Minutes of the North of Scotland Regional Cancer Advisory Forum Time: 1.15-3.10pm Date: Tuesday 24 May 2016 Main venue: Board Room, Level 10, Ninewells Hospital, Dundee V/C from: Meeting Room 2, Dental School, ARI site Mr Remmen s office, ARI site Surgeon s Office, Gilbert Bain Hospital, Lerwick Argyll & Bute Hospital, Lochgilphead Boardroom N110, 1 st Fl, C for HS, Raigmore site Gill Chadwick s office, Western Isles Hospital, Stornoway Chair: Lesley McLay, NOSCAN Chair, (Chief Executive, NHS Tayside) Present: Attendees: Lindsay Campbell, National MCN Manager, WoSCAN; Jim Cannon, Director of Regional Planning, NoSPG; Gill Chadwick, Lead Cancer Clinician, NHS Western Isles; Keith Farrer, NOSCAN Manager; Chrissie Lane, Consultant Cancer Nurse, NHS Highland; Neil McLachlan, NOSCAN MCN Manager; Derick Macrae, Cancer Services Manager, NHS Highland; Dr William Moore, NOSPHN representative; Ruth Nisbet, NOSCAN PA; Jackie Rodger, TCAT Clinical Lead; Mr Sami Shimi, NOSCAN Lead Clinician; Christine Urquhart, NOSCAN Cancer Audit and Information Manager; Miss Beatrix Weber, Lead Cancer Clinician, NHS Shetland; Mr Sarfraz Ahmad, Consultant Urologist, NHS Grampian; Alan Connor, Project Manager, NoSPG; Jaime Lyon, Skin MCN Manager, NoSPG; Dr Graham Macdonald, Consultant Clinical Oncologist, NHS Grampian; Dr Carol MacGregor, Consultant Oncologist, NHS Highland; Mr Hardy Remmen, Lung MCN Chair; Item 17-16 Welcome: Lesley McLay thanked everyone for coming to the meeting; however she delayed the formal introductions until the sound/link quality improved. 18-16 Apologies: Dr Michael Bisset, Medical Director, NoSPG Dr Kirsten Cassidy, GP Lead Lorraine Cowie, Strategic Manager for Cancer, NHS Grampian Bob Cromb, Patient Representative Dr Roger Diggle, Medical Director, NHS Shetland 19-16 Accuracy of previous minutes (19 January and 22 March 2016) Lesley asked group members to forward any changes to Ruth as soon as possible, after which the minutes will be posted on the NOSCAN website. (pmn Jackie forwarded some changes to the TCAT section of the March minutes) 20-16 Action point update 12-16; 13-16ii; 13-16iii; 35-15 - still stand Page 1 of 7
14-16e Lesley asked Jim to invite Eddie Turnbull to the NoSPG annual event. 40-15 Jim will clarify further details on revenue implications at the July meeting. 13-15h The MCN workplans were on hold until the SACT and CMG work was complete. 21-16 Standing Items Quality Improvement a QPIs i Colorectal QPI Mr Loudon was unable to join the meeting to speak to this item. ii Lung QPI Mr Remmen joined by v/c; he hoped everyone had read the report and now asked for questions. Lesley noted the strong performances in year 2. Mr Remmen replied the resection rates (QPI 6) were under scrutiny but he hoped to see the 5 year survival rate, which would then offer the opportunity to compare the 3 regions. Dr MacGregor referred to QPI 1, which required patients to be discussed at MDT, noting that it is clinically appropriate for some patients with SCLC to receive treatment before MDT despite these patients not meeting the QPI target, while other patients were not referred to the MDT. Regarding QPI 13, 30 day mortality for patients receiving palliative chemotherapy, Christine advised there had been discussion at a national level about the target for palliative treatment; Mr Remmen stated that such treatment on patients who are already weak can alter mortality figures. Lesley said each board should have good governance procedures; Dr MacGregor supported this by emphasising the importance of differentiating between patients who died because of treatment and those who died despite treatment and highlighted the importance of M & M reviews in this respect. Keith said M & M reviews were carried out as a result of deaths within 30 days of SACT treatment and boards were presently addressing the governance around this. Mr Remmen highlighted a few support issues around the services: There were issues around managerial support of the MCN. There were issues with the functioning of MDTs across sites / NHS Boards, caused mainly by IT problems. Mr Remmen had already highlighted these MDT IT issues over some considerable time without resolution. There were issues within Dundee around financing of IT problems. Aberdeen was under scrutiny regarding cardiothoracic surgical volumes. Volumes of primary lung resection in Aberdeen are low in a national context. While some patients travel from Highland and Tayside for surgery at ARI, other Highland / Tayside patients have surgery in Edinburgh / Glasgow. To support the continued provision of this surgery in the North of Scotland it is important that that Grampian surgeons are able to fully participate in MDTs in Inverness and Tayside, so ARI can provide surgical services for as much of NOSCAN as possible. Current MDT facilities hamper this. Mr Shimi said that with respect to NHS Tayside, referrals outwith NOSCAN were often at the wishes of the patients. Mr Shimi recognised the problems with managerial support of the Lung MCN and plans for a replacement were being addressed. There were finance issues in the upgrading of an MDT room but plans were in place to upgrade this. Mr Remmen Page 2 of 7
said these issues had been ongoing for 1.5 years in Tayside and 3 4 years in Highland. Lesley looked for a timeframe when this work would be completed. She thanked Mr Remmen for speaking to RCAF today. iii Bladder QPI Mr Ahmad said this was the first year of QPI reporting (2014-2015) and analysis was based on 341 patients diagnosed within the audit period. Out of the 12 QPIs for bladder cancer, only 1 met the target and some had come within 10% of the target. QPIs 2, 4, 5, 8 + 12 were far off the target. There were a few factors to explain this; mainly the discrepancy between clinical practice and data collection. Surgical data should be recorded on a proforma as the data team are not currently capturing all data required; if these fields were not collected, this was reflected in the results. Mr Ahmad suggested increased collaboration in data collecting. Christine gave some initial views on the bladder cancer dataset; she said this was very complex compared with other tumour groups. The biggest issue was data collection; however some areas for improvement regarding clinical service delivery were also identified. Lesley commented on the small numbers and Mr Ahmad said one patient can be 20% of numbers. Lesley saw standardisation as a key action; Mr Ahmad agreed and said a uniform pro-forma must be established for NHSG & NHSH. Lesley advised responsibility of implementation of action plans and Keith clarified that while the MCN would provide regional support, individual Boards were responsible for developing their own action plans. Keith gave a timescale of 8 weeks for Boards to submit their action plans to NOSCAN; these will then be discussed at the MCNs and any outstanding areas of concern will be escalated to RCAF. Jim advised there was an ongoing national review of urological surgery and Jaime Lyon would be involved in this and her first task was to look at initial data collection and comparison. These details would be taken back to the National Planning Forum and then shared with this group. Mr Shimi referred to QPI 11 and the 20% death rate in NHST there was now an obligation to look at case notes and inform colleagues. iv Testis QPI Dr MacDonald looked at the first year of data, but due to the small numbers of patients diagnosed with testicular cancer in NOSCAN each year, in reality 3 years of data was necessary to best assess the performance of the region against the QPIs. This was a rare cancer, prone to peaks and troughs and low numbers could easily contribute to failing a QPI. QPI 1 - Radiological staging patients were required to have a CT scan of chest and pelvis within 3 weeks of surgery. There has been a change in service leads in NHS Tayside and a better process is now in place to ensure this QPI is met. QPI 6 - Quality of delivery of adjuvant chemo. The north had 90% due to one Page 3 of 7
b i ii patient failing. QPI generic clinical trials - NOSCAN reached 4.2% of patients enrolling to interventional trials target was 7.5%. Dr McDonald noted the scarcity of interventional clinical trials and the difficulty of getting patients into trials run at the Beatson. However it was noted that NOSCAN far outreach the target of 15% for translational research with 38%. QPI 3-95% of patients should undergo primary orchidectomy within 2 weeks of ultrasonic diagnosis. In NHS Grampian, 7 patients failed this QPI and 4 were for good clinical reason. A number of patients failed the QPI by a couple of days and this was echoed across the 3 centres. Hopefully NHSG were in the process of resolving this and similarly in Tayside. Lesley asked how performance was in the east and west: Dr MacDonald said there was poor compliance of this standard with both SCAN and WoSCAN below 50%. This was a pan Scotland problem. However Borders and Ayrshire & Arran achieved nearly 100% by entering patients on an emergency list. Mr Shimi asked if there were any anaesthetic reasons for delays; Dr MacDonald said some patients were in the 40 50 year age group with a history of hypertension and diabetes. Dr Moore asked if there was a clinical rationale for a 2 week wait. Dr MacDonald replied there was no evidence that 2 weeks was better than 3 weeks. Lesley thanked Dr MacDonald for his time today. SACT Recovery SACT visits update and HIS Review At 24th May, Keith had completed 8 reviews, with 7 more to complete. Each of the 15 sites which deliver chemo in the NOSCAN network had to be reviewed and an action plan for each had to be submitted by mid June for final submission on 1 July. It was acknowledged however, that some units would be unable to observe these deadlines as visits were still ongoing. They had however, been invited to complete a self-assessment as an interim measure followed by a draft action plan. An additional organisational chart with satellite units detailing governance was also needed. Keith would also be looking for information from leads this week. Lesley saw a lot of learning from this exercise and proposed using a face to face NOSCAN meeting as the forum for this. Key messages from SACT visits There was much duplication across the north with each of the 3 cancer centres working on 300 documents which could be simplified by collaboration and additional resource to support this. ChemoCare should be rolled out across the satellite units There were issues over consent in smaller units and the question arose on how this is done by post/fax or email? NHS Highland has started to use digital pens for consent with a link to SCI store. However, Miss Weber highlighted that only those with access can see this information and during OOH or weekends, this information was not available. Keith acknowledged this valid point of view that information sharing should be widened. Dr MacGregor said NHS H was working on this. Mr Shimi commented on how technology can improve healthcare, but all Page 4 of 7
suggestions required extra resourcing and questioned what was needed to progress to the next stage. Lesley concluded this section by echoing Mr Shimi s point of working to identify resource for these suggestions for improvements. iii iv v Regional Clinical Management Guidelines Neil was working on an accelerated recovery plan, although the challenging schedule and turnaround time for response was proving difficult. However, Neil anticipated completion by mid June. Lesley thanked Neil for progressing this work so rapidly. Regional Cancer Medicine Governance Keith advised this was still live and Ian Rudd was keeping discussion going in the north. There will be a scoping exercise in June followed by testing on one tumour group. It was expected that there will be good progress once the SACT reviews are finished. Letter to NOSCAN on behalf of NSAG membership This letter had been addressed to NOSCAN on behalf of the SACT leads; it highlighted the present strain on clinical staff plus their ongoing daily workload in order to satisfy the SACT reviews. Jim had discussed this with Dr Marianne Nicolson and the main gap is the backfill of clinicians. Keith agreed that clinical services were struggling to support Boards and again raised the issues of 3 cancer centres triplicating effort over 000s of documents. WoSCAN and SCAN approached this as a regional support to the Boards, but NOSCAN does not support a similar structure. Lesley said Dr Bisset had identified gaps in terms of clinical resource but questioned how to find a model where clinicians felt engaged. Jim suggested writing back to the signatories advising what NOSCAN had discussed today asking for more detail on the specifics of the resource required. A group comprising of Mr Shimi, Dr Bisset and Jim would take these discussions forward. Neil was in agreement in the lack of capacity to deal with the future workload. Lesley asked this be added to discussions on resourcing at the July RCAF. c Transforming Care after Treatment TCAT Projects update The Project Board was establishing a Steering Group whose role was to demonstrate the robustness of future funding allocations. This would be chaired by Elaine Peace, Director of Nursing, NHS Orkney. Simon Bokor-Ingram was hoping to nominate someone from NHS Shetland to the group, whilst Dr Cassidy would propose someone from NHS Grampian Modernisation team. Mr Shimi cautioned against assuming these Phase 3 monies, he said there was work to be done on how to spend these monies and a proper evaluation to be completed. Jackie thought the group would get a proportion of the money, but there would need to be an options appraisal with subsequent identification of the gaps and what to progress. Jackie suggested looking at one big project or look at other gaps in the region. Julie Gowans would begin in the TCAT Project Manager role at the beginning of June. TCAT presentation, Professor Angus Watson My Cancer Portal Prof Watson had intended to present this part of the agenda at the beginning of the Page 5 of 7
meeting. However as there were initial delays in NHS H with poor sound/visual quality, he had to leave for another appointment. This will come back to the July meeting. 22-16 For Discussion and Action a b c Regional OD MDT update Jim advised he had escalated the IT systems concerns to Chief Executive level this morning, plus the ongoing difficulties in attendance from the 3 mainland Boards. There would be full representation from NHS Grampian but not from NHS Tayside or NHS Highland. Jim said representation issues were as a result job planning & capacity. Lesley noted this and asked for Jim to arrange a meeting with her, Elaine Mead and Jim to find a solution. This will be brought back to the July RCAF meeting. Regional Oncology Board PID issues log Alan reported on the above; he said an engagement event may be necessary to relook at the PID. There had been good feedback from colleagues and a further ROCB meeting was due to be held on 1 July. Lesley asked for the ROCB item to come back to the agenda at the July RCAF meeting. HPB cancer surgery review Mr Shimi gave a brief history of this item; after a series of day-long surgeons meetings in the summer of 2016, the consensus was that there should be a single operating centre in the north of Scotland. Lindsay Campbell had since offered support for a scoping exercise for a SLWG. He had line management support for this with no cost to RCAF. Lindsay said there had been 2 years of QPIs where there was evidence of the need for clinical improvement and surgeons had subsequently met together to review as a group. These small volumes incur risk to patients. Jim saw this as being part of a wider surgical issue and questioned if it should go to NoSPG. Lesley and Jim were to have a further discussion outwith this meeting. Lesley asked Lindsay how much support would be needed for this exercise; Lindsay advised that colleagues had been involved in the OG appraisal and work together on a daily basis. Lesley asked for a measured approach to this issue: Allowing the group to scope/outline plans Look for agreement from all parties The group to be clinically led to indentify implications and impact Dr Mike Bisset involved as Medical Director Mr Sami Shimi involved as NOSCAN Clinical Lead Agreed links to National Clinical Strategy We need to be ready for a national discussion over this This item will come back to the July RCAF agenda d e Regional Clinical Leadership Dr Bisset had offered his apologies today; therefore this item would come back to the July meeting. Regional Cancer Intelligence Dr Moore reported that 5 from 6 of the north Boards had been represented at the initial meeting and they planned to meet again in June for a scoping exercise. NHS Shetland had offered their apologies for the meeting, but was in support of this proposal. Dr Moore explained the possibilities in both service and Page 6 of 7
operational development by combining information from different systems into one system. Mr Shimi asked what would be needed in terms of resource; Dr Moore replied this would function on a collaborative basis across the 6 Boards and he hoped to look at various avenues for funding. Jim asked for a Terms of Reference in order to engage Boards in further discussion if funds were to be accessed from a regional resource. Lesley viewed this proposal as an enabler in supporting the cancer agenda. 23-16 For information The following items were included for information only, without requiring any further discussion. a Info for me Project Annual Report 2015/2016 b Info for me personalisation tool on Care Information Scotland website c DCE newsletter Issue 11 d DCE Conference 2 September 2016 Glasgow e TCAT blog f Scottish Cancer Prevention Network g Cancer Plan for Children and Young People with Cancer h National Sarcoma MCN Clinical Audit report i ISD Melanoma QPI Report 2014-2015 j ISD Head & Neck cancer QPI Report 2014-2015 24-16 Date of next meeting Tuesday 19 July 2016 Lesley proposed a face-to-face meeting/development workshop in Aberdeen and invited island teams to attend if possible. Among items for the agenda would be a governance model/cancer portfolio/leadership and Terms of Reference for this group. The meeting time would be extended to accommodate the extra discussion. (post meeting note : Lossie/Spey room is booked from 11.30am-4.30pm) v/c sites if unable to attend in person Lossie/Spey room, Aberdeen Dental Education Centre, ARI site 4 th Floor meeting room, Raigmore Board Room, Level 10, Ninewells Page 7 of 7