NLG(14)413. DATE OF MEETING 30 th September Trust Board of Directors Public REPORT FOR. Chairman REPORT FROM. Dr James Whittingham

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1 NLG(14)413 DATE OF MEETING 30 th September 2014 REPORT FOR Trust Board of Directors Public REPORT FROM Chairman CONTACT OFFICER Dr James Whittingham SUBJECT Charitable Funds Committee Breastcare Radiography System BACKGROUND DOCUMENT (IF ANY) REPORT PREVIOUSLY CONSIDERED BY & DATE(S) EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN AND / OR NED CHALLENGE THAT THE BOARD NEED TO BE MADE AWARE OF) This paper has been to the Charitable Funds Committee where it received approval to bring it to the Trust Board for ratification HAVE THE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS? ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS? IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED? ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF? WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED? WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE? THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S) AND COMPLIANCE WITH THE REGULATORY STANDARDS LISTED ACTION REQUIRED BY THE BOARD For Ratification

2 Agenda Item 8.2 DATE 4 SEPTEMBER 2014 REPORT FOR Charitable Funds Committee REPORT FROM Janine Hughes Business Support Manager Surgery & Critical Care / Medicine Group (SGH & GDH) SUBJECT Purchase of Faxitron Biovision Digital Specimen Radiography System for SGH. Total Cost 60,100 S440 (Breast Care) 40,000 (Q2 Bal. 66,637) T001 (Pink Rose) 20,100 (Q2 Bal. 291,868) CONTACT OFFICER Paul Marchant, Financial Accountant OTHER GROUPS WHO HAVE CONSIDERED PAPER (Where applicable) EXECUTIVE COMMENT (including key issues of note or, where relevant, concerns that the committee need to be made aware of) COMMITTEE ACTION REQUIRED As the expenditure is over 25,000, approval is required by the Committee.

3 DECISION OUTLINE PAPER : Breast Care Services Purchase of Faxitron Biovision Digital Specimen Radiography System Reference: PP00x Version: 4 Issue Date: 3 February 2014 Responsible Parties: Anthony Fitzgerald Kate Wood Kerry Carroll Sheldon Mill/Rachael Hinkley Kirsty Edmondson Jones Chris Graygoose Gavin Cogley Steve Mattern Persons involved General Manager, Clinical Group Clinical Director, Clinical Group Contracting, Planning & Performance Finance Facilities Theatre Manager, SGH Medical Engineering IT Services Date approved: Approving body: Date for review: Owner: Document type: Number of pages: Author / Contact: Surgery & Critical Care Decision Outline Paper (including front sheet & appendices) Pauline Antcliff/Rajesh Vijh Associated Documentation: Document Date Location Stored Decision Outline Paper Implementation Plan

4 Decision Outline Paper: Breast Care Services Purchase of Daax Faxitron Biovision Digital Specimen Radiography System for Scunthorpe General Hospital Surgery & Critical Care 1. Purpose of This Paper/background: The purpose of this paper is to gain organisational support to purchase Faxitron Biovision Digital Specimen Radiography System for Scunthorpe General Hospital using charitable funds from Breast Care Funds and Pink Rose Suite Funds. Approval has already been obtained from the Medical Equipment Group and it has been requested that the machine is purchased using the following funds: Fund Number S440 (Breast Care) Funds - 40,000 Fund Number T001 (Pink Rose Suite) Funds 19,500 Fund Number T001 (Pink Rose Suite) Funds additional for software The purchase of this equipment is in line with NHS Cancer Plan and subsequent Cancer Reform Strategy with the aim to improve screening, early diagnosis and treatment. 2. Current Service Description: Northern Lincolnshire and Goole NHS Trust covers a wide geographical area, supporting a population of over 350,000. The Breast Service is provided by three surgeons who are based across Scunthorpe and Grimsby hospitals. Grimsby hospital has a dedicated outpatient Breast Care Unit, The Pink Rose Suite, where all new patients are assessed. Follow up for patients can be undertaken at both Scunthorpe and Grimsby Hospitals though those requiring imaging are followed up at Grimsby. Surgery for patients is undertaken at both Scunthorpe and Grimsby Hospital though currently only Grimsby Hospital possess the Faxitron Biovision Digital Specimen Radiography System which was purchased in June As a result patients requiring imaging during their procedure are listed at Grimsby Following procedure patients are seen by Oncology at the respective site for consideration for chemotherapy and all patients are referred to Castle Hill Hospital for radiotherapy. 3 Need for change The provision of breast imaging equipment would allow the full range of breast surgery to be undertaken at Scunthorpe Hospital.

5 3.1 Patient s Perspective Patients receiving breast care in the trust have expressed a desire to have their breast care locally at Scunthorpe General Hospital. This has been expressed to the staff working within the trust and also through the comments in the National Cancer Patient Experience Survey 2011/12. A number of comments have been made regarding lack of investment in Breast Services at SGH in comparison to the dedicated suite at DPoW. it would have been nice to be able to go to hospital closer to my home it took 2hrs round trip for all my appointment 3.2 Demand Demand for this equipment is predominantly generated from patients who have had small cancers detected from the Breast Screening Service. These small cancers cannot be felt and are therefore listed for Wire Guided Biopsy which in itself can be undertaken at either site. Faxitron Biovision machine enables the surgeon to test the specimen during the procedure to ensure clear breast tissue margins of 2mm (NICE recommendations). In accordance with guidance it is mandatory for impalpable lesions to undergo intra-operative specimen radiography. Best Practice recommendations include all specimens taken from wide local excision and excision biopsy to have intra-operative imaging available. Without intra-operative imaging it is not possible to determine the margins at the time of procedure. This would be determined by histological examination and reporting at a later date. Histology showing involved margins have been left behind would result in readmission for the patient. 3.3 Expected increase in Demand The current demand for wire guided excision of breast cancer is primarily from the Breast Screening services and the current numbers are based on the screening of women for breast cancer between the ages of 50 and 65. This screening age has now been extended from 47 years to 72 years. The age extension in screening is expected to increase the demand by 50% for wire guided breast cancer excisions. This increase in demand will be difficult to meet if the provision for undertaking specimen Xrays in operating theatres is only present at one site namely DPOW. Increasing demand is exacerbating existing pressures faced within theatres across the Trust. There is an ongoing struggle to run established lists due to national theatre staff shortages and the inability to recruit impacting heavily on patient pathways. The need for additional sessions is essential to accommodate demand but increasingly difficult and costly to support. The ability to perform procedures at both sites would alleviate the pressures at DPoW and avoid costly additional sessions. The impact to SGH would require a period of monitoring though it is anticipated that there is capacity within General Surgical Lists to allow for the breast work to be re-aligned.

6 3.3.2 Activity Table Procedure DPoW Scunthorpe Excision of lesion of breast Partial excision of breast Wire guided partial excision of breast 33 2 (report anomaly non undertaken at sgh) Total Activity information from Ormis for period April 2012 to March 2013 Table demonstrates all procedures requiring intra-operative specimen radiography in accordance with NICE guidance and Best Practice Recommendations. Those with mandatory requirements for intra-operative radiography are directed to DPoW. The procedures undertaken at SGH are done so against Best Practice Recommendations as capacity at DPoW is already challenged. It is expected that one third of the above will be realigned to SGH with the purchase of the DAX system. 3. Outline of the Proposal/Option appraisal: Option 1 Do not purchase equipment for SGH Continue as is. Offer Wire Guided Wide Local Excision only at DPoW site. Continue to offer wide local excision and excision biopsy at both sites with the knowledge that DPoW patients are receiving a procedure in line with best practice recommendations whilst Scunthorpe is not. Risks Benefits Not in line with Best Practice Save charitable funds Unnecessary readmission for patients Continue to add pressure to DPoW capacity Additional sessions/job planning exercise Need for patients to travel for procedure Peer review recommendation to provide services locally Consideration Expected increase in Breast Screening referrals due to age extension and health promotions Option 2 Consolidate Breast Service to DPoW Site Risks Pressure on DPoW Capacity Impact to staff No local service for patients (more travel) Additional Sessions Changes to Consultant Job Plan Benefits In line with Best Practice Save charitable funds Support sustainability review Reduce unnecessary readmission rates Consideration Expected increase in Breast Screening referrals due to age extension and health promotions

7 Option 3 Purchase Faxitron Machine for Scunthorpe Site Risks Impact to SGH capacity Not in line with sustainable services review Maintenance Costs Consider impact to pathology services Financial loss Benefits Local service for patient In line with Best Practice Supports Peer Review recommendations Reduce unnecessary readmissions Decrease capacity pressures on DPoW theatres Reduce additional sessions with current numbers Consideration Expected increase in Breast Screening referrals due to age extension and health promotions

8 4. Financial Analysis: Activity and Income: Commissioner Activity Type Activity Unit Price Total This will re-lign SGH patients from DPoW to SGH. Overall income will be unchanged Total Income Cost Saving: Staff Costs Additional Sessions Reduction in additional sessions undertaken at DPoW Total Saving Expenditure: Band Resource Unit Price Total Staff Costs Admin / Reception Staff Band Technician Band Nurse Band Additional Sessions Total Staff Costs Non Pay: Clinical Consumables across New and Review patients Equipment Maintenance Confirmation from Theatre Manager that Network Points already in place Software Total Non Pay Costs Facilities Costs: Estates Running Costs Soft Services TBC TBC Total Facilities Costs Capital Charges:,000 Buildings - Depreciation % Buildings - PDC % Equipment - Depreciation % Equipment - PDC % Total Capital Charges Total Expenditure Net Margin Margin %

9 5. Implementation Considerations: In order to move forward with reconfiguration/service development, a number of factors have to be resolved: Quality Indicators/overview (inc infection control): Medical Staffing: Information / Patient Flows (IM&T): Scheduling/Timetabling: Financial Constraints: Reference to Trust Strategic Direction/QIPP: 6. Summary / Recommendation: The paper recommends that Option 3 is approved by the Executive Team. Date: Appendices References National Cancer Patient Experience Programme, 2011/12 National Survey EJSO, Surgical Guidelines for the management of breast cancer, Association of Breast Cancer at BASO 2009