Wessex Cancer Alliance. Wessex Cancer Strategic Clinical Network

Transcription

1 Wessex Cancer Alliance Wessex Cancer Strategic Clinical Network Chair : Tim Billington Friday 11 th September 2015

2 Patients are our priority

3 Patients are people

4 Perception versus what is said

5 Pathways versus priorities

6 Protocols versus people

7 Wessex Cancer Alliance Wessex Cancer Strategic Clinical Network Matthew Hayes Clinical Director, Cancer Strategic Clinical Network

8 Cancer today Half of people with cancer survive at least 10 years 50% increase in suspected cancer referrals since 2009/10 In million people were living with cancer; 4 million by 2030 The NHS has a 30bn funding gap between 2013/14 and 2020

9 Cancer still kills

10

11 Jenny, 65 year old lifelong Wessex resident, grandmother of three

12 Was sent bowel cancer screening test 2 years ago, did not participate, not chased Several months non-specific change bowel habit No visible blood Didn t want to bother anyone, busy looking after grandchildren

13 Developed abdominal pain and vomiting on holiday Came back to UK, presented to ED vomiting and in pain Transferred to surgical team with bowel obstruction

14 Emergency surgery obstructing tumour of tranverse colon, liver mets and multiple peritoneal and pelvic seedlings Bowel resection, no stoma ITU admission, sepsis Discharged day 15 post op For palliative chemotherapy?in trial 70% likelihood of death within 1 year

15 What might have been better? Screening, safety netting Earlier detection (93% vs 7% 5 year survival) Lower complexity treatment better outcomes, much cheaper Better patient experience

16 Ambition 1 - cancer survival Over the next five years cancer survival in Wessex will continue to exceed the England average, and will improve by 5% across all cancers.

17 Ambition 1 - cancer survival Progress will be monitored using the one year survival index estimates published in the National Cancer Intelligence Network (NCIN) Cancer Commissioning Toolkit 2012 data 1 Year Survival Index England 69.3% Wessex 70.5% NHS Dorset CCG 70.9% NHS Fareham and Gosport CCG 68.2% NHS Isle Of Wight CCG 69.1% NHS North East Hampshire and Farnham CCG 73.3% NHS North Hampshire CCG 70.2% NHS Portsmouth CCG 67.4% NHS South Eastern Hampshire CCG 68.7% NHS Southampton CCG 69.5% NHS West Hampshire CCG 72.2%

18 Ambition 2 - cancer prevention Smoking cessation Exercise Healthy weight Screening coverage (bowel, breast, cervix)

19 Ambition 2 - cancer prevention In 2013, 8% of 15 year olds were regular smokers nationally There is no Wessex wide figure for smoking prevalence but 4 local authorities have prevalence above national average. National Cancer Strategy has more ambitious targets than Wessex; <13% by 2020, <5% by People with an SMI have half the success rate of smoking cessation as compared to people without an SMI. Just 2 local authorities are below the national average for physically active adults.

20 Ambition 2 prevention, year 1 Smoke free children increase focus on education in schools Smoking rates in routine and manual workers remain higher than general adult population. Gain baseline data and research bespoke interventions. With patients, develop and consult on changes to commissioning strategy to improve smoking cessation in people with SMI, completing a pilot in 2016.

21 Ambition 2 - screening Wessex achieves, the national minimum uptake for all cancer screening, including cervical, breast and bowel There is variation across the area, some CCGs do not meet the standards. Coverage of cervical screening is declining. Breast cancer screening for Wessex is above the minimum standard Bowel cancer screening for Wessex is above the national average and minimum standard

22 Ambition 2 screening, year 1 Gather baseline data Rank screening programme at GP practice level and identify practices within the lowest quintile. Agree performance trajectory based on Increasing coverage (x 3 programmes) in Southampton and Portsmouth CCG areas to as close to the minimum programme standard as possible. Increasing coverage (x 3 programmes) in GP practices in the lowest quintile (across Wessex) Develop action plan to increase coverage via Screening Partnership Group, working with CCGs, LA, SCN and providers

23 Ambition 3 - cancer detection The proportion of patients presenting as an emergency with a new cancer diagnosis will be below the England average across all nine CCGs in Wessex, aiming for an aggregate figure of 15% by 2020.

24 Ambition 3 - cancer detection Progress will be monitored using measure for emergency presentations for cancer published in the NCIN Cancer Commissioning Toolkit. These figures are reported in 6 month time periods and the most recent figures are for July - December 2012 CCG Percentage England 20.6% Wessex average 21.2% Dorset CCG 18.4% Fareham and Gosport CCG 20.4% Isle of Wight CCG 23.3% North East Hampshire and Farnham CCG 22.4% North Hampshire CCG 20.8% Portsmouth CCG 19.8% South Eastern Hampshire CCG 23.8% Southampton CCG 21.6% West Hampshire CCG 20.3%

25 Ambition 3 - cancer detection For year 1 Data collection complete Jan 16 for the 10 pts per trust presenting prior to 31/3/15 Analysis and comparison with London Cancer Alliance will be undertaken by March 2016 Recommendations for commissioners available by end March 2016 Implications and impact of new 2ww guidance to be described as part of the project report

26 Ambition 3 earlier cancer detection The proportion of patients diagnosed with early stage (stage 1 and 2) disease will improve by 20% across Wessex from around 50% currently.

27 Ambition 3 earlier cancer detection Site Earliest Stage Five Year Survival Latest Stage Five Year Survival Colorectal 93.2% 6.6% Lung 35.3% 6.3%*

28 Ambition 3 earlier cancer detection Reported stage of diagnosis for all cancers in Wessex, where recorded. Total cancers detected in calendar year Cancers detected at stages % (aim c70%) Cancers detected at stages % (aim c30%) Cancers not stageable 2.42% The unrecorded stage patient group still accounts for just over 40% of the total cancers detected. Data source: COSD Conformance Summary Level 3

29 Ambition 3 earlier cancer detection

30 Ambition 3 earlier cancer detection

31 Ambition 3 earlier cancer detection For year 1: Inclusion of plans to improve recording of cancer staging in all cancer MDTs. Establish monitoring of staging by CCG and inclusion in commissioning intentions for 16/17. Reporting on quality of staging by Trust reporting at QSG.

32 Ambition 4 patient experience Within 5 years all patients will receive cancer care in Wessex on the basis of a personalised, evidenced based treatment pathway designed to optimise both outcome and experience.

33 Ambition 4 patient experience Aiming for the best treatment outcomes, meaning: best best for the patient, before provider and commissioner treatment everything in the cancer journey outcomes everything from satisfaction to survival Plans should reflect the stakeholder comments during the consultation process the right treatment.patient support.equality of accessibility modern, evidence-based -

34 Some key priorities for SSGs in year 1 Pathway development timed (CWT), optimising access and outcome, reducing variation, improving IPT Assurance regarding centrality of patient experience in pathways, patient information quality standardisation Workforce development, horizon scanning Improved working between primary and secondary care, and between SSGs and commissioners

35 Ambition 4 patient experience No patient requiring cancer treatment using modern radiotherapy technologies need travel outside Wessex unless by patient choice.

36 Ambition 4 patient experience Stereotactic radiosurgery is not currently provided in Wessex Patients may choose to go outside Wessex as some pathways on the edge of the patch flow into Surrey and Wiltshire Patient choice is not currently reported so not tracked by Spec Commissioning Data collection is on the basis of provider geography, not patient geography

37 Ambition 4 year 1 Stocktake of current RT provision and activity in Wessex using existing national datasets (RTDS within NATCANSAT via RCIG) Better understand existing RT pathways from providers and SSGs who currently goes where for what? (NCPES) In one year we will know who the providers are for Radiotherapy and where they are located. For year two the priority should be focused on patient choice. Build on existing opportunities for patients to understand their treatment options and influence their care.

38 Ambition 5 rehabilitation and recovery Within 5 years all Wessex patients with a new cancer diagnosis will be offered a holistic needs assessment, a primary care cancer review and a detailed treatment summary, as a consequence of the implementation of the recovery package.

39 Ambition 5 - year 1 Every patient should have a holistic needs assessment undertaken at least once. Trust HHFT UHS PHT IOW Poole Bournemouth DCH Current stage of Holistic Needs Assessment implementation Paper HNA being used. ehna planned for the future Patient Triggered Follow-up (PTFU) sites formally undertake HNA s on all patients. These are breast, gynae, colorectal, testis, prostate and lymphoma. Pilot site for ehna Paper HNA being used by all tumour groups Paper HNA being used by all tumour groups. Pilot site for ehna colorectal, breast and lung HNA being used ehna In Wessex 50% of all patients will have a holistic needs assessment by March 2016.

40 Ambition 5 - year 1 Cancer care reviews will take place in primary care following receipt of a treatment summary and care plan. It is recommended that 50% of patients will have a cancer care review by March A task and finish group is reviewing the quality of cancer care reviews undertaken across Wessex, chaired by Dr David Matthews.

41 Ambition 5 - year 1 + Treatment summaries are integrated into all CCG contracts for 2015/16 and 50% of all new patients receive at least one treatment summary during 2015/16 in the following sites: Trust HHFT UHS PHT IOW Poole Bournemouth DCH Site with treatment summaries actively implemented Colorectal Prostate, Endometrial, Lymphoma Breast, some Oncology Colorectal, Lung Breast, Colorectal, Head and Neck, Skin Colorectal Colorectal Planning to increase to 100% across all sites by March In Wessex treatment summaries were included in the 2014/15 commissioning intentions across the region and in contracts from 2015/16.

42 Ambition 6 clinical trials All cancer patients who are eligible will be offered recruitment into a clinical trial.

43 Ambition 6 clinical trials Findings of the National Cancer Patient Survey 2014 indicate that access to information about clinical trials and the proportion of patients who enter clinical trials is highly variable:

44 Ambition 6 clinical trials Some of our Acute Provider Trusts are above national average for discussing clinical trials with patients, although this remains variable across the area:

45 Ambition 6 clinical trials Access to clinical trials is inequitable, although we will need to investigate these findings in more detail, e.g. many IOW patients receive their treatment at UHS or PHT, which may affect results

46 Ambition 6 year 1 Improved inter trust referral through the SSGs. Use regional MDTs to share data on all available trials. Articulate the value of trials in terms of financial cost savings where applicable to further expand trust support. Build inter and intra trust communication networks to share information on trial availability. Issues with clarity - offer training and education days to improve knowledge and understanding of live trials across the clinical community.

47 Contact details: Matt Hayes, Clinical Director, Cancer Strategic Clinical Network Sally Rickard, Manager, Cancer Strategic Clinical Network Website