National Cancer Registration Service South West Cancer Alliance Manager NHS England South, South West

Transcription

1 Present : Apologies: Meeting of the SWAG Area Cancer Operational Group (formerly ASW) Held on Wednesday 18 th April 2018, Sanford Education Centre, Room 10, 32 Keynsham Road, Cheltenham, GL53 7PX Belinda Ockrim Caren Attree Ed Nicolle Helen Dunderdale James Curtis (Chair) James Withers Jonathan Miller Luke Curtis Patricia McLarnon Ruth Hendy Samuel Wadham Sian Middleton Zena Lane Asha Sahni Carol Chapman Caroline Gilleece Catherine Donnelly Deirdre Brunton Claire Smith Hannah Marder Jessica Barrett Michelle Gregory Nathan Brasington Yeovil District NHS FT Taunton and Somerset NHS FT Royal United Hospitals Bath NHS FT SSG Support Manager SWAG CA SSG Support Service Gloucestershire Hospitals NHS FT Data Liaison Manager National Cancer Registration Service South West Cancer Alliance Manager NHS England South, South West Yeovil District NHS FT Programme Manager SWAG Cancer Alliance NHS England South, South West University Hospitals Bristol NHS FT North Bristol NHS Trust Gloucestershire Hospitals NHS FT Taunton & Somerset NHS FT SSG Support Administrative Coordinator SWAG CA SSG Support Service North Bristol NHS Trust Royal United Hospitals Bath NHS FT Senior Analyst Somerset Cancer Register Weston Area Health NHS Trust Salisbury NHS FT University Hospitals Bristol NHS FT Assistant Directorate Manager Salisbury NHS FT Deputy University Hospitals Bristol NHS FT Weston Area Health NHS Trust Page 1 of 8

2 1. Welcome and apologies J Curtis welcomed all group members. Apologies received prior to the meeting were noted. 2. Notes and actions from the last meeting As there were no amendments or comments following distribution of the minutes from the meeting on Wednesday 13th December 2017, the notes were accepted. Actions: 005/17: The SWAG pharmacy and oncology chemotherapy protocol roles will be funded by the Cancer Alliance until the end of March Development of a business case for continued funding from providers after this date will be planned by COG, with assistance from J Miller. This will be discussed at a future COG meeting. 005/17: Action H Marder/J Miller 006/17: The Clinical Guidelines and Constitution for the Children s Cancer Services have been drafted. These will be finalised and uploaded on to the SWCN website prior to the 4 th June /17: Action H Dunderdale 021/17: The Cancer Alliance (CA) will provide external mediation to define how to record Inter- Patient Transfer (IPT) dates for the scenarios not accounted for in the current Cancer Waiting Times guidance document. This should be decided before the reporting of Inter-Patient Transfer (IPT) dates becomes a live activity. Performance was now noted to be measured Alliance wide rather than Trust wide. The CA will arrange a meeting with NHS Improvement Leads to assist with this discussion. 021/17: Action J Miller It was noted that Cancer Services in University Hospitals Birmingham do not track investigations as part of tracking IPT. When the IPT policy has been updated this will be shared with the Cancer Service team in Birmingham. It is hoped that an event organised by the Somerset Cancer Register (SCR) next week will provide some solutions to IPT via the e-referral system. Gloucestershire have the Infoflex information system rather than the SCR. A programmer is currently writing the structured query language required for this, which is proving to be very complicated; this may not be available by the reporting deadline. 031/17: The action for S Wadham to request information on the rationale behind the 62 day funding decisions can be closed due to recent developments which will be discussed at today s meeting. 037/17: A resilience plan to ensure that the SWAG chemotherapy protocols can be made available via an alternative route in the event that access to the website is disrupted, will be discussed with S Murdoch and J Braybrooke at a meeting on Wednesday 2 nd May /17: Action H Dunderdale The SSG Support Service team may not have the same access to upload documents online once the SWCN website has been migrated to the NHS England website. Different solutions were being explored; the contract on the current website was not due to end for another few months. Page 2 of 8

3 038/17: A process for fortnightly updates to s on the CA workstreams has been set up between P McLarnon and H Marder. Action closed. 040/17: CA Programme Manager P McLarnon had identified a radiology lead for the Lung Early Diagnosis work, but it has since been confirmed that the interested party cannot be released from their other work commitments for this purpose. No other expressions of interest have been received to date. The actions completed and communicated to the COG group prior to the meeting are listed in the COG actions log. All other actions are on the agenda for discussion today. From the agenda: 3. update UH Bristol: An additional Clinical Nurse Specialist (CNS) will be joining the Head and Neck team to enable the team as a whole to provide patients diagnosed with thyroid cancer with sufficient support. There was an ongoing issue with CNS support for Brain and CNS patients; a scoping exercise was underway to the resources required. A review of Breast Cancer Support Services is also underway. Currently, the CNS team in NBT are focused on supporting patients through the surgical part of the pathway, and the BHOC team are focused on patients with metastatic disease. Advanced Clinical Practitioner posts are due to be advertised in the near future. Half of their time will be dedicated to providing support to breast cancer patients, and the other half will be dedicated to the other cancer sites. The feasibility of appointing a nurse consultant for oncology is being reconsidered due to the shortage of medical oncologists. The post would be linked with the University of the West of England. YDH: B Ockrim has been providing cover for the Upper GI CNS role and also for the Lead Acute Oncology Service (AOS) nurse role since January An AOS nurse has now been appointed and is due to start in post in 9 weeks. The chemotherapy nurse and medical oncology workforce have been short staffed for some time; an oncologist has now been appointed. GLOS: The Head and Neck, Neuro Oncology, Upper GI, and Colorectal CNS teams are currently understaffed. The Urology and Haematology teams have recently successfully recruited. Lead Cancer Nurse S Middleton has now handed over management of palliative care and will also be handing over management of the lymphoedema service by the end of June TST: Five Band 4 Cancer Support Workers started in post last week and the first end of treatment Living Well event has taken place. The Breast, Metastatic and Upper GI CNS teams are currently understaffed. RUH: The oncology workforce is understaffed by one medical oncologist and 2 clinical oncologists; recent attempts to recruit to the posts have been unsuccessful. Medical oncology cover for gynae oncology has not been established. The nursing workforce for oncology is currently understaffed; it is hoped that the LWBC funding for support workers will help with CNS capacity. NBT: The Upper GI and Neuro Oncology CNS teams are currently understaffed. A review of CNS capacity in the Urology and Breast teams is underway. There have been issues with appointing to the Page 3 of 8

4 post in pharmacy to set up e-prescribing and submit SACT data. Pharmacy need to resolve the issue, as it could result in a fine from the Clinical Commissioning Group. It was noted to be a particularly difficult time for oncology capacity across the board. 4. Cancer Waiting Times Performance Day update by Trust GLOS: The performance of two week waits is currently 90%. There has been an unprecedented rise in referrals. In February, 62 day performance was 79% and March is expected to be similar. There are issues managing the number of lower GI referrals, as endoscopy and outpatient clinics are overwhelmed. Saturday clinics have been arranged to manage the backlog, which should enable performance to recover in April The majority of breaches relate to urology which should improve now that clinic and Theatre space have been increased. There are 2 new Theatre slots for robotic assisted radical prostatectomy (RALP). It has also been decided to manage the urgent urology referrals in Gloucester and the elective referrals in Cheltenham. RUH: 62 day performance continues to remain on target. The most common performance breaches occur in the lower GI referral pathway, due to endoscopy and radiology capacity, and in the upper GI and Head and Neck pathway when patient care is shared with UH Bristol. There are also occasional difficulties with lung, breast and skin cancer sites, but performance in general was not an issue. UH Bristol: 62 day performance was gradually recovering from the effect of winter pressures on surgical and critical care capacity. NBT: 62 day performance was 77% in January due to organisational problems rather than winter pressures. This has recovered reaching 82% in February and now stands at 84.96% for March. There have been some issues with booking the breast cancer one stop clinics. The majority of breaches are due to prostate referrals with approximately half now referred now following the multi-parametric MRI pathway. Processing the additional MRI reports each week is proving to be difficult. There is also a shortage of urology surgeons and Theatre capacity for RALP. After the recent installation of an additional robot, it had been hoped to run two simultaneously, but the original robot was unexpectedly decommissioned. It was noted that the number of referrals for cystectomies has risen; J Curtis will assess the Gloucestershire service to see if there is a comparable trend. 001/18: Action J Curtis The most significant pathway delays were caused by referrals sent from Great Western Hospital (GWH) and Royal Cornwall Hospital (RCH). The RCH team recently reported that the prostate pathway had been streamlined. J Miller will make contact with them to establish the cause of the delays. 002/18: Action J Miller YDH: 62 day performance was 82.6% in February and 82.4% in March. There is expected to be a cluster of breaches in April due to patient choice. There are problems with the prostate pathway related to the use of different biopsy techniques; this is due to be discussed with the team in the Page 4 of 8

5 near future. A new MDT Coordinator for urology has commenced in post and is invited to visit the MDT Coordinator in NBT for the purpose of sharing best practice. Difficulties have arisen with the Head and Neck referral pathways which are notoriously difficult to track. It was the recommendation of J Miller that TST and YDH adopt a combined approach to manage the pathway. TST: Two week wait performance targets were not met in March due to recent weather conditions. 62 day performance has fallen to 75% due to delays in transfers between sites for diagnostic tests. There was currently a 4 week wait for Octreotide scans. Delays should improve with the return of an oncologist from maternity leave. Work is underway to streamline access to dental services to avoid delays to the Head and Neck pathway. Many breaches have been caused by the sheer volume of colorectal cancer referrals. It was noted that a Bowel Cancer Awareness Campaign is due to commence in April, and a Prostate Cancer Awareness Campaign will commence in the next couple of weeks. 5. Cancer Alliance and Transformation Funding day funding: the role of the Cancer Alliance and Cancer Transformation Funding update The National Board has notified the South West CA that Transformation Funding will be reduced to 75%, due to recent creation of a rule that links funding to 62 day CWT performance. It has been calculated that existing commitments can be accommodated by redirecting core funding from CA workforce and related activities. It will not be possible to accommodate an additional reduction, potentially to 50%, should overall performance drop below 80% which, in light of the previous discussion, is now a significant risk. NHS England South Finance Team, who have ultimate responsibility for managing financial risks, has been informed. It is necessary to identify funds that have yet to be committed to see if these can now be made reavailable. For example, a sum of money was allocated to the lung project for clinical leadership in acute and primary care; it would significantly reduce the deficit if this spend could be halted. It is recognised that this may have already been used to reduce radiology backlog or fund Support Worker posts. In addition, a number of projects have had to be abandoned, including the development of the Somerset Cancer Register and the Patient Information Portal. An accurate prediction of the worst case scenario will be made in time to inform C Chapman if she can still offer a full time position at the conclusion of the LWBC Project Manager interviews due to be held next Tuesday. If this is not possible, it would be preferable to offer a part time post over 2 years rather than a full time post over 1 year, due to the need for the Clinical Commissioning Groups to have time to develop a sustainable model for LWBC by Lead Cancer Nurse R Hendy is appointing related roles to 18 month fixed term contracts with the option to extend to 22 months. Any loss of funds will need to be directed to those provider Trusts that have yet to recruit. Page 5 of 8

6 Transformation Funding has not been received in YDH and TST as it was not possible to sign the Service Level Agreement (SLA) proposed by the Somerset CCG; service specifications had been included that were not achievable and were additional to those requested by the Cancer Alliance, including a navigator role and prostate tracking system. The CA will contact R Rowe to discuss this; if an SLA cannot be agreed, the funding will be redirected. 003/18: Action P McLarnon There have been initial talks with Macmillan, who may be able to provide some assistance with funding for the LWBC initiative if necessary. J Miller has discussed the process by which the funding was reduced with National Programme Lead D Fitzgerald and Regional Medical Director Acheson. D Fitzgerald will now converse with SWAG Managerial Lead, James Rimmer, to discuss future plans. There was no indication that it would be possible to negotiate an alternative outcome to the performance related punitive measures. It had been reported that a disproportionate amount of funding had been allocated to Alliances for the LWBC projects; this will be addressed in the near future. The CAs capacity to assist with improving CWT performance was limited to project work rather than being able to provide the additional equipment and resources needed. An Alliance wide report detailing the exact requirements is underway. 004/18: Action J Miller The offer for provision of training to endoscopists and radiographers had not been taken up at a local level. It had not been possible for Trusts to send team members as backfilling the posts in order to release them for the training was not affordable, and would have had a detrimental impact on 62 day performance. 5.2 Living With and Beyond Cancer (LWBC) tariff The appropriate tariff for LWBC activity will be calculated by a Macmillan Evaluation Manager appointed for this purpose. The tariff previously negotiated in NBT of 125 per patient has been found to be insufficient. 5.3 Early Diagnosis and LWBC updates and CA developments The South West Project Manager for the early diagnosis lung pathway, N Gowen, is working closely with individual providers to progress the project, and has developed a process mapping tool which includes every step in the National Optimal Lung Cancer Pathway. The communications package will be completed by the end of the week and will be circulated together with the mapping tool. At the most recent Steering Group, a patient information leaflet template had been approved. This will need to be amended to include local information and will be ratified by local patient user groups. Clinical Lead A Randle has developed an information leaflet for General Practitioners, which will also need to be revised to include local information. Page 6 of 8

7 Data on CWT performance and stage of disease will be gathered on those patients referred straight from chest x-ray to CT. The CA have requested a monthly highlight report giving an overview of any existing or new challenges. A quarterly update of the STP Plan on a Page is also required, with the next report due on Friday 25 th May A SWAG Clinical Forum has been formed for the purpose of developing clinical protocols for the management of CX2 category chest x-rays. The next Steering Group meeting is in early July. An engagement plan is underway to encourage radiologists to adopt use of the CXR reporting tool, and a dashboard has been created to track progress and work towards alignment with the NOLCP. There have been some issues with pathology turnaround times. The Quality Surveillance quality indicators for lung cancer will be sent to P McLarnon by R Hendy. 005/18: Action R Hendy Access to the Faecal Immunotherapy Test is due to commence in June A video about appropriate use of the test is being produced for GPs. Project Manager S-J Davies has been visiting the regional urology teams to discuss implementation of the prostate pathway to understand the challenges unique to each centre. It was noted that Commissioners should be invited to attend these meetings. An event will be held on Monday 14 th May 2018 when feedback from the Trusts will be presented together with potential radiology and pathology standards, and an associated data collection tool. It has been reported that some funding will be made available to assist with the data collection; this will be verified by P McLarnon. 006/18: Action P McLarnon Regular news bulletins on the progress of each project will be circulated. A communications administrator for the Cancer Alliance is due to be appointed in July. Handbooks are going to be published to facilitate implementation of the lung, prostate and colorectal pathways. The recent Living With and Beyond Cancer (LWBC) event had received positive feedback. An LWBC Project Manager, hosted by Wiltshire CCG, has started in post, and CNS K Horton-Fawkes has undertaken the role of Patient and Public Engagement Manager for the SWAG region and will be co-producing an evaluation plan. 6. Network issues 6.1 Transfer of patients post treatment The draft standard operational procedure for transfer of cancer patients between organisations will be reviewed by the site specific groups. It was likely that a variety of solutions for mapping the transfer would be decided upon according to cancer site. It may be possible for this to be an official part of the LWBC work. 029/18: Action LWBC working group Page 7 of 8

8 6.2 SSG Support Service update Requirement for regional parity in the commissioning of reconstructive breast surgery post cancer treatment: The CA Board has agreed to raise this with the Somerset CCG. A draft letter is in progress 007/18: Action H Dunderdale / A Randle Change to provision of Fertility Cryopreservation service for oncology patients: The NBT service has been decommissioned. The change in pathway has been raised as a concern by the Haematology SSG. The referral criteria for the Fertility Service in Bath will be clarified 008/18: Action H Dunderdale The increasing requirements of the Clinical Genetics service in accordance with the National Strategy / NICE guidelines and subsequent length of reporting times have been raised at the Breast, Colorectal and Gynae SSG meetings Closure of the primary Brain and CNS service in RUH Bath following the recent publication Modernising Radiotherapy: Discussions are underway with Specialist Commissioners The potential to have a Cancer Alliance or SSG Risk Register for cross cutting issues, which will include the risk of inadequate tracking systems for follow up of bladder/other cancer patients: An SSG Risk Register will be developed with recognition that all risks should be registered and managed via provider Trusts internal risk management processes. A meeting of the SWAG Cancer Clinical Leads will be held on Monday 16 th July 2018, seeking to agree on a loco-regional approach to MDTM reform, and to share best practice prior to meeting (on another occasion) with Professor Martin Gore, and the NHS England Clinical Policy Managers who are developing treatment algorithms to streamline MDT discussions (where appropriate). Representatives from all cancer site groups have confirmed attendance. Members of COG are invited to contribute ideas for the agenda. 6.3 National Cancer Registration and Analysis Service Everyone will be required to register on the new cancer statistics website as it will not be possible for the existing accounts to be migrated from the previous system. A link to the website has been circulated. Reports (called dataviews) of COSD, the National Lung Audit and the National Urology Audit datasets have been developed in the Somerset Cancer Register so that these can be run to show the missing data that needs to be recorded. Data collection systems will be checked to see if there is a reason for the recent significant drop in the reporting of cervical intraepithelial neoplasia and basal cell carcinoma. Date of next meeting: Wednesday 20 th June 2018, 10:00-12:00, Weston General Hospital -END- Page 8 of 8