AGENDA ITEM 6.4 6 May 2014 ANNUAL CANCER DELIVERY ACTION PLAN REPORT Executive Lead: Medical Director Author: UHB Cancer Lead Clinician/Cancer Lead Manager Contact Details for further information: Maggie Lucas 029 2074 6682 SITUATION Following the publication of Together for Health Cancer Delivery Plan (June 2012) the Welsh Government requires Health Boards to produce an Annual Report and Action Plan which sets out the progress made against priorities set out within our Local Cancer Delivery Plan (October 2013), and actions for 2014. This report presents Cardiff and Vale s action plan for consideration and approval prior to submission to Welsh Government and publication on the Cardiff and Vale UHB internet site. The Cancer Delivery Action Plan (Appendix 1) sets out in detail actions required to achieve the objectives of the cancer plan. The updated Local Cancer Delivery Plan is available at http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/864/6.4c%20e%20li nk%20cancer%20local%20delivery%20plan.pdf and will be presented formally to the UHB Board in the Autumn of 2014 as part of the Annual Report for cancer services. BACKGROUND Together for Health Cancer Delivery Plan was published in June 2012 and provides a framework for action by Local Health Boards and NHS Trusts 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 its responsibility to meet the needs of people at risk of cancer or affected by cancer. It sets out: - The population outcomes we expect. - The outcomes from NHS treatment we expect. - How success will be measured and the level of performance we expect. - Themes for action by the NHS, together with its partners. Annual Cancer Delivery Plan Page 1 of 3 Board Meeting and Action Plan for 2014-15 6 May 2014
ASSESSMENT In summary the attached Action Report at Appendix 1 provides data/information on progress made over the last 12 months in the following areas: Preventing Cancer Detecting Cancer Quickly including screening services and work undertaken in relation to promoting early diagnosis. Delivering Fast Effective Treatment Meeting People s Needs Caring at End of Life Improving Information. Research There has been a considerable amount of work undertaken to meet the requirements of our Local Cancer Delivery Plan over the last 12 months. It must however be recognised that there is need for progress to be maintained if the requirements of the Welsh Government s Cancer Plan are to be met by 2016. This includes the need to look across the breath of the actions required in the seven areas described above which also includes key Tier one targets (Delivering Fast and Effective Care) and the need for continued improvement in performance as described in the UHB performance report and as an example a current focus on the delivery of urology targets. We are planning to work closely with all staff involved in providing care to our patients and their carers; this includes working closely with our sister Health Boards and Third Sector Organisations to help inform our priorities for our revised Local Delivery Plan. RECOMMENDATION The Board is asked to: CONSIDER the progress made and actions being taken to deliver against our Local Cancer Delivery Plan. Annual Cancer Delivery Plan Page 2 of 3 Board Meeting and Action Plan for 2014-15 6 May 2014
Financial Impact Quality, Safety and Experience Standards for Health Services The financial impact of the Together For Health Cancer Delivery Plan is currently being assessed although some new service developments are identified within it e.g. Acute Oncology Service, Psychooncology service. However, partnership working with Macmillan Cancer Charity is helping to address these issues. The delivery of the Local Cancer Delivery Plan assists in improving quality, safety and patient/carer experience. Identification of the actions required to deliver the action plan ensures a coordinated approach to the plan. The delivery of the Local Cancer Delivery Plan assists in improving patient care and specifically leads to improvement in performance against the following standards; Standard 8 Care Planning and Provision Standard 7 Safe and Effective Care Standard 3 Health Promotion, Protection and Improvement Risks and Assurance Equality and diversity The Local Delivery Plan is important to the delivery of key Tier One targets and other local and national standards for care for patients with cancer. The delivery of the Local Cancer Delivery plan provides opportunities to reduce inequalities and improve access to health care. Annual Cancer Delivery Plan Page 3 of 3 Board Meeting and Action Plan for 2014-15 6 May 2014
Cardiff and Vale University Health Board Local Delivery Cancer Action Plan 2014/15 Themes: Preventing Cancer Cancer services in conjunction with public health to develop collaborative working and explore ways to: Work already commenced and is ongoing. Promote better public awareness of cancer risk factors Reduce smoking, obesity and excess alcohol intake Reduce the gap in inequalities in incidence rates for cancer Encourage participation in the programme of health checks for people aged over 50 Cardiff and Vale Deliver Cardiff and Vale s alcohol action plan Deliver the prevention elements of Cardiff and Vale s 10-year Older People s Strategy (includes promotion of the health checks programme in older peoples planning groups & through Communities First programmes) Delivery of the Tier 1 target: 5% of smokers to set a firm quit date and of those, 40% to quit smoking at 4 weeks, CO verified Delivery of the UHB Healthy Weight Framework in order to achieve increased levels of healthy weight for adults and children. This includes delivery of: A range of action plans (healthy eating and physical activity plans across each unitary authority area; the UHB s Practising Public Health Organisation action plan) A range of pathways, including the nutrition and dietetic weight management service; the National Exercise Referral Scheme; Foodwise for Life, and a level 3 MDT obesity service Public Health Team/Cancer Services/MDTs Cancer Delivery Action Plan 2014-15 1
Themes: Detecting Cancer Quickly Ensure that the uptake across Increased uptake in Cardiff and Vale for National screening programme. Screening Programmes bowel, cervical and breast are within Reported in Cancer Annual Report. national targets A key priority in this work stream is addressing inequity in uptake, working with Screening Division of Public Health Wales, the local public health team and community partners Inequities in uptake of the cancer screening programmes have been described across Wales, and in Cardiff and Vale. Uptake is lower in the more deprived areas, and is also known to be lower in other groups including ethnic minority communities. Work with public health and screening service to engage with communities has already commenced. Local Public Health Team & Screening Engagement Team (Public Health Wales) To address waiting times for colonoscopy within the Bowel Screening Programme. Figures for waiting times against the standard have been provided by Screening Division demonstrating the need. The aim of the bowel screening programme is to reduce mortality from bowel cancer by 15% in the population invited for screening by 2020. Currently the uptake of bowel screening in Cardiff and Vale is lower than the target of 60% and lower than the all Wales achievement. In order to interpret the complexities of the findings identified as a result of screening, a funded national referral centre for polypectomy has been established at University Hospital Landough Increased uptake in screening programme. Reported in Cancer Annual Report. Work to review performance by June 2014 and include work to achieve JAG accreditation. Medicine Clinical Board with Screening Division, Public Health Wales Cancer Delivery Action Plan 2014-15 2
In relation to the Cervical Screening uptake will Ongoing with Screening Wales programme, the be reported and Target 90% by UHB is working with partners in monitored via Public 2016. screening and primary care to Health and UHB (Public improve access to cervical Cancer Annual Wales) smears in the Cervical Screening Reports. Programme. Cardiff and Vale is working with partners in screening services to implement changes to improve access to cervical cytology in community clinics. To increase Consultant pathologist input into cervical cytology and histology reporting, and the colposcopy MDT. In 2012-13 coverage was 73.5% in Cardiff and Vale and 76.2% for all Wales. There is no significant deterioration in the screening figures but nor is there a marked improvement or attainment of the screening targets. Uptake is lowest in the 20 to 25 year age group; the cohort 25 to 64 years had higher screening ascertainment figures (78.4%). The age of initial invitation to Cervical screening has increased to 25 since September 2013. Local Public Health Team & Screening Engagement Team Health Executive Lead for Cancer/Lead Cancer Clinician PHW Screening Division and the Health Board to continue working together to improve turnaround times for sample reporting, and to ensure that MDT discussions are carried out in a timely manner. Screening Division has recently carried out a Quality Assurance visit to the colposcopy clinic, and a draft report is due to be released which will be used to measure performance. Cancer Delivery Action Plan 2014-15 3
To continue to use National profiling data of cancer prevalence, mortality and survival rates to inform targeted action on particular cancers and communities. Within Primary care and GMS discussions take place within the annual QOF visits or neighbourhood meetings with practices with lower or higher than average prevalence and reasons why this may be the case with a view to improving. Review of general cancer prevalence rates against the C&V and National Averages Annually GPs/Primary Care Managers To raise public awareness of cancer symptoms needing prompt GP assessment. To raise GP awareness of symptoms to promote prompt referrals in line with national guidance, local pathways and waiting times standards. To provide GPs with direct and prompt access to diagnostics to diagnose cancer. This is mainly undertaken via public health campaigns and central programmes e.g.: Cervical Screening/Bowel Cancer/Breast Test Wales and supported within poster campaigns/leaflets GP practices/primary care. The primary care team arrange regular Clinical Development sessions for both GP's and Nurses. At these sessions speakers are invited to attend and update on key topics. Teledermatology services in place across a number of practices in C&V and uptake/provision of this service in increasing. This provides GP's with direct access to a specialist dermatologist opinion for suspicious lesions. There is also a GP with special interest in place specifically for Dermatology to treat and manage patients with identified suspicious complex lesions in primary care. Uptake of screening as reported in Public Health annual report Annually Waiting times targets Monthly/Annually GPs/Nurses Audit of numbers of patients referred via this service Ongoing Dermatology service C&V/GPs Cancer Delivery Action Plan 2014-15 4
To review the need to audit the pathway for each person diagnosed with advanced cancer and act on findings to improve services for early diagnosis and implement as part of the new national cancer pathways Currently not in place. Pathway audit reviews June 2014 Primary Care/GMSs Themes: Delivering fast, effective treatment and care The Health Board will continue to strive to meet all cancer targets and is fully participating in Cancer Weekly performance monitoring Cancer meetings Ongoing Waiting Times - Single Pathway with each tumour site. Pilot in line with the recent Welsh Government proposals. To roll out new tracking system (Tentacle) across all tumour sites Delivering this is a complicated endeavour and requires robust communication between numerous departments whose IT systems currently exist in separate systems, which are unable to communicate across each other. There has previously been no clear way to get an overview of a patient s pathway from an administrative view to track, chase and organise their care. To this end we have developed and introduced a new tracking system (Tentacle) within the Health Board to provide this administrative overview; to identify where patients are on the pathway and to optimise their appointments for imaging and definitive care. Monthly cancer reports to Welsh Government re waiting times. Chief Operating Officer / Clincal lead for cancer/medical Director Cancer Services / Tumour site managers To develop acute oncology services (AOS) to support the needs of people admitted as The development of AOS is a key priority for improving care for patients with cancer at Cardiff and Vale. It brings together Patients safety (e.g.. timely investigations; objective Service to be designtated as soon as Executive Lead for Cancer/Lead Cancer Clinician Cancer Delivery Action Plan 2014-15 5
emergencies. multi-disciplinary clinical expertise to optimise the management of patients presenting acutely with either a new diagnosis of cancer or complications of the cancer itself or its treatment. improvements in neutropenic pathway; time to definitive therapy in metastatic spinal cord compression (MSCC). Key worker for patients presenting with Cancer Unknown Primary possible. To Identify mechanisms to plan and deliver equitable access to new diagnostic and treatment procedures in line with evidence Introduce Robotic Surgery in Urology Launch of Robotic surgery in Urology in May 2014. To continue to reduce the waiting time for all endoscopy (and other investigations) for patients with suspected cancer.. A review of both gastroenterology and endoscopy services was commissioned by the Chief Operating Officer in April 2013. The review identified a range of efficiencies that could be made to improve productivity, support the delivery of RTT and Cancer targets and improve quality and safety for patients. They also obtained agreement to appoint an additional Consultant Gastroenterologist Reduction in the waiting times (waits of between 30-40 days for colonoscopies for suspected cancers, have now been reduced to 14-30days). April 2014 ongoing Medicine Clinical Board/ Clinicians Cancer Delivery Action Plan 2014-15 6
to provide long term additional capacity for endoscopy and out-patients. As a result of the review the decision was made to form a new directorate for these services as from 1 st of April with the relevant staffing structure under the Medicine Clinical Board. To Undertake complex surgery in line with peri-operative care standards as in the ERAS programme The Enhanced Recovery After Surgery (ERAS) is being actively implemented across cancer sites. There has been very positive feedback from patients and very encouraging results, both in terms of clinical outcomes and patient experience. The Programme received an NHS Wales award in July 2012 for improving patient safety. To continue to reduce surgery and chemotherapy related mortality by eliminating preventable deaths There have been specific areas of improvement - of note surgical outcomes in Upper GI cancer have improved following centralisation of services At this time we are unable to report death rates by cancer however Cardiff and Vale are currently 12 months Clinical Lead for Governance/ Executive lead for cancer Cancer Delivery Action Plan 2014-15 7
undertaking a formal review of all deaths within the Health Board and it will be possible to relate these to cancer and its therapy and will be available for future reporting. Theme: Delivering Fast Effective Treatment and Care To participate in national and local Completeness of data for Annually clinical audit and other quality Audits is high. improvement activities and reflect action to be taken in local cancer delivery plans Currently there are 5 National Audits 1. National Lung Cancer Audit (NLCA) 2. National Bowel Cancer Audit Programme (NBOCAP) 3. National Oesophago- Gastric Cancer Audit (NOGCA) 4. Data for Head and Neck Oncologists (DAHNO) 5. Welsh Breast Cancer Clinical Audit (WBCCA) Tumour Site Leads/ Cancer Services To participate in Peer Review and reflect learning in local cancer delivery plans Cardiff and Vale has fully engaged with the Peer Review process, led by Peer review reports. Progress against action Lung May 2014 UGI September 2014 Tumour Site Leads/MDTs/ Cancer Services Cancer Delivery Action Plan 2014-15 8
To receive no areas of Immediate concern, Serious concern or Concern highlighted within the Peer Review reports. To produce action plans for making improvement against any concerns raised by the review process. Health Inspectorate Wales working in partnership with the South and North Wales Cancer Networks. plans Urology January 2015 Key Areas to date that need improvement include Recognise the importance of data to assure the Board and the public that a quality service is being delivered and identify any areas of weaknesses. Early Prostate Cancer MDT outcome information is to be available in an electronic format for all clinicians to access. The need for formal MDT business meetings to plan service and address issues. Patient dignity/safety following TRUS biopsy with transfer to Suite 18. Waiting times for tertiary surgery. Lack of an organised Acute April 2014-04-22 May 2014 ASAP annually April/May 2014-04-22 April 2014 ongoing Chief operating officer and cancer executive lead Urology cancer lead Urology cancer lead Urology directorate Cancer Delivery Action Plan 2014-15 9
Oncology Service within the Health Board. Plans for providing this service are under discussion. A declaration of interest application to Macmillan for AOS development Project funding For 3 years has been submitted April 2014 Clinical Board UHB Lead Cancer Clinician Theme: Meeting Peoples Needs To achieve the target that all patients with cancer are assigned a Key Worker from the point of diagnosis onwards, to coordinate their ongoing care Ongoing The key worker underpins the care of patients with cancer and a high level of provision of this service was confirmed by the Macmillan Cancer Patient Experience Survey where C&V received a very high score for patients having CNS (93% - highest score of any Board in Wales) and also performed best for patients being given the name of Key Worker. 1. Cancer Rehabilitation Standard annual progress report 2. Local Key Worker audits per tumour site 3. National Patient Experience Survey 4. Peer Review Cancer services/ Cancer Nurse Specialists/ MDTs To review and redesign services recognising the changing needs of people with cancer and to deliver person centred services to meet ongoing needs as locally as possible in Cancer Delivery Action Plan 2014-15 10
line with National Standards. These include: To provide Cancer Psychological services. To 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 care plan to be reviewed regularly The lack of psychological services available to cancer patients within the health board has been addressed and the Heath Board has secured funding (Macmillan) to provide 1 0.5 WTE Consultant level clinical psychologists and 1 0.8 WTE clinical psychologist fixed term for 20 months; both are to be appointed in May 2014. These posts will develop a sustainable service. The UHB are now, working closely with Tenovus to increase patient awareness and access to support in this area (including to the benefit/financial advisors supported by Tenovus) Compliance against the National Cancer Standards Patient Satisfaction surveys Patient Experience survey National Cancer Standards May 2014 Ongoing Cancer Services/ Clinical Psychology Service To improve information provision for patients with cancer across the Health Board Establish a satellite Information Centre at University Hospital Llandough Macmillan Quality Environment Award was awarded for the Macmillan Patient Information Centre at the University Hospital for Wales in February 2014 Patient Experience Team/Cancer Services Cancer Delivery Action Plan 2014-15 11
To provide each patient and GP with an end of treatment summary to inform the care plan. This will involve working with cancer Network and other cancer information providers to develop summaries for patients. This requires further developmental work and significant resource. This is being actively addressed within some cancer sites (e.g. paediatric oncology) but further work is required to implement this. Delivery of this action will require close working with other Health Boards as the patient pathway for cancer patients often includes treatment outside C&V Compliance against the Cancer Delivery plan Progress reports. Availability of summaries for patients Ongoing MDT Leads / CNSs/Cancer Services/ Cancer Network To plan and deliver co-ordinated services for metastatic cancer patients and measure outcomes This will be supported by the development of the acute oncology service. Patients are also supported by the Clinical Nurse specialists, other information providers and palliative care services Patient feedback Peer Review Ongoing Theme: Caring at the End of Life - all priorities are aligned to the End of Life Care Delivery Plan To plan, secure and deliver well coordinated palliative and end of life care End of Life Delivery Compliance against the Ongoing on a 24/7 basis in line with published plan(2013-16) standards and guidance The palliative care team and clinical board have developed the End of Life Delivery Plan (2013-16) for C&V which has been ratified by the Board and is now in its delivery phase. MDTs/Cancer Services/ CNSs Palliative Care Team/Clinical Boards Cancer Delivery Action Plan 2014-15 12
To support all providers who care for dying patients to participate in the All Wales audit of the Integrated Care Priorities documentation The inpatient community and hospice areas within C&V UHB have all participated in the All Wales audit of the ICP for 2013/2014. Results of all Wales audit Ongoing Palliative Care Team To develop improved links to Unscheduled Care this will be supported through the Acute Oncology Service To further review of the support is needed for patients who wish to die at home. This will be reviewed as part of the Fast Track Task and Finish Group To improve use of the Care Priorities for End of life care in the community areas T improve the numbers of iwantgreatcare audit returns from patients and families A number of initiatives are taking place to improve choice around place of care. We have a task and finish group who have completed the first phase of work by improvements to the discharge process home of patients who meet continuing health care/ fast track 3. The second phase will review the support available for people to remain at home. Compliance against the Cancer Plan Delivery Annual reports. Ongoing Ongoing Ongoing Acute Oncology Service Fast Track Task and Finish Group Palliative Care/Community Care providers Theme: Improving Information Objective/Priority Comment Key Measurables Timescales Leads To record and use clinical information for all cancer patients using CaNISC National Cancer Minimum or extended datasets. Ongoing The Health Board uses CaNISC to record data on patients in all tumour sites and aims to complete all parts of the National Cancer Minimum or extended National Audits. Annually Cancer services/mdts / National Canisc Support Team Cancer Delivery Action Plan 2014-15 13
datasets. Case ascertainment and data completeness are very good in the majority of tumour sites. This is due largely to clinical engagement and participation in National Audits. To publish regular and easy to understand information about the effectiveness of cancer services within the Cardiff and vale UHB Cancer annual Report and cancer Delivery Action Plans published on the UHB internet site. Annually with progress reports to the UHB Board quarterly Cancer Services/MDTs Cancer Services Website Theme: Targeting research Objective/Priority Comment Key Measurables Timescales Leads Increase in percentages Ongoing To maintain a strong culture of reported within this research and maximise the use of performance indicator. Welsh Government funding for NHS and research, to increase participation in Office cancer research clinical trials and to report trial activity by number of Report on trials uptake to patients diagnosed with cancer within be included in Cancer Cardiff and Vale who participate in Annual Report. research. The Cancer Delivery Plan 2012-2016 expects that by 2016 at least 10% of new cancer patients each year agree to participate in high quality studies on the NISCHR portfolio or commercial research register, with at least 7.5% of these research participants taking part in more complex studies which involve an intervention. Cardiff and Vale actively participates in Number of Clinical trials for cancer and the number of patients recruited to each R & D Lead/Cancer Lead Clinician/Research Development Cancer Delivery Action Plan 2014-15 14
many aspects of clinical research. trial. Cancer Delivery Action Plan 2014-15 15