Cancer Peer Review. Lower Gastrointestinal Cancers. Cycle 3 Years (Second Round)

Transcription

1 Cancer Peer Review Cancer Type Health Board/Region Hospital/Key sites Lower Gastrointestinal Cancers University Hospital of Wales, Cardiff Cycle 3 Years (Second Round) 1

2 REVIEWEE REPORT Key Themes Structure and Function of the Service brief overview The Cardiff and Vale UHB MDT for Colorectal Cancer fulfils several roles. It endeavours to implement the aims of the Cancer Delivery Plan 2015, specifically with regard to the domains of being Person Centred, Effective, Timely and Efficient. This is achieved through close multi-disciplinary working within the MDT meeting, but also through the USC clinic which directly follows this. It is also an essential tool for submitting NBOCA audit data (contemporaneously into CANISC) and validation of this data during follow-on discussion of patients during their treatment cycles. Pathway describe links between primary care, diagnostics, MDT and treatment The previous submission for peer review is included below and variation on policy (and changes to the service) have been annotated in accordance with the advice on reassessment provided. Note is made of the Wales Cancer Network Guidance ( Referral guidelines Referrals from primary care as USC are mostly made through the electronic USC referral pathway (HERS2). This allows direct communication with referrers and for requests for further information. Any downgrade from a USC referral is automatically notified to GP s through this route. The MDT encourages all referrers to use the NICE referral guidelines. If a USC referral is deemed not to meet the criteria, the referrer is informed electronically or in writing and a summary of the NICE referral guidelines referenced. Improvements/Changes since last review refer to last Action Plan 2

3 MDT Service MDT Local/ Regional VC Used with who? Membership/ attendance Adequate time for discussion MDM Module used DETAILS MDT is a local meeting serving the population of. The MDT is a single site MDT. Consultants present their own cases for discussion. Core members routinely attend the MDT however pathology and radiology have ongoing concerns with regard to appropriate cover. All patients routinely discussed in the allocated timeframe. The Co-ordinator displays the module during the meeting and types the discussions for all patients. Minutes are discussed and validated at the MDT meeting. Patient Centred Care and Experience Named Keyworker/ contact details Care plans/ Holistic needs assessment Follow up process Patient Involvement and quality measures A team of 3 Clinical Nurse Specialists attend/input into the MDT. Patients are allocated a CNS as Key Worker for their tumour type. The Oncology CNS from VCC attends the MDT. HNA s are not being used routinely. The MDT has a protocol-driven nurse led follow up service for post-treatment patients. No recent evidence provided for patient involvement or pathway quality audits. 3

4 Supportive care Arrangements post treatment or not suitable for radical treatment There is no routine palliative care input at the MDT meeting but access to palliative care team when needed. The VCC AOS team meet daily to discuss all patients admitted to VCC following which a management plan is made. UHW has an AOS nurse based locally. There is access to the on-call team for advice. There is no Unknown Primary MDT meeting in place although this is being considered for the future. C&V patients can be discussed at the VCC MDT meeting. Strategic Interface Business meetings Policy Links to organisational strategy/planning Bowel Screening Business meetings are not routinely undertaken. The MDT follow NICE guidelines. There are local pathways but no operational policy was evidenced for the MDT. The MDT has engagement with the senior cancer management team for the Health Board and this was evident in the review visit. Concerns are escalated to the Board through a formal process. The MDT are aware of changes to the Bowel Screening Wales programme and are looking at ways to increase capacity. There are long term issues with screening colonoscopy waiting times in Cardiff and Vale and additional demand is likely to cause further difficulties. General Observations The Peer Review was well attended by the MDT with all specialities present & engaged with the process. It was clear that they had found the first round of Peer Review useful and had prepared well for this second round. 4

5 GOOD PRACTICE Identify any areas of good practice Good Practice/Significant Achievements: Good team dynamics with evidence that the multi-disciplinary team value each other s contribution. 3 nurse endoscopists now in training which demonstrates a willingness to explore new ways of working Only HB engaging in routinely reporting issues whilst waiting (SUIs) nationally. 18 months strategy for capacity and demand of the service is being developed. Outcome data eg laparoscopy, 1/2 year mortality for surgery is very good Nurse led follow up needs to be commended but concerns regarding the impact on nursing time are acknowledged Evidence that the team have responded to previous report with input now from the oncology nurse from Velindre Immediate Risks Identified None Title Detail Risk assessment/ rationale Serious CONCERNS Title Detail Risk assessment/ rationale Cancer Pathway Waiting Times The percentage of USC referrals treated within 62 days has dropped to 58.9% (65% in 2013). There was a lack of evidence of activity to respond to this with low priority being given to breach dates at the MDT meetings & lack of ownership of the problem by the MDT, Delays to treatment can impact on patient outcomes. Pathway improvements are the responsibility of the whole MDT. Tentacle is an important system for a complex and busy service & needs fully incorporating into the pathway. 5

6 The Health Board is not using Tracker 7 and has been slow to incorporate Tentacle for colorectal patients, noting the high patient numbers and complexity of their pathway, Improved awareness of breach dates by the whole MDT can reduce breaches. CONCERNS Title Detail Risk assessment/ rationale Service improvement delays Business meetings Patient experience The MDT described a block in actioning reports from peer review at executive / divisional level, whilst acknowledging support from Cancer Services management. Lack of regular business meeting distinct from the MDT meeting. No evidence of any patient experience surveys being undertaken. Lack of HNA assessment due to CNS time/capacity. No evidence of different ways of addressing this being considered eg. postal, other HCP to undertake etc. Notwithstanding the austere financial times and increased burden on the services there needs to be support of the cancer teams by senior management to help make service improvements Without regular business meetings the MDT cannot review its functioning, evaluate breaches, pathway developments, manage data, audits etc. all of which are necessary to provide a high quality forward-looking service. Patient experience is invaluable in assessing the quality of the service and to enable development. The HNA is an essential means tested way of measuring patient needs & subsequently addressing service shortfalls. 6

7 Title Detail Risk assessment/ rationale Radiology/Pathology Endoscopic Ultrasound (EUS) Reporting times for radiology Capacity & demand for endoscopy service Clinical trials Radiology and pathology departments are under huge duress and are concerned with lack of succession planning. Single handed service leading to a vulnerable service with no contingency in place. Reporting times for radiology are slow due to busy service and limited numbers of reporting radiologists. Demand has overtaken capacity surveillance waiting times are long, which is a concern Poor recruitment to clinical trials despite oncologists on the MDT being active UK trialists. There is a lack of resource in UHW for recruitment to trials but alsoseems to be a lack of communication between UHW and Velindre regarding support for clinical trials. A national problem for both radiology and pathology with no clear solution but local consideration does need to be given to succession planning to sustain the service The MDT deem this to be a valuable tumour assessment tool. The solution may be with a regional service but this option needs to be considered and explored. Need to consider an options appraisal of all possible solutions to reduce turnaround time eg insourcing / outsourcing. Capacity and demand modelling for the service would be beneficial in planning the service in order to maintain & improve the diagnostic pathway. Trials are viewed as a sign of quality within the provision of services, they give opportunity to both patients and clinicians & an active MDT should have a good trial portfolio. 7

8 Appendix 1. MEETING ATTENDANCE Peer Review Team Name Job Title Organisation Catherine Bale Associate Medical Director/Chair Wales Cancer Network Tom Crosby Medical Director/Oncologist Wales Cancer Network Anil Lala Consultant Surgeon Betsi Cadwaladr University Health Board Edward Favill Consultant Radiologist Betsi Cadwaladr University Health Board Elin Jones Oncologist Hywel Dda University Health Board Carol Greenway Clinical Nurse Specialist Abertawe Bro Morgannwg University Health Board Les Hammond Cancer Manager Abertawe Bro Morgannwg University Health Board Hywel Morgan Network Director Wales Cancer Network Dana Knoyle Improvement Team Wales Cancer Network Hayley Heard Programme Lead Bowel Screening Wales Gareth Popham Peer Review Programme Lead Wales Cancer Network Benjamin Williams Observer 1,000 Lives 8

9 Network Title Organisation Title Team title Wales Cancer Network Lower gastro-intestinal cancers Review Date Title 17 th May 2017 Name Job Title Organisation Simon Phillips Consultant Surgeon Micheal Davies Jared Torkington M Mohsin D O'Reilly Meriel Jenney Sunil Dolwani Adam Christian Rwth Ellis Owen Thomas Alexander Micic Consultant Surgeon Consultant Surgeon Consultant Surgeon Consultant Surgeon AMD / Cancer Lead Clinician Consultant Gastroenterologist Consultant Pathologist Radiologist Radiologist 9

10 Name Job Title Organisation Annette Beasley Lead Nurse Gary Howell AHP Cancer Lead Claire Williams Nurse Practitioner Cath Powel Colorectal CNS Sarah Davies Colorectal CNS Cheryl Folland Student Nurse Maggie Lucas Service Delivery Manager - Cancer Alyn Coles Cancer Improvement Manager Atreyee Saha MDT Co-ordinator Helen Roberts Directorate Manager Caroline Trezise Ward Manager 10