Lower GI (Colorectal) NSSG Annual Report 2010/11 Agreement Cover Sheet

Transcription

1 Lower GI (Colorectal) NSSG Annual Report 2010/11 Agreement Cover Sheet This Annual Report has been agreed by: Position: Name: Organisation: Chair of the NSSG Mr Hugo Taylor Date Agreed: Basildon & Thurrock Hospital University NHS FT Position: Name: Chair of the Network Board Sheila Bremner Organisation: NHS North Essex Cluster Date Agreed: NSSG members agreed the Annual Report on: Date Agreed: 5 th May 2011

2 Category Report Introduction This annual report from the Lower GI (Colorectal) NSSG covers the period 1 st April st March NSSG Meetings Schedule / Attendance 11-1c-101d Annual Review 11-1c-102d The key emphasis in 2009/10 and 2010/11 was consolidation of the group and implementing the agreed network plans for delivering IOG compliant Lower GI Cancer services. Key achievements in 2010/11include: Making progress with the Anal cancer MDT and early rectal cancer., running successful half day Lower GI cancer audit event and supporting Lower GI MDTs and NSSG through new Peer Review process. Increasing laparoscopic resection rates in all 4 acute trusts with 3 out of 4 trusts operating at rates above the national average. Being part of a DH pilot for the raising awareness of Bowel Cancer. This group met on three occasions during 2010/11(business meetings) and held one audit event. Minutes attached Appendix 1. Key challenges where some progress made but additional work required next year, includes: Continued development of Anal Cancer SMDT. Introduction of Somerset audit tool across network. Finalisation of a single referral pattern for hepatic resection in line with the London cancer services review. Continuing to increase laparoscopic rates where appropriate and to make use of the ICENI training facilities in Colchester when available. Local Rehabilitation Pathway to be agreed and service report developed. There have been 4 Lower GI NSSG meetings during 2010/11, three dedicated to business and one audit event. The attendance demonstrates involvement from core members from each of the four Lower GI MDTs that serve the Essex Cancer Network (Appendix 2). Date: 1 st April 2010 with Mr Nigel Richardson. Conducted by: Tom Carr, Medical Director Appendix 7 New Chair in post January 2011 for review in April Laparoscopic Resection rates. BTUHFT 16% CHUFT 79% MEHT 41% SUHFT 64% National Average 34% There was however some concern noted by the NSSG that this may be underestimated due to the limitations of coding in some theatre systems. Clinical lines of enquiry See Appendix 6

3 Activity and Waiting Times Network Audit 11-1c-119d See Appendix 3 for 2010/11 Data A range of topics were presented at our Network audit event agreed via NSSG. Each project was assigned a co-coordinator and the results of the projects were presented at our Half Day event in June 2010 held at the The Waterfront, Chelmsford. The meeting was highly successful and was well attended by members of the NSSG Audit flyer shown in Appendix 4. Audit projects presented included: Management of Liver Mets Audit in ECN Network-wide Lower GI Patient Survey Actions agreed at Audit Event: 1. Providers of liver resection surgery for colorectal metastases to be invited to present at September NSSG. NSSG to then agree provider of this service for the Network. 2. Discuss each Trust survey with local MDT/User Group/ to determine local action plan for 2011/14 work programme. 3. Discuss ECN wide survey findings at next ECN GI CNS/patient group meeting to determine areas for further attention. E.g. Patient information Research 11-1c-120d All patients with a diagnosis of Lower GI cancer should be considered for inclusion in clinical trials and other well designed research studies. Research nurses at each site are encouraged to attend MDTs and out patients to facilitate recruitment into studies. The Cancer Research Network Manager and or Clinical Lead for Research attend the NSSG to provide reports on recruitment and the current portfolio of research trials available. The NSSG will regularly review and agree Lower GI studies available and have identified a lead responsible for ensuring recruitment into clinical trials and other well designed studies is integrated into the function of the NSSG The NSSG, at its meeting on 8 th December 2010 discussed clinical trial list for 2010/11 and activity (as required by measure 1c-120d) will be reviewed at all future meetings and action agreed as required to increase recruitment in to trials during 2010/11. The current list and recruitment into each clinical trial for the 2010/11 is listed in Appendix 5. Patient & Carer Feedback and Involvement Patient satisfaction surveys were completed and presented at june audit meeting. Actions agreed are documented above under audit. The NSSG will be reviewing the results of the National Patient experience survey at its Autumn business meeting. Site specific results are embedded below: Lower GI Pt experience survey.xls

4 Appendix 1 Essex Cancer Network Lower Gastro-intestinal Cancer NSSG Thursday 9 th September pm 4.00pm Kestrel House, Board Room CM2 5PF MINUTES Present: Mr. Nigel Richardson (Chair) NR Consultant Surgeon, MEHT Hugo Taylor HT Consultant Surgeon, BTUHFT Dawn Beaumont-Jewell DBJ Research Nurse Clinician, MEHT Deep Tolia Shah DTS Colorectal CNS, MEHT Jacqueline Joels JJ Colorectal CNS, SUHFT Dawn Stiff DS Colorectal CNS, CHUFT Anna Wordley AW Nurse Consultant (GI Cancers) CHUFT Janet Wagstaff JW Vice Chair, User Group, Southend, Castle Point and Rochford Roger Bassett RB Chair, User Group, Southend Castle Point and Rochford Roger Motson Mike Dworkin RM MD Surgeon, CHUFT Surgeon, SUHFT Jackie Glover JG Colorectal CNS, SUHFT David Tsang DT Consultant Oncologist, SUHFT Sue Maughn SM Interim Network Director, ECN Bruce Sizer BS Consultant, CHUFT Saad Tahir ST Consultant Oncologist, MEHT Kim Tolton KT Senior Colorectal Nurse Practitioner/ Service Manager, BTUHFT

5 1. Apologies Tan Arulampalam, Matt Tutton, Javaid Subhani, Gary Bray, Saad Tahir, Jackie Gibson, Karen Hull 2. Previous Minutes 2 nd March 2010 Deferred to the next meeting 3. Election of new NSSG Chair Two candidates had been nominated: Hugo Taylor, Matt Tutton Vote was tied.* SM asked to count back NSSG attendance over the previous 12 months. * Post-meeting note: SM stated that all core members as in the Constitution should have the opportunity to vote. voting was carried out, which still resulted in a tie. Count Back: Attendance in in last 12 months M.T. 0% H.T. 40% SM to contact HT to see if he still wishes to take up the post of Chair. 4. Service Developments Tertiary Referrals for Liver Mets Background: - Audit of liver resection services presented in June. - ECN liver resection rates lowest in the country - A review following Audit suggested - NSSG require one tertiary centre or at the most two.

6 Addenbrookes Presentation (1.4m) - Within EoE - Supra-regional centre for some time so experience with needs of patients and families - Separate and specific MDT for liver mets - 80 resections per year ( three surgeons) - Active use of clinical trials - Five year survival 45% (up to 60% using PET) - Ten year survival 30% - Staging and follow up locally - PET at Addenbrookes - Downsizing chemo locally - Anything specialist at Addenbrookes - IEP in place Royal Free Presentation (2.8m) - Unified North London service with UCLH from July Referrals from MVCN, NLCN resections annually - Use of enhanced recovery programmes - Same day one-stop clinics - Image Exchange portal (IEP) - Use of Augis MDS - Web portal link into MDT Royal London Presentation (3.1m) - 50 liver resections p.a. - 15% resection rate of those referred with liver mets - LOS median nine days - Overall mortality 1.8% - Post chemo mortality 0% - MDT discussion and clinic same day where possible - Admit on the day (on site accommodation the night before) - Joint follow-up - New site in No transplants, only cancer - No IEP Basingstoke Presentation - Centre for liver mets - No transplants, only cancer - Complex and laparoscopic work - IEP in place resections per year - Median LOS five days - One-stop visit includes date for surgery

7 Post-meeting note: On advice from SHA, suggested no final decision until the result of the London review is known. Providers to be written to. SM to meet with Network Director North East London to see potential changes in current configurations. All other items carried over to next meeting due to lack of time. 5. Date of next meeting Wednesday, 8 th December 2010, 2.00pm, Kestrel Board Room. Essex Cancer Network Lower Gastro-intestinal Cancer NSSG Wednesday 8 th December pm 4.00pm Kestrel House, Board Room CM2 5PF Present: MINUTES Mr Hugo Taylor (Chair) HT Consultant Surgeon, BTUHFT Mr Nigel Richardson NR Consultant Surgeon, MEHT Dawn Beaumont-Jewell DBJ Research Nurse Clinician, MEHT Jacqueline Joels JJ Colorectal CNS, SUHFT Dawn Stiff DS Colorectal CNS, CHUFT Dr Gary Bray GB Consultant Gastroenterologist SUHFT Kim Tolton KT Colorectal CNS, BTUHFT

8 Babette Knott BK User Representative Mr Tom Carr TC Medical Director, ECN Belinda Grant BG General Manager, MEHT Dr David Tsang DT Consultant Oncologist, SUHFT Ashley Solieri AS Research Network Manager, ECRN In Attendance: James Brandon JB Head of Social Care Communications and Marketing, DH Jennifer Benjamin JBe Head of NAEDI, Cancer Waiting Times and Informatics, DH Sally Sanger SS Patient Information Manager, ECN 1. Apologies Audrey Loos, Deep Tolia Shah, Anna Wordley, Jackie Gibson, Matt Tutton, Kate Patience 2. Presentation from DH Bowel Cancer Awareness Campaign Team JB delivered a presentation on the background and development of the Campaign. The Campaign will be launched on 31 st January 2011 and will run for 7 weeks. JBe explained that the Campaign was part of the wider NAEDI project and will advise patients to contact their GP if they have an altered bowel habits or blood in their stools for 3 weeks. There was discussion on the reasons why the Campaign chose 3 weeks and not the NICE Guidelines of 6 weeks. The Group felt this would create confusion. BK expressed surprise that the Campaign was extremely similar to the Beating Bowel Cancer Charity Campaign and was surprised that the Campaign was not more focused on screening. JB said that they had worked closely with the Charity. The Group also had serious concerns about the impact on the already stretched acute services and their ability to meet the targets. JBe explained there was no additional funding to support the Campaign. It was agreed that the Chair would write to Mike Richards and Andrew Lansley outlining the Groups concerns.

9 Action: HS 3. Previous Minutes 9th September 2010 KT wished to be added to the attendance list. Minutes then agreed as a true record of proceedings. 4. Matters Arising 4.1 Service Developments Tertiary Referrals for Liver Mets It was agreed to continue with the current referral pathways to Royal London, Royal Free and Basingstoke, until the London Review had been published. It was also agreed that the MDTs at Colchester and Chelmsford would then need to agree a single referral pathway. 4.2 IOG Implementation Anal Cancer DT confirmed the anal cancer MDT met once a month on a Thursday morning, however, Colchester had yet to attend. DS will follow up. 4.3 Bowel Screening Update There was discussion on who should undertake follow-up of polyps. SUHFT understood it should be the screening centre, however CUHFT felt it should be the local Trust. The Chair would seek clarification from the National Screening Programme. 4.4 Laparoscopic Colorectal Cancer Surgery All sites reported they are undertaking laparoscopic surgery and all patients that are deemed suitable are offered this option. There was discussion on recovery time and BTUHFT felt that, due to the enhanced recovery programme, length of stay was no different from open surgery.

10 4.5 Data Collection Somerset Update BTUHFT Experiencing some problems importing data from database so will continue using current one until problem can be resolved MEHT Experiencing some problems with support and training from the supplier. It was explained that the ECN had a graduate trainee, Victoria Dawson, who was project managing the implementation of Somerset and it was hoped that this will improve implementation 5. New Business 5.1 EoE Bowel Cancer Awareness Campaign Update Covered in Agenda Item Chemotherapy Flowchart It was agreed that the flow chart should state that a patient has a diagnosis of colon cancer and not colorectal cancer and that a separate flowchart should be developed for rectal cancer. The chart was then approved. 5.3 Community Pharmacist, Early Detection and Prevention Project Report JJ reported that this was a project initiated by Netty Wood and had taken place earlier in the year over a 6 week period when the CNS s had undertaken training and raising awareness among community pharmacists and technicians about the signs and symptoms of bowel cancer. There is a report available and AS would locate this. (Report attached with these minutes) 5.4 ECN Rehabilitation Deferred to the next meeting 5.5 Information Prescriptions SS explained that the two local beacon sites were now in the implementation phase. CHUFT had a facilitator in post, based at the County and the BTUHFT facilitator will be in post in January. SUHFT and MEHT would not be getting facilitators until 2012; however SS will continue to support these two sites. SS informed the Group that she was now

11 the Network Patient Information Manager and would primarily be collating all local patient information across the network and making this available on the ECN website. SS informed the Group that NCAT have recently published a Patient Information Policy for consultation and she would be collating an ECN response, however, Trusts were also encouraged to respond. 6 Any Other Business 6.1 Research Trial Update AS circulated the current list of trials and recruitment figures and explained that the NSSG need to nominate a research lead. AS also explained that she would circulate the trial list to the Chairs of the MDTs for a response, as required by Peer Review. NR suggested DBJ undertake the research lead role and DBJ agreed to speak to Dr Tahir 6.2 Peer Review TC circulated a Peer Review Document. There was some confusion regarding the document and serious concern was expressed about the fact that the anal MDT was only held once a month. It was agreed that the Operational Policy would include a statement on an anal MDT being held every two weeks when there were patients to discuss. TC also informed the Group that there would be a Peer Review visit in June Audit HT outlined a project he was undertaking at BTUHFT on outcomes of T1 and T2 and agreed to circulate the proformas to the group so that a Network wide project could be undertaken. Essex Cancer Network Lower Gastro-intestinal Cancer NSSG Thursday, 3 rd March pm 4.00pm Kestrel House, Board Room CM2 5PF

12 MINUTES Present: Mr Hugo Taylor (Chair) HT Consultant Surgeon, BTUHFT Anna Wordley AW Nurse Consultant, CHUFT Sue Maughn SM Network Director, ECN Dawn Beaumont-Jewell DBJ Research Nurse Clinician, MEHT Mike Dworkin MD Colorectal Surgeon, SUHFT Dawn Stiff DS Colorectal CNS, CHUFT Joanne Glover JG Colorectal CNS, SUHFT Dr Gary Bray GB Consultant Gastroenterologist SUHFT Kim Tolton KT Colorectal CNS, BTUHFT Babette Knott BK User Representative Deep Tolia-Shah DTS Colorectal CNS, MEHT Kate Patience KP Macmillan AHP Lead, ECN Miss B Lovett BL Colorectal Surgeon, BTUHFT 1. Apologies Belinda Grant, Karen Hull, David Tsang, Ashley Solieri, Jacquie Joels, Rachael West, Tom Carr, Nigel Richardson, Mr Tutton, Michael Scanes 2. Previous Minutes 8 th December 2010 Corrections made as follows: BK was disappointed that the campaign was not more focused on Screening All polyps are followed up by the screening programme, but all cancers are followed by the local Trust. 5.3 CNS s had given training With the above corrections made, the minutes were recorded as a true record of the meeting.

13 3. Matters Arising 3.1 Service Developments Tertiary Referrals for Liver Mets Timescales to be reflected in the Work plan. 3.2 IOG Implementation Anal Cancer CHUFT are still unable to join the Anal Cancer MDT due to unavailability of equipment. This has been escalated a number of times and will be raised at the next Network Board as it makes the team non compliant. This has been highlighted as a serious concern at external validation and prompted in visit in June. Network to undertake a review of MDT connectivity. 3.3 Bowel Screening Update Uptake in PCT s consistently below 60% target. Approx. 55% South Essex; 57% North Essex. 3.4 Laparoscopic Colorectal Cancer Surgery Most recent HES data for 2010 demonstrated:- BTUHFT 16% CHUFT 79% MEHT 41% SUHFT 64% National Average 34% NCAT view is that Trusts should be aiming for at least National Average figures. Coding varies, i.e., is dependant on theatre systems. The Network is performing well. Teams will have use of the ICENI Centre. This will be added to the Work Programme. 3.5 Data Collection Somerset Update All confirmed the commitment to NBOCAP. Somerset roll out varies across the Trusts.

14 5. New Business 4.1 EoE Bowel Cancer Awareness Campaign Update Some had heard the radio coverage and seen T.V. ads. Delays in distribution of education packs by Dept. Health had led to the Network having to distribute some locally. Mike Richards had written to GP s to clarify suggested referral criteria and SM had received feedback from local GP s to say it was helpful. CHUFT are seeing extra referrals. Pilot evaluation is being agreed and other Networks are participating. 4.2 Audit 2011 To be held on 17 th June, with Venue to be confirmed Topics:- 1. Operations in May 2011: Practice against ERP suggested key features. 2. T1 and T2 treated disease 5yr survival HT 3. Rectal Cancer Audit: Patients who received neo-adjuvant chemo and RT histology post resection. 4. CNS involvement in raising awareness in pharmacy project Community Pharmacist, Early Detection and Prevention Project Report Available on Website for information. 4.4 ECN Rehabilitation Pathways NCAT have developed site specific rehabilitation guidelines which specify what services should be available for patients from Allied Health Professionals (Physio, OT, SaLT, dieticians and lymphoedema therapists) at each stage of the patient pathway. KP has developed draft local pathways using these national documents which lists signs and symptoms that can be treated by each speciality. As part of the Rehabilitation Peer Review these local pathways must be agreed and signed off by the NSSG. The draft pathway was distributed with the agenda and any comments should be directed to kate.patience@nhs.net prior to the next meeting to ensure that the document can be signed off. 4.5 Research Trial Activity DBJ asked that details of all the Trust Research Leads be forwarded so that the agreed list of

15 trails can be distributed. 4.6 Peer Review 2011 All teams will be visited in June 2011 and all Lead Cancer Managers are aware of the dates. BET clash with LOREC training. The new dates suggested are not possible at Network due to clash with other teams and events. It is suggested BET try and swap the date of their visit with one of the other Trusts. The visit has been prompted over the arrangements for the Anal Cancer MDT. Work Programme 2011/14 Group reviewed the programme and adjustments required. Section included on the 30 day mortality audit to be published in April. This has been sent to Trusts, but has not been shared with the team at all sites. The data covers the period The Network is seen as an outlier, although improvements are seen in the data from The Public Health Team at the SHA have requested more recent data. There was acknowledgement that surgical practices have changed significantly since Agreed changes will be made then forwarded to the ECNB for approval. 4.7 T&YA UCLH is the designated centre for dealing with all cancers in the 16-18yr old age group ye olds have the choice of being treated locally or at UCLH. If treated locally, UCLH will just need to be notified. This ensures that they get access to age appropriate support. The Constitution will need to be updated to reflect this. Action: COL/MS GB requested that there is a named clinician documented who will be responsible for receiving the referrals 5. Dates of business meetings for 2011 All 2pm 4pm Tuesday 6 th September, Middle and Annexe, Swift House Wednesday 7 th December, Middle and Annexe, Swift House Audit Friday 17 th June 1pm 4.30pm ( venue to be advised)

16 Peer Review NSSG visit 16 th June - A representative group from the NSSG will be required to attend late morning for questions.

17 Summary Attendance at Lower GI 2010/11 Appendix 2 Name Title ORG % North East Essex Tan Arulampalam Consultant Surgeon CHUFT x x 33% Dawn Stiff Colorectal CNS CHUFT 100% Isabella Hyde CHUFT x x x 0% Michelle Bath Assistant Cancer CHUFT x Services Manager x x 0% Philip Murray Consultant Oncologist CHUFT X X x 0% Bruce Sizer Consultant CHUFT x x 33% Saad Tahir Consultant Oncologist CHUFT x x 33% Matthew Tutton Consultant Surgeon CHUFT X x X 0% Anna Wordley Nurse Consultant (GI CHUFT Cancers) x 66% Roger Motson Professor of Surgery CHUFT Y X X 33% Rachael West Lead Cancer Manager CHUFT X X X 0% Mid Essex Research Nurse MEHT Dawn Beaumont-Jewell Clinician 100% Belinda Grant Lead Cancer Manager MEHT x x 33% Mary Butler MEHT X X x 0% Karen Hull General Manager - MEHT X x Surgery X 0% Nigel Richardson Consultant Surgeon MEHT x 66% Gopalakrishnan Srinivasan MEHT X X x 0% Theresa Bell Divisional Manager for MEHT X x Planned Care X 0% Saad Tahir Consultant Oncologist MEHT X x 33% Deep Tolia-Shah Colorectal CNS MEHT X South Essex Southend Audrey Loos Lead Cancer Manager SUHFT X X x 0% Gary Bray SUHFT x 66% David Tsang Consultant Oncologist SUHFT x 66% Ian Linehan Consultant Surgeon SUHFT X X x 0% Mike Dworkin SUHFT X X 33% Jacqueline Joels Colorectal CNS SUHFT 100% Claire Langdon SUHFT X X x 0% South Essex Basildon Jackie Gibson Lead Cancer Manager BTUHFT X X x 0% Jarvaid Subhani Consultant BTUHFT X x Gastroenterologist X 0% Kim Tolton Senior Colorectal CNS BTUHFT Hugo Taylor Consultant Surgeon BTUHFT 100% 100%

18 User Representation Janet Wagstaff X x 33% Joan Studd X X x 0% Cancer Network Sue Maughn(from June Network Director X 2010) 66% Tom Carr Medical Director x x 33% Netty Wood/Anjum Sair Network Pharmacist X X x 0 Michael Scanes User Involvement X X x Facilitator 0 Essex Cancer Research Network Ashley Solieri Manager x x 33% Entries in Blue are Core Lower GI MDT members

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20 Appendix 3 Colorectal Cancer Activity and Waiting Times 2010/11 Performance against 3 cancer waiting times targets for each of the 4 Essex Cancer Network Trusts BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS TRUST Two Week Waits 31 Day First Treatment 62 Day Standard Total referrals seen during the period Seen within 14 days Total treated Treated on or within 31 days Total treated Total over target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-11 Total

21 COLCHESTER HOSPITALS UNIVERSITY FOUNDATION TRUST Two Week Waits 31 Day First Treatment 62 Day Standard Total referrals seen during the period Seen within 14 days Total treated Treated on or within 31 days Total treated Total over target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-11 Total

22 MID ESSEX HOSPITAL SERVICES NHS TRUST Two Week Waits 31 Day First Treatment 62 Day Standard Total referrals seen during the period Seen within 14 days Total treated Treated on or within 31 days Total treated Total over target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-11 Total

23 SOUTHEND HOSPITAL NHS TRUST Two Week Waits 31 Day First Treatment 62 Day Standard Total referrals seen during the period Seen within 14 days Total treated Treated on or within 31 days Total treated Total over target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-11 Total

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25 Appendix 4 Sponsored by: with an unconditional Educational Grant TIME PRESENTATION TITLE PRESENTER 1.00pm Buffet Lunch to be served in the Brasserie Restaurant 1.50pm WELCOME Mr. N. Richardson (Chair, Lower GI

26 Network Site Specific Group) 1.55pm Management of Liver Mets Audit in ECN Mr. N. Richardson 2.25pm Network-wide Lower GI Patient Survey Member of ECN GI CNS group 2.55pm Refreshment Break 3.10pm 3.40pm ECN Performance against key Colorectal Cancer Commissioning Guide Questions Snapshot Survey of Clinical Nurse Specialist Activity across ECN To be confirmed Member of ECN GI CNS group 4.10pm 4.30pm Discussion: Colorectal NSSG - Role and function / Commitment and Contribution End Mr. N. Richardson For more information please contact Kevin McKenny, Network Director, Essex Cancer Network (tel ). If you plan to attend, please

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28 Appendix 5 Essex Cancer Research Network Lower GI Studies and Recruitment 2010/11 Trial Name and Short Description COIN B / randomised trial of intermittent chemotherapy + continuous cetuximab vs intermittent chemotherapy + intermittent cetuximab in 1 st line t/ment of K-ras-normal (wild-type) metastatic colorectal cancer (Closed) Southend Basildon Chelmsford Colchester 10/11 Total 10/11 Total 10/11 Total 10/11 Total 3 31 EXCITE / Erbitux, Xeloda, Campto, Irradiation Then Excision for locally advanced rectal cancer 1 2 Focus 3 / Feasibility molecular selection K-ras and topo-1 in colorectal ca FOXTROT / Fluoropyrimidine, oxaliplatin & targeted receptor pre-op National Study of Colorectal Cancer Genetics New EPOC / Peri-operative chemo with resectable liver mets QUASAR 2 (Closed) SCOT / Study of Adjuvant chemotherapy in colorectal cancer Timing of surgery after preoperative radiotherapy 6 vs 12 weeks - Is greater downstaging and tumour regression observed when surgery is delayed to 12 weeks In set up

29 Appendix 6 Colorectal Clinical Lines of Enquiry Indicator 1: The proportion of newly registered colorectal cancers being submitted to NBOCAP

30 Indicator 2: The 30-day post operative mortality following major resection for Colorectal Cancer Data source ECRIC (Red Line indicates EoE average)

31 Indicator 4: Proportion of newly diagnosed colorectal cancers being radiologically staged with CT (and MR pelvis for rectal cancers) Organisation CT All CT ST MRI All MRI ST Basildon & Thurrock Mid Essex There is no data provided from the other 2 trusts. CT All CT ST MRI All MRI ST Proportion of surgically treated rectal cancer patients having an MR scan pre-operatively Indicator 5: Surgery A. Returns to theatre within 30 days: Not currently available. B. Re-admission rates within 30 days: Proportion of patients with colorectal cancer undergoing CT imaging Proportion of surgically treated patients undergoing CT imaging Proportion of patients with rectal cancer having an MR scan preoperatively Emergency Readmissions within 30 Days for Colectomy/Excision of Rectum (for Lower GI Cancer Patients) Based: Lower GI Procedures Table (2008/2009 & 2009/2010) Readmission Number of Procedures YEAR within 30 D Total Total Trust Proc L1 No Yes No Yes

32 Basildon and Thurrock University Hospitals NHS Foundation Trust Colectomy Excision of Rectum Basildon and Thurrock University Hospitals NHS Foundation Trust Total Essex Rivers Healthcare NHS Trust Colectomy Excision of Rectum Colchester Hospital University NHS FT Total Mid Essex Hospital Services NHS Trust Colectomy Excision of Rectum Mid Essex Hospital Services NHS Trust Total Southend University Hospital NHS Foundation Trust Colectomy Excision of Rectum Southend University Hospital NHS Foundation Trust Total C. Proportion of newly diagnosed cases undergoing a major surgical excision: NCIN Selected Lower GI Surgical Procedures Based: Lower GI Procedures Table (2008/2009 & 2009/2010) Number of Procedures YEAR Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Colchester Hospital University NHS FT Mid Essex Hospital Services NHS Trust Southend University Hospital NHS Foundation Trust

33 Indicator 6: Enhanced Recovery Basildon and Thurrock University Hospitals NHS Foundation Trust The trust has secured funding to establish an ERP in colo-rectal surgery with support from the Cancer Network during 2010/11 and is currently out to recruitment. Colchester Hospital University NHS FT The trust has a well established ERP with more than 800 documented cases. Mid Essex Hospital Services NHS Trust Essex Cancer Network funded the secondment of a senior nurse to start a formal enhanced recovery after surgery (ERAS) programme in Mid Essex. The appointment commenced in October 2010, and the first patients joined the programme in January In the first month of audited results an reduction in length of stay of 3 days was achieved. It is understood that this relates to small numbers and further audit will be required to confirm the actual reduction in length of stay, it being expected to be rather less than the first month's data suggests. The programme has been well received by all staff involved, and patient satisfaction is high. Southend University Hospital NHS Foundation Trust The trust has a well established ERP.

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35 NSSG Chair Annual Review Essex Cancer Network Name: Nigel Richardson NSSG Site: Lower GI Date of Review: 1 st April 2010 Structure: Nigel has held the post of Chair of the NSSG for 2.5 years, and plans to hand over to someone else on 1 st September Ian Linehan and Hugo Taylor have acted as deputies. There has been poor engagement and attendance at the NSSG meetings. The meeting has only just managed to be quorate on occasions. Strengths: Establishment of an SMDT for Anal cancer Areas for Improvement: Attendance at NSSG has been dropping and this trend needs to be reversed. There is a risk that Basildon will miss the Laparoscopic target which states that all patients shall be offered laparoscopic surgery by October There is a need to establish plans for the resection liver secondaries. Documentation: The NSSG has produced the following documents: Constitution including treatment guidelines Annual Report Work Programme Peer review outcomes and concerns: Anal cancer and early rectal cancer issues have been addressed. Data and audit: Nigel has high hopes that the introduction of Somerset will ensure good data collection. Network wide audit has been conducted and reported on. Personal development needs and plans: The role of chair needs admin support to ensure that all essential items are included in the agenda. Nigel hopes to move on from the role and there are plans in place for a new chair to rep[lace him in September 2010.

36 Signed Mr T W Carr Medical Director Essex Cancer Network 1 st April 2010 Next Review Due by 1 st April 2011