Activity Report April 2012 March 2013

Transcription

1 Gynaecological Cancer Managed Clinical Network Activity Report April 2012 March 2013 Nadeem Siddiqui MCN Clinical Lead Kevin Campbell Network Manager 1

2 CONTENTS EXECUTIVE SUMMARY 3 1. INTRODUCTION 4 2. MCN WORKPLAN AND ACTIVITIES (REPORTING PERIOD 04/2012 TO 03/2013) CORE OBJECTIVES INDIVIDUAL MCN OBJECTIVES OTHER MCN ACTIVITIES 5 3. QUALITY ASSURANCE / SERVICE DEVELOPMENT AND IMPROVEMENT 5 4. KEY PRIORITY AREAS FOR THE MCN IN THE NEXT 12 MONTHS 7 5. CONCLUSION 7 ACKNOWLEDGEMENT 8 2

3 Executive Summary Introduction The purpose of this document is to report the Gynaecological Cancer Managed Clinical Network (MCN) activities in respect of: Performance against agreed work plan objectives; Outcomes achieved; and Challenges encountered and actions taken to remedy defined issues. This activity report covers the period April 2012 to March It also reports on key audit findings and resultant actions from the 2011 clinical audit, as well as looking forward from April 2013 to March MCN Objectives The Gynaecological Cancer MCN has made progress and delivered a number of key objectives which include: Enhanced Recovery after Surgery (ERAS): Development work on a regional exemplar pathway has progressed well and the document produced by the multi disciplinary working group was presented to the Regional Cancer Clinical Leads Group in June 2013 and was endorsed for circulation and local implementation. Implementation of Regional Follow-up Guidelines: Indications are that local implementation has taken place and there is broad adherence to the guidance. Regional Clinical Audit: The 2011 clinical audit data report was published in March Action plans have been produced by the Boards in response to the issues highlighted in the report and progress against outstanding actions will be monitored by the MCN Advisory Board. Quality Performance Indicator (QPI) development: Ovarian Cancer QPIs have been in development throughout this year and are expected to be published and implemented by 1 October These will facilitate local service performance assessment and quality assurance and will also enable regional comparative assessment and periodic national comparative reporting of performance. Regional Ovarian Cancer Surgical Service: Full implementation of the agreed regional service model requires appointment to the agreed and funded fifth gynaecological oncologist post. In the meantime the MCN continues to monitor referral activity; the 12 month period to end December 2012 shows an increased proportion of cases discussed at the MDT and subsequently operated on by the specialist team at Glasgow Royal Infirmary. Key Priority Areas for the MCN in the next 12 months The MCN work plan has been developed with an emphasis on identifying outcomes that improve the quality of patient care and overall service efficiency. Below are the objectives to be progressed in the coming year: Continue to support the regional clinical audit programme and effectively utilise audit findings to inform and drive service improvement; Support implementation of the ovarian cancer QPIs and engage in development of QPIs for endometrial and cervical cancers; Finalise the ERAS exemplar pathway for endometrial cancer and support local implementation Develop a regional service map, identifying the points of service delivery and the connections between them; Complete the review of regional Clinical Management Guidelines; Appoint a fifth consultant gynaecological oncologist, fulfilling the requirements of the agreed regional service model for the management of ovarian cancer; and Assess consistency of MDT treatment decisions through a review of patient management. 3

4 1. Introduction The Gynaecological Cancer Managed Clinical Network (MCN) was established in 1999 with the ambition of delivering high quality, equitable clinical care to all Gynaecological cancer patients within the constituent NHS Boards that comprise the West of Scotland (WoS) region; Ayrshire & Arran, Forth Valley, Greater Glasgow and Clyde and Lanarkshire. Gynaecological cancers account for approximately 10% of all cancers affecting woman. Incidence of ovarian cancer has decreased over the last ten years, conversely incidence of endometrial cancer has risen significantly over the same time period. Incidence of cervical cancer since the introduction of the Scottish Cervical Screening Programme, however in the past few years this decline has halted which may be due to a slight decrease in the uptake of the cervical smear test. The MCN continues to support and develop the clinical service for approximately 800 new gynaecological cancer patients each year and management of this patient group relies heavily on close collaboration between specialists who comprise the regional multi-disciplinary team (MDT) which meets weekly via videoconferenced links to plan and review the management of all patients. A total of 726 newly diagnosed gynaecological malignancies were recorded by audit teams within the West of Scotland (WoS) during This included 277 new cases of ovarian cancer, 315 cases of endometrial cancer and 134 cases of cervical cancer; there is currently no audit of the very small number of vagina/vulval cancers. Treatment for complex gynaecological malignancy often requires a multi-modal approach, but surgery remains a key component of effective curative management. The purpose of this document is to report the Gynaecological Cancer MCN activities in respect of: Performance against agreed objectives; Outcomes achieved; Challenges encountered and actions taken to remedy defined issues; and Update on progress of actions identified from the Audit Report. MCN Governance Dr Nadeem Siddiqui, Consultant Gynaecological Oncologist, leads the MCN and he is supported by Dr Nick Reed whose experience enables him to deputise as required. Ewen Walker, a founding member of the Network Advisory Board, has retired and Dr Prassad Konamme has replaced him as representative for NHS Ayrshire & Arran. Dr Sophie Hepple has replaced Dr Rachel Connor, representing radiology. 2. MCN Work plan and Activities (reporting period 04/2012 to 03/2013) 2.1 Core Objectives Enhanced Recovery after Surgery Work on developing a regional exemplar enhanced recovery patient pathway was initiated with the formation of a short-life working group. The group agreed an operational terms of reference, identifying specific outcomes and agreeing related timelines. Development work on an exemplar ERAS pathway for the management of endometrial cancer patients was complete by May 2013 and was subsequently endorsed for circulation and local implementation by the Regional Cancer Clinical Leads in June. 4

5 Implementation of Regional Follow Up Consensus Guidelines The Regional Gynaecological Cancer Follow-up Guidelines were previously published and circulated for implementation in December Indications are that local implementation has taken place and there is broad adherence to the guidance. Regional Clinical Audit Programme Effective utilisation of audit data to support service improvement is a key objective of the Gynaecological Cancer Managed Clinical Network. The report of 2011 audit data identified a number of aspects of service provision requiring further investigation by local health boards. In response Boards have prepared actions plans identifying their findings, resulting actions and the progress made toward complete resolution. A revised national data set for ovarian cancer audit is scheduled to be introduced on 1 October 2013 as part of the implementation of the national Quality Performance Indicator (QPI) programme. This will promote national consistency and should promote good quality data recording. 2.2 Individual MCN Objectives National Quality Performance Indicator Development Programme The Scottish Cancer Taskforce Quality Subgroup is currently taking forward the development of national Quality Performance Indicators (QPIs) for all cancers. MCN members were well represented in the group tasked with developing the QPIs for ovarian cancer. The development programme will begin to address the development of quality measures for both endometrial and cervical cancers in August 2013 and the work is expected to be completed within 12 months. The QPI programme will facilitate ongoing local and regional comparative assessment and will also enable periodic national comparative reporting of performance. Implementation of Regional Service Model Achieving full implementation of the agreed regional ovarian cancer surgical service model requires appointment to the agreed and funded fifth Gynaecological Oncologist post. In the meantime the MCN continues to monitor referral activity; the 12 month period to end December 2012 shows an increased proportion of cases discussed at the MDT and subsequently operated on by the specialist team at Glasgow Royal Infirmary. 2.3 Other MCN Activities Education The MCN continues to support an educational programme and two events were convened during the last year, one focussed on the management of ovarian cancer, the other on cervical cancer. The MCN also participated in a national event, the programme for which included complex case studies and an attempt to present nationally comparative results from analysis of clinical audit data. 3. Quality Assurance / Service Development and Improvement The primary function of the MCN is to facilitate continuous clinical service improvement, supporting delivery of high-quality, equitable, treatment and care to patients with gynaecological cancer in the West of Scotland. The prospective clinical audit programme underpins much of the regional service development and improvement work of the MCN and supports quality assurance (QA) by providing the means for regular assessment and reporting against recognised and agreed measures of service performance and quality. The annual regional quality assurance of service provision for ovarian cancer utilises thirteen nationally recognised Standards (Health Improvement Scotland (HIS) formerly Quality Improvement Scotland) 5

6 and the latest report of audit data is based on 277 new diagnoses of ovarian cancer presenting in 2011, set against results obtained from the previous reporting period. Five key outcome measures were also regional agreed to assess the quality of endometrial cancer service provision and were applied to the 315 new patients identified. The MCN QA process requires local multi-disciplinary teams to critically review and verify their own results before these are collated to provide a regional comparative report of performance against the agreed measures. The report of the 2011 clinical audit data was published in March 2013 on the West of Scotland Cancer Network internet site. Regional Audit and Governance Process In accordance with agreed governance procedures, Boards were asked to produce Action/Improvement Plans, in response to audit findings, to take forward recommendations set out in the Audit Report; the expectation thereafter is that these actions will be progressed and monitored via local governance structures. Plans are expected to be submitted to the regional network Information Manager within two months of publication of the report. The MCN Manager/Clinical Lead will periodically review Board Action Plans to identify priorities for co-ordinated regional action and these, along with progress against specific Board actions are monitored by the MCN Advisory Board under the standing MCN Work Plan agenda item. Action Plan Progression Recommended actions on the basis of the key findings of the audit report were directed to Boards requesting that local plans are developed to address areas of deficiency identified. Boards have produced plans and outlined below is a summary of progress to-date: Ovarian Cancer NHS Forth Valley has identified the 5 patients for whom the data indicate inadequate pre-operative preparation and the 1 patient whose histopathological report was incomplete and has scheduled a review of these cases. NHS Ayrshire & Arran and NHS Lanarkshire have undertaken a review of their surgical cases reported as not undergoing omentectomy or omental biopsy; Lanarkshire concluded that this should have been done in the single case identified and Ayrshire reported that in most cases either cancer was not suspected and only subsequently confirmed by histopathology or the operation was done laparoscopically where omental biopsy is technically not possible. Lanarkshire has re-iterated to those operating on suspected ovarian cancer patients that an omental biopsy should be carried out. Endometrial Cancer NHS Forth Valley has agreed to review the 2 cases where it has been reported that washings were not done for cytological assessment. Across all Boards all the actions identified in the Board-specific action/improvement plans have been reviewed and an Action/Improvement Plan produced in line with the governance framework. The actions identified as not yet fully implemented will be reviewed by the Advisory Board. Escalation Process Any service or clinical issue which the Advisory Board considers not to have been adequately addressed will be escalated to the Regional Lead Cancer Clinician and relevant NHS Board Cancer Clinical Lead by the MCN Clinical Lead. 6

7 4. Key Priority Areas for the MCN in the next 12 months The MCN work plan has been developed with an emphasis on identifying outcomes that improve the quality of patient care. Below are the key areas identified in the work plan for the coming year, 2013/14: Continue to support the regional clinical audit programme and effectively utilise audit findings to inform and drive service improvement. The existing NHS Health Care Improvement Scotland (formerly Quality Improvement Scotland) Standards for the management of ovarian cancer will be superseded by National Quality Performance Indicators in Assessing these measures of performance and quality of treatment and care will necessitate implementation of a revised data set; Support implementation of the ovarian cancer QPIs and engage in development of QPIs for endometrial and cervical cancers; Support local implementation of the ERAS exemplar pathway for endometrial cancer; Develop a regional service map, identifying the points of service delivery and the connections between them; Complete the review of regional Clinical Management Guidelines; Appoint a fifth consultant gynaecological oncologist, fulfilling the requirements of the agreed regional service model for the management of ovarian cancer; and Assess consistency of MDT treatment decisions through a review of patient management. 5. Conclusion The MCN has made good progress in regard to the work plan and the continuing support of the Advisory Board members is critical to delivery of the identified outcomes. The Gynaecological Cancer MCN continues to focus on improving quality of care through effective and efficient models of service delivery. The MCN recognises the critical role that clinical audit plays in underpinning this through regular regional comparative assessment of performance and quality assurance of treatment and care provided; the recently agreed national ovarian cancer QPIs will further support this programme of continuous service improvement. The MCN will continue to participate in and support regional and national strategies aimed at delivery improvements in quality and efficiency and the MCN recognises the need for collaboration both regionally and nationally in delivering incremental improvements. 7

8 Acknowledgement This report represents the achievements and challenges progressed across the four partner NHS Boards of the : NHS Ayrshire & Arran NHS Forth Valley NHS Greater Glasgow and Clyde NHS Lanarkshire We would like to thank all members and active participants in the cancer network for their continued support of the Managed Clinical Network, without their efforts this level of progress would not be possible. 8