Cancer Services Position & Recovery Plan June 2015

Transcription

1 Appendix 6 Cancer Services Position & Recovery Plan June 2015 Introduction The Trust is required to achieve 85% compliance for patients on a 62 day pathway from the referral date to the date they receive their first definitive treatment. Intermediate standards of 14 days to be seen in outpatients and 31 days from a cancer being diagnosed to the patients being treated are also measured. The table below shows the position for May as at 2 nd July and previous quarters The day to day achievement of cancer standards continues to remain a challenge. The June position is; 62 day target 65.5%. The 14 day target of 93% was not met sitting at 90.1% The overall 31 day target has been met with no breaches currently recorded. Screening 62 day target was 88.9% against a target of 90%. Key challenges in month June proved to be a very poor month for meeting 14 day and 62 day targets. Excluding upper and lower GI performance (accounting for seven breaches this month) the Trust achieved 72.7% of the 62 day target where there are only currently 56.5 treatments accounted. Lower numbers in some of the modalities mean that fewer patients unable to be treated cause a large percentage fall in outcome e.g. 4 patients in total, 1 is not treated = 25% fall in performance. Actions are being taken in each individual tumour site to strengthen the monitoring and capacity and demand work undertaken in diagnostics. Breaches occurred in breast, lung, UGI, LGI, gynaecology, urology, testicular and head and neck. Screening breaches were in breast with 1 patient breaching. INDIVIDUAL CANCER PATHWAY PERFORMANCE All pathways continue to be at risk of non-compliance with poor resilience built into the system. Areas of greatest risk continue to be upper and lower GI where there can be multiple diagnostics, urology, lung and head & neck pathways. This is due to the complexities of the pathways in North Cumbria as well as access to diagnostics.

2 Target Q3 Q4* April May June Cancer 2 week wait Cancer 31- day wait Cancer 62 day wait All cancers 93% 88.8% 90.8% 88.7% 91% 90.1% Breast symptomatic 93% 93.9% 87.5% 68.7% 84.5% All cancers diag to treat Not available at 2 nd July 96% 99.1% 96.5% 97.3% 100% 96.4% Sub-treat: surgery 94% 100% 94.3% 50% 100% 100% Sub-treat: drugs 98% 98.5% 95.3% 100% 100% Sub-treat: radiotherapy Urgent referral to treat 94% 100% 96.4% 100% 100% Not available at 2 nd July 85% 83.1% 75.8% 65.4% 77.4% 65.5% Screening 90% 78.8% 74.4% 87.5% 90.9% 88.9% Percentage achieved by modality Target Dec-14 Jan-15 Feb-15 Mar-15 April-15 May-15 June-15 Breast 85% Head and neck 85% Gynaecology 85% Lower GI 85% Lung 85% Skin 85% Upper GI 85% Urology 85% There are 21 Breaches some of which were unavoidable due to patient choice and complex pathways. Others were due to unusual domestic circumstances and others due to capacity in diagnostics and admissions. 2 in upper GI due to one patient on holiday and delaying treatment and another involving complex pathway and EUS at RVI. 5 occurred in the urology service due to a combination of clinic capacity and delays in seeing patient, patient choice to delay treatment date and clinical reason due to interaction with other therapy.

3 1 in gynaecology where patient was unfit for surgery due to high blood pressure. Here the patient wanted to receive other treatments, and so declined cancer treatments whilst this was happening. Waiting time rules have been checked and medical unfit is not a clock stop. 3 in head and neck including patient choosing to have treatment in Newcastle late in pathway, histology delay due to need for second opinion in Newcastle 2 in lung due to complex domestic issues resulting in patient delaying treatment, and delay in CT guided biopsy. 6 in LGI including 3 due to complex pathways, one requiring specialist lymph node biopsy with limited clinical availability to carry out procedure and one where patient decided against treatment (breach by 2 days) 2 in breast due to decisions about treatment delayed due to patient choice, and capacity to see patient in clinic. Work is ongoing with Surgery to provide additional Breast symptomatic appointments, but limited by staff numbers who can deliver this.

4 Cancer services improvement plan to achieve cancer standard updated July 2015 Action Timeline to recovery Lead Officer Current Position Current RAG rating against timeline Key next steps Histopathology turnaround times to improve 30/10/15 F Duncan 1 x Consultant Histopathologist appointed to commence October 2015 This will increase reporting capacity, thereby shortening the request to report time. Work sent to Backlogs outsourcing to ensure workload is managed and turnaround times for cancer cases met Continue use of locum histopathologists. Approval being sought to introduce advanced BMS role who can assist with cut ups and relieve consultants of some work Yellow stickers being used in all specialities to highlight cancer cases Histopathology cancer tracker in post to focus on cancer cases. This will assist with the prioritisation and scheduling of MDT cases. Escalation sheet in place for PTL meeting and cancer trackers for histopathology Radiology additional capacity 30/10/15 J Grubb Independent sector support for CT, MRI and USS providing capacity for up to 100 patients per week Additional capacity at WCH installation of Recruitment of radiographers and sonographers continues. Agreement reached with independent MRI provider to

5 new CT scanner and MRI scanner operational from October. provide staffing for MRI unit at WCH Move of routine pre-assessment work from CIC in surgical specialities will enable pre-assessment and diagnostics to be undertaken at WCH 1 locum MRI radiographer appointed Lung 31/07/15 L Gorley /P Plant/ J Grubb Adequate capacity in lung pathway however delays due to access to diagnostics and treatment modalities Abnormal chest x-rays and 2 week wait referrals sent straight to CT scan before being seen by consultant to reduce time on pathway. This reduces pathway time by 7 days Ensure access to PET CT on site at CIC from July Discussions have taken place with Imaging to ensure regular weekly slots are available for diagnostics. Review information provided to MDT to enable delays in pathway to be identified early and ensure standard operational procedures are being followed The Lung AGM has recently agreed to a stretch target to refer patients on for treatment (surgery,chemo/radiotherapy ) by day 35 of the pathway currently day 42. The Lung AGM also agreed to plan the implementation of a shadow booking for

6 chemotherapy at the point where the MDT decision is to recommend this treatment. This will avoid delays in the pathway caused by waiting for the patient s initial consultation appointment with the oncologist before booking the chemotherapy date. This is currently being worked up to be rolled out at the start of September. It will reduce the booking delay time for the start of treatment and therefore the number of patients likely to breech. Escalation process agreed to ensure that turnaround of triage and completion of referral forms for CT scan is not delayed when allocated consultant is away. Urology 31/08/15 C Robinson Review of all clinics underway by end of June 2015 Working with contact centre to review process around 2 week referrals New consultant approved, nurse specialist approved where are we with recruitment. What will happen when they Cancer network supported event September 2015 to review whole system approach Capacity and demand analysis through network benchmarking with other providers

7 are recruited and when will there be recovery of position? Skin 30/08/15 K Martin Average of TWR referrals per week to accommodate demand. Dermatology service currently provided by 2 wte locum dermatologists, supported by 1 GPSI with interest in surgery and 1 GPSI with interest in dermatology TWR patients seen by 2 dermatologists (8 patients per clinic), 3 clinics per week. Additional capacity can be created if required by moving general dermatology appointments from above consultants to 3 rd locum to release clinic slots for TWR. Loss of 0.5 wte locum cover in April has increased demand on above resource. This vacancy has not yet been filled and responses to adverts have not been forthcoming. Advert remains live at time of reportwr appointments are delivered at both CIC and WCH (2 clinic per week at CIC and 1 at WCH) with additional capacity created when required as above. Utilisation of the 3 rd locum consultant has been introduced this month to support existing team with arrangements for him to access MDT being made. 6 additional clinics organised throughout July to accommodate current activity and cover for annual leave to avoid clinic Meeting in May 2015 with Salford dermatology department - outcome - to consider supervisory arrangements and peer support for existing team. Educational sessions were considered as the most appropriate to begin with, Due to ongoing pressures at Salford this team were unable to commit at present. Meeting 06/17/15 with Newcastle Hospitals dermatology department to consider supervisory arrangements and peer support A specific proposal was discussed from NCUH relating to implementing BAD report around supervision for Locum consultants, specialist nurses and possibly GPs also. The proposal is that supervision is delivered in NCL (and could contribute to capacity) and that once 'accredited' it may be possible to arrange (esp with GPs) for them to help with extra work Newcastle have agreed to host

8 cancellation. Appointments provided within target for all patients referred to time of report. BAD report recommending review of pathway and network led services with community services/gp s and this is the action we are taking as a result. A Meeting with Roy McLaughlin Network lead and CCG to review pathways has been arranged for September (delay due to annual leave commitments within both the Trust and community services) to accommodate both primary and secondary care clinicians and consider actions from BAD review and how this links with the supervisory arrangements. (See next column) one locum consultant in Hexham clinic once a month. This would not be a formal supervisory or assessment/accreditation arrangement at this stage An invitation to all dermatologists in Cumbria was extended to join the regular Friday afternoon teaching session in Newcastle. Additional clinics provided ad hoc to increase capacity by up to 10 patients per week to meet 2 week wait as described above. CNS acts as liaison with bookings team. UGI/LGI K Watts / C Robinson New clinics set up during June/July Dedicated CT list providing 4 appointments per week at CIC in addition to other ad hoc appointments and this closes or does not close the capacity gap? New consultant starting 20/07/15 which will provide additional clinic capacity of up to 120 patients to include cancer patients per week. This will assist in reducing new patient waiting times at wch from the current 8/9 weeks down to 6/7 and provide additional Gatro capacity in endoscopy at CIC. Pathway re-design workshop

9 planned for July for UGI with CLIC involving all members of the MDT to take out any delays in the pathway process. Similar event to be held for LGI pathway supported by CLIC Gynaecology 30/09/15 S Jenner Increase in hysteroscopy at WCH to 10 per week with plans for further increase Patients moved from day case lists to outpatient clinics Clinical and managerial team have met and are actively working up plan for one stop clinic High number of referrals via 2 week rule which are not all appropriate. Plan for rapid access appointments Revise C&B to allow for urgent appointments rather than 2ww Plan to move patients off day case lists to do hysteroscopy in clinic from August 2015 Develop one stop shop for post - menopausal bleeding from September 2015 Additional 5 hysteroscopy per week on top of 10 already undertaken from July 2015 Referrals increasing now up to 30 referrals per week.