SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT MDT Lead Clinician NECN NORTH TEES AND HARTLEPOOL North Tees And Hartlepool Lung MDT (11-2C-1) - 2011/12 Dr D N Leitch Compliance Self Assessment LUNG MDT 77.8% (21/27) Key Themes Structure and function of the service The Lung cancer MDT has a clinical lead and is fully constituted with all core team members. Since the External CSPR visit in 2010 and over the previous 12 month period the team worked very hard with the support of the Trust to achieve this. A new oncologist was appointed to attend the MDT, radiology cover was identified, and the cardiothoracic department of surgery at JCUH worked to rearrange job plans to allow for attendance by a surgeon for each meeting with nominated cover. A specialist Macmillan palliative care nurse has been appointed who is now able to attend the meeting weekly and who, working closely with the lung cancer nurse specialists, together provide an excellent service supporting discharge and palliative care at home. These developments need to be monitored over the forthcoming 12 months. The MDT has identified core team lung cancer clinical nurse specialists who have been attending the MDT for many years and who have provided and continue to provide an excellent and dedicated service of the highest standards. These CNSs have identified and agreed roles and extended roles, and training which is beyond the scope of the level identified within the Manual of Cancer Standards. The lung MDT is very well aware of the National Waiting times standards. Figures for the relevant periods can be seen below: Two Week Rule Referrals - Target = 93% Quarter Patients Seen Patients seen within target % Within Target April - June 2010 97 93 95.9% July - September 2010 83 83 100% October - December 2010 182 179 98.4% January - March 2011 145 141 97.2 Total 507 496 97.8% 31 day - 1st treatment - Target = 96% Quarter Patients Treated Patients treated within target % Within Target SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 1/6
April - June 2010 33 33 100% July - September 2010 32 32 100% October - December 2010 28 28 100% January - March 2011 38 38 100% Total 131 131 100% 31 day Subsequent Treatment - Target = 98% Quarter Patients Treated Patients treated within target % Within Target April - June 2010 8 8 100% July - September 2010 13 13 100% October - December 2010 1 1 100% January - March 2011 7 7 100% Total 29 29 100% 62 Day - Referral to Treatment - Target = 85% Quarter Patients Treated Patients treated within target % Within Target April - June 2010 32 26 81.2% July - September 2010 34.5 29.5 85.5% October - December 2010 27 22.5 83.3% January - March 2011 36.5 28.5 78.1% Total 130 106.5 81.9% Over each quarter the Trust achieved each target except for the 62 day treatment target which was achieved in one quarter and nearly in the other quarters. To ensure the highest possible standards are met the Trust has recently set up a working group to try to further improve the current level of treatment within 62 days. Throughout the 12 month period relating to this report the Trust diagnosed and treated over 300 patients. The breakdown of the number of patients treated, the route of presentation, the treatment received can be seen below. Lung Referral UHH UHNT Emergency Admission 52/145 (36%) 48/170 (28%) GP Referral 81/145 (56%) 94/170 (55%) Other Source 12/145 (8%) 28/170 (17%) Lung Treatment UHH UHNT Surgical Resection 20/145 (14%) 25/170 (15%) Chemotherapy 43/145 (30%) 62/170 (36%) Radiotherapy 58/145 (40%) 48/170 (28%) Palliative Care/Active Monitoring 80/145 (55%) 63/170 (37%) The Lead Clinician is working with the Network on Early Diagnosis Initiatives to try to reduce the number of emergency presentations. At present relating to function and structure of the MDT the team regards itself as non-compliant around attendance of the core team members. This is due to the recent changes in core team membership which have been identified above. These changes have only recently over the last 6 months come into place. Any attendance assessment based on the last 12 months will therefore inevitably be non-compliant due to the previous absence of the relevant core members. Future attendance should be compliant. The team are also working hard to ensure that all core team members have attended National SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 2/6
Advanced Communication Skills training, which at the moment must be regarded as non compliant. To date there has been a year on year increase and at present only 3 members still have to attend, noting 2 have places for 2012. Coordination of care/patient pathways The Lung MDT fully agrees with the Network guidelines and where available the National guidelines. In particular the team work toward the recently published NICE clinical guidelines on lung cancer in April 2011. The Network guidelines cover clinical aspects, radiology aspects, pathology aspects as well as data collection. The team has a comprehensive operational policy which covers policy around communication of diagnosis to GP's and policy for nomination of key worker. The provision of information to GP's within 24 hours has been audited in 2010 and 2009 with an increase between these dates. The team recognise a slight weakness in this area in particular around the inconsistent presence of a CNS on the ward at the time an inpatient might be diagnosed with lung cancer. To address this issue the team has secured funding for 0.5 WTE clerical support to try to free up CNS time to allow for greater access to inpatients. The team identify a key worker and record this data and the treatment plan for each patient discussed at the MDT. It is particularly important to note that the team has been recorded as entering data for 99% of the expected number of cases in the last NLCA. Similar figures around 100% have been noted for the preceding several reports. This stability and consistency is a reflection of the robust procedures in place to ensure that all patients have and are discussed at the MDT. Patient experience The team has participated in the National Cancer Patient Survey. In addition the team also completed a local patient survey in 2010. The results from both these surveys have been very positive and have been presented at an MDT and an action point identified around provision of written communication and provision of information around support groups. In relation to a previous Network wide survey in 2008 the team identified the need to provide written communication to patients at the time of diagnosis and when their treatment is discussed. Since this was identified the team have greatly increased the proportion of patients offered such written information. Indeed the offer has been extended to all other areas of the care pathway. The team still regards itself as non-compliant in this area however as not all patients are given this offer at all stages of the care pathway. The lung MDT team started an on going and successful lung cancer self help group following previous surveys and recently have also started a mesothelioma self help group in addition. Clinical outcomes/indicators SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 3/6
Please see appendix 1 for the NLCA local action plan template which incorporates the Trust performance and treatment figures for the important clinical outcome variables described in the NLCA. Compared with the figures for the 2009 and 2008 NLCA reports the figures demonstrate very good year on year improvement with results for almost all indicators above the National benchmark target. The resection rate for the cohort in the 2010 report was 16.2% for all patients, higher than the Network average of 12.2% and the National average of 13.7%, as well as the target of 14% Survival figures taken from the NLCA (LUCADA) are as follows: 6 month Survival - (2010 patients): Hartlepool 34.8%, North Tees 36.1%, National 35% 1 Year Survival - (2009 patients): Hartlepool 17.2%, North Tees 19.1%, National 19.7% 5 Year Survival - (2005 patients): Hartlepool 4.6%, North Tees 4.6%, National 7.4% The mortality rates within 30 days of treatment are linked to surgical resection and are not directly relevant to North Tees and Hartlepool NHS Foundation Trust and should be identified in the report from James Cook University Hospital. During the period 2010-11 the MDT recruited 34 patients to clinical trials an increase from the previous year total recruitment of 7 patients. This reflects the MDT's commitment to clinical trials. Every effort will be maintained to continue this increased recruitment. The MDT participated in the network wide audit on histological and cytological confirmation of lung cancer. Results demonstrated that 75.4% of patients received a histological or cytological diagnosis. This level is above the National target figure identified in the 2010 NLCA report and must also be noted in line with the route of presentation of many patients seen in the Trust through emergencies. Such patients are often more unwell and often investigations to confirm histology less clinically appropriate. The lung MDT will be participating in the Network audit around chemotherapy in small cell lung cancer in 2011-12. The other important clinical indicators which should be noted from the NLCA 2010 report include: - PS and stage recorded in 96.3% (above target 85%) - 97% discussed at MDT (above target 95%) - 88.9% seen by nurse specialist (above target 80%) - 64% nurse specialist present at time of diagnosis (below target 80%). Noted by the team and see above narrative and plans for additional clerical support to try to address this. - 64.6% active treatment (above target 60%) - 52.9% small cell receive chemotherapy (below target 65%) Previous figures above target. Previous audit demonstrates no opportunities for chemotherapy missed and plans for re-audit as part of Network audit in 2011-12. Chemotherapy rates for WHO PS0-1 NSCLC patients 61.3% above the national target of 55%. SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 4/6
Good Practice Good Practice/Significant Achievements -Consistent and high quality data submission to the NLCA and use of the data locally to influence practice -Introduction of Endobronchial ultrasound transbronchial node aspiration to facilitate and improve the patient diagnostic and staging pathways. Concerns Immediate Risks Serious Concerns Concerns -To ensure that adequate attendance is achieved by all core team members across the year -Recognition that changes in acute emergency medicine may have a knock on effect on specialty work which may impact on National Waiting Times targets. To monitor closely. -To provide written patient communication at all stages of the pathway to all patients. -To appoint clerical support for the lung CNS's to ensure their presence across the whole care pathway and increase numbers to beyond the target for nurse specialist present at the time of diagnosis. -To complete audit around small cell chemotherapy to ensure no opportunities are missed for this treatment General Comments The team underwent external CSPR in 2010. Three concerns were identified. There were no immediate risks or serious concerns. 1.Expedite plans for cardiothoracic surgeon at MDT - now achieved. 2.Permanent consultation record rolled out at all key points in the patient pathway. This has been partly achieved and is being addressed by the team further. 3.Clerical support to allow CNS involvement across the whole care pathway. Funding for this has been secured and the team is awaiting advertisement and appointment. SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 5/6
Organisational Statement I, Mr M Tabaqchali (Lead Clinician) on behalf of NORTH TEES AND HARTLEPOOL agree this is an honest and accurate assessment of the Lung MDT. SELF ASSESSMENT REPORT for North Tees And Hartlepool - Lung MDT (published: 29th September 2011) Page: 6/6