INTERNAL VALIDATION REPORT (MULTI-DISCIPLINARY TEAM)

Transcription

1 INTERNAL VALIDATION REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT NECN N Tees & Hartlepool North Tees And Hartlepool Date Self Assessment Completed 23rd July 2009 Date of IV Review 19th June 2009 Lead Clinician Mr I Zamora Compliance LOCAL UROLOGY MDT Key Questions Self Assessment 84.4% (38/45) Internal Validation 82.2% (37/45) Does the team demonstrate that this is a properly constituted and functioning MDT? The local Urology MDT in North Tees and Hartlepool NHS Foundation Trust (NT&HFT) manages symptomatic patients referred from the surrounding areas including Stockton, Sedgefield, Hartlepool and Peterlee with a population of about 400,000. The local team manage and treat urological cancer locally as described in the urology IOG (2003) and Manual of Quality Measures. Patients requiring discussion by the specialist MDT (as prescribed in IOG) are referred to the specialist team at South Tees Foundation Trust (STFT) and presented by urologists / oncologist. It is noted that the Oncologist core member at the local team is also a core member in the specialist MDT. More radical surgery is referred to the Specialist Urology MDT at STFT (James Cook University Hospital (JCUH)). It is noted that several of the urologists work across both trusts and some undertake Radical Cystectomy and Prostatectomy at JCUH. Minimally invasive resectional surgery is carried out at JCUH by some of the local urology MDT in accordance with the IOG guidance. The team fully adopt the cancer network guidelines which are based on NICE guidelines and European Association of Urology guidelines. There were 51 Urology MDT meetings between 1/4/2008 and 31/3/2009. During this period 1844 discussions took place. 233 new invasive cancers and 44 pta bladder cancers were diagnosed during this period. The Operational Policy complies with most of the quality measures and the team follows the NSSG agreed guidelines Does the team demonstrate that it has effective systems for providing coordinated care to individual patients? A forward looking team with service improvement at the heart of their business. Strong nursing leadership is evident with a good skill mix amongst nurse specialists. The validation panel was impressed with the quality of the service provided. A highly skilled team which offers a patient centred service with wide ranging treatment modality for patients with urological cancer including minimally invasive techniques in suitable patients. The team follow the Network agreed guidelines. A clear pathway for patients with haematuria, prostate cancer and two week rule referrals. INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 1/6

2 Does the team demonstrate that it has adequate information to help improve service delivery? The Urology MDT have also carefully analysed each breach of the 62 day target over the last two years to highlight possible areas of improvement to the patient pathway The MDT have presented and discussed the Network Patient & Carer survey and devised an action plan The minimum dataset is collected on Somerset Registry Database and follows the agreed Network SSG guidelines and dataset The MDT also participates fully in the National British Association of Urological Surgeons (BAUS) data collection and National Audit Support Programme Does the team demonstrate that it is continuously improving its service including both clinical effectiveness and the patient experience? The team have presented and discussed the Network Patient & Carer survey and devised an action plan Several examples of continuous service improvement were seen including: Changing the timing of the MDT meetings to improve and allow better attendance by core members. This resulted in significant improvement in MDT attendance since the last Peer Review. A new oncologist has been appointed and has been able to attend the meeting via video conferencing from JCUH. The MDT also participates fully in the National BAUS data collection and National Audit Support Programme. Testing of new method of urine cytology which is hoped to expedite haematuria pathway. Development of Parallel Clinics with Oncology, Surgery and CNS A significant contribution by the team for the development of Laparoscopic Urology in the southern part of the cancer network. Streamlined MDT meeting process and prioritisation Telephone follow-up for prostate cancer patients Key Evidence Submitted Operational Policy A comprehensive Operational Policy that covered most of the quality measures. It describes the team function, patient pathway, policies and procedures and clinical guidelines and treatment protocols. INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 2/6

3 Annual Report The Annual Report gave a detailed summary of achievements, for example The timing of the MDT meetings has been moved to Thursday morning starting at until This has allowed for a better meeting and for improved data collection. A new oncologist, Dr Shakespeare has been appointed. He covers both the University Hospital of Hartlepool and University Hospital of North Tees and should be able to attend the entire urology MDT meeting from the start, via video conferencing from JCUH. In response to previous breaches the MDT has implemented a policy whereby every breach is analysed to try to identify areas for improved practice. The Urology MDT, led by radiology, has worked to develop dedicated CT Urography slots to increase speed of investigation and results Mr I C Zamora has competed extensive training and is now performing laparoscopic renal and prostatic surgery and radical cystectomy for local patients at the Cancer Centre Other areas which were included are; Use of data to assess service provision MDT workload and activity data National and local audits, Patient feedback Trial recruitment Work Programme Detailed Annual Work Programme which describes how the MDT will work with the North of England Cancer Network and Cancer Centre to meet the challenges outlined in the Annual Report over the next few years. It also included: Action from audit or patients surveys Action from new NICE or National / Regional guidelines Plans for service improvement and development INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 3/6

4 Good Practice Good Practice/Significant Achievements Direct to test Haematuria clinic with booked appointments Clinical Nurse Specialist led clinics in own specialist area Testing of new method of urine cytology which is hoped to expedite haematuria pathway Development of Parallel Clinics with Oncology, Surgery and CNS A significant contribution by the team for the development of Laparoscopic Urology in the southern part of the cancer network Good nurse led audit carried out by the Urology Nurse Practitioner Phone clinics for prostate cancer Prostate booklet with PSA level recorded Streamlined MDT meeting process and prioritisation Tailor made patient information Concerns Immediate Risks: None Serious Concerns: None INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 4/6

5 Concerns: Although there has been a significant improvement in oncology input into the MDT in recent years (61%), currently there is no cover for the oncologist when on leave. This may lead to rescheduled discussion for the following week or discussing the case in the centre MDT. Named oncology cover to the MDT needs to be defined to ensure timely decision making. This issue was highlighted in the last peer review report. The NT&H FT need to work with South Tees Foundation Trust (ST FT), locality group and network to address this deficiency. The system for notification of serious diagnosis to GP (within 24hours) appears to not work on most occasions. This issue needs to be addressed and a suitable system needs to be put in place. Further consideration It is commendable that a single handed pathologist covers over 70% of MDT meetings. It is understood that lack of named cover is due to manpower issues within pathology, there currently being two whole time equivalent vacancies. With the appointment of an additional 2 Consultant Histopathologists to the Trust, it is hoped that this will allow for cover arrangements to be formalised. It is noted that there are good links between the local pathologist and the centre pathologists. However it is recommended that the pathologist involved in reporting on urological cancer should undergo the required EQA as outlined in the Manual of Quality Measures. There appears to be an issue in the quality of radiology images transferred to the centre MDT meeting. However it must be noted that STFT have extended the MDT deadline to accommodate disc transfer. It is recommended that IT and radiology departments in both trusts are encouraged to resolve this issue. Consideration should be given to the length of MDT meetings to allow adequate discussion The team took part in the Network Patients' and Carers' Group survey for patients treated in the Urology MDT. The team expressed wishes to do their own annual patients' survey to establish more contemporaneous views of patients and with a higher return. Consideration should be given to the process of breaking bad news and the presence of a CNS. General Comments A forward looking team with service improvement at the heart of their business. Strong nursing leadership is evident with a good skill mix amongst nurse specialists. The validation panel was impressed with the quality of the service provided. A highly skilled team which offers a patient centred service with wide ranging treatment modality for patients with urological cancer including minimally invasive techniques in suitable patients. INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 5/6

6 Summary of validation process An internal meeting was held on 2nd June 2009 and a review of all of the documents was carried out including Annual Report, Work Programme and Operational Policy. Advice and recommendations were made to the MDT to provide further evidence and clarification (as would have happened with a pre-visit). Final documentation was distributed to members of the internal validation panel listed below. The IV panel met on 19th June The evidence was reviewed, questions formulated and assigned to different panel members. The team was reviewed on the same day. At the end of the review the IV panel agreed a draft report and recorded the compliance with the measures. The draft report was circulated and a final report agreed Internal Validation Panel Mr M Tabaqchali - Trust Lead Cancer Clinician Mrs J Gillon - Director of Clinical Services & Compliance/Executive Director Lead for Cancer Services Miss Joanne Preston - Network Service Improvement Facilitator Dr C Parker - Professional Executive Committee Chair Mrs M Leckonby - Patient & Carer Representative Urology MDT Members in attendance Mr I Zamora - Consultant Urologist Mrs K Kilburn - Nurse Practitioner Dr M Siddiqui - Consultant Histopathologist Mr P Clark - Urology Specialist Nurse Mr E Gilliland - Consultant Urologist Mr Peedikayil - Staff Grade Urologist Organisational Statement I, Mr M Tabaqchali (Validation Chair) on behalf of N Tees & Hartlepool agree this is an honest and accurate assessment of the Local Urology MDT. Agreed by Mr A Foster (Chief Executive) on 28th Sep INTERNAL VALIDATION REPORT for North Tees And Hartlepool - Lcl UROL MDT (published: 29 September 2009) Page: 6/6