Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Alliance Minutes of the Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance Board Meeting held on Friday 9 th June 2017 10:00-12:00 Conference Room, Trust Headquarters, Bristol Royal Infirmary, BS2 8HW Present: Dr Amelia Randle James Rimmer (Chair) Jonathan Miller Patricia McLarnon Asha Sahni Helen Dunderdale Anna Field Beverley Haworth Dr Glenda Beard Samuel Wadham Marissa Morris Maggie Crowe Nigel Andrews Tariq White Ardiana Gjini Sarah Dove Ulrike Harrower Kathryn Hall Dr Sadaf Haque Rachel Rowe Hannah Marder Ruth Hendy Steve Maddern Representing: SWAG Cancer Alliance Programme Management Team SWAG Cancer Alliance Clinical Lead SWAG Cancer Alliance Executive Lead SW Cancer Programme Lead SWAG Cancer Alliance Programme Manager SWAG Cancer Alliance Services Administrative Coordinator SWAG Cancer Alliance Services SSG Support Manager Bath, Swindon and Wiltshire STP Cancer Group Associate Director for Commissioning Swindon CCG BNSSG STP Cancer Group Senior Project Manager Bristol CCG GP Clinical Lead for Cancer Bristol CCG Cancer Manager North Bristol NHS Foundation Trust Cancer Research UK Primary Care Engagement Facilitator Macmillan Cancer Support Macmillan Partnership Manager NHS England South of England Programme of Care Lead for Cancer, Specialised Commissioning Assistant Director of Transformation and Outcomes Public Health England Screening & Immunisation Lead Bath, Gloucestershire, Swindon, Wiltshire SW Screening & Immunisation Bristol CCG Consultant in Healthcare Public Health One Gloucestershire STP Cancer Group Associate Director, Service Redesign Gloucestershire Macmillan General Practitioner Gloucestershire CCG Somerset STP Cancer Group Clinical Networks Programme Manager Somerset CCG SWAG Cancer Operational Group Cancer Manager University Hospitals Bristol FT Lead Cancer Nurse University Hospitals Bristol FT Guest Acting Public Health Consultant Wiltshire Local Authority Page 1 of 9
Apologies: Caroline Powell Dr Dorothy Goddard Ed Murphy Georgia Diebel Jill Ireland John Graham Julie Yates Dr Nicola Harker Rosie Edgerley Director of Intelligence SWAHSN Senior Consultant and Associate Medical Director RUH Strategic Partnership Manager SW England Macmillan Facilitator Manager SW Health Professional Engagement, Cancer Research UK Health Professional Engagement Manager Cancer Research UK Consultant in Clinical Oncology, TSTFT Lead Consultant SW Screening & Immunisation Macmillan GP BNSSG Rotational STP Representative General Manager Surgical Directorate WGH BNSSG Rotational STP Representative 1. Welcome and Introductions J Rimmer welcomed all group members; it was noted that that all 4 STPs in the region had representation at the meeting. 1.1 Review of previous meeting s notes (10 th March 2017) The last paragraph of Page 4 does not fully reflect issues that were articulated at the last meeting. Appropriate wording will be provided. 018/17: Action B Haworth With the inclusion of the amendment above the minutes were agreed as a true record of the meeting on 10 th March 2017. 1.2 Review of previous meeting s actions 003/17. Breast cancer services to work together in a sustainable model has been reinstated in the work programme. 004/17. STP chairs were emailed at the end of April introducing the Cancer Alliance team and with a request to identify the executive lead SRO for cancer with a view to having them as a member of the board; however no responses were received. It was agreed that STP chairs might choose to delegate responsibility and that what was crucial was that STP representatives had a clear reporting structure to ensure that STP chairs were kept up to date with Cancer Alliance issues. 010/17. The skin pathway was discussed at the skin SSG meeting on 16 th May 2017. Whilst there are systems in place to ensure results are actioned there was recognition that the mechanism for communication between primary care and pathology was a broader issue. BNSSG is happy to progress this issue and it will be brought back to the next meeting for resolution. 019/17: Action B Haworth Page 2 of 9
011/17. Each STP cancer group is due to respond to SWAG Cancer Alliance about their approach to the use of Commissioning through Evaluation packs by the end of June 2017. 2. Making Every Contact Count (MECC) Presented by Steve Maddern (SM) Acting Consultant Public Health, Wiltshire Council and BSW MECC steering group chair Making Every Contact Count enables organisations and individuals to develop and be able to use a different approach to working with people to address health and wellbeing. Telling people what to do is not the most effective way to help them to change. Making Every Contact Count is about altering how professionals interact with people through learning how to recognise opportunities to talk to people about their wellbeing. It was noted that MECC is within the NHS England 2016/17 NHS Standard Contract Service Conditions and each STP has this approach within their prevention workstream. The board acknowledged MECC s role within the cancer agenda particularly with early diagnosis and the Living with and beyond cancer (LWBC) agenda by supporting: Promoting screening uptake Promoting cancer campaigns Promoting healthy lifestyles getting more active, quitting smoking, drinking less alcohol MECC training is delivered through an e-learning package and 2 half day sessions. Train the Trainer courses give people the tools to help cascade the MECC message throughout their organisation, creating MECC champions as part of this process. A MECC Coordinator is being recruited and a grants scheme will be implemented to help smaller organisations engage with MECC. It is hoped that support at STP level can be used as a lever to encourage organisations to buy in to the MECC message. MECC will feed in to prevention/early intervention STP groups; funding has come from STPs so MECC is accountable to them. Meeting attendees were encouraged to speak to their STP MECC lead and explore ways of accessing the training for the cancer workforce. 3.0 Transformation Bids 3.1 Bids status 020/17: STP cancer groups to explore with local MECC leads Deadlines for resubmission of transformation bids are now 7 th July for Early Diagnosis and 1 st September for LWBC. NHS England has prioritised the delivery of the 62 day cancer standard and NHS England South has been allocated 2,900,000 from the National Cancer Transformation Fund to support this work. Access to Cancer Transformation funding locally will now be linked to delivery of this standard. It is unknown at this point in time if there is less funding now available and if so whether the bids need to be amended to reflect the reduction in available funding. It was agreed in the absence of feedback resubmission of Page 3 of 9
bids will include original costs and timings as in year equivalents may be approved. It was noted that the original LWBC bid had not addressed one of the metrics for delivering HNAs (successful bids all had a target for this metric) this may have been a factor in the bids not getting through first time. It was agreed that the LWBC group should convene a meeting to agree a way forwards 3.2 Early Diagnosis Lung pathway progress report 021/17: Action P McLarnon The Somerset reporting tool for chest x-rays was presented at the Lung SSG by the Alliance clinical lead. SWAG radiologists are meeting on 21 st July to agree a universal reporting tool for SWAG and a proposed implementation date of November 2017. 3.3 Prevention and Early Diagnosis Working Group Proposal The board approved a Prevention and Early Diagnosis group; A Randle will take the lead in establishing the group. 022/17: Action A Randle 4.0 Quality Improvement 2WW Referrals Proposal When discussing implementation of the CXR reporting tool at the SSG a question that has regularly arisen is how do we plan to work with GPs to improve quality of referral information? Criticism of referral quality is a source of frustration to many GPs who pride themselves on high standards, although many accept there is variation in practice. There is also a variation in understanding of what information is useful to secondary care teams. A Randle proposed introducing a two week wait referrer s code which would work in a similar way to a smear taker s code. Initially GPs would be issued a code and invited to voluntarily enter the code when making 2ww referrals. In return for this they would be given a report of performance annually to use in appraisals. The emphasis would be on quality of referral information rather than clinical judgement. Participation would initially be voluntary with the potential for making it compulsory in due course, i.e. referrals only accepted if with a 2ww referrer s code. In principle this could lead to improved referrals, better demand management and more appropriate patient investigations with the potential for improvements in cost, clinical effectiveness and patient experience. It would maintain best practice as the primary care workforce diversifies and would include Allied Health Professionals who make 2ww referrals, thus ensuring receive a minimum standard of training. Board consensus was that this could be perceived as performance management rather than a quality improvement initiative and therefore needed to be explored further with GP colleagues and revisited at the next meeting. 5.0 Data and Analysis Work Programme 023/17: Action A Randle Page 4 of 9
The Cancer Alliance has a number of inter-related information and analysis needs including: Monitoring progress towards Cancer Alliance objectives Monitoring local progress with the ambitions of the National Cancer Strategy. Information to support capacity planning Information to support delivery of cancer waiting times Understanding of the cost effectiveness of various cancer services to help identify opportunities for increasing value for money in cancer services. The board were asked to approve commissioning of a south wide cancer dashboard provided by the South Central and West Commissioning Support Unit. The commissioning of the dashboard was approved in principle; each STP cancer group will review the detail within the specification and respond with comments. 024/17: Action STP cancer groups/b Haworth Feedback on Dashboard progress will be provided at the next meeting. 6.0 Cancer Alliance Delivery Plan Actions from the March board included: Providing further clarity on the Alliance governance arrangements, in particular the working/reporting relationship with the STPs, STP cancer working groups, provider cancer boards, SSGs and QST. Rewriting the work plan with SMART deliverables. This work is in progress by the Programme Manager and will be published this summer. Factors that will influence the revised version Alliance delivery plan are: Outcomes of the National Meeting: Leading Change: Cancer Alliances National Launch held on 16 th June 2017 Further guidance from the national cancer team regarding governance of cancer alliances including the relationships between the alliances, DCO, regional and national teams. The national cancer team will also provide a defined, approved and communicated process for working with NHS Improvement, NHS England national and regional teams, Specialised Commissioning to unblock issues due at the end of June Regional gap analysis of Alliance and STP delivery plans against the 96 recommendations; for each quarter to 31 st March 2018 there will be agreement on the priorities to be addressed; the team/organisation that will lead on ensuring those gaps are addressed will be identified due at the end of June The priorities identified above will be communicated to Cancer Alliances and STPs with a request for them to be added to local delivery plans due at the end of August Outcome of the transformation funding bids. It was noted Alliance reporting against deliverables starts on 30 th September 2017 so as to provide reassurance to the regional programme board and national teams of progress. Page 5 of 9
In terms of local governance arrangements between each STP and STP cancer group the board were reassured by each cancer group that they had been endorsed by their respective STP as the STP cancer workstream and formal reporting arrangements were in place. It was proposed that a Lead Cancer Nurse be a core member of the Cancer Alliance board. The proposal was approved and will be discussed with SWAG Lead Cancer Nurses to agree representation. 025/17: Action R Hendy 6.1 Patient and Public Engagement (PPE) At the March board the STP cancer groups agreed to nominate a user representative to be a member of the board. Somerset and BSW confirmed they do not have user representation on their boards. BNSSG and Gloucestershire do have user representatives on their boards however they did not action this in time for the June board. The board were informed that on 28 th July the Cancer Alliance is hosting a patient and public involvement event. All stakeholders and user groups have been invited and the event should provide a good forum to explore with stakeholders how they can help support the implementation of the strategy. Once a pool of expert users has been identified the board can recruit user representatives from this group. 6.2 National Team The National Team update, circulated pre-meeting, was for information only. 7.0 Public Health England Update and Work Plan Presented by Dr Ardiana Gjini, Consultant in Public Health Medicine, Screening and Immunisation Lead: Bath, Gloucestershire, Swindon and Wiltshire Public Health England (PHE) focuses on prevention, inequalities, early diagnosis, reducing emergency presentations and lifestyle in relation to cancer. A cancer prevention work programme is to be agreed with Cancer Alliances for the 2017/18 year by November 2017. Nationally the PHE work plan is based on Taskforce Recommendations. The PHE work programme involves a number of priorities including: A new tobacco control plan within the next 12 months Obesity HPV vaccination the focus is on reducing HPV in girls aged 12-13. HPV primary testing will be implemented across the country as the primary cervical screening method, replacing cytology testing workforce training is an issue and NBT are part of pilot. There is a pilot targeted HPV vaccination programme for men who have sex with men (MSM) aged up to and including 45 years who attend GUM and HIV clinics in Swindon, Bristol and Salisbury. It is looking at the impact of vaccination against penile, anal and oropharyngeal (head and neck) cancers, and genital warts. Evidence suggests that 80-85% of anal cancers, 36% of oropharyngeal and 50% of penile cancers are linked to HPV infection. Page 6 of 9
The Faecal Immonochemical Test (FIT) test the UK National Screening Committee (UKNSC) recommended the test should be rolled out nationally by 2019. It is expected to increase screening uptake by around 10% and result in around 200,000 more people a year being tested, potentially saving hundreds of lives. There is a national target of 75% uptake of FIT by 2020 a huge challenge. It was noted that the emphasis was on GPs to influence the uptake however they are unable to keep the kits within their practices. It was also noted that introduction of FIT could have potential impact on endoscopy capacity. UKNSC will publish evidence on lung and ovarian cancer screening later this year. Other activity which may impact on SWAG providers includes: A focus on interventions to increase screening uptake. Results of the PROTECT trial recommend a pre-biopsy multi-parametric MRI scan for the diagnostic workup of prostate cancer; radiology capacity would need to be increased to make this possible with parity across the region. The Public Health England respiratory campaign started with breathlessness and is moving to coughing from 6 th July, running for 14 weeks. BNSSG is working with health promotion and Cancer Research UK to address poor bowel screening uptake. It is hoped that the introduction of a GP endorsed letter will increase uptake (a 0.7% increase in uptake resulted from the national trial). Bowel scoping may not continue to be viable in Weston which could result in patients travelling to Bristol. Eastwood Park prison now has access to breast screening this will result in small numbers being screened at high cost. A new pathway for women with a high risk of breast cancer who need to be screened yearly needs is to be incorporated into the screening programme to ensure quality assurance. 8.0 Chemotherapy Group and Protocols 026/17: Action Slides to be shared with notes As a temporary measure following on from the previous ASWCS network the Network Chemotherapy Service is currently funded by the Strategic Clinical Network (SCN). Funding of the SCN is now time limited and it is not the appropriate vehicle for provision of this funding; future funding arrangements need to be agreed if the SWAG Alliance wishes to continue this service. Purpose of the Service - To maintain the protocols for chemotherapy regimens being delivered in the region. This ensures consistency, safety and good practice across the region - To develop new protocols when new chemotherapy regimens are introduced - To provide a forum for chemotherapy nurses, pharmacists and oncologists to meet, share good practice and ensure high standards are maintained Risks if the Service is Lost - Variation in practice across the region, leading to inequalities of care - Inefficient every Trust would need to develop their own protocols, requiring an equivalent amount of resource in every organisation Page 7 of 9
- Potential for risks to quality and safety as protocols will be developed in isolation without the benefits of collaboration - Loss of opportunity to share good practice and drive improvement - Negative impact on research if protocols for new trials cannot be developed in a timely way The board consensus was that the service should be funded as part of normal business for the SWAG providers and it needs to be worked in to the business planning rounds for pick up next year. SCN funding will cease at the end of March 2018. A letter from the board will be sent to each SWAG provider informing them of this decision. SWAG providers will be provided with a breakdown of proposed costs for the posts as of next financial year. The post holders contracts will be extended to March 2018. 027/17: Action H Marder, J Miller & J Rimmer It was agreed that the Cancer Alliance budget should be transparent and that ways to communicate this information would be reviewed. 028/17: Action J Miller 9.0 Achieving the 62 day standard The board reviewed a paper outlining an Alliance approach to delivering 62 day cancer performance at individual provider level within the Alliance. The paper proposed actions to enable a more sustainable approach to the 62 day cancer performance target. A review of local action plans and information from cancer services managers supports the view that the key issues for performance lie within the prostate, lung, colorectal and upper GI cancer pathways. Issues include all aspects of diagnostics (including histopathology and CT colonography) and delays are caused in the main by workforce, inpatient bed and theatre availability and late inter-trust referrals. The introduction of the breach allocation policy should help facilitate smoother inter-trust pathways. Improving performance across the system requires action across a number of areas including improving local operational issues as well as more strategic issues such as diagnostic capacity and improving key pathways. The proposed key actions are: 1. Projecting Cancer Activity 2. Ensuring Operational Excellence 3. Better approach to diagnostics 4. Changing pathways to be more effective Urology, lung and colorectal pathways account for the majority of 62 day cancer breaches across the Alliance. Therefore we are focussing work on improving these pathways using the support of site specific groups to gain clinical consensus. Prostate The redesign of the prostate pathway is being led by a Regional project, funded from the Diagnostics Capacity Fund. The Urology Site Specific Group has begun the work of understanding local pathways and how to implement the recent evidence form the PROMIS Page 8 of 9
study, which recommends multiparametric MRI before biopsy. North Bristol Trust is now the best performing specialist prostate cancer surgery provider in the South West and has published a review of the work undertaken to achieve this. Proposal: o o The SWAG Alliance will contribute to the regional project and implement revised pathways for prostate cancer All prostate surgical providers in the South West will meet to share best practice and agree improvements Lung Cancer Proposal: o The SWAG Alliance will introduce the national optimal lung cancer pathway with particular focus on streamlining the beginning of the pathway to reduce time between x-rays, CT and outpatient appointments Upper and Lower GI Cancers Proposal: o The SWAG Alliance will introduce straight to test pathways for all GI endoscopy procedures for all providers All the proposals were agreed in principle but more time was requested to help facilitate local discussion before feeding back to the Cancer Alliance; the deadline was extended to Friday 16 th June 2017. 10.0 AOB 030/17: Action All providers to respond to proposals by Friday 16 th June It was agreed that a summary note of the meeting would be sent round to all partners. 11.0 Date and time of next meeting 029/17: Action J Miller Friday 8 th September 2017, 10.00-12.00 South West House, Blackbrook Park Avenue, Taunton, TA1 2PX Page 9 of 9