Meeting: Cancer Steering Group Date: 04/08/15

Transcription

1 Meeting: Cancer Steering Group Date: 04/08/15 Time: 2:00pm Venue: Evolve Business Centre Present: Alison Featherstone, Network Manager, NHS England Roy McLachlan, Associate Director, NHS England Chris Walker, Chair Network Service User Partnership Group Chris Tasker, GP Cancer Clinical Lead, NHS England Chris Callan, Delivery Manager, NHS England Nicky Moon, Deputy Director, Northumbria & N Cumbria NHS Sarah Perkins, Director of Performance, County Durham & Darlington Adrienne Moffett, Network Delivery Manager, NHS England Lisa Edwards, Screening & Immunisation Co-ord, NHS England/PHE Lynn Kirby, Associate Director Operations, N Tees & Hartlepool Mohamed Tabaqchali, Lead Clinician, N Tees & Hartlepool Linda Wintersgill, Information & Outcomes Manager, NHS England Mikki Golodnitski, Service Delivery Manager, Hambleton & Whitby CCG Sheila Alexander, Directorate Manager, Newcastle Hospitals AF RM CW CT CC NM SP AF LE LK MT LW MG SA In Attendance: Anne Lewis, Network Administrator, NHS England AL Apologies: Nick Wadd, Consultant Clinical Oncologist, South Tees Katie Elliott, GP Lead for NESCN Carolyn Harper, Lead Cancer Nurse, Gateshead Health NHS FT Sue Gordon, Consultant Public Health, PHE Tony Branson, Medical Director, NECN Glen Wilson, Acting Screening and Immunisation Lead, NHS England Robin Mitchell, Clinical Director, NESCN Richard Bliss, Consultant Surgeon, Newcastle Hospitals Elaine Criddle, Divisional Director, South Tees NHS FT Phil Kane, Trust Cancer Lead, South Tees NHS FT NW KE CH SG AB GW RM RB EC PK MINUTES 1. INTRODUCTION Action 1.1 Welcome and Apologies AF welcomed everyone to the meeting and introductions were made. Apologies were noted as above. 1.2 Declaration of Interest There were no declarations of interest. 1.3 Minutes of the previous meeting The previous minutes were confirmed as a true record of the meeting. 1.4 Matters arising Breast Cancer Plan Update Riomed have been appointed as the preferred supplier. The 0

2 project plan has gone before the project board. The first interactive demo is due end of September. They are to be asked to provide a demonstration to this group. RM 2. AGENDA ITEMS Day Event Update AF gave a brief overview and update on the action plan (circulated). The action plan will be reviewed in Cancer Unit Managers meetings. 2.2 Cancer Screening LE gave a brief to the group. Work has been done with the LD Network trying to improve access into the Cancer Screening Programmes. Bowel scope screening is being slowly rolled out across the region. They are meeting with CRUK tomorrow with a view to raising awareness and uptake of FOB in Newcastle area. They have been involved in increasing cervical screening for people in the Armed Forces and this is now being commissioned by NHS England. Early feedback is positive. The radio campaign is due to run until October and then will be fully evaluated. Working with South Tees NHS FT on an ACE project on targeting women who are attending other appointments. 2.3 Cancer Waiting Times There is no updated data available for this quarter yet. It was a pressured start to the year for cancer waits, a number of our trusts failed in May and it was red across the board. 62 days, North Cumbria, South Tees struggled and a number of trusts will fail quarter one which may mean that the Network as an aggregate will fail. Forecasted activity for the year based on April and May returns shows only a minimal increase - but this does not take into account any impact from updated NICE referral guidelines. Anecdotal evidence suggests that Quarter two will also be difficult for trusts. The group discussed the issues of 2ww and patient choice; patients are referred but have a holiday or other reason for refusing appointments. GPs are able to defer making referrals if they know a patient is not available but there is the potential risk of patients being missed. Locality groups are being asked to put safety netting on their agendas to address issues like this. There is still a perceived problem in primary care when patients are not being told that they are being tested to exclude cancer. Locality groups will be asked to look at this too. Tripartite Letter from Monitor - Many of the key requirements are Enc 1 1

3 already being done by trusts. Cancer Unit Managers felt that the requirement to have an improvement plan for each tumour site could be beneficial. It has been agreed to have a network standard improvement plan so that all trusts are completing the same plan. It was acknowledged that diagnostics are a bottleneck. The national team have held an event to share best practice and good ideas. This was received in a very positive way. There will also be a national deep dive and data is being gathered. CC suggested that a consolidated paper from the self-assessments is presented to this group. Cancer waiting targets have been on QSG agendas too. LW 2.4 Risk Register The risk register was displayed and discussed. A number of issues were removed from the register and some updated. The group also considered some new additions. AF to update the register accordingly. AF 2.5 Peer Review An update was tabled and discussed. Cancer of the Unknown Primary teams will be visited in 2016; dates will be notified in September. Lisa Cunnington spoke at Cancer Unit Managers to give an update. Peer Review will now sit within Specialised Commissioning and the process is likely to change this may involve Organisations submitting a declaration, and then they may be required to a self-assessment. The group agreed that the current processes should stay in place until there is more clarity. The group discussed putting peer review on the risk register and agreed that until the new format is known it should be added. AF 2.6 Cancer Research UK Facilitators CT updated the group that the CRUK facilitators have had their induction and will be covering primary care and the early part of the pathway. There will be one facilitator per locality and they will be working alongside GP Cancer Leads. MG to provide contact details for a GP Cancer Lead for Hambleton & Whitby CCG. The Facilitators have been making contact with their locality groups. MG 2.7 Cancer Strategy Achieving world class cancer outcomes The groups discussed the newly published Strategy for England The group discussed the new NICE Guidelines and the potential confusion from them. The NSSG s are being asked to develop Network wide referral templates. CT & KE are leading on this with network groups. MG to contact KE outside the meeting to discuss this MG 2

4 further. H & W have looked at the 96 recommendations to see which ones affect commissioners and MG will share this. The group discussed the status of the strategy as it is independent cancer taskforce report. However the arms lengths organisations have been consulted and involved. A number of the recommendations are for the arm s length bodies. The group discussed Cancer Alliances and agreed that for the North East it would seem appropriate for the cancer network to just get on with it. Any change to business plans would also be dependent on what is incorporated into the operating framework. The group agreed that it would be useful to have an extraordinary meeting to consider the content and agreed that the next meeting planned for November would be extended to incorporate this. Network to set up an internal network planning group to work with various NSSG s, NCCG s and individuals to look at how we can best utilise the time to respond to the various recommendations. The event should be a maximum of fifty and a mix of disciplines. MG AF 3. STANDING ITEMS 3.1 Any Other Business i. Survivorship CW advised the group that the NSUPG are keen to keep Survivorship on the agenda and the members will be asking five questions at all the groups the NSUPG attend. AF to provide a Survivorship project update for the next meeting. AF ii. Teenage Cancer Trust Lead Natalie Marshall has been recruited to Newcastle and will be visiting designated hospitals and looking at equity of access to services. 3.2 Next meeting The next meeting will take place on 03/11/15, 2:00pm at Evolve. MH 4. MEETING CLOSE 3

5 Northern England Strategic Clinical Networks Cancer Steering Group Meeting 4 August 2015 Title: Cancer Network Performance Report Author(s): Information Team Summary: This report provides an overview of progress against a range of cancer indicators for organisations within NESCN with particular reference to: Prevention Screening Awareness Diagnosis Treatment Outcomes Recommendation: The group is asked to note performance Presented by: Linda Wintersgill

6 Cancer Steering Group Performance Report August 2015

7 Contents Contents...1 Introduction Cancer Landscape Cancer Incidence Cancer Spend Information Prevention Lifestyle Factors Tobacco Alcohol Screening Breast Screening Cervical Screening Bowel Cancer Screening Awareness and Presentation Awareness Campaigns GP Practice Data Early Diagnosis Diagnostic waits Treatment Effective Pathway Management National Clinical Audits National Programmes Outcomes Cancer Patient Experience Survey Staging Year Survival Year Survival Mortality Reduction

8 Introduction This report provides an overview of progress against a range of cancer indicators for organisations within the Northern England Cancer Network. It is not intended to replace more detailed analyses that organisations will undertake in order to understand the needs of their local population and the quality of services they commission. The report will act as a baseline and will be updated and presented to the Network Board at each meeting. The content and layout of this report is currently being reviewed to ensure that it continues to reflect the work and priorities of the network. It is currently organised along the patient pathway but it is envisaged that future issues will be reflective of the Outcomes Framework and the network work plan. Much of the information presented is on a Primary Care Organisation or Local Authority population basis until data based on CCG populations becomes available over time. Where trust data is presented it will continue in this format. 2

9 1 Cancer Landscape 1.1 Cancer Incidence Strategic Clinical Network for Cancer - Northern England Age-Standardise Incidence Rates per 100,000 population - All Cancers 2013 (Source Cascade NCRS) CCG Network England Source CASCADE, NCRS 2013 age-standardised rates for cancer incidence by CCG are shown in the chart above this data is derived from the National Cancer Registration Service. This chart shows the range of values across the network area with rates ranging from 572 in Hambleton, Richmondshire & Whitby CCG to 719 in Newcastle North & East CCG a difference of over 25%. Most CCGs in the network area have rates which exceed the national average. The corresponding mortality rates range from 382 in South Tyneside to 249 in Hambleton, Richmondshire & Whitby a difference of over 50%. Once again most CCGs in the network area have rates above the national average. There is generally broad correlation between mortality and incidence rates across CCG s. 3

10 Strategic Clinical Network for Cancer - Northern England Age-Standardised Mortality Rates per 100,000 Population - All Cancers 2013 (Source Cascade, NCRS) CCG England Cancer Spend 7 NHS Programme Budgeting /14 CCG spend per 100,000 (weighted) population ( M) - Cancer (02) (source NHS England) NHS Cumbria CCG NHS Sunderland CCG NHS Hambleton, Richmondshire and Whitby CCG Source NHS England NHS Northumberland CCG NHS North Tyneside CCG NHS South Tyneside CCG NHS Hartlepool and Stocktonon-Tees CCG Based on 2013/14 Programme Budgeting submissions, per capita spend on Cancer by CCG varies from 6.5m (per 100,000 population) to almost 3.5m. There are some data quality issues identified in the data and numbers vary significantly when NHS Darlington CCG NHS North Durham CCG NHS Gateshead CCG NHS Durham Dales, Easington and Sedgefield CCG NHS Newcastle North and East CCG NHS Newcastle West CCG NHS South Tees CCG 4

11 compared to previous year analyses based on PCO expenditure. However it serves to show the apparent variation that does exist across network areas. There are 23 programme budgeting categories of which Cancer is one across the network CCG spend on cancer equates to between 3% and 5.3% of total CCG expenditure. 1.3 Information Cancer Outcomes and Services Dataset (COSD) The COSD is the new national standard for reporting cancer in the NHS in England. It replaced the National Cancer Dataset and includes the Cancer Registration dataset and additional site specific data items relevant to the different tumour types. The COSD received full stage approval from the Information Standards Board in July 2012 and data collection commenced in January 2013 phased until submission of the full dataset from January Registration data up to May 2015 is now available on the COSD Portal allowing generation of reports at trust and CCG level showing numbers of diagnosed cancers as well as stage and pathway information. We are currently exploring ways to incorporate this data into this report routinely. Work continues at national and local level to improve the quality and completeness of the data submitted to the national registration system. This report will include some headlines and site specific information will be presented to NSSGs on a regular basis to highlight progress and consider actions to address exceptions and variations. Cancer Unit Managers and the Cancer Network Steering Group will also be informed of progress with this dataset. Further information and related documentation on COSD is available on the NCIN website ( Systemic Anti Cancer Therapy Dataset (SACT) Information Standards (ISB 1533). Data collection commenced on 1 April 2012 for all NHS trusts providing chemotherapy services. Implementation was phased with full returns from April The SACT portal is now live and like the COSD dataset reports will be presented to NSSGs, Cancer Unit Managers and the Steering Group to help monitor progress, identify issues and consider actions for improvement to ensure that the dataset provides meaningful intelligence across the network. More information on this dataset can be found at: The Diagnostic Imaging Dataset (DID) Information Standards (ISB1577). The Department of Health (DH) and the NHS Information Centre launched a new monthly data collection 'The Diagnostic Imaging Dataset' from 14 May 2012, based on imaging carried out in April. This data will give 5

12 information about access by NHS patients to diagnostic imaging tests across the country and is mandatory for all NHS Providers. Radiology Departments and Radiology Information System managers will play a key role in extracting and submitting data. This collection will provide a rich national dataset on key diagnostic tests concerned with the earlier diagnosis of cancer. The first full year data extracts have been published but gaps and some anomalies remain. The data is also suppressed where activity falls below a certain number. However the hope remains that in time this data will provide a rich source of referral and activity patterns. More information on this dataset can be found at: 6

13 2 Prevention 2.1 Lifestyle Factors In December 2011 the British Journal of Cancer published a supplement by Parkin et al which explored the link between cancer incidence and sub-optimal levels of major lifestyle and environmental factors and estimated the population attributable fraction of key tumour sites. The analysis was undertaken at the Wolfson Institute of Preventive Medicine, Queen Mary University of London, with funding from Cancer Research UK. Further details can be found on the Cancer Research UK website at: NESCN has begun to use the tables produced as part of this analysis in the development of a model to help determine those interventions which will have the greatest impact on reduced incidence and mortality and/or increased survival for a number of tumour sites. As part of this work, there will be renewed emphasis on some of the lifestyle factors which have the most significant impact and these will be explored in future reports. It is proposed that as well as Smoking/tobacco - which continues to have the biggest impact across all tumour groups a number of other factors will be explored including: Alcohol Physical Activity/Exercise Bodyweight Diet Infection The table below shows the % of cancer incidence cases in the UK attributed to these factors and an indicative number of cases for NESCN based on this breakdown. Data is for persons for all cancers (excluding non-melanoma skin cancer) and is based on 2013 incidence for the NESCN population. For 2010 incidence in the UK over 42% of all cancers are attributed to these lifestyle and environmental factors most of which are avoidable. There is variation between the impact on male and female incidence and considerable variation between individual tumour sites in terms of the extent of impact and the % of attributable cases for each factor. Such analyses are indicative as no adjustment has been made for the population profile in NESCN. 7

14 Exposure % Attributable Cases * Total Cases 2013 NESCN ~ NESCN Attributable cases Tobacco ,065 3,893 Alcohol , Fruit & Vegetables , Meat , Fibre , Salt , Overweight & Obesity ,065 1,104 Physical Exercise , Post-menopausal hormones , Infections , Radiaton - ionising , Radiation - UV , Occupation , Reproduction (breastfeeding) , All ,065 8,568 * Estimates of UK incidence in 2010 atributed to factor (exposure in prev 10 years) ~ Source Cascade, NCRS 8

15 2.2 Tobacco Measure Source Time Period April December 2014 Number of people successfully quitting at 4 week follow-up through the NHS Smoking Cessation Service The NHS Information Centre for Health and Social Care Stop Smoking Services - Provisional Data April December 2014 Local Authority Number setting a quit date Number who successfully quit Percentage who successfully quit Rate per 100,000 Setting a quit date Rate per 100,000 who successfully quit (selfreported) England 312, , Darlington Borough Council Durham County Council 4,303 2, , Gateshead MBC 1, , Hartlepool Borough Council 1, , Middlesbrough Council 1, , Newcastle-upon-Tyne City Council 1, North Tyneside Council 1, Northumberland County Council 2, Redcar & Cleveland Borough Council 1, South Tyneside MBC 1, , Stockton-on-Tees Borough Council 1, , Sunderland City Council 2,958 1, , Cumbria County Council 1, North Yorkshire County Council 1, Provisional activity data for the first three quarters of 2014/15 shows that over 25,000 people in network local authorities accessed NHS smoking cessation services to set a quit date in order to give up smoking. Of that number over 11,000 (43.8%) reported success at 4 weeks (A client is counted as having successfully quit smoking at the 4 week follow-up if he/she has not smoked at all since two weeks after the quit date) less than across England where 50% of clients reported success. At individual local authority level, success rates at 4 weeks range from 28% in Middlesbrough to over 53% in North Yorkshire. However it should be noted that due to changed responsibilities following NHS reorganisation, some data quality issues have been identified and these data are provisional and will be finalised at the year end. Population rates for those setting a quit date and successful at four weeks are shown in the chart below derived from the same data source. It can be seen that, in line with previous reports, rates for setting a quit date are generally above the national average in network areas. However, a number of Local Authorities have lower success rates reflective of the reduced rates in the table above. Hartlepool continues to have the highest success rate per 100,000 population in the network area for setting a quit date and is ranked 5 (highest) across all local authorities in England. South Tyneside has the highest rate of successful quitters and is ranked 6 (highest) across all local authorities in England. 9

16 NHS Stop Smoking Services - Rate per 100,000 population by LA - April to December ,800 1,600 1,400 1,547 1,507 Set Quit Date Successful (self reported) Eng - Set Quit Date Eng - Successful 1,200 1,297 1,248 1, ,041 1,041 1, Smoking Prevalence Estimates Smoking prevalence figures are difficult to collect accurately. Model based estimates are derived from responses to the Integrated Household survey (IHS), and while these figures are useful in planning services changes to the organisation of the survey mean that data cannot reliably be used to monitor change but they provide an indication of where activity should be focused. Smoking and the wider effects of tobacco are attributed as the cause of over 80% of lung cancer cases; almost 20% of all cancer cases and is recognised as a largely preventable cause of death and ill health in the UK, (IOG 1998). Nationally, smoking prevalence among persons aged 16 and over has reduced over the last 3 decades. In 1974 it was estimated that 45% of over 16s smoked (51% of males; 41% of females). Data from the integrated household survey for shows national prevalence of 18.5% a reduction on the 2006 rate of 22%. Historically, the network area has had some of the highest smoking rates in England. Based on latest data, this remains the case, although the range of prevalence has reduced. However, the legacy of high smoking prevalence will be seen in lung cancer incidence and mortality for a number of years. The chart below shows estimated prevalence by local authority for all groups and Routine and Manual Groups compared to the England average in each case and is derived from IHS Generally rates in network areas are above the national average for both groups and a number of areas show increased rates when compared to the 2012 data. Additionally estimated smoking prevalence rates for Routine & Manual groups remain above 30% in a number of local authority areas despite good uptake of Stop Smoking Services. While some local authority areas 1 Integrated Household Survey ONS 10

17 have reduced overall rates, rates for Routine & Manual are increased which widens the inequalities gap. Recognising that rates are based on a fairly small sample nevertheless it is worrying that in some areas rates appear to be increasing and further work will be undertaken to understand the drivers for this. Source Tobacco Control Profiles Expenditure 700 NHS Stop Smoking Services - Cost per quitter by Local Authority (LA), April to December

18 The chart above shows the wide variation in estimated cost per quitter across local authorities in the network area but the data are provisional should be used with caution. North Yorkshire has the highest cost in England at 644 per quitter. Newcastle in year data is not available and an annual submission will be made. There are also other concerns about completeness and quality of data so results should be treated with caution. 12

19 2.3 Alcohol Measure Source Time Period Proportion of Population who engage in binge drinking (self-reported) LAPE (Local Alcohol Profiles for England) Public Health England LAPE Binge Drinking Binge Drinking Adults - CCG (Modelled Ests 2007/08) - Practice Min/Max Shown CCG Practice Min Practice Max Cumbria Darlington Durham Dales, Easington & Sedgefield Gateshead Hambleton, Richmondshire & Whitby Hartlepool & Stockton Newcastle North & East Newcastle West North Durham North Tyneside Northumberland South Tees South Tyneside Sunderland Source APHO Practice Profiles Synthetic estimates of the proportion (%) of adults who consume at least twice the daily recommended amount of alcohol in a single drinking session (that is, 8 or more units for men and 6 or more units for women) ( ). Estimates are modelled on responses to the Health Survey for England. There is no more recent information for this indicator. This data shows variation in model-based estimates for CCGs in the network area, with estimates ranging from 37% in Newcastle North and East to 21.6% in Cumbria. The lines show the range of values for individual practices in each CCG some are as high as 50%. Although based on sample data, it may provide an indication of some of the reasons for the higher levels of cancer incidence in this area. If estimates are ranked every network CCG, except Cumbria, is in the bottom 10% across all CCGs in England Newcastle North and East has the highest rate for CCGs in England in this extract. Although this data does not map directly back to the table on Page 8, which indicates the potential impact of these factors, reduction in the variation across the network could reduce the number of cancers attributed to alcohol. Calculating an incidence burden of 4% across individual CCGs then calculating the effect of reducing all 13

20 PCOs to the lowest estimate (21.6%) indicates that ~200 cancers could be prevented which equates to 100 fewer deaths based on current incidence/mortality ratios Alcohol Related Admissions Alcohol Related NHS Admitted Hospital Episodes /13 Based on Primary and Secondary Diagnoses - Local Authorities Narrow Broad England - Narrow England - Broad The chart above shows directly standardised rates (DSRs) for alcohol related admitted Hospital Episodes for 2012/13 by Local Authority area with England averages shown. This data was published in April The methodology for calculating the number of Episodes has been changed and results in this issue are not directly comparable to previous issues. The narrow indicator provides a narrower measure of alcohol harm that enables fairer comparison between levels of harm in different areas and over time. This will be more responsive to change resulting from local action on alcohol. However, the broad indicator is a better measure of the total burden that alcohol has on community and health services. Despite showing them on the same chart the two indicators measure different things and are to be used for different purposes. Rates in the network area are above the national average in almost every case with some significantly so. 3 and 4 of the 19 Local Authority areas are ranked in the bottom 10 of 326 Local Authorities in England for the Broad and Narrow Indicators respectively. Middlesbrough has the highest overall rate for admissions nationally (Broad). In addition 13 and 14 local authority areas are ranked in the bottom quintile nationally for broad and narrow indicators respectively. 14

21 3 Screening 3.1 Breast Screening The number of women aged screened for breast cancer in the last three years/the number of women aged eligible for screening. Measure Coverage is defined as the proportion of women resident and eligible for screening who have had a screening mammogram at least once in the previous three years. Women who are ineligible (e.g. those who have had a bilateral mastectomy) are excluded. Target 70% Source Open Exeter Time Period Provisional Data for December Breast Screening Coverage December 2014 CCG 36 month coverage % Age Range Age Range Practice Min % Practice Max % 36 month coverage % Practice Min % Practice Max % NHS Cumbria CCG NHS Gateshead CCG NHS Newcastle North And East CCG NHS Newcastle West CCG NHS North Tyneside CCG NHS Northumberland CCG NHS South Tyneside CCG NHS Sunderland CCG NHS Darlington CCG NHS Durham Dales, Easington And Sedgefield CCG NHS Hartlepool And Stockton-On-Tees CCG NHS North Durham CCG NHS South Tees CCG NHS Hambleton, Richmondshire And Whitby CCG Provisional CCG data (derived from GP Practice data) up to December 2014 shows that all CCGs in NESCN have screening coverage above the national target of 70% for women aged years including Newcastle West which was previously below this level. Rates range from 71.2% in Newcastle West to 79.3% in Hambleton, Richmondshire & Whitby. Individual GP practice rates range from 16.7% to 100% - with a variance of up to 80% between highest and lowest practice coverage in CCGs. However it should be noted that this data is provisional and final figures may be different. Consideration should be given when looking at these data to the fact that in some practices numbers of eligible women are very small. For the extended age range coverage is generally lower and ranges from 62.3% in South Tees to 72.6% in Gateshead. Once again within these CCG rates there is significant variation between individual practice rates though the same caveats apply to the data. 15

22 3.2 Cervical Screening Measure The effectiveness of the programme can be judged by coverage. This is the percentage of women in the target age group (25 to 64) who have been screened in the last five years. Target 80% Source Open Exeter Time Period Provisional Data for December Cervical Screening Coverage Lower Age Range (25-49) Higher Age Range (50-64) Target Age Range (25-64) December year coverage % Practice Min % Practice Max % 5.5-year coverage % Practice Min % Practice Max % 3.5/5.5- year coverage % Practice Min % Organisation NHS Cumbria CCG NHS Gateshead CCG NHS Newcastle North And East CCG NHS Newcastle West CCG NHS North Tyneside CCG NHS Northumberland CCG NHS South Tyneside CCG NHS Sunderland CCG NHS Darlington CCG NHS Durham Dales, Easington and Sedgefield CCG NHS Hartlepool And Stockton-On-Tees CCG NHS North Durham CCG NHS South Tees CCG NHS Hambleton, Richmondshire and Whitby CCG Practice Max % Provisional data for December 2014 based on GP Practices shows that generally coverage is below the national target of 80% for all network CCGs. Overall coverage for all ages is below recommended levels with rates ranging from 69.2% in Newcastle North and East to 78.8% in Hambleton, Richmondshire & Whitby and these levels are in line with previous reports. However it should be noted that this data is provisional and final data may change. Generally, coverage for the older age group (50-64) is higher than for the younger (25-49) age-band, but the round length is longer for this cohort. 2 CCGs record coverage above the target 80% for this age group with a range from 75.3% in Hartlepool & Stockton and 80.6% in Hambleton, Richmondshire & Whitby. For the younger age group coverage ranges from 65.4% in Newcastle North & East to 77.6% in Northumberland. At individual practice level there is a lot of variation within CCGs with ranges of up to 60% between highest and lowest practice rates. However, the same caveats apply to this data as above and in some cases practice eligible cohorts are small. 16

23 3.3 Bowel Cancer Screening Measure The Bowel Cancer Screening programme has recently been rolled out nationwide and regular screening has been shown to reduce the risk of dying from bowel cancer by 16% Target 60% uptake of FOB Source Open Exeter Time Period Provisional Data for December Bowel Screening Coverage Standard Age Range (60-69) Extended Age Range (60-74) Bowel Screening December 2014 Uptake % 2.5-year coverage % Practice Min (Coverage) Practice Max (Coverage) Uptake % 2.5-year coverage % Practice Min (Coverage) Practice Max (Coverage) NHS Cumbria CCG NHS Hambleton, Richmondshire & Whitby CCG NHS Gateshead CCG NHS Newcastle North & East CCG NHS Newcastle West CCG NHS North Tyneside CCG NHS Northumberland CCG NHS Sunderland CCG NHS Darlington CCG NHS South Tyneside CCG NHS Durham Dales, Easington & Sedgefield CCG NHS Hartlepool & Stockton-On-Tees CCG NHS North Durham CCG NHS South Tees CCG Provisional CCG data (derived from GP Practice data) up to December 2014 shows that 5 of the 14 CCGs in NESCN have screening coverage above the national target of 60% for those aged years. Coverage rates range from 54.6% in Newcastle West to 65.5% in Hambleton, Richmondshire & Whitby. Individual GP practice rates range from 0% to 75.6% - with a wide variance between highest and lowest practice coverage in CCGs. However it should be noted that this data is provisional and final figures may be different and practice rates will be impacted by numbers eligible for screening. For the extended age range (60-74) coverage ranges from 56.4% in Newcastle West to 66.1% in Hambleton. Once again within these CCG rates there is significant variation between individual practice rates though the same caveats apply to the data. 17

24 4 Awareness and Presentation 4.1 Awareness Campaigns National Bowel Cancer Awareness Campaign The Government s first ever national cancer campaign to raise awareness of the symptoms of bowel cancer was launched on 30 January 2012 and ran until the end of March. The campaign used TV, radio and magazine advertising to encourage people to discuss symptoms with their GP and included a series of local events in shopping centres around the country. A refresh campaign with lower levels of media activity commenced on ran for 4 weeks in August/September NESCN, with the former SHA, worked extensively with trusts, PCOs and GPs to prepare for the impact of the campaign. Locally the campaign had a huge impact with significant increases in two week wait referrals across the network - residual effects continue to be monitored as activity has not reverted back to pre-campaign levels Oesophageal Cancer Awareness Campaign Following the local pilot in NESCN from April to June 2012, and the regional campaign early in 2014 a national campaign commenced on 26 January 2015 for 4 weeks instead of the usual 6 weeks designated for these campaigns. The National Reference Group agreed that the leading message was around heartburn and indigestion rather than difficulty swallowing. Initial data shows an increase in two week wait referrals in February 2015 which exceeds the overall increase in referrals indicating that this may be a result of the campaign. As more data becomes available the impact of the campaign will be explored National Lung Cancer Awareness Campaign The National Lung Cancer Awareness Campaign ran in May 2012 and used TV, radio and press advertising, as well as pharmacy bags, online advertising and also some community events. The objectives were to raise awareness that coughing for more than 3 weeks may be an early sign of lung cancer; encourage those with symptoms to visit their GP and thereby increase the number of lung cancers diagnosed at an earlier stage. The National Lung Cancer Awareness Campaign Refresh or Reminder ran for 6 weeks from 2 July A lower level campaign ran from 10 March 2014 in parallel with other campaigns using TV advertising only National Blood in Pee Campaign Following the regional campaign during January to March 2013 in NESCN a national campaign ran in October/ November The campaign included TV, radio and national press advertising, together with adverts on pharmacy bags and GP TV screens, events in shopping centres and direct mail activity although none in the 18

25 North East and Cumbria. Leaflets and posters were also displayed in many GP surgeries. A reminder campaign was run in November National Breast Over 70 Campaign A refresh of this campaign is currently underway and will continue until the middle of September. Impact analyses from all campaigns will be the subject of a separate report as data becomes available. 4.2 GP Practice Data The National Cancer Intelligence Network (NCIN) produced GP practice Profiles for every GP practice in England for the first time at the end of The profiles present a number of indicators around cancer services for each practice in a single sheet with a chart showing the practice position for each indicator in relation to PCT and National averages. The purpose of the profiles is to assess and understand variation between practices as well as allowing comparison of local performance across the country. The annual refresh was anticipated in December 2014 but this release was delayed until March Profiles are available on the Cancer Commissioning Toolkit GP practice profiles are now publicly available via the NCIN website ( Data is provided in the same format as presented on the Cancer Commissioning Toolkit but smaller values (<=5) have been suppressed in this version to avoid potential identification of individual patients. Some key messages from the 2014 profile release in NESCN include: Practice profiles produced for 488 practices across NESCN (including Cumbria) Almost 60% of practices in NESCN are ranked in the lowest 2 socioeconomic deprivation quintiles (most deprived) while just over 13% of practices are ranked in the highest quintile (least deprived) Nationally 17.2% of practice populations are aged over 65; individual practices in NESCN range from 0.3% to 40.9% Nationally 15.1% of practice populations are income deprived ; individual practices values range from 4.7% to 43.5% Crude incidence rates by practice range from 30 to nationally the rate is 504. Mortality rates for network practices range from 14 to 742; the national rate is 228. Prevalent cancer cases range from 0.1% to 5.4% - nationally the figure is 2.1% For individual practices age-standardised 2 week wait referral rates range from 0.24 to 2.22 which is similar to previous releases (compared to national mean of 1). 19

26 Conversion rates (diagnosis of cancer following 2 week wait referral) range from 0% to 40% for individual practices in NESCN (though in some cases numbers are very small) the national average is 9.5% For individual practices the % of new cancers treated which were referred via the two week wait route ranges from 0% - 87%; the national average is 48.8%. From the snapshot shown above it can be seen that there is wide variation across GP practices in the NESCN area. On its own the data looks stark but there are undoubtedly complex issues behind these figures. One of the priorities of NESCN is to understand the reasons for variation across the patch and where appropriate work with stakeholders to minimise that variation. The latest refresh allows time series analysis over 5 years, which will help demonstrate the progress practices are making in key areas and outputs will feature in future reports. 20

27 5 Early Diagnosis 5.1 Diagnostic waits As part of the process to monitor the 18 weeks target the DH initiated a process for collecting monthly diagnostic investigation waiting times. This data is extracted from the national DH published data on Measure a monthly basis. This data includes all tests/providers regardless of referral route or setting, so the waits are not necessarily reflective of waits for patients with suspected cancer who are fast tracked through. Source DH Diagnostics : Department of Health - Publications Time Period May 2015 While data in this section is not specific to cancer referrals it is included to give an overview of waiting times for relevant diagnostic investigations where patients are waiting up to 1, 3 and 6 weeks. When considered in conjunction with cancer waiting times performance it can help to identify potential pressures in the system which may require remedial action. Data is produced monthly by DH and shows patients waiting at the end of the month, providing a snapshot of diagnostic waits. % of patients waiting by time band is shown rather than numbers as this allows easier comparison across varied populations Colonoscopy NESCN Waiting Times Colonoscopy May % <1 week 1 - <3 weeks 3 - <6 weeks 6+ weeks 90% 80% 70% % Patients Waiting 60% 50% 40% 30% 20% 10% 0% 21

28 Data for Colonoscopy waits shows that typically between 20% and up to 30% of patients had waited less than a week at the end of May In most cases between 30% and 80% of patients had waited less than 3 weeks at the end of the month. Activity for recent months shows an increase in the number of patients who had waited in excess of 6 weeks. At the end of May, across the network this amounts to almost 7% of the total number waiting slightly less than in previous months (2.7% waiting in excess of 13 weeks). This cohort represents a substantial proportion of those waiting in Hambleton (2.5%), North Durham (9.5%), DDES (35.7%), Hartlepool (2%) and Darlington (19.7%) where the target of 1% of patients waiting over 6 weeks is exceeded. At the end of May 2015 the total number of patients waiting for this test, across CCGs in NESCN is broadly in line with preceding months but is almost 10% above the number waiting at the end of the same month in the previous year. Numbers waiting in Darlington are more than double the numbers waiting at the end of May Reported waiting list activity (excluding planned and unscheduled procedures) for this test at the end of May 2015 is broadly in line with previous months and 10% above activity in the same month of the previous year. In previous years this activity has been greater than or in line with the total number waiting at the end of each month indicating that system capacity was sufficient to meet demand. Since April 2014 the number waiting at the end of each month has consistently been greater than total activity suggesting that services are running at capacity which may explain some of the lengthened waiting times Flexible Sigmoidoscopy NESCN Waiting Times FlexiSig May % <1 week 1 - <3 weeks 3 - <6 weeks 6+ weeks 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% DARLINGTON DURHAM DALES, EASINGTON AND SEDGEFIELD HARTLEPOOL AND STOCKTON-ON-TEES NORTH DURHAM SOUTH TEES CUMBRIA NEWCASTLE GATESHEAD NORTH TYNESIDE NORTHUMBERLAND SOUTH TYNESIDE SUNDERLAND HAMBLETON, RICHMONDSHIRE AND WHITBY % Patients Waiting 22

29 Data for Flexible Sigmoidoscopy waits show a similar pattern to that for Colonoscopy with a greater number of patients waiting in excess of 6 weeks at the end of May Once again the problem seems to be in Durham CCGs with over 14% of network patients waiting more than 6 weeks at the end of the month (5.7% waiting >13 weeks). About 1/3 of Darlington, DDES and North Durham patients had waited more than 6 weeks at the end of the month accounting for three quarters of all patients across the network. Generally the majority of patients had waited less than 3 weeks with between 40% and 70% of patients waiting in each organisation in this group. There is apparent variation between CCGs - but for some organisations numbers are small. The total number of patients waiting at the end of May is in line with previous months but shows an increase of about 10% when compared to the same month in the previous year. Reported waiting list activity (excluding planned and unscheduled procedures) for this test at the end of May 2015 is about 20% up on April though in line with the number waiting in the same month of the previous year. This activity is marginally below the total number of people waiting at the end of the period suggesting that the system is operating to capacity Computer Tomography (CT) NESCN Waiting Times CT Scan May % <1 week 1 - <3 weeks 3 - <6 weeks 6+ weeks 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% DARLINGTON DURHAM DALES, EASINGTON AND SEDGEFIELD HARTLEPOOL AND STOCKTON-ON-TEES NORTH DURHAM SOUTH TEES % Patients Waiting CUMBRIA NEWCASTLE GATESHEAD NORTH TYNESIDE NORTHUMBERLAND SOUTH TYNESIDE SUNDERLAND HAMBLETON, RICHMONDSHIRE AND WHITBY Data for CT waits shows that 9 patients had waited more than six weeks at the end of May 2015, less than in previous months. The majority of patients across the network had waited less than 3 weeks at the end of the period typically between 70% and 80% in each area. Total patients waiting at the end of May for this test (Sum of CCGs) is broadly in line with the number waiting in previous months and marginally above the previous year. Reported waiting list activity in May 2015 (excluding planned and unscheduled procedures) for this test is also in line with previous months and is significantly 23

30 higher than the number waiting indicating that there is sufficient capacity in the system to manage demand Magnetic Resonance Imaging (MRI) NESCN Waiting Times MRI May % <1 week 1 - <3 weeks 3 - <6 weeks 6+ weeks 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% DARLINGTON DURHAM DALES, EASINGTON AND SEDGEFIELD HARTLEPOOL AND STOCKTON-ON-TEES NORTH DURHAM SOUTH TEES CUMBRIA NEWCASTLE GATESHEAD % Patients Waiting NORTH TYNESIDE NORTHUMBERLAND SOUTH TYNESIDE SUNDERLAND HAMBLETON, RICHMONDSHIRE AND WHITBY Data for MRI shows that typically between 20% and 40% of patients had waited less than one week at the end of May Generally about 60% - 80% of patients had waited less than 3 weeks at the end of the month. Some CCGs had a small number of patients waiting more than 6 weeks in total 0.5% of the total number waiting. Total patients waiting at the end of May 2015 for this test (Sum of CCGs) is broadly in line with previous months and is about 10% below the number waiting at the end of May Reported waiting list activity (excluding planned and unscheduled procedures) for this test is also in line with previous months and remains higher than the number waiting indicating that there is sufficient capacity to meet demand Gastroscopy With similar patterns to other tests, at the end of May 2015 typically between 20% and 30% of patients had waited less than one week for this test; and generally between 40% and 80% had waited less than 3 weeks. Over 6% of patients waiting had waited more than 6 weeks at the end of the month with a number of CCGs Durham CCGs, Darlington, Hambleton, South Tees and Sunderland exceeding the 1% threshold for longer waits. Durham and Darlington patients account for over 80% of the total number waiting over 6 weeks. 24

31 The total number of patients waiting at the end of May for this test slightly lower than most recent months and the same period in 2014; reported waiting list activity (excluding planned and unscheduled procedures) is in line with previous months and the same period last year. Overall monthly activity is greater than the total number of people waiting at the end of the month indicating that capacity is sufficient to meet demand for this test but for those areas with the greatest number of long waits, the number waiting at the end of the month exceeds activity in the month suggesting that capacity is becoming an issue. 100% NESCN Waiting Times Gastroscopy May 2015 <1 week 1 - <3 weeks 3 - <6 weeks 6+ weeks 90% 80% 70% % Patients Waiting 60% 50% 40% 30% 20% 10% 0% DARLINGTON DURHAM DALES, EASINGTON AND SEDGEFIELD HARTLEPOOL AND STOCKTON-ON-TEES NORTH DURHAM SOUTH TEES CUMBRIA NEWCASTLE GATESHEAD NORTH TYNESIDE NORTHUMBERLAND SOUTH TYNESIDE SUNDERLAND HAMBLETON, RICHMONDSHIRE AND WHITBY 25