CIG SCP Health Board/Velindre Implementation Plan (Aneurin Bevan University Health Board)

Transcription

1 CIG SCP Health Board/Velindre Implementation Plan (Aneurin Bevan University Health Board) 1 Governance, Leadership and Planning a) Describe your SCP Programme Board (or equivalent), its membership and where it reports to. ABUHB Cancer Strategy Board The ABUHB Cancer Strategy Board is established to review existing service provision and provide recommendations to the Executive Board on strategy and delivery of cancer services for Aneurin Bevan University Health Board patients. It is responsible for the strategic planning of cancer services by prioritising and overseeing delivery of the cancer priorities in the Health Board IMTP and Cancer Delivery Plan. The Project Board consists of multi-professional representatives and is responsible for identifying priorities and planning delivery of the most appropriate service model to ensure the provision of sustainable, patient focused, high quality and clinically effective cancer services for Aneurin Bevan patients. b) Please name the Executive Lead for SCP and the respective leads/contacts for the work streams described below: Executive leads: Nicola Prygodzicz / Nick Wood 1

2 Part 1: Implementing Enabling Systems and Infrastructure Information and intelligence Demand and capacity analysis Quality improvement Communication and engagement Part 2: Transforming Whole Pathways Site specific pathways Primary Care Diagnostic Pathways Treatment Pathways Patient Centred Care Information and intelligence Lloyd Bishop Demand and capacity analysis Iestyn Davies Quality improvement Chris Heath Communication and engagement Ian Williamson Site specific pathways Tumour site leads Primary Care Mary Craig Diagnostic Pathways - Ian Williamson and tumour site lead clinicians Treatment Pathways - Tumour site leads Patient Centred Care Jane Gray c) Outline how you will performance monitor and manage the implementation of the SCP in your organisation The implementation plan for the SCP will be managed through the Cancer Strategy Board. d) Where there remain unknown factors that may influence the predicted performance explain what is being done to develop the necessary knowledge, expertise and infrastructure. Cancer Services in conjunction with ABCi have recently employed a dedicated member of staff to support in Demand and capacity and pathway modelling. This post will help identify any capacity gaps or bottlenecks within Tumour site pathways and key diagnostics. The Health Board has also developed an Electronic PoS trigger within the CWS system which will help capture patients that historically wouldn t have be tracked by Cancer Services. 2

3 Part 1: Implementing Enabling Systems and Infrastructure Describe SCP implementation plans with detailed timelines up to End of March 2019 using work streams below to guide 1 Information and Intelligence Detail timelines within plans a) Outline your plans to implement the use of an electronic referral system including timelines for full implementation of e-referral linking to e- management/tracking systems b) Outline your plans and timelines to implement an integrated tracking system that will prospectively track patient on SCP and record and report agreed performance and component SCP points. c) What are the barriers to a paperless referral and tracking system and detail plans to overcome such barriers? d) How and when will referrals, considering all referral routes, be picked up and tracked as identified in the Point of Suspicion Document? Please include timelines for full implementation. Clinical Workstation (CWS) already established within the Health Board with Electronic referrals being a key component. Any referral identified as suspected cancer will automatically be uploaded into the Health Boards tracking system (Tracker 7) and will be tracked from point of suspicion. Tracker 7 fully bedded within the Health Board and all component waits available. There are a number of IT developments planned to be undertaken by NWIS to improve the interface between tertiary providers and screening services. The Health Board will also need support from NWIS to provide interfaces with Pathology and Endoscopy systems. Electronic interfaces will need to be development to improve communication and Tracking for screening and Tertiary referrals. This is currently under with NWIS for development. Existing Tracking resource will need to be made substantive to report and improve performance on the SCP. The Health Board has also developed an Electronic PoS trigger within the CWS system and any increase in Tracking associated with the SCP will need to be resourced. The Health Board has already undertaken a lot of work capturing NUSC patients within the system. In 2017 the Health Board captured 7,500 NUSC referrals with 4,500 of those being downgrade. The Health Board are also developing an Electronic PoS trigger within the CWS system which will help capture patients that historically wouldn t have be tracked by Cancer Services. The functionality will be able from August 2018 and cancer services plan on a number of communication events to raise awareness of the new process and gain clinical engagement. 3

4 NWIS will be key in formalising interfaces between such areas as screening, primary care and tertiary providers. e) Outline your plans to review variation in referral, conversion and detection rates between cancer sites and with other HBs. f) Outline when median and 95 th centile waiting times from PoS to FDT by cancer site will be known for all cancer patients. g) Outline if and when median and 95 th centile waiting times from PoS to FDT by cancer site will be known for all suspected cancer patients found NOT to have cancer. h) Outline when other reports regarding component waits will be known (which steps will be recorded and reported). Try to include as many of the planned steps in the pathway that will be recorded and available for reports as possible. 3 Demand and Capacity Analysis Detail timelines within plans a) Describe your demand and capacity analysis work planned to predict the capacity (and gap Cancer Services currently use the Tracker 7 system to monitor all patients on the USC, NUSC and Single Cancer pathway. This system contains a wealth of information and in July 18 the Health Board plan to implement the Business intelligence system, Qlik Sense. Cancer Services plan on using this tool to monitor and analyse referral, conversion and detection rates and formulate plans in conjunction with primary care, individual Tumour sites and other Health boards. Data already available within Tracker 7 and can be produced on an adhoc basis. Analysis of this data will be far more accessible with the implementation of Qlik Sense. 1 st version planned for July Data already available within Tracker 7 and can be produced on an adhoc basis. Analysis of this data will be far more accessible with the implementation of Qlik Sense. 1 st version planned for July All applicable reports suggested by the WCN are available within Tracker 7 and can be produced on an adhoc basis. Analysis of this data will be far more accessible with the implementation of Qlik Sense. 1 st version planned for July Cancer Services in conjunction with ABCi have recently employed a dedicated member of staff to support in Demand and capacity and pathway modelling. This post will help identify any 4

5 where present) required to meet the future demand for SCP with a compliance target of 95% 62 days from the point of suspicion. This should include infrastructure, workforce and equipment and the timeline for completion. b) Outline how it is planned to meet the gap between required future with current capacity considering: Demand broken down by specific activity (e.g. OPA, CT/MRI imaging, endoscopy and treatment). Causes of this capacity gap attributed to improved performance to be compliant with current targets, continued increase in suspected cancer referrals and the SCP initiative itself. 4 Quality Improvement Detail timelines within plans a) Identify and describe where your planned focus on improvement is. For example, improved access to diagnostics, straight to test, implementing best practice (common) intelligent pathways, reducing delays caused by MDT decision making etc. capacity gaps or bottlenecks within Tumour site pathways and key diagnostics. This post will commence in July 18 with an implementation plan to be agreed with Cancer Services and ABCi. Information currently unknown. Please point 3a. Information currently unknown. Please point 3a. Information currently unknown. Please point 3a. The Health Board continues to have focus on improving all aspects of the patient s pathway including better access to Diagnostics, straight to test/optimal pathways and reducing delays using the Tracker 7. The Health Board is already currently undertaking a number of pilots to help support straight to test such as: Direct access to CT Thorax from Primary Care for Lung patients Radiologists to trigger a CT scan for suspicious Chest x rays 5

6 Direct access to USS for Head & Neck patients The Health Board is also planning to implement: Direct to test for Colonoscopy FIT testing for Symptomatic GI Patients Point of Care testing for patients needing an EGFR blood test for Contrast scans. b) Outline your planned work to understand pathway component waits from referral, through diagnostic steps through to treatment. c) Outline the improvement work that is planned in collaboration with 1000 lives, WCN and other HB s/trusts? Please outline how your local Improvement Hub is supporting the improvement required as outlined in a) above. d) Outline whether there are plans for increased IQT training for staff involved in the implementation of the SCP. What is the estimated numbers/% of MDT teams. 5 Communication and Engagement Detail timelines within plans Cancer Services in conjunction with ABCi have recently employed a dedicated member of staff to support in Demand and capacity and pathway modelling. This post will help identify any capacity gaps or bottlenecks within Tumour site pathways and key diagnostics. This post will commence in July 18 with an implementation plan to be agreed with Cancer Services and ABCi. Cancer Services are working with our local improvement team ABCi for pathway improvement and demand capacity analysis. Please see point 4a. We are also working with 1000 lives and screening services to analyse screening pathways to identify areas for improvement. ABCi offer many IQT courses such as IQT bronze, silver, improvement lead and modelling/ measurement courses. All Cancer Services staff are encouraged to under these courses for CPD. Series of workshops have been undertaken within the Health board to raise awareness of the SCP and to try and understand the impact this will have on individual tumour sites/diagnostic areas. These workshops are facilitated by ABCi and involve Executive leads, Tumour site leads, Primary Care, Lead managers, Diagnostics and Cancer Services. 6

7 a) Outline your plans to communicate to, and engage with, staff and patients in relation to the changes and improvements in patient outcomes through implementing the SCP and the plans to implement SCP across the HB/Velindre including: Cancer services have also devised a rolling programme to engaged with individual Tumour sites to discuss the SCP and optimal/pathway improvement. Action plans have been developed on the back of these meetings and will be overseen by the Cancer Delivery Board. These actions will also form a part of the Cancer Annual report that is presented to the executive team. Identifying Stakeholders Communication Action Plans Engagement with MDTs Communicating Good Practice/ Developments Cross Health Board Communication Sharing examples good practice nationally. ABUHB continue to be highly visible at network SCP meetings to discuss cross Health Board communication and sharing examples of good practice nationally. Part 2: Transforming Whole Pathways Describe SCP implementation plans with detailed timelines up to End of March 2019 using work streams below to guide 6 Site Specific Pathways Detail timelines within plans a) Outline your plans for each site specific group within your organisation and which are your priorities. Include a named lead for each cancer site who will engage with the national CSG s and lead on engagement and improvement locally with MDT s and non-cancer clinicians. Rolling programme agreed with Tumour site and Diagnostic lead clinicians to discuss SCP, pathway improvement and Optimal pathways. Action plans and next steps will be formulated at these meetings. b) Describe your work and plans to support clinicians to input into CSG s and adopt Please see point 6a. 7

8 standardised pathways, and/or sharing evidence based variations c) Outline if and when information on where the patient is on the SCP Pathway (days from PoS) will be available (and presented) to all patients discussed at your HBs MDTs 7 Primary Care Detail timelines within plan a) Describe your plans for engagement and collaboration with GP s and primary care practices; improving direct access to diagnostics as per NG12 (addressing issues DCE review).* b) Outline your plans to improve the interface between primary and secondary care including clarity on referral routes, support for primary care and access for patients with vague symptoms. c) Outline your plans to agree the use of standardised e-referrals to be used across NHS Wales. *Available from Sue.Davies6@wales.nhs.uk Single Cancer pathway wait in days is already available to clinicians via the MDT pro-forma used at all MDT meetings. Ongoing inclusion of primary care in the Cancer Strategy Group meetings and Cancer Committee meetings to disseminate key information/communication to NCN leads and LMC. ABUHB Macmillan GP Facilitators actively engaging with practices and clusters for primary care education updates and feedback. Primary Care Oncology newsletter/bulletin being developed in conjunction with primary Care. Plans to establish our interface goals and strategy. Plans to improve timeliness of access to be agreed, provided for and monitored. Consideration of Site specific templates within primary care software to improve quality of referrals once pathways agreed between primary and secondary care esp. as new Vision and Micro test software coming to Primary Care Consideration to advice lines/ to discuss cases between primary and secondary care Currently auditing CT referrals from Primary Care with view to developing Vague Symptoms pathway. The Heath Board currently operates a fully integrated e-referral process across all primary care practices and Secondary care Radiology requesting. Plans needed to introduce Radiology e-referrals from Primary care with the ability to prioritise as USC. This accepting that complex multi entry point pathways are problematic to primary care. 8

9 8 Diagnostic Pathway Detail timelines in plans a) Outline your plans, including a named diagnostic pathway lead, within your organisation who will lead and partake in the diagnostic pathway working group. Describe the actions that will Support 28 day diagnostic pathway from point of suspicion to last diagnostic test Improved direct access and timeliness to diagnostic investigations New diagnostic pathways promoting straight to test, one stop clinics and hot reporting. The Health Board is currently undertaking a number of pilots to help support the 28 day diagnostic pathway such as: Direct access to CT Thorax from Primary Care for Lung patients Radiologists to trigger a CT scan for suspicious Chest x rays Direct access to USS for Head & Neck patients The Health Board is also planning to implement: Direct to test for Colonoscopy FIT testing for Symptomatic GI Patients Point of Care testing for patients needing an EGFR blood test for Contrast scans. 9 Treatment Pathway Detail timelines in plans The lead clinician, along with MDT leads for each tumour site, will lead on the treatment pathways for their own respective Tumour site. a)outline your plans to identify a treatment pathway lead, and leads for each treatment modality within your organisation, to partake in the treatment pathway project working group including: Describe the actions that will: Support the standardised treatment pathway for SACT Support the standardised treatment pathway for RT Within ABUHB this will form a part of the rolling programme of work undertaken with specific Tumour sites and in conjunction with optimal pathways being agreed at a national level. Work ongoing with Tertiary providers to improve on interface between Health Boards and tracking of all SCP patients. 9

10 Support the standardised treatment pathway for Surgery Support the standardised treatment pathway for Best Supportive Care All within 21 days from DDT (it is accepted that many pathways will be shorter but detail any that you feel likely to be longer)* b) Agree the standardised referrals for treatment modalities to be used across NHS Wales c) Outline your plans to implement the changes in these treatment pathways as a result of this work. Please highlight any views from management or clinical teams that patients should NOT be treated within 21days of the decision to treat (DTT) 10 Patient Centred Care Detail timelines in plans a) Outline your plans, including your Identified PCC lead within the organisation, to agree opportunities for information and support to be shared with patient and HCPs throughout the pathway including: Plans to consider when Key Worker Allocation is made in site specific pathways The Health Board identified Patient Centred Care (PCC) Lead is Senior Nurse for Cancer Services Work ongoing within the Health Board towards ensuring that for each tumour site the Health Needs Assessment is undertaken as early in the patient s journey as is practical, preferably at the point of suspicion of cancer or at the treatment planning clinic where the patient can be provided with a care plan specific to their needs. Work ongoing towards developing tumour site specific patient summaries/general Practitioner letters that can be shared across the health board and other organisations supporting the patient through their journey. 10

11 and how this is generically recorded and reported When health needs assessments will be made in site specific pathways and how these are shared across pathway(s) and with primary, secondary, tertiary and palliative care where appropriate; Plans to undertake PROMS/ PREMS and how these will be recorded and shared Plans for agreeing time points and scope of site specific and generic prehabilitation (eg smoking cessation, exercise prescription, CPEX etc). Plans to use consistent information sources, wherever possible with the same content and time points as other MDTs in Wales Plans to use consistent approach to introducing research opportunities to patients, wherever possible with the same content and time points as other MDTs in Wales Work ongoing to develop communication between tumour cancer site and General Practitioners around HNS s and patient summaries. Lung PROMS & PREMS to commence soon as pilot within cancer services Work ongoing to develop a consistency of approach. The Health Board, through the PCC lead, will work with the tumour site Clinical Nurse Specialists to agree how and when key worker should be allocated which if possible should be at diagnosis. The Health Board will await the outcome of recent pilot of Prehabilation to build on business case for further funding Information hubs in place across the HB. The PCC lead to work internally and with others across Wale to develop unify the approach to MDT activity and recording It is recognised that Research and Development is a core activity of the Health Board. Through collaboration with the Department of Research and Development the Health Board s aim is to develop a culture within which all health professionals understand and are supported to engage in research activities and that this activity becomes an integral part of the role of all health professionals. The lead nurse through engagement with Oncology Clinical Nurse Specialist will incorporate a focus on Research and Development though annual PADRs 11