Richard Watson, Chief Transformation Officer. Dr P Holloway, GP Clinical Lead for Cancer Lisa Parrish, Senior Transformation Lead

Transcription

1 GOVERNING BODY Agenda Item No. 08 Reference No. IESCCG Date. 23 January 2018 Title Lead Chief Officer Author(s) Purpose Cancer Services Update Richard Watson, Chief Transformation Officer Dr P Holloway, GP Clinical Lead for Cancer Lisa Parrish, Senior Transformation Lead To provide an update on current cancer performance. Applicable CCG Clinical Priorities: 1. To promote self care 2. To ensure high quality local services where possible 3. To improve the health of those most in need 4. To improve health & educational attainment for children & young people 5. To improve access to mental health services 6. To improve outcomes for patients with diabetes to above national averages 7. To improve care for frail elderly individuals 8. To allow patients to die with dignity & compassion & to choose their place of death 9. To ensure that the CCG operates within agreed budgets Action required by Governing Body: To note current cancer performance and endorse the programme of work outlined to implement the national cancer strategy within the CCG. Page 1 of 5

2 1. Background 1.1 Achieving World-Class Cancer Outcomes, A Strategy for England set the ambition to improve radically the outcomes for people affected by cancer. It outlines a series of initiatives across the patient pathway and emphasises the importance of earlier diagnosis and of living with and beyond cancer. 1.2 A vision of what cancer patients should expect from the health service is described: effective prevention; prompt and accurate diagnosis; informed choice and convenient care; access to the best effective treatments with minimal side effects; always knowing what is going on and why; holistic support; and the best possible quality of life. 1.3 The national strategy also recommended the establishment of Cancer Alliances in each region as the main vehicle for local service improvement in cancer services. The East of England Cancer Alliance has been designated by the National Cancer Team to cover 19 acute trusts, with a population of 6.3 million. The Alliance has a four year programme of work to improve cancer services through implementation of the 96 recommendations in the National Cancer Strategy. National cancer transformation funding of 200m has been ring fenced for two years for Cancer Alliances to deliver cancer transformation across STPs. 1.4 To support local delivery of the cancer transformation programme funding has been made available for clinical and programme management resource from East of England Cancer Alliance for the STP. These posts are being hosted by North East Essex CCG giving leadership and change management resource into the STP for the local delivery of cancer transformation. 1.5 Within the CCG a number of initiatives are in progress that support the delivery of the strategy. This work is led by the Ipswich and East Suffolk Cancer Locality Group and will be further enhanced by a number of transformation projects being co-ordinated by the Cancer Alliance particularly around early diagnosis. 2. Key Issues 2.1 Cancer performance Ipswich and East Suffolk s cancer performance is rated as good against the Improvement and Assessment Framework outcomes: Cancer Diagnosed at an early stage: 57.2% (target to get to next rating 60%) People with urgent GP referral having first treatment for cancer within 62 days of referral: 83.7% (target to get to next rating 85%) One year survival from all cancers: 68.2% (target to get to next rating 70.4%) Cancer patient experience: 8.7 (target to get to next rating to be assessed and agreed) Year to date CCG performance (April to October 17) for patients having their appointment within two weeks of referral is above the operating standard, this has not been the case for symptomatic breast referrals with current performance at 89.74% against the operating standard of 93%. Performance is also above the operating standard for patients receiving their first definitive treatment within one month of cancer diagnosis. However, performance for first definitive treatment for cancer within 62 days from urgent GP referral is currently below the operating standard of 85% at 80.81% (YTD) with performance in quarter 2 improving from quarter 1. Page 2 of 5

3 Like most providers Ipswich Hospital has had issues with sustaining cancer performance over the past 12 months. However, a red to green project was carried out in summer 2017 which helped to identify the issues affecting improvement of the 31 and 62 day targets and fed into a comprehensive cancer action plan. This work has been supported by the CCG with input at the Ipswich Hospital Cancer Services Development Group and the Planned Care Board. The CCG has worked alongside the Hospital team to assist in the development of straight to test pathways, the management of prostate cancer patients in primary care and the introduction of a two week wait referral card to ensure that patients are aware they have been referred to exclude cancer and need to ensure they do not cancel their appointment. In November 2017 the 62 day target and the 31 day target were both achieved as well as the two week wait standard. 2.2 Early diagnosis Prevention and early diagnosis are key strands of the local work with a number of related projects. The CCG is participating in a Public Health England led project to increase the number of 25 to 49 year old women who access cervical screening by targeting specific GP practices where screening rates are lower than expected and working alongside them to address the issues that are affecting access. The Suffolk Cancer Research UK Facilitator and Macmillan GP are involved in this project alongside their work with practices to help improve early diagnosis and the management of cancer patients within primary care. New NICE guidance for suspected cancer recognition and referral has been successfully embedded across the CCG with all referral forms amended to reflect the new guidance. Practice against the guidance has been audited by the GP Clinical Lead and found that referrals were compliant with the guidance. The Ipswich Macmillan Ipswich Diagnosis Assessment Service (MIDAS), is one of three pilot projects set up in partnership with the East of England Cancer Clinical Network and Macmillan. It is closely aligned to the national Accelerate, Coordinate, Evaluate (ACE) Multidisciplinary Diagnostic Centres Programme. The overall aim is to develop the shortest and safest route to cancer diagnosis for patients with non-specific, vague symptoms, through fast track access to diagnostic testing. Key objectives are to: 1. Provide a rapid route to diagnostics tests for patients with non-specific, vague symptoms which are of a concern to the GP; 2. Provide a more supportive route for patients to be seen to reduce the referrals to the emergency route; 3. Evaluate the pilot service improvement model to develop a proposed service through the development of a business case for further adoption and spread; 4. Evaluate the service against GP and patient experience satisfaction. The pilot service features include: Primary care work-up to identify suitable patients for MIDAS Referral to Diagnostic Practitioner who will triage for appropriate tests with support from either a Consultant or a GP with Special Interest. Tests co-ordinated and tracked. Aim for definitive diagnosis within four weeks of referral in line with the National Cancer Strategy target. In addition to the vague symptoms pathway local GPs have direct access to key investigative tests as outlined within the cancer strategy. The CCG meets the requirements set out by NHS England and has in place diagnostic endoscopy, chest X-ray for lung cancer, ultrasound, MRI for brain and Central Nervous System Tumours and CT scanning. Page 3 of 5

4 Ipswich Hospital is one of five national pilot sites who are testing the new 28 day Faster Diagnosis Standard which aims to either confirm or exclude cancer within 28 days of urgent GP referral. Initially the colorectal and gynaecological referrals are within scope for this pilot with an aspiration to roll out to all tumour sites in preparation for this becoming a national target in Together with the West CCG we have been successful in securing funding from Macmillan for Navigator roles. It is anticipated there will be five such roles for IESCCG who will focus on the interface between primary and secondary care to ensure that patients, and their GP, know where they are in their cancer pathway and what the next steps in their pathway will be. These roles will be crucial as diagnostic pathways become more rapid to ensure the 28 day standard is met. It is hoped they will also be able to support safety netting within practices to ensure test results are reported and communicated, and that any abnormal results are followed up appropriately. 2.3 Living with and beyond cancer Cancer is increasingly being viewed as a long term condition with half of those diagnosed with cancer now living for at least ten years. As such models of care need to be developed to support those patients living with and beyond their cancer diagnosis. Traditional models of care have centred on support provided within acute care with traditional patterns of follow up care. However, these have not always been successful in addressing all the survivorship needs of patients. Furthermore the current model of follow up for cancer patients is unsustainable given the number of patients who will be living beyond their cancer in the future. Increasingly patients will be risk stratified at the end of their acute treatment period and either be identified suitable for shared care or supported self- management. This will require primary care to play a role in the management of these patients that historically they have not been asked to. To support primary care to fulfil their role of supporting patients with cancer a programme of training for practice nurses has been developed as part of a five year programme to ensure there is at least one trained nurse in each practice. This is currently being funded by Macmillan and will be enhanced by additional transformation money. These nurses will be able to assist in the management of shared care between primary and secondary care and facilitate patients who are able to self-manage. This would support the model of cancer support currently being developed which will include the Macmillan Navigator role to ensure patients receive appropriate support throughout their cancer pathway. The Strategy sets out a commitment to ensure that every person with cancer has access to elements of the recovery package by The recovery package consists of Holistic Needs Assessment and Care Planning, End of Treatment Summary, Cancer Care Review and Access to Health and Wellbeing events. Across the CCG not all patients have access to the recovery package although there are pockets of good practice particularly within the cancer information centre at Ipswich Hospital where a Macmillan Survivorship Co-ordinator is based. As the Macmillan Navigator role develops they will also support this work to ensure all patients regardless of tumour site or treatment modality are offered the recovery package. The CCG achieved a rating of 8.7 in the latest National Cancer Patient Experience Survey which is equivalent to the national average. Ipswich Hospital are one of the national pilot sites for the new Quality of Life Metric that is to be tested. Page 4 of 5

5 3. Patient and Public Engagement 3.1 There is an active Cancer Services User Group at Ipswich Hospital with representation from the group at the Ipswich Hospital Cancer Services Development Group as well as the Ipswich and East Suffolk Cancer Locality Group. As a result patients and users are engaged and playing an active role in many of the projects outlined above. For example users were consulted and agreed the wording used on the two week wait card given to patients within primary care. 4. Recommendation 4.1 The Governing Body is asked to note current cancer performance and endorse the programme of work outlined to implement the national cancer strategy within the CCG. Page 5 of 5