Improving Cancer Pathways. Mel Warwick Macmillan Cancer Manager / Lead Nurse Aintree University Hospital NHS Foundation Trust

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1 Improving Cancer Pathways Mel Warwick Macmillan Cancer Manager / Lead Nurse Aintree University Hospital NHS Foundation Trust

2 Background Poor / inconsistent 62 day performance, across a number of specialities NHS IMAS Intensive Support Team (IST) visit invited in by Trust Management team restructure Administration team restructure Some processes not robust Lack of policies e.g. consultant upgrade / escalation / specific cancer access policy / breach reporting Disconnect between clinical teams, Clinical Business Unit (CBU) management and cancer management team Clinical pathways not formally reviewed / no timed pathways in place

3 Review of Cancer Pathways Work commenced during November 2011 (prior to IST visit in 2012) Supported by the Trust Service Improvement Team Four key areas identified as having concerns with 62 day performance (Lung, Colorectal, Urology & Head & Neck).

4 Aims To process map the current cancer pathways identifying issues / delays and make improvements. Set out the future state pathways per speciality (including any developments). To align the current and future state pathways to timed pathway trigger points using the key points of the 62 day cancer pathway (first seen, date of diagnosis, decision to treat).

5 Urology prostate pathway Performance for the 62 day standard for Urology variable during 2010/11. Delays seen within the Prostate pathway with the built in delay between prostate biopsy & Magnetic Resonance Image (MRI) scan. Review of prostate pathway and sharing of pathway information from other Trusts development of prebiopsy MRI for some patients.

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7 January February April May June July August September October November December January February April May June July August September October November December January February April May June July August September October November December January February Urology Performance referrals versus 62 day performance Performance target Referrals

8 Colorectal pathway Variable / poor performance during 2010/11 Significant improvement in performance seen following focus on pathway review. However - recurrent delays seen at the beginning of the pathway (straight to test Flexi-sigmoidoscopy and poor prep, further investigation required) High Did Not Attend (DNA) / Cancellation rates for scope investigations.

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10 January May July September November January May July September November January May July September November January Colorectal Performance referrals versus 62 day performance Performance target Referrals

11 Key influencing factors Clinical engagement Involvement of Service Improvement (SI) team Re-launched Lead Clinicians meeting Developed governance structure Cancer as agenda item on Clinical Business Unit (CBU) / directorate level meetings Information schedule / sharing of Cancer Waiting Time (CWT) performance across tumour sites Introduction of Situation Background Assessment Recommendation (SBAR) breach analysis clinical engagement in process Introduction of electronic patient tracking list (E-PTL) report via Trust reporting system. Involvement of SI team from outset Clear expectations & milestones for delivery set Facilitation seen as unbiased focus on quality & performance Pathways produced in same format with key pathway triggers clearly identified. Regular updates on each pathway project produced and sent to the key stakeholders

12 Key influencing factors Multi-Disciplinary Team (MDT) approach Involved all key disciplines, including: Cancer Management Team, Clinical Business Unit management team Clinical leads, Clinical Nurse Specialists Multidisciplinary Team (MDT) coordinators Administration staff, Radiology / Pathology representatives. Stakeholder involvement Executive team support Clinical / Managerial support Involvement of Clinical Commissioning Groups Involvement of Cheshire & Merseyside Cancer Network and sharing of pathway information at Cancer Network Group. Taking into account the views of patients.

13 Positive outcomes Allowed teams to take stock and focus on pathways (automatic focus on quality and performance) Improvement in CWT performance Improved patient experience seen in National Cancer Patient Experience Survey site specific results. Timed pathways valuable in providing a benchmark of where patients should be at various stages of care / useful for escalation of delays. Reduced DNA s / Cancellations Improved utilisation of capacity

14 Challenges Revised pathways one size does not fit all! Maintaining focus / engagement On-going process need to review? Annually