Cancer Delivery Plan. April Abertawe Bro Morgannwg University Health Board

Transcription

1 Cancer Delivery Plan 16 April Abertawe Bro Morgannwg University Health Board Page 1 of 15

2 1. Background and context Together for Health a Cancer Delivery Plan was published in 2012 and provides a framework for action by health boards and NHS trusts working together with their partners to improve cancer services. It sets out the Welsh Government s expectations of the NHS in Wales to tackle cancer in people of all ages, wherever they live in Wales and whatever their circumstances. The Plan is designed to enable the NHS to deliver on their responsibility to meet the needs of people at risk of cancer or affected by cancer. It sets out: The population outcomes we expect. The outcomes from NHS treatment we expect. How success will be measured and the level of performance we expect. Themes for action by the NHS, together with its partners. What do we want to achieve? The Cancer Delivery Plan sets out actions to improve outcomes in the following key areas between now and 2016: Preventing cancer Detecting cancer quickly Delivering fast, effective treatment and care Meeting people s needs Caring at the end of life Improving Information Targeting research 2. Abertawe Bro Morgannwg University Health Board s Delivery Plan The Abertawe Bro Morgannwg University Health Board produced its first delivery plan in December In last year s delivery plan we set the following priorities for 2014: Design and implement clear pathways for rapid access to diagnostic services and treatment for patients with suspected cancer e.g colorectal cancers Implementation of an acute oncology service. To actively participate in the Peer Review programme. Develop a core cancer group to focus on strategic planning. Ensure cancer waiting times targets remain a priority on HB agenda. Improve performance to sustainably deliver radiotherapy waiting times. Implementation of IMRT 5 year plan. Phased replacement of ageing Linear Accelerators. Establishment of an EBUS Service in Morriston Hospital. Funded CPEX Service To establish a network IPFR system to ensure consistency and transparency of decision making. Maintain and strengthen established chemotherapy safety group. Page 2 of 15

3 To implement Chemotherapy National Data set. Improve and strengthen Morbidity and Mortality data collection and audit across cancer MDT s. Deliver holistic needs assessment and care planning for all cancer patients across ABMU HB. Deliver a person centred service. Consistent, appropriate and robust Clinical Nurse Specialist cover for all Multi Disciplinary Teams to improve patient care. Improve data quality and develop internal reporting mechanisms Increase the number of patients participating in palliative care studies, less common cancer trials and radiotherapy trials Considerable progress has been made against these priorities as highlighted below: A new Colorectal Cancer and Rectal Bleed Pathway has been developed. An Acute Oncology Service has been piloted. Funding has been approved by the Health Board to implement a sustainable service. We are 12 months ahead of target for the implementation of IMRT, and our IMRT treatment rates are now above the UK median. RTDS and SACT Datasets are now working, and are the first in Wales to do so. This allows benchmarking against English data, and for sophisticated audit which will inform service development. Collaborative working continues with Hywel Dda with regards to the coordinated regional provision of future Oncology Services in South West Wales Effective engagement with the All Wales Cancer Peer Review Programme An EBUS service has been implemented at Morriston Hospital Performance has improved to sustainably deliver radiotherapy waiting times. Establishment of a Cancer Commissioning Board Formalisation of Multi Disciplinary Team Leadership and processes. Appointment of a Macmillan Person Centred Project Manager A Tenovus mobile chemotherapy unit has started, initially at Singleton Hospital, delivering some treatments at weekends, which is convenient for patients and which relieves pressure on the Chemotherapy Day Unit (CDU.) Singleton CDU is planning to support the C-Port chemotherapy activity data tool. We will be the first centre in Wales to implement this. Expansion of Clinical Trial Recruitment, notably for radiotherapy trials. In delivering our services for patients with cancer, there are a number of service improvements that we have implemented locally that have had a real impact on patient care. Examples of this include: Lymphodema Services Metastatic Spinal Cord Compression pathway Page 3 of 15

4 Implementation of IMRT 5 year plan. Welfare Benefits advisor Pathway work, notably: shortening the time from surgery to adjuvant radiotherapy for patients with Head and Neck Cancer. 3. The vision: To improve the health of our community and to deliver effective and efficient healthcare in which our patients and users feel cared for, safe and confident. The people of South West Wales served by Abertawe Bro Morgannwg University Health Board should expect to have cancer-related health outcomes on par with equivalent populations in the UK and Europe, and to receive the best evidence-based treatments at all levels delivered in a timely and appropriate manner. We will respect people s rights in all that we do and plan our services and care with them. Wherever and by whom it is provided, care will be safe and compassionate, meeting agreed national standards, providing excellent outcomes and an experience that is as good as it could be. 4. The drivers: There are clear reasons why cancer remains a top priority for the Abertawe Bro Morgannwg University Health Board (ABMU HB): In ABMU HB nearly 34,000 people will be living with cancer by For most cancers, there is considerable variation in incidence and mortality which is strongly associated with levels of social deprivation. The inequality dimensions to cancer are complex and range from social deprivation, lifestyle factors, detection, available treatments, survival and service configuration. ABMU HB area contains some of the most and least deprived areas in Wales. Overall 25% of Lower Super Output Areas (LSOAs) in ABMU HB fall within the most deprived quintile of LSOAs in Wales. Lifestyle factors are strongly associated with the development of a number of cancers. There is a considerable variation in percentage of the population leading a healthy lifestyle across ABMU HB area. Percentage point difference between BEST and WORST ABMU HB Upper Super Output Areas. Obesity (%) Inactive (%) Smoking (%) Drinking above limits (%) Page 4 of 15

5 The uptake of screening programmes is strongly associated with social deprivation. Based on a small sample of cases, nearly 1 in 3 (27%) cases of small cell lung cancer are detected following an emergency admission. Over 1 in 2 (56%) cases are stage 4 at the point of detection. There has been a 15% point increase in cancer incidence between 2001 and 2013 in ABMU HB. There has been an increase in the cancer incidence inequality gap between the least and most deprived communities between and There has been a 5% point decrease in cancer mortality between 2001 and 2013 in ABMU HB. There has been an increase in the cancer mortality inequality gap between the least and most deprived communities between and Survival varies considerably by cancer site. For all cancers, one year survival is similar to the Welsh average but for 5-year survival ABMU HB is statistically significantly lower than the Welsh average. International benchmarking 5-year survival data show Wales has considerably lower survival rates for breast, colorectal, ovarian and lung cancers compared to the Australia, Canada and Swedish regions. ABMU HB data from the Welsh Cancer Patient Experience Survey 2013 shows that information provision, care planning and discharge are areas for improvement. The survey also showed considerable variation across hospital sites. 5. ORGANISATIONAL PROFILE Organisational Overview The Health Board covers a population of approximately 500,000 people and has a budget of 1.3 billion. The Health Board employs around 16,500 members of staff, 70% of whom are involved in direct patient care. The Health Board has four acute hospitals providing a range of services; these are Singleton and Morriston Hospitals in Swansea, Neath Port Talbot Hospital in Port Talbot and the Princess of Wales Hospital in Bridgend. There are a number of smaller community hospitals and primary care resource centres providing important clinical services to our residents outside of the four main acute hospital settings. The Health Board acts as the service provider for Wales and the South West of England in respect of Burns and Plastic Surgery. In addition, Forensic Mental Health services are provided to a wider community which extends Page 5 of 15

6 across the whole of South Wales, while Learning Disability services are provided from Swansea to Cardiff. A range of community based services are also delivered in patients homes, via community hospitals, health centres and clinics. The Health Board contracts with independent practitioners in respect of primary care services which are delivered by General Practitioners, Opticians, Pharmacists and Dentists. There are 77 General Practices across the Health Board. The Health Board manages two practices in the Neath Port Talbot area: in the Afan Valley and Neath town centre and one in Bridgend.. All other practices are independent, self-governing organisations. Practice list sizes vary across the area, with the lowest approximately 1,000 patients and the highest 20,000 patients. Outside normal practice hours the Health Board also has responsibility for the provision of an Out of Hours GP service. There are more than 300 General Practitioners, around 275 dentists, 125 Community Pharmacies and 60 Optometry premises across the Health Board. General Medical Services within Her Majesty s Prison Swansea are also provided via ABMU HB. The Health Board is a University Health Board and has close links with Swansea University with whom it has a number of joint projects currently underway. As a result of these links, we have secured, in partnership, the Wales Graduate Entry Medical degree award. In addition, the development of the Institute of Life Science (ILS) and ILS 2 at the School of Medicine at Swansea University has created a safe and effective environment for an outstanding Clinical Research Facility. This provides rich potential for medical and health advance and also for the strong promotion of the local knowledge economy. Further, impressive progress at the Swansea University College of Human and Health Sciences responsible for nursing, midwifery, and allied healthcare professional education across the Region has been made. This collaborative approach has led to the development of an ambitious programme for multi-disciplinary clinical skills teaching at the postgraduate level to support the development of new and innovative ways of working. Page 6 of 15

7 Our Values caring for each other working together always improving caring for each other - in every human contact in all of our communities and each of our hospitals working together - as patients, families, carers, staff and communities so that we always put patients first always improving - so that we are at our best for every patient and for each other Our Purpose To improve the health of our community and to deliver effective and efficient healthcare in which our patients and users feel cared for, safe and confident. Non-Surgical Cancer Services for people living within South West Wales are provided by the South West Wales Cancer Centre (SWWCC), based at Singleton Hospital. A proportion of ABMU patients living in Bridgend and the Vale of Glamorgan receive their non-surgical oncology treatments at Velindre Cancer Centre. Patients treated at SWWCC come from the Swansea, Neath and Port Talbot areas, and from the whole of South West Wales as far North as the Aberystwyth area. Some patients from the Bridgend area are also treated at the centre. The area covered by the Cancer Centre includes a population of around 850,000 and over 3000 patients are treated each year. The Cancer Centre operates as part of the South Wales Cancer Network. The South West Wales Cancer Centre was opened in 2003 and is a centre of excellence. Many patients with cancer will require an operation first, but most will require other specialised forms of treatment at the Cancer Centre. Services include Clinical & Medical Oncology, Clinical Haematology, Haematology, Palliative Care, Lymphoedema, Cancer Genetics and the Cancer Research Institute. Most patients are treated as out-patients but some require in-patient treatment. Clinics are held in Swansea and across South West and West Wales, where patients meet with their oncologists who will monitor and lead the planning of their treatment. This is planned using a multi-disciplinary approach to ensure that all treatment and rehabilitation considerations are taken into account. Page 7 of 15

8 Where possible, treatments such as Chemotherapy, and Palliative care are delivered locally, in a suitable setting, based in hospital clinics close to the patient s home. Radiotherapy and some specialised forms of drug therapy however, are delivered at SWWCC, in Singleton. Overview of Local Health and Challenges for Cancer Services The need for better information. Information is fundamental to guide the way ABMU commissions and delivers its cancer services. We need to understand the demographics of patient presentation, the outcomes of our treatments, and the issues which affect waiting times and the overall patient pathway. It is often difficult to access the data. A priority is to develop tools to allow for quick, easy access to the necessary information. Inequalities. The way people access both general health and specialist cancer services, and the outcomes, are uneven. A major challenge is to understand the issues in detail so that targeted solutions can be devised and instituted. Quality The experience of ABMU HB patients using our Cancer Services is variable. ABMU HB needs to provide consistently good clinical care, information and support in all settings. Peer review will continue to inform our service planning. Infrastructure and Human Resources We must ensure that we have adequate facilities to manage patients in a safe and timely fashion. MDT s require specially equipped meeting rooms. Similarly, cancer MDT staffing needs to be resourced to permit the MDT s to carry out extended responsibilities. 6.Development of Abertawe Bro Morgannwg University Health Board local delivery plan for cancer In response to the Together for Health A Cancer Delivery Plan (2012), health boards are required, together with their partners, to produce and publish a detailed local service delivery plan to identify, monitor and evaluate action needed within timescales. These plans need to be updated annually and the health board executive leads for cancer will need to report progress formally to their Boards against milestones in these delivery plans and publish these reports on their websites at least annually. Following our assessment of progress against priorities we have reviewed how service provision may need to change, we have drawn up actions to be undertaken during the period of the national delivery plan and in particular actions and outcomes we want to see happen this year. In addition to this we held a stakeholder event to assess key achievements over the last year, to Page 8 of 15

9 review what we are currently doing, and to set priorities for -16 within this plan. 7. Priorities for the coming year In Abertawe Bro Morgannwg University Health Board has set up a Cancer Commissioning Board (CCB). The CCB is co-chaired by a GP and a hospital consultant, and also includes the ABMU HB Director of Strategy, ABMU HB Cancer Lead, Public Health, and members of the third sector. The CCB will take a strategic overview of the entirety of the cancer pathway in ABMU, looking at the best way to prudently commission services for our population- based on need, with an emphasis on prevention, early detection, and the interface between primary and secondary care. CCB activities are highly congruent with the CDP and with the /16 National Priorities. The CCB will constructively monitor progress against both of these. Over /16 it is planned that the CCB will develop a systematic, data-driven process for the selection of suitable topics from across the whole pathway of cancer care. This will significantly inform the ABMU HB cancer delivery plan from 2016/17 onwards. For /16 the following national priorities have been agreed: Organisation of cancer support services to ensure improved services, delivery, planning and performance Primary Care Oncology Develop and pilot a single urgent cancer pathway Patient experience Lung Cancer national focus. In addition to these national priorities Abertawe Bro Morgannwg University Health Board highlights the following priorities for /16 which reflect the needs of the local population. Preventing cancer To integrate Public Health and Primary Care into the ABMU cancer services commissioning process To understand better at a local level the factors that affect healthy behaviour, in order to tailor schemes the needs of individual communities To integrate processes with the ABMU C4B Long Term Conditions work stream. Detecting cancer quickly To understand in more detail the factors causing late or unplanned presentation of cancer, starting with lung cancer To improve the uptake of cancer screening services To coordinate with mobile breast screening in order to plan for changes in patient flow Page 9 of 15

10 Improved communication at the interface between primary care and hospital diagnostic clinics To reduce delays in diagnostic biopsy Delivering fast, effective treatment and care Implementation of the Single Cancer Pathway for referral of suspected cancers The establishment of a Cancer Operational Delivery Board. Cancer MDT-led development of specific cancer pathways Review of individual MDT functionality and requirements for time and staffing. Annual audit and outcome programme for each MDT. Development of the surgical pathway for Metastatic Spinal Cord Compression in conjunction with the South Wales Cancer Network To develop internal standards for radiotherapy waiting times Meeting people s needs Strategic development of the ABMU cancer Clinical Nurse Specialist (CNS) establishment MDT-led patient experience surveys Caring at the end of life Advance care planning, training and implementation Improve public awareness of death and dying. Improve communication skills support and training. Improve information provision. Targeting research To expand our research portfolio by opening more high-quality multicentre trials, especially in radiotherapy and surgery. Development of infrastructure and human resources to facilitate an expanding research base. Improving information To improve our ability to routinely access patient-specific information about cancer presentation, access to treatment, and outcomes, including survival data Further development and utilisation of the national Radiotherapy Dataset Further development and utilisation of the national Systemic Anticancer Therapy (SACT) dataset 8. PERFORMANCE MEASURES/MANAGEMENT Together for Health a Cancer Delivery Plan (2012) contained an outline description of the national metrics that LHBs and other organisations will publish: 10

11 Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales. National performance measures which will quantify an organisation s progress with implementing key areas of the delivery plan. Progress with these outcome indicators form the basis of each health board s annual report on cancer. We have already produced three annual reports that highlight our progress against these measures. Our next annual report will be published in. 11

12 9. ACTION PLAN 2016 Priority Actions required - 16 Lead Due Date Expected Outcomes Preventing cancer To integrate Public Health and Primary Care into the ABMU cancer services commissioning process Public Health and Primary Care membership of the Cancer Commissioning Board Cancer Commissioning Board Left shift of Cancer Commissioning objectives To understand better at a local level the factors that affect healthy behaviour, in order to tailor schemes the needs of individual communities Detecting cancer quickly To understand in more detail the factors causing late or unplanned presentation of cancer, starting with lung cancer Improvements of screening services. Undertake an analysis of disease presentation by GP practice / stage at presentation / performance status To improve the uptake of cancer screening services Cancer Commissioning Board Public Health To integrate processes with the ABMU C4b Long Term Conditions work stream. Improved commissioning Improved commissioning Improved communication at the interface between primary care and hospital diagnostic clinics To coordinate with mobile breast screening in order to plan for changes in patient flow Develop robust communication and referral pathways Cancer Commissioning Board To reduce delays in diagnostic biopsy 12

13 Delivering fast, effective treatment and care Implementation of the Collaboration with Welsh Single Cancer Pathway Government for referral of suspected cancers To actively participate in the peer review programme to drive improvement through self assessment. MDT development Development of the surgical pathway for Metastatic Spinal Cord Compression in conjunction with the South Wales Cancer Network Reduced waiting times for radiotherapy Develop improvement action plans in response to findings of review to develop and improve services Cancer MDT-led development of specific cancer pathways Review of individual MDT functionality and requirements for time and staffing. Annual audit and outcome programme for each MDT Collaboration with the South Wales Cancer Network and Cardiff & Vale HB. To develop internal standards for radiotherapy waiting times Cancer Commissioning Board Cancer Lead Clinician (MR) & Directorate Performance Manager (MS) Cancer Lead Clinician (MR) & Directorate Performance Manager (MS) Macmillan Team Lead Physiotherapist Specialist (KE) Consultant Clinical Oncologist (RB) Ongoing Ongoing Full implementation of the Single Cancer Pathway Sustainable, high quality services and performance which are compliant with the National Cancer Standards. Efficient and effective MDT function Access to emergency spinal surgery Improved patient experience and outcomes 13

14 Meeting people s needs Strategic development of the ABMU cancer Clinical Nurse Specialist (CNS) establishment Establish a working group to gather baseline data in order to provide recommendations to the Health Board Head of Nursing Regional Services (PD) Sustainable CNS service and improved patient care and experience. Caring at the end of life Advance care planning, training and implementation. Improve public awareness of death and dying. Improve communication skills,support and training Improve information provision Improving information Improved data access MDT-led patient experience surveys Adopt appropriate documentation. Training of staff in administering documentation. Active engagement with public health colleagues within ABMU HB and nationally improve signposting. Deliver training in communication skills Review of existing written information provided and development of improved Work with HIW to improve Canisc functionality Establish links with SAIL End of Life Care Group Director of Public Health (SH) End of Life Care Board, Director of Workforce & OD Andrews Task Force Assistant Director of Nursing/ Head of Patient Experience Cancer Commissioning Board End of 2016 End of 2016 Ongoing Ongoing Better anticipatory decision making with people nearing end of life Healthier attitudes to death and dying. Better Care and reduced incidence of distress through poor communication. More consistent provision of information and possibly better information. People better informed about choices. Ability to routinely access patient-specific information about cancer presentation, access to treatment, and outcomes, including survival data to inform commissioning. Work with Public Health Wales 14

15 to re-establish access to patient specific survival data from the Office of National Statistics Further development and utilisation of the national Radiotherapy Dataset Continued liaison with NATCANSAT and Public Health England for development of RTDS Cancer Lead Clinician (MR) Ongoing Sophisticated live audit data to inform commissioning. Further development and utilisation of the national Systemic Anticancer Therapy (SACT) dataset Targeting research Expand research portfolio Commercial collaboration for development of SACT project Opening high-quality trials including radiotherapy and surgical trials. Development of research infrastructure and HR to support an expanding portfolio Research Network Manager & NISCHR CRC Cancer Lead. (JC) Ongoing Improved patient choice Quality assured service development The above action plan has been developed to incorporate and support the five national cancer priorities for