SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT MDT Lead Clinician ASWCN TAUNTON AND SOMERSET Taunton Lung MDT (11-2C-1) - 2011/12 Dr Sarah Foster Compliance Self Assessment LUNG MDT 85.2% (23/27) Key Themes Structure and function of the service The Taunton and Somerset NHS Foundation Trust Lung Cancer Multidisciplinary Team is a multi-professional group serving Taunton and the surrounding area in the Somerset Primary Care Trust, a population of over 340,000. It is part of the Avon Somerset and Wiltshire Cancer Network (ASWCS). The lead clinician is a Consultant Respiratory Physician, supported by three other consultant respiratory colleagues. The lead clinician leads the clinical activity of the team, working to agreed guidelines, ensuring we provide a high quality, integrated service which meets local, regional and national standards. All the key core members are in place with cross cover available: - consultant respiratory physician - thoracic surgeon - clinical oncologist - imaging specialist - histopathologist - lung clinical nurse specialist - MDT co-ordinator - palliative care nurse specialist Extended members of the team include: - clinical trials nurses - nurse counsellor - bereavement officer The lung clinical nurse specialist has responsibility for user issues. Cross cover is provided for SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 1/6
her by the palliative care nurse specialists and vice versa. The team meets weekly on a Thursday lunchtime. A list of patients to be discussed at the meeting is held on the Somerset Cancer Register and is e mailed on the Wednesday to all core MDT members by the MDT coordinator. Urgent cases arising in the twenty four hours preceding the meeting are discussed and added to the Somerset Cancer Registrar at the meeting. We also videolink with the Yeovil Lung multi disciplinary team to facilitate communication, team working and discuss shared cases. We provide thorocoscopy diagnostic service to the Yeovil lung MDT. Where a patient with lung cancer is deemed to require an urgent treatment planning decision that needs to be made prior to the next scheduled lung cancer MDT meeting, the following procedure is in place: - Telephone discussion with the relevant treating consultant or their cross cover - Formal written letter to follow telephone discussion as a permanent record - The case will be discussed at the next scheduled MDT meeting The lung multi disciplinary team has benefited from having a stable core team with good communication. In the last year, it has benefited from the appointment of a fourth Consultant Respiratory Physician and increased thoracic surgical input. This has been achieved following the appointment of a new Consultant Thoracic Surgeon at Bristol and via the videolink to Yeovil. The Lung MDT meets annually to discuss operational matters, audit data and service improvement matters. The team are proactive in ensuring sufficient clinic space is available to accomodate two week wait patients and achieved 98% compliance with the 2 week wait standard in 2010-2011. With the 31 day and 62 day targets, achievement was 100% and 85% compliance respectively. A breakdown of age and sex profile of the patients treated by the team can be found in the annual report. The Somerset Cancer Register does not currently hold data on ethnicity. This data is collected on other electronic patient systems and the Trust is looking to integrate with these so that we will be able to assess this fully in the future. The ethnicity profile of the local area is predominantly White British so this is not something the team or Trust has prioritised to date. Coordination of care/patient pathways The lung cancer multidisciplinary team aims to ensure a coordinated approach to diagnosis, treatment and care services for all patients with lung cancer and mesothelioma. The Lung MDT is committed to achieving the highest standards of care and patient outcomes by: - Working to agreed NSSG guidance - Collection of high quality data - Analysis of such data in audit cycles - Involvement in local, national and international research studies - Incorporation of new research and best practice into patient care SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 2/6
- Referral of patients to the ASWCS Network Mesothelioma MDT - Providing comprehensive information to patients and their relatives - Involving patients in assessment and redesign of the services Patients with suspected lung cancer are referred by their GP to the Consultant Chest Physicians via the 2-week wait referral system. The referrals and CXR are screened by one of the four consultants, if cancer is considered likely on the basis of the initial referral and CXR, a CT scan is arranged. An out-patient appointment is offered by telephone -- if this is not acceptable to the patient, a second offer is made within the 2-week time frame. The consultants' secretaries arrange the outpatient appointments. Urgent slots are available in all four consultants clinics. The team work proactively to achieve compliance with the 2 week wait standard. Imaging investigations are arranged through the Radiology department with alternative dates suggested where necessary. The patient is seen in outpatients in the Somerset Lung Centre at the hospital or in a peripheral clinic. Lung function testing is performed at the appointment and arrangements are made to obtain a histological diagnosis via bronchoscopy, radiologically guided biopsy or thoracoscopy as necessary. There are four bronchoscopy lists available each week, with also the facility to perform medical thoracoscopy. All patients are offered a follow up appointment to receive results either in person or via telephone, dependent upon patient choice. All patients are allocated a key worker, which is usually the lung cancer nurse specialist but can be any core team member. All patients are given the contact details of the nurse specialist and she runs an open access outpatient clinic once weekly. Where a patient is given a diagnosis of lung cancer, the patient's GP is informed by the end of the next working day. This policy applies both to in-patients and out-patients. This measure is the subject of regular audit. All relevant members of the MDT offer patients a permanent record of consultations at which treatment options are discussed. All treatment decisions are recorded on the Somerset Cancer Register. The team adhere to the Network guidelines and NICE guidance for the diagnosis and management of lung cancer. We aim to ensure there is at least one member of team present at the Network lung SSG meetings. In the last year, a further two core team members have attended the advanced communication skills training. Patient experience The team aim to be accessible to patients and carers. They encourage patient feedback, both formal and informal. The National Patient Experience Survey 2010 provided the team with feedback relating to their performance. On the whole, patients and carers were very happy with the way they were treated throughout the patient pathway. They felt they were provided with plenty of information and were able to SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 3/6
ask questions. This has been conveyed to the team. There were mixed experiences in relation to PET scans but hopefully this should improve with the weekly PET scan provision in Taunton by Inhealth. One patient raised an issue around the place of delivery of diagnosis. The team aim to ensure diagnosis is delivered in a quiet, private place, with next of kin present if the patient wishes and specialist nurse if possible. With only one lung cancer nurse specialist, the team acknowledge that this may not always be achievable. There was also some disparity around written records of patient consultations. These are now given as a matter of course, unless the patient requests otherwise. Patients and carers can also be directed to the Cancer Information Centre within the hospital and the counselling service. Clinical outcomes/indicators Lung Clinical Lines of Enquiry Data for the Taunton and Somerset Lung MDT 2010 from the National Lung Cancer Audit 2010 (Lucada data): 1. Percentage of expected cases of whom data is collected - 149% 2. The percentage histological confirmation rate - 55.6% 3. The percentage having active treatment - 61.1% 4. The percentage undergoing surgical resection (excluding mesothelioma and confirmed small cell lung cancer) - 15.0% 5. The percentage of small cell cancer patients receiving chemotherapy - 80% Histological confirmation rate - the national average rate is 76%. Our lower than the national average figure is most likely a combination of data entry and patients being only fit for palliative or supportive care on presentation. Lung Cancer is unfortunately often detected late in people with other medical co-morbidities. We are looking at our accuracy of data entry to ensure this is not a contributing factor and working with our data entry people to improve this measure. Our percentage of patients receiving active treatment is above the national average of 59%. The surgical resection rate is above the national average of 13.9% and has improved with weekly thoracic surgical input to our mdt either in person or via videolink. This is also demonstrated in our recent audit of surgical resection. Our percentage of patients receiving chemotherapy for small cell lung cancer is in line with the national average. A consultant physician takes the lead for integration of research and recruitment to clinical trials. He is supported by the clinical trials nurses. Since July 2009, we have recruited 54 patients to TIME1. We have recruited 2 patients to SWAMP and 21 to Fragmatic. We have just opened TIME3 in taunton and have recruited our first patient. SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 4/6
The team completed the last network audit of oncology treatment related admissions and are collecting data for the current audit of clinical nurse specialist presence when a patient is informed of a lung cancer diagnosis. Good Practice Good Practice/Significant Achievements - Good compliance with cancer wait time standards - Videolink of MDT to Yeovil to facilitate cross county working - Increased thoracic surgical input via core member attendance or their cross cover and videolink to Yeovil - Recruitment to clinical trials - Positive feedback from the National Patient Experience Survey 2010 - Team attendance at SSG Concerns Immediate Risks Serious Concerns Concerns Key team challenges: 1. To improve our histological diagnosis rate This is being addressed by ensuring our data input is accurate by working with our MDT coordinator and assistant. The team do acknowledge however that a proportion of patients will only be fit for palliative or supportive care on presentation and therefore would not be suitable to pursue a histological diagnosis. Lung cancer is unfortunately often detected late in people with other medical co-morbidities. 2. The team currently only has one lung cancer nurse specialist. SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 5/6
General Comments The Lung MDT has a well established team which works well together and communicates effectively with its tertiary centre and the Cancer Network. Organisational Statement I, Sarah Foster (Lead Clinician) on behalf of TAUNTON AND SOMERSET agree this is an honest and accurate assessment of the Lung MDT. SELF ASSESSMENT REPORT for Taunton - Lung MDT (published: 30th September 2011) Page: 6/6