Hywel Dda Health Board s Cancer Delivery Plan

Transcription

1 Hywel Dda Health Board s Cancer Delivery Plan

2 Hywel Dda Health Board s Cancer Delivery Plan Background and context Together for Health Cancer Delivery Plan was published in June 2012 and provides a framework for action by Local Health Boards working together with their partners. 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 of 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 2. Hywel Dda Health Board s Cancer Delivery Plan The attached document is Hywel Dda Health Board s plan that outlines the action we are planning to progress to improve outcomes for patients, in a patient centred way. Our plan has been developed to match the patient pathway and covers the following areas: 1) Preventing cancer: people live a healthy lifestyle, make healthy choices and minimise the risk of cancer 2) Detecting cancer quickly: cancer is detected quickly where it does occur or recur 3) Delivering fast, effective treatment and care: so people have the best chance of a cure 4) Meeting people s needs: people are placed at the heart of cancer services with their individual needs identified and met so they feel well supported and informed, able to manage the effects of cancer. 5) Caring at the end of life: people approaching the end of life feel well cared for and pain/symptom free 6) Improving information 7) Targeting research Each of the seven areas has been reviewed to determine the actions required along with current status, expected outcomes, timescales and lead officers. The Cancer Delivery Plan provides a focused framework for bringing all the initiatives which have an impact on a cancer patient s pathway together in one document. 2

3 Many of the actions/initiatives which are included in Hywel Dda Health Board s Cancer Delivery Plan are already part of other local Health Board and National Plans. Due to Hywel Dda Health Board s close working relationship with Abertawe Bro Morgannwg University Health Board, for example, our Cancer Delivery Plan has been aligned to ensure compatibility for the further development of working relationships/arrangements. 3. Governance Arrangements/Monitoring Mechanisms The Health Board is also producing a Cancer Annual Report which provides a baseline for our population on our current services and will provide a platform for taking forward and monitoring the actions contained within our Plan. Progress against the Cancer Plan will be monitored through quarterly meetings of the Cancer Clinical Programme Group alongside the monitoring of the Cancer Annual Report. In addition to the above, it is expected that Health Boards will report progress against their local delivery plan milestones to their Boards on a quarterly basis and to the public, via their websites. It is expected that this Local Delivery Plan and its milestones will be reviewed and updated annually. 3

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5 1. PREVENTING CANCER PEOPLE LIVE A HEALTHY LIFESTYLE, MAKE HEALTHY CHOICES AND MINIMISE RISK OF CANCER Ref Planned Actions Current Status/Expected Outcomes Responsible Completion date PC1 Engage effectively on Local Service Boards to ensure appropriate local population outcomes are identified within single integrated plans and actions of all partners are clearly set out, monitored and measured. PC1 Membership of the Cancer Clinical Programme Group to include Public Health representation. CPG Terms of Reference and Membership currently being reviewed to align with work of Population Health Programme Groups. Head of Cancer Services October 2013 PC1 PC1 PC2 PC2.1 PC2.2 PC2.3 PC2.4 PC2.5 To work in partnership with Hywel Dda Public Health Team to improve services and tackle inequalities, placing emphasis on disadvantaged groups and deprived areas. Population Health Programme Groups to Alignment of officers to each Population Director of October 2013 include representation from Public Health Health Programme Group Public Health Three LSBs operate within the Health Single integrated plans (developed by the Director of Ongoing review Board area (aligned to the three counties LSB and local authority) are in place and Public Health by the LSBs of Carmarthenshire, Ceredigion and Public Health have inputted into the Pembrokeshire). The LSBs meet outcome measures and are involved in the regularly to discuss need and the need monitoring of the SIPs assessment work. Work with local government, Public Health Wales, GPs, pharmacists, dentists, opticians, the Third Sectors and others to use data on cancer incidence and mortality to identify, implement and audit local strategies, clearly stated population outcomes and performance measures and targets to prevent cancer. In particular, to: Promote better public awareness of cancer risk factors; Reduce smoking, obesity and excess alcohol intake; Reduce the gap in inequalities in incidence and mortality rates for cancer; Work collaboratively through the Cancer Networks; Encourage participation in the programme of health checks for people over 50 facilitate access to personally relevant, clear 5

6 and consistent health advice PC Team Briefings by the Chief Executive Public Health Strategic Framework Director of 2.1- will include briefings, where appropriate, identifies the following as priority area: Public Health 2.5 on Public Health priorities tobacco, obesity, sexual health, imms and vaccinations, alcohol, mental wellbeing and making every contact count. Completion date Ongoing reviews PC Public Health Strategic Framework identifies: tobacco, obesity, sexual health, imms and vacc, alcohol, mental wellbeing and making every contract count as key areas of work. The relevant key priorities for the Hywel Dda area are: Reducing smoking prevalence and protecting people from exposure to tobacco smoke Improve diet and nutrition and reduce overweight and obesity Decrease alcohol consumption Increase uptake of Imms and Vacc rates (including those which have an impact on cancer: HPV for Cervical Cancer prevention) Increase mental well being Decrease environmental risks (skin cancer prevention) Reducing premature deaths The team work across all settings and life Reducing smoking prevalence and protecting people from exposure to tobacco smoke Tobacco action plan in place (refresh required in 2013 Foundations for Change (F4C) target across all 3 counties. Close fits with Strategic Implementation Groups. Hywel Dda Pledge made re: helping 5,000 people stop smoking or preventing people from starting (2015 target) Currently monitored at Public Health ership Team As Population Health Programme Groups commence, the Tobacco Action Plan will fit with the transformation work being undertaken and the identified need to increase pre-surgery activity and also link with Smoking Cessation and our Smoke Free Sites. The Public Health Team are working with Public Health Wales (Stop Smoking Wales) to Principal Officer Refresh during 13/14 (by end of Q3) 6

7 course areas. Established links are in improve the service model and ensure place with Public Health Wales. A services are offered more flexibly (as national Consultant in Public Health part of Tier 1 discussions). The Public (CPH) lead will be established by Public Health Team are exploring a Level 3 Health Wales during 13/14 pharmacy scheme for smoking cessation. Waiting times for Stop Strengthen links to preschools, healthy Smoking Wales Services are being schools and workplaces. monitored. Completion date During 2013/14 there will be an increased focus on developing Public Health links with primary care. Public Health Team to focus resources in specific settings where evidence indicates they will be most efficiently used. These settings include: Local authority settings eg pre schools, schools and school nursing Primary care Pharmacy Workplaces Vulnerable populations including Communities First Use Foundation to Change approach to reduce health inequalities and improve health across the whole of the population by interventions that create supportive Key stakeholders include: local authorities, Public Health Wales, Third Sector, County Voluntary Councils, Tobacco Network/ASH, Primary Care, Clinicians and Pharmacy. Improve diet and nutrition and reduce overweight and obesity Overweight and obesity action plan in place (full refresh required by end April 14) F4C targets/actions being agreed across all 3 counties for monitoring through the Health Board Strategic Implementation Group Hywel Dda Pledge made re: helping 12,000 people to lose weight (2015 target) Fit with Population Health Programme Group Close fit with 3 SIPs Monitoring in place through the Public Principal Officer - with links to Dietetics/ Therapies Refresh by April

8 environments. Health leadership team. Completion date Use the Health Board s Helping Group to raise awareness of practical messages around cancer. Key stakeholders include: local authorities, Public Health Wales, Third Sector, Primary Care, Clinicians and All Wales ership Group. During 13/14, the Public Health team will explore opportunities to develop further action relating to childhood obesity and the obesogenic environment. Links have already been made with local partners and Public Health central support sought. 2013/14 (Q4) Decrease alcohol consumption Plans in place to decrease alcohol consumption refresh required by end April 14) Brief intervention training roll out being monitored Monitoring in place through Public Health ership team F4C priority in all 3 Counties. Key stakeholders include: local authorities, APB, Public Health Wales, Third Sector, Primary Care, Clinicians. Principal Officer Refresh by April 2014 Increase uptake of Imms and Vacc rates Consultant Plan reviewed 8

9 for those which have an impact on cancer ie HPV Vaccinations 3 County Plan in place (refreshed annually) Monitored by Public Health ership team and also Quality and Safety Committee Close fit with 3 SIPs Strong links to the nursing team already established. Targets in line with national requirements. Key stakeholders include: local authorities, Public Health Wales, Primary Care, school nursing Completion date Public Health during 13/14 as normal part of Imms and Vacc programmes and planning Increase mental well being Public Health Action Plan required Close fits with Mental Health Partnership Board and will dovetail to relevant Population Health Programme Close fit with 3 SIPs Links being explored between the brief intervention portfolio and psychological management Key stakeholders include: local authorities, Public Health Wales, Third Sector, County 9 Consultant Public Health To be completed by December 13.

10 Voluntary Councils, Primary Care and Clinicians. Completion date Decrease environmental risk (skin cancer prevention) This is currently under review for 13/14 - will be discussed at Public Health leadership forum given the priority list of actions for the team Activity for 13/14 is likely to relate to healthy pre-school, school setting and proactive communications activity. The Public Health Team are already linked to sun safety agenda with the Local Authorities. Reducing premature deaths F4C identified life expectancy and health inequalities as core areas to monitor improvement for all three counties. County plans are being developed. Director of Public Health Consultant Public Health April 14 (by end Q4) Yearly review. Increase screening update (new local focus) see also section re: detecting cancer quickly Work with Public Health Wales to increase Screening Uptake (national targets in place): All Public Health stakeholders contribute to this agenda. Public Health Wales plans in place regular reports received Link person with Public Health Wales agreed Monthly monitoring in place already through Public Health ership Team Public Health Wales project on Director of Public Health September 13 complete unless otherwise noted. 10

11 inequitable compliance due for completion end of financial year. Breast Bowel (PRIORITY see below) Cervical During Q3 12/13, the team identified the need to monitor closer the screening update rates after variation identified across the three counties. Agreement that the main focus for 13/14 will be the Bowel screening programme. This links well to the F4C programme given the focus on inequalities and life expectancy. This is a new priority area for the Hywel Dda Public Health Team with Public Health Wales as the lead screening organisation. The overall worst performing screening area is bowel screening hence the identified target area. Variation in cervical screening has also been noted especially in Ceredigion. Completion date Key stakeholders include: local authorities, Public Health Wales, Pharmacy, Primary Care, Third Sector and Clinicians. PC 2.4 The South Wales Cancer Network will develop an implement in partnership with the Health Boards: Hywel Dda Health Board staff to participate and present to the groups. Head of Cancer Services Ongoing Sharing good Cancer Rehabilitation Practice event annually An Allied Health Professional and Nursing Head and Neck Cancer Pathway A Fatigue pathway for cancer patients 11

12 Metastatic Spinal Cord Compression education Cancer key worker education event Completion date The Cancer Network will develop and improve web based information eg Cancer Services Directors. 2.5 Roll out of the Public Health Wales/Wales Government over 50s health check scheme. 50+ health check will be supported by the Public Health Team (main lead is Public Health Wales). It is cross cutting work with other lifestyle activity work. In its initial format, the focus will be on the Community First area in Carmarthenshire (as per Welsh Government guidance), however information is being shared with relevant partners. Public Health Wales/ Director of Public Health Ongoing 12

13 2. DETECTING CANCER QUICKLY WHEN IT DOES OCCUR OR RECUR Ref Planned Actions Current Status/Expected Outcomes Responsible Completion date Screening DC1 DC2 Regularly review, plan and deliver screening programmes as recommended by the Wales Screening Committee Promote better take up of screening programmes to meet the best practice uptake targets particularly targeting those less likely to take up screening DC3 Provide sufficient capacity, workforce, infrastructure and equipment to treat and care for people referred to the cancer screening programmes DC1 Regularly review, plan and deliver screening programmes as recommended by the Wales Screening Committee Residents across the Health Board are offered the following screening services Breast Test Wales Screening is provided by Public Health Wales mobile units. Uptake in 2011/12: Ceredigion = 29.7% Carmarthenshire = 76.5% Pembrokeshire = 81% Hywel Dda = 75.7% Wales = 73.5% Minimum uptake standard is 70%, while target is 80% Please note that care is required when reviewing uptake rates in localities because of the rotational organisation of this screening programme. 13 Director of Public Health (in conjunction with PHW) Ongoing

14 Completion date Cervical Screening Wales The cervical screening target standards 12/13 is 80% of eligible women aged 20 to 64 years. Screening occurs first then commences to assessment and treatment. Update of cervical screening in 2011/12 was: Ceredigion = 75.9% Carmarthenshire = 67.5% Pembrokeshire = 75.8% Hywel Dda = 74.1% Wales = 76.3% Since 1 st April 12, cervical smears taken from women living in Hywel Dda are transported for processing at the Cervical Screening Wales Laboratory at Llantrisant and returned for screening and reporting at ABMU laboratories. The results continue to be issued back to women as usual. The HPV vaccination programme is being rolled out across Hywel Dda. Bowel Screening Wales Colonoscopy services are delivered 14

15 Completion date well for the Health Board and the waiting times for the clinics are consistently within standard. The first stage of screening uses bowel screening kits (sent through the post). If further investigation is required, the assessments are undertaken at 3 sites across Hywel Dda: For 2011/12 the uptake rate: Ceredigion = 53.4% Carmarthenshire = 52.5% Pembrokeshire = 52% Hywel Dda = 52.6% Wales = 51.1% Ceredigion endoscopy service is already JAG accredited and the Carmarthen and Withybush units have just achieved JAG accreditation. Double reporting of cases identified by screening can cause delay. There is ongoing work around centralisation of pathology services and consultant recruitment The reviewing and planning of cancer services will become an integral part of the role of the new Population AMD Pathology Ongoing 15

16 Completion date Health Programme Groups. DC1-3 Increase awareness of the signs and symptoms of Cancer Awareness raising/training - to encourage people to recognise the signs and symptoms of cancer and see their GP if there are issues. This is a new area of work for the Public Health Team which will commence in October 13. Explore working with primary care communications Communication work already in place through the Helping Group, however further opportunities to raise awareness will be considered. Consideration will be required on the impact on diagnostics and services Consideration will be given to the fit with the Making Every Contact count approach. Consultant Public Health Director of Public Health October 13 April 14 (in first instance) Key stakeholders include: local authorities, Public Health Wales, Third Sector, Primary Care and Clinicians DC2 Promote better take up of screening programmes to meet the best practice update targets particularly targeting those less likely to take up screening. NB: Prevention section also includes information on screening programmes. The Public Health Team are linked into Public Health Wales Activity/projects looking at update rates. Director of Public Health The Hywel Dda Public Health Team A Specialty Registrar in Public Health 16

17 Completion date are liaising with the screening engagement team of Public Health Wales regarding possible further wider health community work. DC4 DC5 DC6 DC7 DC8 DC9 DC10 based in Hywel Dda Health Board undertook a piece of work on coverage and access for cervical screening in Hywel Dda and the three counties during 12/13. The conclusions were that work is needed to increase the uptake of cervical screening and links are being established between the local public health team and the screening engagement team. The report highlighted that most women in Hywel Dda attend their GPs for smears but other access points are important to give women and choice. Work to review the Sexual Health Service is ongoing but aims to be completed by March March 2014 Early Diagnosis Use National profiling data of cancer prevalence, mortality and survival rates to inform targeted action on particular cancers and communities Raise public awareness of cancer symptoms needing prompt GP assessment Raise GP awareness of symptoms to promote prompt referrals in line with national guidance, local pathways and waiting time standards Work with GPs to introduce evidence based Risk Assessment Tools to help identify those at most risk of having cancer Provide GPs with direct and prompt access to diagnostics to diagnose cancer Audit the pathway for each person diagnosed with advanced cancer and act on findings to improve services for early diagnosis Develop acute oncology services to support the needs of people admitted as emergencies DC4 Using information to inform service plans and provision The recently agreed national lead (Consultant Public Health) in Cancer Consultant Public Health (PHW) Ongoing 17

18 Completion date (for Public Health Wales) will support Public Health practitioners across Wales at a local level on issues relating to cancer. DC4 Adopt good practice arising from the ABMU/Cancer Research UK project on attitudes of people with early cancer symptoms. The Public Health Team has relevant information with Health Board colleagues and relevant parties. To provide patients with appropriate information and awareness to contact services when they notice changes that could be cancer. Encourage people to be more self awareness and promote positive attitudes. Head of Cancer Services/Patient Experience Manager Commence January 2014 DC5 The Health Board participates in public awareness raising using a number of mediums including the Healthy Wednesday scheme to reflect national awareness weeks and promote other aspects of health and well-being. The Health Board will continue to develop, participate and support programmes for awareness and symptom recognition. Links to the Helping Group Assistant Director of Corporate Services/Public Health Wales Ongoing activity DC5 Establish a local planned programme in line with National Awareness Days for Cancer and related risk factors to be led by MacMillan Information Co-Ordination Team Improve communication with public by working in partnership with South Wales Patient Forum to establish planned awareness days MacMillan Information Co- Ordination Team/ Assistant Director of Corporate Services Ongoing. 18

19 Completion date DC6 In house PTFL (Practice Time for Learning) already in place in GP Practices. GP Practices NICE guidance summary sent regularly to primary care. Explore monthly updates (bullet point guide) via GP newsletter staggered around early signs of cancers. Clinical Effectiveness Coordinator AMD Primary Care and Primary Care Officer - GMS Ongoing October/November view to start in January 2014 A range of information eg SIGN guidance, etc is easily accessible on the internet. GP Forums exist in Pembrokeshire, Ceredigion and Carmarthenshire (3 localities) where the opportunity exists for clinical colleagues to inform/advise/interact with primary care. GPs with an interest in dermatology have regular MDT meetings with secondary care colleagues and audit their work. Consultant Dermatologist DC7 Introduction of risk assessment tool in primary care. Identify the most appropriate risk assessment tool (poss Hamilton Assessment Tool) to help identify those AMD Primary Care January

20 Completion date most risk of having cancer within the Primary Care setting. For inclusion on GMS newsletter as a standing item. DC8 DC9 Design and implement clear pathways for rapid access to diagnostic services and treatment for patients with suspected cancer eg colorectal cancers. Ensure provision of rapid access clinics for patients with red flag symptoms eg post menopausal bleeding, haematuria. Introduce automatic review of patients who have presented with late stage cancer and act upon the findings. DC10 Hywel Dda Health Board will explore the establishment of a Project Board to develop a sustainable oncology model which operates across the three counties. Standardised and clear proforma for urgent referral of common cancers. The aim is to improve management of USCs by reducing inappropriate or unclear referrals. In collaboration with South Wales Cancer Network agree diagnostic specialist pathways with Hywel Dda Health Board. Improve capacity of rapid access clinics for patients with red flag symptoms eg post menopausal bleeding, haematuria. These cause bottlenecks on various pathways and are a significant issue with respect to SAFF target breaches. The Health Board is currently working to improve compliance with the recording of the stage of cancer at diagnosis. Review of cases of advanced diagnosis will be commenced as part of the MDT annual audit cycle. The scope of the work needed to be undertaken by the Project Board is currently being worked up. This will include summary terms of reference, outline work programme and 20 MDT Clinicians/Assistant Director of Clinical Services/ Head of Cancer Services MDT lead clinicians/assistant Director of Clinical Services Associate Director of Clinical Services/ Health Planning Manager/ Head of Cancer Annual review Establishment of Project Board November/December 13

21 Completion date membership of the Project Board. Services The Project Board will work with South Wales Cancer Network to coordinate and deliver high quality, equitable patient care. Work areas include: Development of an acute oncology model Ensuring effective and sustainable staffing models Ensuring activity information is managed effectively Ensuring consistent service provision across the three counties. Exploring cross border issues Consideration of medicines management issues including aseptic units Linking into the work being undertaken with regards to patient transport. Alignment of the Project Board with Cancer Programme Group and relevant Population Health Programme Groups. Timescales for work programme will be determined at first Project Board meeting. DC10 Develop an agreed transport protocol to ensure Hywel Dda Health Board patients meet the criteria for PET scans at UHW Currently these arrangements are made on an adhoc basis often outside the current Welsh Ambulance Trust contractual arrangements Assistant Director of Strategic Partnerships December 13 21

22 3. DELIVERING FAST, EFFECTIVE TREATMENT AND CARE Ref Planned Actions Current Status/Expected Outcomes Responsible Completion date TC1 Review, plan, reorganise all services where appropriate to deliver best experience and outcomes in line with latest evidence, standards and guidance TC2 TC3 TC4 Provide definitive treatment consistently in line with national waiting times targets Identify mechanisms to plan and deliver equitable access to new diagnostics and treatment procedures in line with evidence Determine Individual Patient Funding Requests promptly and equitably across Wales using the All Wales protocol, TC5 TC6 TC7 TC8 TC9 exceptionality criteria and training Plan radiotherapy services strategically through the Cancer Networks Undertake complex surgery in line with peri-operative care standards as in the ERAS programme Reduce surgery and chemotherapy related mortality by eliminating preventable deaths Participate in national and locally clinical audit and other quality improvement activities and reflect action to be taken in local cancer delivery plans Participate in peer review and reflect learning in local cancer delivery plans. TC1 Develop Health Board Wide MDTs The Health Board commenced a programme to integrate county based MDTs in The Urology and Dermatology MDTs were already integrated and since 2010, the Lung, Breast and Colorectal MDTs have been integrated. These are 3 services which still have county based structures: Gynaecology: the MDT is expected to integrate in November Upper GI: the MDT will integrate to Clinical for Cancer Dec 2013 (except haematology) 22

23 reflect the new service models Haematology: will integrate once the service model for Ceredigion is agreed TC1 Review, plan, reorganise all services Associate where appropriate to deliver best Director of experience and outcome in line with Clinical latest evidence, standards and Services guidance. TC1 Review, plan, reorganise all services where appropriate to deliver best experience and outcome in line with latest evidence, standards and guidance. The Health Board will empower MDTs to offer patients the best possible diagnostic, treatment and rehabilitation care within Hywel Dda and as locally as possible to the patient s home. Service reviews will take into account the need to ensure safe, sustainable services and the need to minimise patient travel. Through the work of the Population Health Programme Groups, an improving service user experience framework has been developed. This will guide involvement and ensure that planned improvements consider the impact of experience on care, treatment and outcomes of care. Population Health Group s Patient Experience Manager Completion date Ongoing Population Health Groups to commence October/November 13 Shadowing, observations and patient stories will be built into our improvement work to ensure improvements are grounded by real experience of people. TC1 Review, plan, reorganise all services where appropriate to deliver best experience and outcome in line with latest evidence, standards and guidance. Provision of information and advice to patients undergoing chemotherapy regarding neutropaenic sepsis. Audit of current neutropaenic sepsis policy Consultant Haematologist Completed 23

24 compliance Exploring current attitude and behaviour Patient through the use of patient stories with a Experience view to improving the awareness and Manager information provided to put into place speedy response. TC1 To act upon the outcome of Peer Review visits to improve service provision and organisation. Quick implementation of recommendations will ensure that the services provided by the Health Board reflect latest best practice. Clinical lead for Cancer/Head of Cancer Services Completion date Dec 2013 April 2014 Timescales according to action plans TC1 Ensure agreed NICE guidelines are embedded within the MDT functions. Implementation of NICE Clinical Guidelines and NICE Cancer Service Guidelines will help ensure services are provided to acceptable standards. MDT s/ Clinical Effectiveness Co-ordinator Within 4 months and thereafter annual TC2 The Health Board regularly achieves the 31 day target but is consistently underperforming against the 62 day target. Review of implementation status of guidance should be undertaken; audit as required. Capacity planning is underway to identify both cancer and non-gaps. Review of whole cancer diagnostics pathways will support the delivery of care in target. Head of Cancer Services Regular review TC2 The key areas to improve are Urology and Lung Hywel Dda Health Board is committed to sustainable achievement of the target by ensuring that any USC referral will be Refining systems and processes to monitor key stages within the pathway. Meeting has been held to start reviewing Director of Operations Ongoing 24

25 treated within target date. the diagnostic pathway. Completion date Hywel Dda will work to achieve the target sustainability by aligning its workforce, finances and clinical capacity to this priority area. We recognise that there are specific challenges for us relating to diagnostics, particularly radiology. This will also include more frequent and clinically led liaison with counterparts in tertiary providers (particularly ABMULHB) and ensuring these systems are robust, sustainable and support ongoing timely and high quality cancer provision. Operational managers are authorised to work with clinical teams to step-up additional capacity when necessary to ensure that the standard (urgent suspected cancer referrals are booked within 10 days) is maintained. We have developed an increased emphasis on breach reporting and sign off clinically to assure our Board that patient safety, quality and standards of care are being appropriately managed. In particular, engagement is taking place with Clinicians regarding their cancer performance and sharing of data. Assistant Director of Clinical Services November 13 TC3 TC4 Work with tertiary providers to ensure provision of advanced diagnostics and treatment as locally as possible, along with rapid access to services where it cannot be provided locally. To establish a network Individual Patient Funding Request system to ensure consistency and transparency of decision making and to minimise delays in the pathway for cancer patients Patients have access to EBUS, IMRT, IGRT, CHART, and other new optimal treatments as required to ensure our patients receive the best care possible. Hywel Dda have an IPFR panel every other week. In emergency situations, emergency panels are convened via telephone/video conferencing. The IPFR Panel members have recently Clinical for Cancer/Head of Cancer Services Head of Cancer Services Ongoing Ongoing Review 25

26 Subsequently, to determine Individual attended an All Wales IPFR information Patient Funding Requests promptly and day where a number of cases were equitably across Wales using the All discussed to ensure all Health Boards in Wales protocol, exceptionality criteria Wales were consistent in their decision and training making. Completion date Head of Cancer Services liaises with IPFR managers within Wales and has meetings to discuss cases, concerns, etc. TC5 Hywel Dda does not provide radiotherapy services but accesses services provided by ABMU and Betsi Cadwaladr Health Boards, Velindre and Shrewsbury & Telford NHS Trusts for patients being diagnosed with cancer by Hywel Dda doctors. Opportunities are presented by emergency technology (mobile units for the treatment of certain cancers) which will need to be explored in time. Hywel Dda Health Board will work with the South Cancer Network to ensure the requirements of its residents are provided for. Head of Cancer Services Ongoing Review Review of current transport arrangements for HDHB patients to be undertaken for those travelling to ABMU and Velindre. The trend for those attending Singleton requiring Non Emergency Patient Transport (NEPT) continues to increase. Alternative transport provision, currently provided by WAST to be considered as part of NEPT Strategy and review of WAST. Assistant Director of Strategic Partnerships 26

27 TC6 Embedding of ERAS across all surgical Hywel Dda Health Board has a fully Director of specialties developed ERAS programme in place in Operations all three counties, along with a General Surgery ERAS Board however this is not yet embedded in all specialty areas and to the same extent Completion date July 2014 TC7 TC8 TC9 Compliance with National Guidance (Wales) on preventable deaths To establish a range of Population Health Groups which will integrate clinical audit activity and quality improvement activities. Participate in the peer review programme Hywel Dda Health Board is reviewing all patient deaths. The process will change shortly following the publication of National Guidance (Wales) and this may help to identify and eliminate preventable deaths. Clinical audits are currently undertaken by the relevant surgeons for example colorectal, breast, haematology, urology. Cancer will be framed within each of the Population Health Programme Groups. Hywel Dda s Clinical Audit Department will support further development of audits. A workplan will be developed in partnership with the Programme Groups. Peer review completed for Lung and Upper GI Urology is due for completion Spring 2014 with Colorectal, Head & Neck and Gynaecology being reviewed in 2014/15 27 AMD Information & Research (Anaesthetics Department) Population Health Programme Group Chairs AMD Information & Research (Anaesthetics Department) Head of Cancer Services End of 2013 Ongoing Review Completed Spring /15 TC9 Monitor MDT compliance against the Cancer Standards data completed Head of Annually

28 National Cancer Standards Data set. annually and will be reported to MDTs Cancer Services TC9 Develop integrated MDT performance Pathway tool in development. Head of toolkit including nationally collected Cancer standard/audit data and local Discussion has been had with Cancer Services performance measures to support MDT National Specialist Advisory Group functioning. (NSAG) Core Team have been had regarding the development of the National Cancer Standard Database to incorporate all such information and to become a key source for Peer Review and self assessment. Completion date

29 4. Meeting People s Needs. People are placed at the heart of cancer care with their individual needs identified and met so they feel well supported and informed, able to manage the effects of cancer. Ref Planned Actions Current Status/Expected Outcomes Responsible Completion date MN1 MN2 Assign a Key Worker to each person with cancer, from the point of diagnosis onwards, to co-ordinate their ongoing care Review and design services recognising the changing needs of people with cancer and to deliver person centred services to meet ongoing needs as locally as possible in line with National Standards MN3 Assess the clinical and non clinical needs (such as information needs on accessing financial, emotional and spiritual help) of people following a diagnosis of cancer and draw up and implement a careplan to be reviewed regularly MN4 MN5 MN6 Provide each patient and GP with an end of treatment summary to inform the care plan Support patient participation in cancer patient experience surveys and include action on the outcome in local cancer delivery plans Plan and deliver co-ordinated services for metastic cancer patients and measure outcomes MN1 Key Worker Plan Around 80-90% of patients are provided with a key worker at the point of their diagnosis. Coverage is not, however, equitable across the Health Board or for all types of cancer. Head and Neck - 1 post in Carmarthenshire for whole of Health Board. Need to establish contact arrangements for patients accessing services from Bronglais and Withybush Upper GI - Gap in Ceredigion, support provided by generic oncology nurses in Pembrokeshire Haematology Gap in 29 Deputy Head of Cancer, Nursing and Quality/ Assistant Director of Therapies and Health Science Situation under ongoing review. Will be reviewed in light of MacMillan patient satisfaction findings

30 Carmarthenshire and Pembrokeshire Gynaecology Gap in Carmarthenshire. Support provided by Women s Cancer Nurse service in Ceredigion (combined with Breast). Support provided by generic oncology nurses in Pembrokeshire Completion date It is considered that there is insufficient capacity in the Urology, Colorectal and Dermatology Services A bid for 3 wte Macmillan Dermatology CNSs was approved by Macmillan in September MN1 Key Worker Plan To develop a key worker concept with a patient and family centred care approach. To ensure key workers work with the interests of patients in mind, and tailor care to fit their needs. MN1 MN1 Ensure cancer patients are supported as the recover in the community Development of a chemotherapy advice line The Health Board has participated in the Macmillan Practice Nurse Scheme to improve cancer awareness and service within primary care. The Health Board is establishing a neutropaenic sepsis admission single contact number which will ensure patients 30 Head of Cancer Services/Patient Experience Manager Head of Cancer Services Assistant Director of Clinical Project plan to be scoped by April 14. Ongoing Neutropaenic admission via a single contact

31 are supported through the admission process and the admitting teams are aware of treatment requirements. Work around a more general advice line is being addresses through the Oncology Services review MN2 Develop patient Focused services A Macmillan Patient Focused Care Project has been funded to support the development of cancer services. Recruitment to commence in Autumn MN2 Establish Patient Focused work stream Work stream to be sub-group of Cancer Programme Group. To be established Autumn MN2 Further development of MDTs The MDT must also identify the broader care issues which need to be addressed in order to maximise the potential for the patient to return to normal post recovery. MN2 MN3 Review oncology services to ensure they are designed around meeting patient needs Improve information and support provided to patients with cancer Potential role for CNS to be explored and collaboration with third sector organisations The Health Board is planning a review of Oncology Services with a view to restructuring. Further information is provided in the Detection Section. Funding for three Macmillan Cancer Information and Support Workers (one 31 Completion date Services point Dec 2013 Chemotherapy advice line 2014 Head of Cancer Services Head of Cancer Services Associate Director of Clinical Services via Oncology Services review Assistant Director of Clinical Services/ Health Planning Manager Head of Cancer Services/Patient January 14 January 2013 May 2014 To commence November 13. January 2014

32 including their families and carers per county) approved in Posts are Experience through establishing a Macmillan currently being recruited to and are Manager Cancer Information and Support Project planned to be in post early against the Health Board MN3 MN3 MN3-4 Site Macmillan Info-Pods in Bronglais, Withybush and either Glangwili or Prince Philip hospitals. Development of psychological support services for patients Implement Macmillan Holistic Care Plan for all Cancer Patients Info-pods to be designed into the development of the Chemotherapy Units at Bronglais and Withybush General Hospital. A pod and an environment to be installed at the Carmarthenshire hospitals. Additional information environment will be installed at appropriate community settings to support the service. The Health Board is in liaison with MacMillan Cancer Care and other agencies regarding the development of psychological support services for patients. The Macmillan Holistic Assessment and Care Plan toolkit is being used/piloted by Lung Nurses in Ceredigion and Carmarthenshire, and Breast Nurses in Pembrokeshire. Review to be presented to CPG in Autumn Modernisation Manager/ Head of Cancer Services Head of Cancer Services Deputy Head of Cancer, Nursing and Quality Completion date March 2014 Ongoing January 14 MN5 Embed patient experience within Cancer Services It is anticipated that it will be rolled out to all cancer patients post review. The experiences of patients, their families and carers will underpin all of our work to review, improve and deliver cancer services. We will adopt appropriate Head of Cancer Services/Patient Experience Manager November 13 32

33 methodologies to support this process including surveys, focus groups, stories, shadowing and observations of care. Completion date The Health Board has supported the Wales National Cancer Patient Survey and will act upon its results. MN6 Develop service to manage patients with metastic cancer Local patient surveys and stories to be used to inform MDT development and assessment of performance. Metastatic cancer is being considered by the National Cancer Implementation Group. Patient Experience Manager/ Deputy Head of Cancer, Nursing and Quality Head of Cancer Services April 14 April 2014 Hywel Dda to work with ABMU to assess the potential for a South West Service 33

34 5. CARING AT THE END LIFE PEOPLE APPROACHING THE END OF LIFE FEEL WELL CARED FOR AN PAIN AND SYMPTOM FREE. Ref Planned Actions Current Status/Expected Outcomes Responsible EOL1 EOL2 EOL3 EOL4 EOL5 EOL6 EOL7 34 Completion date Plan, secure and deliver sustainable, high quality End of Life care for HDHB population. Support all providers who care for dying patients to participate in the All Wales audit of the Integrated Care Priorities documentation. Have clear funding streams for specialist and palliative care services which are above the minimum levels advised by the Palliative Care Implementation Board Support participation in cancer patient experience surveys in particular the IWantGreatCare surveys of palliative care patients and their families. Support people to die in their place of choice. Support people who die in usual place of care. Care home support team established and evaluation supporting improved care and increased support of care home staff. Training and education lead by SDCS to improve patient and family involvement in advanced planning and identifications preferences. [DOC: EOL care in HDHB Care Homes.] Support people with palliative care needs on a Primary Care Practice, Palliative Care and Respite. HDHB: Doc Foundations for Change Development Of Integrated Services with Primary Care, social care and third sector. EOL1 Deliver well co-ordinated palliative and end of life care on a 24/7 basis in line with published standards and guidance (Together for Health Delivering EOL Care, Welsh Assembly 2013) Specialist palliative care is delivered across Hywel Dda Health Board by Specialist Palliative Clinical Nurse Specialist within 3 counties in each acute and community hospitals and community settings (including care homes, each of which has a named CNS). There is one specialist in patient palliative care facility at Ty Bryngwyn and designated palliative beds in other community and acute hospitals. Medical Director In place 7/7 CNS support is in place in all settings. Management In place

35 24/7 Consultant rotas have a direct lead palliative responsibility for the inpatient units and care (County support elsewhere., including when Director necessary direct assessment in any Carmarthen) setting. Completion date Palliative Care Consultants participate in the Regional On Call rota by phone. Non specialist providers are supported by Health Board Teams in following existing all Wales guidance on symptom control and other areas. Continue to monitor and evaluate the service provided Participate in Health Inspectorate Wales Peer Review Process for palliative and end of life care and the development of action plan in line with key recommendations. The Health Board has embraced the development of Foundations for Change in the delivery of HDHB Health Care for the whole population. End of Life care has been identified as a specific measurable outcome. Work with third sector (Marie Curie Nursing Service, British Red Cross, Paul Sartori, 35 Medical Director Medical Director Management lead palliative care (County Director Carmarthen) Management lead palliative care (County Director Carmarthen) Management lead palliative care (County Director Carmarthen) Assistant Director of Ongoing Ongoing Annual reviews undertaken Ongoing Ongoing December 13

36 Shallom, Skanda Vale) and health board Strategic teams to provide integrated approach to Partnerships care. Devolve the following Service Level Agreements with the third sector into each respective county team to ensure they are integrated into mainstream palliative care services: Assistant Director of Strategic Partnerships Completion date December 13 Marie Curie/British Red Cross Carmarthenshire Marie Curie Ceredigion Paul Sartori Foundation Pembrokeshire Support the following third sector organisations in taking forward an agreed model of respite/end of life care. Shalom House Pembrokeshire Skanda Vale Ceredigion Increasing use of CANISC to improve communication across the pathway. Introduced with the Marie Curie Nursing Service a service to improve access for patients with dementia to specialist palliative care 36 Medical Director/Head of Cancer Services Head of Community Nursing Ongoing - constantly developing system Partial implementation June Further appointment to

37 EOL2 Online Support/Use of ICP EOL3 Clear Funding Streams EOL4 Ensure the experience of patients and their families and carers underpins service improvement and delivery. Pathways development of Advanced Care Plan documentation. Implementation on going. 3 counties Palliative Care Implementation Group has been established in HDHB. This board supports each county s palliative care implementation plan. Three County P.C.I.G. and work plan agreed. Launch of Advanced Care Plan Document and approach. The ICP is promoted within the Health Board with designated staff undertaking the rolling training programmes to all staff and partners in care delivery. Allocation of funding is co-ordinated via the Hywel Dda Implementation Board. The funding is utilised effectively and a number of key recommendations have been implemented. Need for ongoing assessment of unmet needs with Palliative Care Services. I Want Great Care survey questionnaire commissioned by the All Wales Implementation Board for Palliative Care. All patients and / or families seen by the service with the exclusion of those whose condition made it inappropriate are offered I Want Great Care questionnaire. Medical Director Management lead palliative care (County Director Carmarthen) Medical Director Management lead palliative care (County Director Carmarthen) Medical Director Clinical Nurse Specialist (Macmillan) Completion date be made. Ongoing Meet quarterly Ongoing In place Ongoing Underway 37

38 Audit of 3 years data completed and to be CNS presented to teams. Develop further Palliative patient experience surveys across the Care Health Board with focus on end of life. In addition, Health Board developing a patient stories approach to capturing patient and carer experience to inform service development. EOL5 Need to improve further assessment and understanding of performance against preferred place of dying within acute setting. This will be guided by work being undertaken by end of life care group and national work on developing outcome EOL6 Support people who die in usual place of care Information and awareness of patient stories should be used to inform service improvement and delivery. End of life will cut across all Population Health Groups - currently being established Roll out of the implementation of the Advanced Care Plan Documentation and Education. Continued use and audit of Integrated Care Priorities (ICP). GP palliative care registers established. Care Home Support Team (CHST) established. Evaluation supporting improved care and increased support of Patient Experience Manager Medical Director Medical Director Medical Director Medical Director Management lead palliative care (County Completion date Underway Ongoing November 13 This has commenced (Sept 13) - ongoing This has commenced (Sept 13) - ongoing This has commenced (Sept 13) - ongoing In place. Annual evaluation 38

39 care home staff. Training and education Director lead by Specialist Palliative CNS to Carmarthen) improve patient and family involvement in advanced care planning and identifications of preferences.[ DOC: EOL care in HDHB Care Homes. HDHB Advanced Care documentation] EOL7 Support people with palliative care needs on a Primary Care Practice, Palliative Care and Respite. Work with third sector organisations to support carers of those with Palliative Care needs. Just in case boxes rolled out within the Health Board HDHB doc Foundations for Change Outcome measures. Development Of Integrated Services with Primary Care and Social Care. Development Of Integrated Services with Primary Care. Doc End of Life Care in HDHB 2013 partners, Local Authority and voluntary agencies. Currently the Health Board are working specifically with the following third party organisations to enhance current services for family carers: Palliative Care Medicines management Advisory Management lead palliative care (County Director Carmarthen) Assistant Director of Strategic Partnerships Completion date Annual evaluation of service Ongoing January 14 Cruse Cymru to develop a regional bereavement service Marie Curie to pilot their new carers service for end of life patients across the three counties 39