AUTHOR : HELEN BYARD - Lead Cancer Nurse Manager/Head of Nursing Diagnostic and Support Business Unit

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1 HEREFORD HOSPITALS NHS TRUST PUBLIC BOARD MEETING 1 st April PRESENTED BY Dr ALISON BUDD Medical Director alison.budd@hhtr.nhs.uk AUTHOR : HELEN BYARD - Lead Cancer Nurse Manager/Head of Nursing Diagnostic and Support Business Unit CONTACT : helen.byard@hhtr.nhs.uk Ext 5775 SUMMARY REPORT - National Cancer Patient Experience Programme 2010 Survey Hereford Hospitals NHS Trust. 1.0 INTRODUCTION The National Cancer Patient Experience Survey was undertaken by Quality Health on behalf of the Department of Health. Quality Health specialises in measuring patients experiences of hospital, primary care and mental health services, using this information to improve the quality of health care and the responsiveness of health services to patients and service users needs. This survey was therefore designed to monitor national progress on cancer care by seeking the views of patients affected by cancer. The full National report is available at There are two reports for Hereford Hospital, which are available on request. The first report outlines percentage scores for patient response to the 67 questions asked. The higher the score, the better the Trust s performance. In addition the percentage scores are displayed on benchmark bar charts which are divided into three sections: A Red section: scores for the lowest scoring 20% of Trusts A Green section: scores for the highest-scoring 20% of Trusts An Amber section: scores for the remaining 60% of Trusts. Patients could make comments in their own words about the cancer care they had received and these are detailed in the second report. 2.0 RECOMMENDATION The Board is asked to note the content of this report.

2 3.0 MAIN BODY OF REPORT 3.1 Response Rates: 158 acute hospital NHS Trusts providing cancer services took part in the survey. Primary Care Trusts, some of whom provide cancer services, were excluded from the survey, as were some specialist Trusts because of very low patient numbers. A total of 109,477 patients who had received treatment for cancer during January to march 2010 were included in the national sample for this survey. These patients fell into 13 different cancer groups. The survey covered both inpatients and day case patients with 40% being inpatients and 60% being day cases (49% general day cases and 11% frequent day cases). The 4 big cancers (Breast, Colorectal, Lung and Prostate) accounted for 50% of all respondents. Breast cancer accounted for a larger proportion of patients than did any other cancer group (21% of all respondents) 266 patients identified as eligible from Hereford Hospitals Trust (HHT) were sent a survey, and 171 questionnaires were returned completed. This represents a response rate of 68% once deceased patients and questionnaires returned undelivered had been accounted for. The national response rate was 67% (67,713 respondents). 3.2 Survey Questions The survey order was designed to reflect the patient s journey through cancer treatment, starting with referral and ending with care from the patient s General Practice and lastly their overall rating of NHS care. The survey covered 14 domains: Seeing your GP Diagnostic Tests Finding out what was wrong with you Deciding the best treatment for you Clinical Nurse specialist Support for people with Cancer Operations Hospital Doctors Ward Nurses Hospital care and treatment Information given to you before leaving hospital and home support Hospital care as a day patient/outpatient Care from your general practice Your overall NHS care

3 3.3 Survey Results - Hereford Hospital NHS Trust Of the total 67 questions asked HHT scored in the top 20% of Trusts for 24 questions. Areas where the Trust did particularly well: Clinical Nurse Specialists were considered to be important in providing the patient with understandable answers to important questions all/most of the time. That the CNS listened carefully to the concerns of the patient, and that the time given to the patient was about right. Hospital care and treatment patients indicated that privacy and dignity needs were met when being examined or treated. Patients also considered that hospital staff did not deliberately misinform them or give conflicting information. Care from your general practice patients indicated that the GP had given them enough information about their condition and treatment, and that practice staff had done everything to support them. In addition the Trust scored above the threshold for the highest scoring 20% of all Trusts in the following areas: Hospital Doctors 91% of patients had confidence and trust in all doctors treating them 93% of patients thought doctors knew enough about how to treat their cancer Ward Nurses 83% of patients got understandable answers to important questions all/most of the time (national threshold was 78%) 76% of patients said that there was always/nearly enough nurses on duty (national threshold was 68%) Hospital care as a day patient/ outpatient 92% of patients said that staff definitely did everything to control side effects of chemotherapy. Patients comments to support the above: I found that all my care from doctors, specialist nurses, ward nurses very satisfactory, comfortable and confidence in everybody who looked after me (Breast patient) I was always spoken to with empathy and friendliness and I particularly appreciated the openness of consultant and the health specialist (Colorectal patient) Everyone at the hospital treated me with respect and patience. Doctors and the ward nurses were exceptional (Gynae patient) I was dealt with promptly and all the staff were kind, courteous and helpful. All through my treatment period, they continued to support me and I was grateful that they were open and honest the illness and the possible outcomes (Haematology patient) I feel my care is exemplary (Prostate patient) Everything from procedures, information, efficiency, through to general genuine care from GP to all other I saw was 100% (Skin patient)

4 Only 4 questions scored within the lowest 20% of Trusts. Detailed as follows: Finding out what was wrong with you Q12 HHT Score Patient told they could bring a friend when first told they had cancer 63% 76% Hospital care as a day patient/outpatient Q57 Staff definitely did everything they could to help control pain 76% 86% Q61 Patient thought doctor spent about the right amount of time with them 92% 95% Your overall NHS care Q66 Given the right amount of information about condition and treatment 84% 90% Threshold for highest scoring 20% of all Trusts 4.0 POLICY AND BUSINESS PLAN CONSIDERATIONS Objective 1 To enjoy a reputation for and be able to evidence exceptional quality, safety and customer service. Objective 4 To be seen by staff and potential employees as an excellent employer and have in place the systems to recruit, develop and retain staff we need to realise our vision Objective 5 To have upgraded facilities and equipment to ensure a first class environment for the delivery of hospital based care. Objective 6 - To post financial surpluses on a routine basis to reinvest in service development by continuously improving efficiency and effectiveness. 5.0 CONSULTATIONS / KEY ACTIONS The results have been shared with the Herefordshire Cancer User Group. The 3CCN Patient and Public Involvement Lead will be working with the newly appointed Macmillan Information and Support Facilitator (Hereford) to further analysis the patients comment report. The report has given us the key themes to look at in more detail: 1. Information given to patients prior to and after diagnosis 2. Management of pain in day case/outpatient setting. Work is already in progress to review patient letters and patient leaflets. However, it is appreciated that further analysis is required to enable us to develop questions for local questionnaires which we will undertake using the Computorised Real

5 Time device for monitoring patient experience with the assistance of the PALS department. Please refer to appendix 1 for the improvement plan. Compliance to undertake a Patient experience survey and act upon the results is one of the measures required for Cancer Peer Review. Therefore, all of the Cancer Site Specific Multidisciplinary teams have received a copy of the results and should report into their Cancer MDT Annual General Meeting. 6.0 CONCLUSIONS From the National survey results the most striking findings are related to the impact of the Clinical Nurse Specialist (CNS). On analysis of the data between those patients who had a CNS and those who did not, there were significant differences between the groups on every single question in the survey. In every case, patients with a CNS are significantly more likely to be positive about their care. The most pronounced differences in view between those patients with a CNS and those without one were in respect of verbal and written prescriptions, discharge information and post discharge care and emotional support. With the continued support of Macmillan over the last couple of years the appointments of a Cancer Skin CNS and a Cancer Upper GI CNS gives Hereford Hospital almost a full compliment of Cancer Site CNS. We currently have Network wide CNS for Brain, Rare Cancers and Head and Neck, therefore providing us with visiting CNS for these specialities. In addition the recent appointment of the Macmillan Information and Support Facilitator in preparation for the opening of the new Macmillan Renton Cancer Unit will undoubtedly enable us to review information for cancer patients across the hospital.

6 Appendix 1 National Cancer Patient Experience - Improvement Plan Hereford Hospitals NHS Trust Key Theme Outcome required Actions Timeframe Lead INFORMATION GIVEN TO PATIENTS PRIOR TO AND AFTER DIAGNOSIS To ensure that cancer patients are aware that they can be supported by relative, carer or friend during clinic appointments To ensure that cancer patients have access to information regarding their condition and treatment 1. Review clinic appointment letters to ensure that it is clear that patients may bring a relative, carer or friend to their consultation. 2. All cancer patients should receive a patient information folder review compliance of this. Ensure that appropriate information is available in the Charles Renton Unit, and other Outpatient Department areas that Cancer patients access. 3. Opening of the new Macmillan Cancer Information Centre within the Macmillan Renton Cancer Unit in June public awareness event to promote this. 4. Implementation of Cancer Information Prescriptions is starting in September/October this year in line with national implementation programme. End of April June June/July November Alison Stemp Macmillan Information and Support Facilitator MANAGEMENT OF PAIN IN DAY CASE/OUTPATIENT SETTING To ensure that patients receiving treatment in day case or outpatient facilities are able to access pain relief in a timely manner. 1. Undertake local patient real time questionnaire utilizing computerized device of patients attending day case unit questions to measure the management of pain relief. 2. Meet and discuss with Day case unit Head of Nursing and Pain Clinical Nurse Specialist to review any potential environmental, or resource issues that may impact on the delivery of timely pain relief. End of April End of March Helen Byard Lead Cancer Nurse Manager/Head of Nursing

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