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

[email protected]

[email protected]

mailto:[email protected]

mailto:[email protected]

1


Date: 07.12.15

Time: 2:00 – 4:00pm




Susan Baxter, Northumbria SB











Apologies: Penny Williams, Research Delivery Manager, NIHR PW



MINUTES





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.


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


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


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

http://www.nescn.nhs.uk/

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


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


Tuesday 5 January 2016, 2.00pm.



3.3 Next meeting

1 February 2016 2:00pm – 4:00pm at Evolve






4. MEETING CLOSE

1


Date: 05/10/15

Time: 2:00 – 4:00pm










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


LW welcomed the group, introductions were made and apologies were noted.


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/


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.


None

2. AGENDA ITEMS


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.


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


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


Jayne Blinco, OSM Cancer Services, North Cumbria JBl


Sarah Danieli, Deputy Director of Performance Mgt, South Tees SD

Fiona Brown, Cancer Implementation Officer, South Tees FB


Chris Callan, Delivery Manager, NHS England CC


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



AF welcomed the group, introductions were made and apologies were noted.


Minutes were recorded as accurate from the previous meeting.

1.3 Matters Arising

All items arising were discussed on the agenda.


None

2. AGENDA ITEMS


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


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

Alewis

Typewritten Text

Alewis

Typewritten Text

Alewis

Typewritten Text

Enc 1

Alewis

Typewritten Text

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


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

https://www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf

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


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









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




1.2 Minutes of the previous meeting 07.12.15

The minutes were agreed as an accurate record. Enc 1


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


None

3.2 Dates for Future Meetings

Webex



4

Face to Face Meetings







4. MEETING CLOSE

National Cancer Breach Allocation Summit

10 December 2015 - London

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

Cancer

Breach

Allocation

Summit

Sean Duffy

NCD for Cancer

December 2015

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 ELEPHANT IN THE ROOM

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

Guy’s and St Thomas’ NHS Foundation

Trust

Dr Maj Kazmi, Clinical Lead

National Cancer Breach Reallocation Summit

Dr Majid Kazmi

10th December 2015

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.

Day 28

SMDM

Day

21 Day

7

Proposed option for sustaining waiting Times

Achieving World class cancer outcomes

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

Thank You

Leeds Teaching Hospitals NHS Trust

Clare Smith, Assistant Director of Operations


Clare Smith

Assistant Director of Operations,

Leeds Teaching Hospitals NHS Trust


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


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



• 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



• 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


• 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


• 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

http://www.rbht.nhs.uk/

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

Roger Spencer, CEO, The Christie NHS FT

The Christie NHS

Foundation Trust

Breach allocation

Greater Manchester

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

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

Day 38 / 42 reallocation rules

The Christie NHS

Foundation Trust

Cancer Network 62 day performance

2011/12 to date

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

Patient improvement

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

Following slides for

information purposes

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


Performance

Trafford 3 43 46 93.5%

Tameside 10 103 113 91.2%

Salford Royal 12 121.5 133.5 91.0%


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%


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


Performance


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%


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


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%

Thank you

1


Date: 07.12.15

Time: 2:00 – 4:00pm















Apologies: Penny Williams, Research Delivery Manager, NIHR PW



MINUTES





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


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.


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


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


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

http://www.nescn.nhs.uk/

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


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


Tuesday 5 January 2016, 2.00pm.



3.3 Next meeting







4. MEETING CLOSE

1


Date: 05/10/15

Time: 2:00 – 4:00pm










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


MINUTES

1. INTRODUCTION Action Enc


LW welcomed the group, introductions were made and apologies were noted.


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.



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.


None

2. AGENDA ITEMS


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
