Cancer services improvement plan to achieve cancer standard August 2015

Transcription

1 Cancer services improvement plan to achieve cancer standard August 2015 Action Timeline to recovery Lead Officer Current Position Current RAG rating against timeline Key next steps General January 2016 J Blinco The plan to achieve 85% across all tumour sites is January Some pathways, for example Breast, may achieve target sooner GREEN 31 st October A review of the NICE Guidelines is required to understand the potential impact on services and the ability to maintain target It must be recognised that there are small numbers of patients in some pathways eg haematology, where even one breach has a significant detrimental effect on the ability to achieve target Ongoing Recruitment of consultants remains difficult however there has been some success recently. It is proposed that each pathway review where alternatives to consultants could ease capacity issues The following action plan by pathway is compiled from information provided by each pathway lead and support services managers. The plan will be developed each month with thought being given to a more standardised 1

2 format where the actions will be incorporated into the TDA Report Histopathology turnaround times to improve 31/12/15 F Duncan 1 x Consultant Histopathologist appointed to commence October 2015 Work sent to Backlogs outsourcing to ensure workload is managed and turnaround times for cancer cases met Yellow stickers being used in all specialities to highlight cancer cases Histopathology cancer tracker in post to focus on cancer cases Escalation sheet in place for PTL meeting and cancer trackers for histopathology Continue use of locum histopathologists, although recruitment is proving limited. Approval given to introduce advanced BMS role who can assist with cut ups and relieve consultants of some work. This post will be advertised September Advert out for substantive histopathologists recruitment closing date 07/09/15. Radiology additional capacity 30/11/15 J Grubb Independent sector support for CT, MRI and USS providing capacity when needed. US capacity has diminished over the last 3 months due to peak leave period. Installation of new CT scanner and MRI scanner at WCH operational from October. Recruitment of Diagnostic Radiographers, Specialist Radiologists and Sonographers ongoing. This is challenging and reflects a national picture but good response to current recruitment campaign. Move of some routine work from CIC in Recruitment to Consultant 2

3 surgical specialities will enable pre-assessment and diagnostics to be undertaken at WCH Radiology Management Team representative (Assistant OSM) attending weekly Trust Cancer PTL pathway meetings to provide diagnostic imaging services link for relevant staff. Actions include reviewing escalated appointment delays, assessing waiting lists and expediting where appropriate. Also ensuring that MRI/CT/Plain Film reporting is completed in a timely manner to prevent delays. Radiologist vacancies continue. Locums are currently used but involvement in recruitment campaign at Trust Level for October 2015 Significant recent success in engaging high calibre Agency Locums (Radiologists, Radiographers, Sonographer) and tele radiology services that address US, MRI and reporting capacity gaps. Improved KPI s should be evident by the end of December Agreement reached with independent MRI provider, In- Health, to provide one experienced Radiographer for MRI unit at WCH. Interim experienced agency MR Radiographers have also been sourced for WCH. The first commenced 7 th September 2015, the second will commence 28 th September. This staffing establishment maintains the level of access previously provided by the mobile service. Ultimately 3

4 Trust staff will be trained in the Lung 31/1/16 L Gorley /P Plant/ J Grubb Adequate capacity in lung pathway however delays due to access to diagnostics and treatment modalities Access to PET CT on site at CIC now from October 2015 due to delay by external provider 2 clinics per week CIC and Workington Meeting with Radiology held week commencing 6th July 2015 to review access to diagnostics and ensure test performed within 7 days of consultant referral Abnormal chest x-rays and 2 week wait referrals sent straight to CT scan before being seen by consultant to reduce time on pathway Escalation process agreed to ensure that turnaround of triage and completion of referral forms for CT scan is not delayed when allocated consultant is away. Review of the information provided to MDT to enable delays in pathway to be identified early and ensure standard operational procedures are being followed.. A regular audit will be designed to review referral to test times for 10 patients. The target will be for 98% of patients referred for a test to receive it within 7 days, as our pathway indicates this is necessary to enable achievement of the overall 62 day performance target. We have an establishment of 6.6 Respiratory consultants, with 3 wte currently in post and a fourth due to join us on 1 October We have part-time input at West Cumberland Hospital from a locum acute physician with Respiratory skills. Further rounds of recruitment are planned. We have previously advertised unsuccessfully for joint appointments of two consultants with ICU/Respiratory skills to work across the two departments, as the team were aware of some suitably qualified potential The Lung AGM has recently agreed to a stretch target to refer patients on for treatment (surgery, chemotherapy/radiotherapy ) by day35 of the pathway currently day 42. MDT Clinical Lead and OSMs to meet with IT System Developer by 4 September The Lung AGM also agreed to plan 4

5 candidates. Discussions are underway regarding the potential success of readvertising these posts. the implementation of a shadow booking for chemotherapy at the point where the MDT decision is to recommend this treatment. This will avoid delays in the pathway caused by waiting for the patient s initial consultation appointment with the oncologist before booking the chemotherapy date. Cancer Services Team to feed back progress by end of September Urology 31/1/16 C Robinson Review of all clinics underway by end of June 2015 Working with contact centre to review process around 2 week referrals Final clearances to be undertaken now that the successful candidate has arrived in the UK. Increased demand for slots in the haematuria clinics at CIC and WCH. 6 additional ultrasound slots have been found each week at WCH to support the haematuria clinic at WCH. Currently liaising with radiology to provide 2 additional slots on a Monday each week at CIC The MDT Lead has reviewed our local timed pathway and confirmed that it is in line with the Clinical Network Ideal Pathway. Cancer network supported event September 2015 to review whole system approach Capacity and demand analysis through network benchmarking with other providers Interviews to take place on 25/8/2015 for the 5 th urology consultant and middle grade doctors. Job Plans for all consultants to be reviewed. Timetables to be confirmed by Clinical Director 5

6 to provide the capacity required. Surgical Administrator now in post to ensure all theatre lists are fully utilised Ultrasound slots at CIC to be confirmed. Clinic templates to be amended to ensure increase in TWR slots. Prostate pathway under review following discussion at NSSG meeting. Timeline pathway to be finalised. Cancer Nurse Specialist to undertake a further 10 TRUS biopsies to enable sign off of the Scope of Practice. This will enable the provision of additional capacity for prostate biopsies. Outpatient department recruiting a qualified staff nurse and HCA to support the additional urology outpatient work. Delays in histology reporting to be investigated 6

7 Skin 30/11/15 K Martin Average of TWR referrals per week to accommodate Service currently provided by 2 wte locum dermatologists, supported by 1 GPSI with interest in surgery Loss of 0.5 wte locum cover in April has increased demand on above resource. TWR appointments delivered at both CIC and WCH Additional clinics organised throughout July to accommodate current activity. BAD report recommending review of pathway and network led services with community services/gp s Locum consultant included in MDT to allow review of TWR Patients July Update: The above plans remain in place and have contributed to an improved performance throughout July with no reportable breaches at time of report. Meeting in May 2015 with Salford dermatology department to consider supervisory arrangements and peer support outcome unable to commit at present Meeting 17/06/15 with Newcastle Hospitals dermatology department to consider supervisory arrangements and peer support awaiting response Meeting with Roy McLaughlin Network lead to review pathways arranged for September to accommodate both primary and secondary care clinicians and consider actions from BAD review. An action plan will be developed. Additional clinics provided ad hoc to increase capacity by up to 10 patients per week to meet 2 week wait but heavily reliant on locums. CNS acts as liaison with bookings team 7

8 UGI/LGI 31/1/16 K Watts / C Robinson Interviews are taking place w/c 7 th September for a Consultant Gastroenterologist. Active recruitment for other vacant posts including a Speciality doctor will continue. Active recruitment is taking place to fill nursing staff vacancies in endoscopy. Vacancies currently prevent 30 lists per week running at CIC Job Plans have been agreed and are currently in the process of being signed off Surgical Administrator now in post to ensure all theatre lists are fully utilised LGI re-design event to be held for LGI pathway supported by CLIC Reviewing OPD templates for UGI and LGI to increase capacity of TWR slots for patients who do not meet the criteria to go straight to test. Timed pathway for UGI to be reviewed. CCG to have discussions with Newcastle with regard to the diagnostic elements undertaken by Newcastle for UGI patients. Colorectal consultant post currently being advertised. Agency Locum colorectal consultant being sought. UGI With the changing service provision between WCH & CIC and the increasing number of patients transferred under the High risk pathway from WCH to CIC we are currently undertaking a re-review of capacity & demand. We have already increased the number of elective diagnostic procedures booked at WCH to support an increase in emergency capacity at CIC. It is also our intention to 8

9 review the current Consultant PA provision by site and change as is necessary within the limits of the current vacancies. Gynaecology 30/11/15 S Jenner Increase in hysteroscopy at WCH to 10 per week with plans for further increase Patients moved from day case lists to outpatient clinics Clinical and managerial team have met and are actively working up plan for one stop clinic High number of referrals via 2 week rule which are not all appropriate. Plan for rapid access appointments Revise C&B to allow for urgent appointments rather than 2ww Plan to move patients off day case lists to do hysteroscopy in clinic from August 2015 Develop one stop shop for post - menopausal bleeding from September 2015 Additional 5 hysteroscopy per week on top of 10 already undertaken from July 2015 Referrals increasing now up to 30 referrals per week Breast 30/11/15 to demonstrate consistent achievement C Robinson Pathway review workshop undertaken by all parties of the MDT. Working with Radiology to identify additional capacity required on an ad hoc basis Consultant job plans agreed, sign off process AMBER Clinic templates to be realigned to ensure flow Ensure enough capacity weekly for maximum number of slots required 9

10 ongoing Review job plans of breast physicians and associate specialist Develop a Business Case for Breast Symptomatic new patient clinic at WCH Oncology 30/9/15 31/10/15 31/8/15 J Blinco Decrease number of cancelled chemotherapy by improving process for script delivery to aseptic suite and back to CIC new process implemented. Pharmacy to audit chemotherapy waste in August to demonstrate a reduction. Decrease number of cancelled chemotherapy due to incorrect/inaccurate prescriptions by education of prescribers, increased vigilance of pharmacy and nursing staff 4 additional ARIA licenses purchased and installed in Haematology, Larch D, Henderson Suite WCH and Pharmacy WCH. Access to Aria will enable all relevant staff to have visibility of chemotherapy scheduling. Visibility enables patients due in each day to be identified and availability of chair space to be seen. AMBER Larch D to implement process for checking in chemotherapy, confirming it is for their patients and contacting Pharmacy immediately if not. This process will reduce wastage and prevent patient cancellations. Introduction of Homecare for chemotherapy later in 2015 or early 2016 will create additional capacity for chemotherapy chair time. An estimated review of potential is being undertaken Scheduling chair time in Reiver House to be more clearly defined to maximise capacity and utilise staff efficiently Review option of standardised diagnostics by GP prior to referral review showed that variation in pathway requirements precludes this from happening Opening of MPU in September will enable some procedures to be undertaken there. This will relieve the demand on Larch D & Riever Definitive live list of patients referred into Movement of oncology and haematology clinics into Reiver House will integrate the services 10

11 31/10/15 chemotherapy/radiotherapy required to enable tracking and timely appointments report produced and being further developed Introduction of Chemocare electronic prescribing in August, initially in Breast, will simplify prescribing and avoid errors 2xnurses to commence chemotherapy training in September this improved skill mix will give greater flexibility in staffing and give some economies of scale, improved communications and better utilisation of staff. All these actions will enable the service to be more pro-active, reduce cancellations and errors. The facility will also improve patient experience for Haematology patients Recruitment of Oncology Consultants ongoing. 4 candidates to be interviewed 21 st August for 3 vacancies 11

12 MDT 30/9/15 31/12/15 Root Cause Analysis RCA will be completed by the MDT Team for breaches in all pathways. These will be forwarded to clinical leads for validation and sign off. The process will be reviewed once a month in the weekly cancer PTL meeting Clinical audits for tumour sites currently input by MDT members to be reviewed and streamlined to enable easy input by a data entry person thus freeing time for MDT trackers AMBER A monthly trajectory plan will be produced and presented at the cancer PTL meeting. This will enable OSM s to plan accordingly. An initial example is attached A Time lined tracking system linked to patient notes is to be viewed and assessed at another Trust for implementation at NCUH 12