were diagnosed with cancer

• 2,298 patients commenced treatment for cancer (an increase of 5% on the previous year)

• 97.4% of patients on the 31 day “non-urgent” pathway target were seen in time (narrowly missing the 98% target).

• 83.62% of patients referred on the “urgent suspected cancer” pathway were treated in time (against the 95% target)

• Performance against the National Cancer Standards improved

• A single Hywel Dda colorectal MDT was established and a single gynaecology cancer MDT has been agreed.

• The number of cancer patients reviewed in primary care within 6 months of diagnosis increased.

• Recruitment to Cancer trials increased

• Donations to the Welsh Cancer Bank increased

1.2 In 2013/14, we must:

• Continue to target and tackle the causes of poor health

• Promote and improve access to screening services

• Work towards recording 90% of the stage of cancer at diagnosis

• Meet the 31 day non-urgent cancer pathway target

• Meet the 62 day urgent suspected cancer pathway target

• Improve Performance against the National Cancer Standards

• Complete the MDT integration programme and ensure MDTs have the support of all core professionals at every meeting

• Ensure every Cancer patient has access to the support of a Clinical Nurse Specialist at the point of diagnosis as their initial key worker

• Participate in Peer Review and deliver the required improvements

• Support access to clinical trials and donations to the Welsh Cancer Bank


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2 THE CANCER CHALLENGE IN HYWEL DDA HEALTH BOARD

2.1 Incidence of cancer is increasing

Figure 1 – CANCER INCIDENCE IN WALES - All malignancies exc. non melanoma skin cancer, European Age Standardised Rate/100,000 population Males / femalesi.

360

370

380

390

400

410

420

430

440

Year

Eu

rop

ea

n A

ge

Sta

nd

ard

ise

d R

ate

s p

er

10

0,0

00

Po

pu

lati

on

Hywel Dda 367 414 396 396 398 389 385 385 423 404 393 405 416 388 387 412 396

All Wales 394 390 396 389 405 405 407 406 413 421 413 426 424 428 417 423 417

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Although the incidence of cancer is increasing within Hywel Dda, it is increasing by less than the rest of Wales. Almost universally, incidence of cancer within Hywel Dda is less than for the rest of Wales although this difference is not very significant except for lung cancer.

2.2 Mortality from cancer is decreasing

Figure 2: CANCER MORTALITY; All malignancies exc. non melanoma skin cancer, European Age Standardised Rate/100,000 population. Males/ females under 75ii

80

90

100

110

120

130

140

150

160

Year

Eu

rop

ean

Ag

e S

tan

da

rdis

ed

Ra

tes p

er

10

0,0

00

Po

pu

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on

Hywel Dda 137 137 127 135 130 120 129 127 122 114 116 108 121 117 109 105 106

All Wales 149 144 141 142 138 132 132 131 125 125 123 124 125 120 116 113 111

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


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The rate of people who die from cancer has been historically lower than Wales and has reduced in line with Wales.

2.3 Survival following cancer is improving

Figure 3 - CANCER SURVIVAL, All Wales One year relative Survival - All malignancies excluding non melanoma skin canceriii

Cancer Survival: One Year Relative

50.00

55.00

60.00

65.00

70.00

75.00

Period

Su

rviv

al

Ra

te

Hywel Dda 59.09 60.11 60.32 60.84 61.71 62.62 62.94 63.33 64.43 65.15 65.91 66.65 67.95 68.23 69.03 69.59

All Wales 56.66 57.16 57.47 58.33 59.42 60.42 61.44 62.57 63.80 64.67 65.67 66.42 67.20 67.89 68.65 69.36

91-95 92-96 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06 03-07 04-08 05-09 06-10

Figure 4 – CANCER SURVIVAL IN WALES, 1991-2006. All Wales Five year relative Survival - All malignancies excluding non melanoma skin canceriv

Cancer Survival: Five Year Relative

35.00

40.00

45.00

50.00

55.00

Period

Su

rviv

al

Ra

te

Hywel Dda 41.88 43.30 44.13 44.34 45.32 46.22 46.52 46.87 48.15 49.18 50.03 51.28

All Wales 40.35 41.05 41.46 42.40 43.57 44.56 45.67 47.04 48.43 49.40 50.41 51.5

91-95 92-96 93-97 94-98 95-99 96-00 97-01 98-02 99-03 00-04 01-05 02-06

Survival after cancer has improved over the time period and is comparable with Wales.


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Incidence of cancer is lower in Hywel Dda than in Wales, but the prevalence of cancer within Hywel Dda is higher than Wales with proportionately more people living after a cancer diagnosis within Hywel Dda then in Wales as a whole. This is a particular case for breast, prostate and colorectal cancers. The principle issue for Hywel Dda, therefore, is the on-going support, screening and the further treatments that will be required due to survivorship.

3 OUR APPROACH TO TACKLING CANCER

In June 2012, the Welsh Government published “Together for Health – a Cancer Delivery Plan”. It provides a framework for action for Local Health Boards (LHB) and NHS Trusts. It sets out the Welsh Government’s expectations of the NHS in Wales to tackle cancer in people of all ages, wherever they live in Wales and whatever their circumstances. The Plan is designed to enable the NHS to deliver on their responsibility to meet the needs of people at risk of cancer or affected by cancer.

This second annual report updates the information provided in the first to chart progress against actual and proxy indicators of improvement and provides a narrative on what we have done in the year to improve cancer services.

The themes within the report map to those in the National Cancer Action Plan:

• Preventing cancer - People live a healthy lifestyle, make healthy choices and minimise risk of cancer.

• Detecting cancer quickly - Cancer is detected quickly where it does occur or recur.

• Delivering fast, effective treatment and care - People receive fast, effective treatment and care so they have the best chance of cure.

• Meeting People’s Needs - People are placed at the heart of cancer care with their individual needs identified and met so they feel well supported and informed, able to manage the effects of cancer.

• Caring at the End of Life - People approaching the end of life feel well cared for and pain and symptom free.

• Improving Information - Improving our intelligence about our cancer services and empowering patients during and after cancer

• Targeting Research - Promoting access to new treatments and services.


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4 PREVENTING CANCER

4.1 Preventing Cancer

Overall health is improving and our population is getting older. However many people in our region suffer from poor health. Obesity is widespread across Wales and rates of smoking, drinking and substance misuse continue to cause concern. Cancer Research UK suggests that these root causes of poor health may be responsible for 40% of all cancer cases.

4.2 Health and Lifestyle

4.2.1 Smoking

Figure 5 - Percentage of adults who reported smoking daily or occasionally Wales, age standardised, 2003/04 -2010/11 v

Reported Adult Smoking

20.0%

21.0%

22.0%

23.0%

24.0%

25.0%

26.0%

27.0%

28.0%

29.0%

30.0%

Period

%

Hywel Dda 27.0% 24.7% 22.8% 22.2% 22.7% 22.9% 22.5%

All Wales 27.1% 26.6% 24.8% 23.8% 23.8% 23.5% 22.9%

2003/4-04/5 2004/5-05/6 2005/6-2007 2007-2008 2008-2009 2009-2010 2010-2011

4.2.2 Physical Activity

Figure 6 – Adults who reported being physically active on 5 or more days a week*, age-standardised (per cent)vi *Did at least 30 minutes of at least moderate intensity physical activity on 5 or more days the previous week. (Prior to 2011 this was the target activity level for meeting physical activity guidelines, but guidelines were revised during 2011 to allow more flexibility in how target activity levels are met).


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Physically Active Adults (more than 5 days in previous week)

25.0%

26.0%

27.0%

28.0%

29.0%

30.0%

31.0%

32.0%

33.0%

34.0%

35.0%

Period

%

Hywel Dda 32.8% 33.2% 32.4% 32.3% 32.8% 32.6% 32.2%

All Wales 29.0% 30.3% 30.4% 29.7% 29.5% 29.6% 29.6%

2003/4-04/5 2004/5-05/6 2005/6-2007 2007-2008 2008-2009 2009-2010 2010-2011

4.2.3 Obesity

Figure 7 – Adults who were obese, age-standardised (per cent)vii

Obesity

15.0%

16.0%

17.0%

18.0%

19.0%

20.0%

21.0%

22.0%

23.0%

24.0%

25.0%

Period

Ag

e S

tan

da

rdis

ed

%

Hywel Dda 17.6% 18.2% 20.2% 20.1% 21.6% 21.7% 22.1%

All Wales 17.9% 18.7% 20.0% 20.7% 21.1% 21.5% 21.9%

2003/4-04/5 2004/5-05/6 2005/6-2007 2007-2008 2008-2009 2009-2010 2010-2011

Overall, Hywel Dda compares well against Wales in all indicators except obesity. However there is more to do in key health promotion areas and we are working closely with local government, Public Health Wales NHS Trust, GPs, pharmacists, dentists, opticians, the Third Sector to tackle these root causes of poor health as part of the Foundations for Change programme.


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5 DETECTING CANCER QUICKLY

Rapid diagnosis and treatment of cancer improves not only survival, but also the quality of life of survivors and can contribute to reducing longer term care needs.

5.1 Screening Figure 8 – Percentage uptake to the breast, cervical and bowel cancer screening programmes by LHB viii

Screening and Prevention Programmes Uptake/Coverage

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Programme / Area

Ra

te

2009/10 57.20% 55.30% 76.70% 74.00% 74.90% 76.20% 78.90% 79.50% 85.4% 85.3%

2010/11 54.70% 53.00% 77.10% 74.70% 74.60% 76.20% 78.60% 79.50% 77.7% 81.6%

2011/12 52.80% 51.10% 75.70% 73.50% 74.10% 76.30% 78.10% 79.60% 84.6% 85.5%

2012/13 85.5% 86.6%

Hywel Dda Wales Hywel Dda Wales Hywel Dda Wales Hywel Dda Wales Hywel Dda Wales

Bowel screening Breast screening aged

50 - 70

Cervical screening

aged 20-64

Cervical screening

aged 25 - 64

Human Papilloma

Virus (HPV) vaccine

Public Health Wales report thatix:

5.1.1 Breast Screening Table 1: Uptake of Breast Screening of eligible women aged 50-70 years for Wales; Hywel Dda HB and unitary authority areas for period 1 April 2011-31 March 2012. Data from Screening Division. Indicator Wales HDd Carms Cered Pembs

Percentage 73.5% 75.7% 29.7% 76.5% 81.0% No. tested 74,332 6,098 92 4,472 1,534

Overall the uptake for breast screening for the period April 2011 to March 2012 for the population of Hywel Dda was 75.7% which met the minimum uptake standard. The uptake for the previous year was slightly higher at 77.1%.

As breast screening is on a three year cycle then a one year period will show some variation as only a proportion of women may be invited from a defined geographical area. This is the case for Carmarthenshire as the number of women tested is low and therefore the uptake is not representative.

There are no local issues of concern reported.


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5.1.2 Cervical Screening:

Table 2: Coverage of Cervical Screening (adequate smear test in previous five years) of eligible women aged 20 to 64 years for Wales; Hywel Dda HB and unitary authority areas for period 1 April 2011-31 March 2012.

Data from Screening Division. Indicator Wales HDd Carms Cered Pembs

Percentage 76.3% 74.1% 75.9% 67.5% 75.8% No. tested 640,156 73,938 36,017 14,039 23,882

For the cohort aged 20-64 years the coverage was 74.1% for the Health Board overall which missed the target of 80%. The coverage for the health board was virtually unchanged from the previous year (74.6%).

For the cohort aged 25-64 years the coverage is better with the health board overall achieving 78.1% (slightly down on last year 78.6%). Following consultation, the age of the first invitation to screening will be raised to 25 in 2013.

Access to cervical screening has been audited with a recommendation to improve access providing additional access points to the service (other than the patient’s GP). It has been recommended that extended provision should be included in Hywel Dda’s plan for the provision of sexual health Care.

5.1.3 Bowel Screening:

Screening is undertaken at three sites:

• Carmarthen: 3 Screening Colonoscopists (SC)and 2 Specialist Screening Practitioners (SSP)

• Bronglais: 1 SC and 1 SSP with cover provided from Withybush. The Unit is JAG accredited.

• Withybush: 1 SC and 1 SSP.

Table 3: Uptake of Bowel Screening of eligible men and women aged 60-74 years for Wales; Hywel Dda HB and unitary authority areas for period 1 April 2011-31 March 2012. Data from Screening Division. Population Wales HDd Carms Cered Pembs

Percentage 51.1% 52.8% 53.4% 52.5% 52.0% No. tested 137,366 19,980 9,572 3,889 6,519

The uptake at 52.8% is lower than the target uptake of 60%. Uptake has reduced from the previous year’s level of 54.7% for the Health Board. There has been a reduction in uptake across Wales in the same period.

Work is being undertaken by the Public Health Wales to identify the causes for the low level of uptake. The test is posted to the person’s home so access does not explain the findings.

Expansion of the programme is planned for the 50-59 age group, but as yet it has not been approved and there would be a need to map surgical capacity understand the impact upon services.


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The evaluation of the pilot to establish a pathway for referral of complex polyps to the specialist centre for therapeutic endoscopy is underway.

The Carmarthen Endoscopy Unit is being assessed for JAG accreditation which is expected in Autumn 2013. The Withybush unit is not yet JAG accredited.

5.2 Early Diagnosis

More advanced cancers usually have poorer prognosis than those which are diagnosed early and it is, therefore, important that patients present and are referred early so that they can be offered the greatest range of options for treatment. How far a cancer has advanced is referred to as its “Stage”, a higher stage meaning that a cancer is more advanced.

Figure 9 – Percentage of people whose cancer is diagnosed at each stage All Wales Stage Grouping new diagnosed patientsx

Stage of Cancer at Diagnosis

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Year / Stage of Cancer

Hywel Dda 40.71% 11.92% 17.01% 13.59% 16.77% 31.95% 13.84% 19.36% 16.30% 18.54%

Wales 41.66% 11.51% 14.56% 13.80% 18.47% 26.23% 15.71% 19.54% 17.55% 20.98%

Not RecordedStage 1 Stage 2 Stage 3 Stage 4 Not RecordedStage 1 Stage 2 Stage 3 Stage 4

2012 2013

The Health Board is aiming to record 90% of all cancer stages on the national Cancer Information System by 1 April 2014. Significant progress has been made over the past year in reducing the number of unrecorded cancer stage we are working with MDT leads and cancer co-ordination teams to ensure that this improvement continues.


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6 DELIVERING FAST, EFFECTIVE TREATMENT AND CARE

6.1 Referrals to Our Service

During 2012/13, over 5,000 referrals prioritised by the referrer as Urgent Suspected Cancer (USC) were made to our services.

Of these:

• 3,261 were confirmed by the consultant as having symptoms described that met the criteria for being seen on the USC pathway

• 1,885 were downgraded by the consultant to another priority and.

In addition, another 3,532 referrals to our consultants were upgraded by our consultants to be seen on the USC pathway.

6.2 Patients Diagnosed with Cancer

During 2012, 2,660 patients were diagnosed with cancer (excluding diagnosis of non-melanoma skin cancer and certain cancers “in-situ”).

The five most commonly diagnosed cancers (breast, lung, colorectal, skin and urology) accounted for 73% of all cancer diagnoses.

6.3 Patients Treated

During 2012/13, 2,298 patients started their agreed treatment for cancer.

This number is not directly comparable to those showing patients diagnosed because they have different criteria.

Of the 2,298 patients treated:

• 788 were treated on the USC pathway. In 2012/13, 83.6% were treated within 62 days of referral against a target of 95%.

This was less than the all-Wales performance of 85.8% and was lower than in 2011/12 when we treated 89.6% of patients within target. The total number of patients treated in the year increased by 5%.

• 1,527 were treated having been identified via other routes, such as a routine outpatient referral, an incidental finding on an x-ray examination or an attendance at A&E with a symptom that is found to be caused by a cancer upon investigation.

These patients were treated on a Non-Urgent Suspected Cancer pathway. In 2012/13, we narrowly missed the national target treating 97.4% within 31 days of the patient and the consultant agreeing the treatment plan against a target of 98%. This was slightly below the all (all-Wales performance of 98.0%) and was comparable to 2011/12 which was 97.8%.


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6.4 Access and cancer waiting times

Our aim is to treat patients as efficiently and effectively as possible.

Figure 10 – Percentage of patients starting treatment within 31 days. Patients newly diagnosed not via the urgent suspected cancer route starting treatment - all Walesxi

31 Day Cancer Target = 98% For people not diagnosed via the urgent suspected cancer referral route

95.0%

95.5%

96.0%

96.5%

97.0%

97.5%

98.0%

98.5%

99.0%

99.5%

100.0%

Quarter Ending

Pe

rfo

rma

nc

e

Hywel Dda 99.1% 99.0% 98.7% 99.5% 99.0% 98.4% 95.5% 98.5% 98.8% 98.6% 97.4% 98.4% 96.7% 97.2%

All Wales 98.8% 98.3% 98.2% 99.0% 99.1% 98.7% 97.7% 99.0% 99.0% 98.8% 98.2% 98.2% 98.1% 97.4%

Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

Dec 09 Mar 10 Jun 10 Sep 10 Dec 10 Mar 11 Jun 11 Sep 11 Dec 11 Mar 12 Jun 12 Sep 13 Dec 13 Mar 13

Performance against the 31 day target has not historically been a challenge for Hywel Dda although it has reduced over the past 2 years.

Figure 11 – Percentage of patients starting treatment within 62 days. Patients newly diagnosed via the urgent suspected cancer route starting treatment - all Walesxii

62 Day Target = 95%For Patients Diagnosed via the Urgent Suspected Cancer Referral Route

80.0%

82.0%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Quarter Ending

Pe

rfo

rma

nc

e

Hywel Dda 95.8% 93.9% 91.8% 95.0% 91.5% 93.7% 88.0% 92.0% 89.1% 89.2% 86.7% 85.4% 81.0% 81.4%

All Wales 91.9% 91.0% 90.7% 93.5% 93.4% 90.8% 87.0% 89.4% 90.3% 89.8% 87.9% 85.9% 85.7% 83.6%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Dec 09 Mar 10 Jun 10 Sep 10 Dec 10 Mar 11 Jun 11 Sep 11 Dec 11 Mar 12 Jun 12 Sep 13 Dec 13 Mar 13


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Hywel Dda is currently facing significant challenges in sustainable attainment of the 62 day target which is significantly worse than for 2011/12 and is lowest performance since monitoring of the 62 day wait commenced. In response to this the Health Board has now further embedded cancer delivery into operational planning and is working closely with diagnostic services to streamline patients within the cancer pathway and is developing performance information for cancer teams.

In addition one stop clinics have been introduced and strengthened for suspected urology and lung cancer patients and development of a similar service is required for colorectal patients.

6.5 National Cancer Standards

In 2010, Hywel Dda Health Board put in place an organisational framework to improve compliance against the National Cancer Standards as reported via the September 2010 compliance processxiii:

Compliance Standard March 11 March 12 Generic Standards 100% 100%

Cancer Standard Pure 79.29% 86.38%

The majority of outstanding compliance issues are attributed to staffing support to MDTs and the Health Board is working to address these issues a considerable proportion of which will be resolved by MDT integration.

The Lung Peer Review was completed in March. The report was received in July 2013 and the action plan will be reported as part of the 2013/14 annual reporting process.

6.6 Progress in 2012/13

• Colorectal: The three colorectal MDTs integrated to form a single Hywel Dda MDT strengthening the clinical decision making

• Gynaecological: The three gynaecology clinical teams agreed to establish a single Hywel Dda wide MDT. This will be a key target for 2013/14 ensuring clinical pathways into specialist care in tertiary centres are consistent and accessed in a timely way.

• Lung: Following the peer review visit, the two Lung MDTs will merge in April 2013.

• Histopathology: Input to the Health Board wide MDTs is now assured.

• Head and Neck: A service model was agreed with funding for an additional consultant with interest in head and neck cancers.

• Urology: A one-stop prostate assessment clinic commenced for Carmarthenshire and Pembrokeshire patients.


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7 MEETING PEOPLE’S NEEDS

7.1 Meeting People’s Needs

We are committed to ensuring that all patients are cared for with dignity and respect and will ensure that services are planned and delivered around the patient and their individual needs

7.2 Key Workers

Clinical Nurse Specialist support is provided to 85% of our cancer services so that approximately 90% of cancer patients in Hywel Dda should have access to a key worker at the point of diagnosis.

Provisional results from the Welsh National Cancer Survey show that 85% of respondents were given the name of a Clinical Nurse Specialist (compared to 88% for all-Wales) who would manage their care. Only around 30% (32% all-Wales) of respondents, however, said that their nominated key worker was the Clinical Nurse Specialist with 22% (27% all-Wales) stating that their key worker was someone else and 49% (42% all-Wales) stating that they did not have a key worker or that they did not know if they had a key worker..

Because the reference period for the Cancer Survey was considerably longer than most patients’ acute treatment for cancer, it is highly likely that the key worker for a patient will change as they move along the cancer pathway. However, it is clear that more needs to be done to improve the profile of the Key Worker and ensure patients are given their contact details

The Health Board also needs to work to reduce variation in access across the area and we will ensure that the remaining gaps in acute key worker provision will be addressed in the Health Board’s response to Together Against Cancer. The rural nature of Hywel Dda leads to significant challenges in promoting key worker coverage back into communities and the Health Board is seeking solutions to this particular issue.

7.3 Care Plans

The national target is for every cancer patient to be provided with a care plan. The Health Board is therefore piloting the Macmillan Holistic Assessment and Care Plan toolkit with the establishment of Macmillan funded Clinical Nurse Specialists and will review the tool in 2013/14 with a view to rolling it out across the board.

Provisional results from the Welsh National Cancer Survey show that 45% of respondents were offered an opportunity to discuss their needs and concerns in order to put together a care plan (compared to 49% for all-Wales). However, only 18% of respondents reported being offered a written care plan (compared to 19% for all-Wales).


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7.4 Patients Reviewed in Primary Care within 6 months of Cancer Diagnosisxiv

Patients Reviewed in Primary Care Within 6 Months of Diagnosis

93.0%

93.2%

93.4%

93.6%

93.8%

94.0%

94.2%

Year

Hywel Dda 93.2% 94.1%

Wales 93.9% 93.7%

UK 93.9% 93.6%

2011 2012

We are committed to ensuring that all patients are cared for with dignity and respect and will ensure that services are planned and delivered around the patient and their individual needs


• The Macmillan Holistic Care Plan tool is being piloted by the Breast and Lung Teams in Pembrokeshire and the Lung Team in Ceredigion and Carmarthenshire.

• An additional Colorectal Clinical Nurse Specialist was recruited to support patients in Pembrokeshire.

• Funding for a Head and Neck Clinical Nurse Specialist was identified.

• The Health Board has actively participated in development of the Macmillan Practice Nurse Programme which is to be run in 2013/14.

8 CARING AT THE END OF LIFE

We will ensure that access to health and social care, support and symptom control will be the same wherever a patient dies. We do this through the close coordination of services across primary, community, social and hospital care and between statutory and Third Sector organisations

Hywel Dda provides 24/7 access to consultant support and 7 days a week access to specialist palliative care nursing support. End of life co-ordinators are currently provided in Carmarthenshire, but not in the other two counties and services have received positive feedback through the “iWantGreatCare” surveys.


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9 IMPROVING INFORMATION

People affected by cancer have significant information needs, not just in terms of their treatment but in terms of their financial and emotional needs. They consistently highlight the need to improve communications between themselves and all relevant agencies. Hywel Dda is committed to improving patient experience and information and will seek opportunities to develop this vital service.


• The Pembrokeshire and Ceredigion Macmillan Cancer Information Project agreements were signed off with a view to starting the project in 2013/14

10 TARGETING RESEARCH

The charts below set out the indicators which will be used to asses the level of performance relating to participation in research and development. Hywel Dda is committed to encouraging participation in clinical trials and the Welsh Cancer Bank and the cancer action plan will set out what needs to be done to achieve this.

Figure 12 - Percentage of patients recruited into high quality clinical researchxv

Recruitment to Cancer Trials

8%

10%

12%

14%

16%

18%

20%

Period

%

All Wales 13% 14% 14% 14% 19%

SW Network 9% 13% 11% 16% 19%

2008/09 2009/10 2010/11 2011/12 2012/13

There has been a significant improvement in the recruitment over the last 2 years reflecting the development of the clinical trials unit .

An additional research nurse was recruited to Carmarthenshire which has helped support the increase in recruitment to clinical trials compared with the previous year.

The Health Board will develop its partnership with ABMU to further increase the availability of trials, including radiotherapy trials, to Hywel Dda patients.


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10.1 Develop cutting edge cancer services

Figure 13 – Percentage of people diagnosed with cancer who consent to donate samplesxvi

Tissue Donations to Welsh Cancer Bank (*2012 Estimated Rate)

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Year

Ra

te o

f C

on

se

nt

(of

all

pe

op

le d

iag

no

se

d w

ith

Ca

nc

er)

Hywel Dda 9.1% 8.8% 9.0% 12.0% 16.6%

All Wales 4.3% 4.9% 5.6% 7.2% 10.6%

2008 2009 2010 2011 2012*

Extension of the cancer bank to Carmarthenshire in 2011/12 has helped increase donations to the cancer bank. However, care must be taken when interpreting the figures because the method by which the performance in calculated changed in 2012. Hywel Dda will continue to support the all-Wales Cancer Bank and support the nurses hosted within our organisation to achieve the national target for donation of 20%.


An additional cancer research nurse has been recruited to support recruitment to clinical trials in Carmarthenshire.


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REFERENCES:

i Source: Welsh Cancer Intelligence & Surveillance Unit June 2013 ii Source: CaNISC 2013 iii Source: Welsh Cancer Intelligence & Surveillance Unit June 2013 iv Source: Welsh Cancer Intelligence & Surveillance Unit June 2013 v Source: Welsh Health Survey http://wales.gov.uk/topics/statistics/theme/health/health-survey/?lang=en vi Source: Welsh Health Survey. http://wales.gov.uk/topics/statistics/theme/health/health-survey/?lang=en vii Source: Welsh Health Survey. http://wales.gov.uk/topics/statistics/theme/health/health-survey/?lang=en viii Public Health Wales ix Report on Population based National Screening Programmes in Hywel Dda Health Board; Dr Sharon Hillier; Deputy Director, Public Health Wales; February 2013 x Source CANISC – June 2013 xi Source: Welsh Government - Health Statistics and Analysis – June 2013 xii Source: Welsh Government - Health Statistics and Analysis - June 2013 xiii Hywel Dda LHB xiv QOF Database June 2013 xv i) The 2012/13 UKCRN recruitment data for this report was provided by the National Institute for Healthcare Research Clinical Research Network, using the 28th June 2013 UKCRN database snapshot. Reported UKCRN recruitment has been validated locally and corrected where appropriate - 34 corrections were required this year (from 207 rows of UKCRN activity data) and are noted on table 2. ii) Historic NISCHR Clinical Research Portfolio cancer trial recruitment information has been taken from published NISCHR CRC annual reports and is provided to allow analysis of trends in recruitment over the past four years. Reported non-NISCHR Clinical Research Portfolio study recruitment for years prior to 2011/12 included Local Investigator Led as well as Commercial study recruits. It has not been possible to distinguish between the Local Investigator Led and Commercial activity and so this data is not included. iii) 2012/13 incidence rates for All Wales have been calculated using the latest published WCISU All Wales cancer incidence rates (excluding skin cancers other than malignant melanoma), to smooth fluctuation in reported incidence a three year rolling average is used (using years 2008, 2009 and 2010 for 2012/13). iv) 2012/13 incidence for the three Cancer Research Networks is calculated by dividing the All Wales 2012/13 incidence in proportion to population served in each region. xvi Source: Wales Cancer Bank May 2013

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