REPORT TO IMPROVING PATIENT EXPERIENCE COMMITTEE

REPORT TO IMPROVING PATIENT EXPERIENCE COMMITTEE Date: Agenda No: 10 Date Paper produced: 25 th July 2014 Sponsoring Director (responsible for signing off report): Author: Paper Title: National Cancer Patient Experience Survey Zoë Packman Jackie Green Nurse Consultant Haematology and Cancer Dr Sanjay Gupta Clinical Lead for Cancer Purpose/Decision required: Impact on Patient Experience: Impact on Financial Improvement The committee are asked to note the report. The committee are asked to note the updated action plan. National Programme is to obtain a national perspective on the cancer patients experience only in patients and day cases. This excludes all outpatient activity. History: (which groups have previously considered this report) Cancer Board. Cancer and palliative care nursing team Executive Summary Croydon Health Services NHS Trust participated in this national survey of cancer patient experiences in 2012/13.The survey included all adult patients with a primary diagnosis of cancer who had been admitted to an NHS hospital as an inpatient or as a day case patient, and had been discharged between 1 st September 2012 and 30 November 2012. 66 eligible patients were invited to the survey of which there were 44 complete responses. This paper is to update the Improving Patient Experience Committee on the action taken to date to improve the cancer patient experience in light of the 2013 national survey. The paper will considered the contributing factors highlighted in the last report and the agreed Trust action plan will be updated. The report will also provide an update on the cancer patient and carers listening event held on 1 st April 2014. Real time feedback is received via the Family and Friends Test in the Macmillan Information Centre and the Life Blood Suite and this is detailed in the report. 1

Key Issues for discussion Key points to note are : The 2014 National Cancer Patient Experience Survey is underway we have to date achieved a 52% response rate. Where we have real time feedback the responses are very positive and we score highly. The listening event has identified key themes and work is underway to address the points rasised. The action plan has been updated. Related Corporate Objective: Corporate Objectives: The Trust continues to work in partnership with Macmillan, London Cancer Alliance and London Cancer to improve the patient experience Related CQC 5 Key Areas of Care: x Safe x Effective x Responsive x Caring Well-Led Has an equality impact assessment form been completed? x Not applicable Has legal advice been taken? Does this report have any financial implication? If so, has the report been approved by the Financial Department? 2

National Cancer Patient Experience Survey 1.0 Background Croydon Health Services NHS Trust participated in this national survey of cancer patient experiences (NPES) in 2012/13.The survey included all adult patients with a primary diagnosis of cancer who had been admitted to an NHS hospital as an inpatient or as a day case patient, and had been discharged between 1 st September 2012 and 30 November 2012. 66 eligible patients were invited to the survey of which there were 44 complete responses. The following tumour groups were represented from Croydon: Breast (n=20) / Colorectal (n=11)/ Haematological n=6)/ Urology (n=5) / Skin (n=1) and Brain (n=1). This compares with 50 and 100 responses from the 2011/12 and 2010/11 surveys respectively. The 2014 National Cancer Patient Experience has been sent and response rate as of 9 th June 2014 was 52%. The results are expected in October 2014. This paper is to update the Improving Patient Experience Committee on the action taken to date to improve the cancer patient experience in light of the 2013 national survey. The paper will considered the contributing factors highlighted in the last report and the agreed Trust action plan will be updated. The report will also provide an update on the cancer patient and carers listening event held on 1 st April 2014. 2.0 Considered contributing factors: Factors thought to have contributed to some of the survey responses include: 1. Long term absence of the Colorectal Clinical Nurse Specialist (CNS) to support cancer services during 2013 2. Ward staff insufficiently trained and briefed to deal with queries from patients and their carers 3. Inadequate signposting on the wards and clinical areas to support services for patients (Citizens Advice Bureau / Macmillan Centre / Patients Advisory Liaison) 4. Lack of Palliative Care team 24/7 for inpatient care 5. Lack of staff in the Research Office to support recruitment into clinical trials and provide patient information (written / verbal) 3

2.1 Action taken to date: The Trust has successfully recruited the colorectal CNS who starts in the Trust on 15 th September. The Trust has taken part in the London Cancer Alliance CNS review The palliative care team provide a 6 day face to face service and the Trust have access to out of hours palliative care advice from St Christopher s hospice. Continued work with Multidisciplinary team members to relate to recruitment into clinical trials is on-going. For some patients clinical trials are not available and therefore discussion with patients around recruiting into clinical trials does not take place. A number of clinical trials are open at the tertiary centre where the discussion will take place. CHS continues to work towards increasing the clinical trials portfolio 3.0 The listening event On 1 st April the Trust held a listening event in the style if LiA. Cancer patients and carers were invited to attend. The event was attended by 24 patients who had been diagnosed or treated with cancer at CHS. The attendees were asked two questions 1) what aspects helped most. and 2) what aspects helped least? The tables were facilitated by external members from Macmillan and the London Cancer Alliance and staff not involved in the delivery of cancer care. As a result of the event some immediate has been taken to date as detailed below. Actions taken to date are: Comments have been fed back to Cancer Board and the Cancer Nursing Team. Lead Nurse is in discussions with the tertiary centre to work on improving the communication across health care providers. The cancer nursing team have business cards with their contact details Clinicians are required to give 6 week s notice for routine clinic cancellation. Work is being done as part of the LiA for Outpatients. Short notice clinic cancellations are being addressed as part of this. Continued education and training for Emergency department staff in relation to acute oncology care. Key themes that came out of the event are: Communication with other health care providers and with patients and family 4

Friendly personal approach Long waits at multiple points in the pathway Having a key worker and a consistent point of contact 3.1 Next Steps: A follow up event is to be planned to share what we have implemented as a result. It is proposed this will held in October 2014 in order that the NCPES 2014 results can also be discussed. Attendees were asked at the event if they would like to be form a patient forum for Cancer Care and this is being considered currently. 4.0 Family and Friends Test (FFT): In addition to the NPES and the listening event the cancer team at CHS are able to obtain patient views from the FFT for those who attend the Macmillan Information Centre and the Life Blood Suite (haematology day care). 4.1 Macmillan information centre: During October 13 to July 14 159 FFT cards were analysed. 100% of those using the service said they were extremely likely (96.1%) or likely (3.9%) to recommend the service. This has given an overall FFT score of 96%. The top three reasons given for this are: 1. Helpful, friendly and caring 2. Helpful information, advise and support 3. Relaxing, welcoming supportive environment When asked how can we improve the comments related to more staff and some with medical knowledge. 4.2 Life Blood Suite During October 13 to July 14 29 FFT cards were analysed. 100% of those using the service said they were extremely likely (93.1%) or likely (6.9%) to recommend the service. This has given an overall FFT score of 93%. The reason given for the score can be attributed to the nursing staff delivering the care within the unit. When asked how can we improve the comments related to better facilities. A business case has been approved to relocate the Lifeblood Suite which will provide improved facilities. 5

Appendix 1: Comments from the listening Event held on 1 st April 2014 Question 1: What aspects helped most? Clear information to family Quick Diagnosis and treatment Professionalism, compassion, caring, flexibility, nothing too much trouble Excellent ward manager Excellent quick referral links GP for diagnostic tests Treated by staff like a member of the family OPA efficient and quick seen on time in clinic RMH friendly personal touch/approachable Consistent across piste Relationship with staff (e.g. CNS) personal touch Doctors answered all the questions GP link to home (pt cover) Blister pack BBN well Macmillan nurse present at diagnosis Question 2: What aspects helped least? Communication Speaking within eavesdropping distance from patient Poor communication skills re: Clinic cancellations. Lack of empathy and compassion 6

Lack of information about the Macmillan Information Centre Poor communication between RMH and CHS A & E lack of awareness of chemo alert card Environment: Infection control (doctors not always observed) Day care unit over crowded Scheduling Lack of medical and nurse team input (during weekends) Lack of empathy and compassion Long waits for admissions, surgery and discharge Delays in chemotherapy drugs being available Transport by ambulance creates early starts and delays in getting home External processes contributing to delays in diagnosis/treatment (availability of PET) OPA cancelled at short notice (1 day only) Delay in results available leading to late diagnosis Inadequate preparation by clinician No beds available at RMH and then long wait in A/E at CHS for a bed IT issues: Computers not functioning in clinic to obtain data from RMH and CHS Imaging taken at CHS not available to RMH staff Wards: Staff turnover: no continuity of ward staff and moved to 3 different wards No named nurse 7

Appendix 2: FFT data for the Macmillan Information Centre and Life Blood Suite FFT Results for the Macmillan centre 2014 What is the main reason for your score? Very helpful advice and pleasant atmosphere 14/07/2014 16:29 They was very helpful 11/07/2014 16:30 Very helpful and understanding 01/07/2014 16:34 Very understanding about own needs could not do enough to be helpful 01/07/2014 16:33 Efficient professional team 30/06/2014 16:34 I needed some information 30/06/2014 16:31 Very efficient and friendly 27/06/2014 16:35 Friendly staff compassionate explained everything well professional 27/06/2014 16:35 Time and patience given in order to impart a full understanding of cancer treatment and side effects 23/06/2014 16:52 The lady was very friendly and helpful 19/06/2014 15:37 For a chat and for a massage 17/06/2014 15:36 Honestly 16/06/2014 15:35 Kindness patience and time given. I was not rushed 13/06/2014 15:35 Was given thorough description of my queries answer. Took time and explained what I should do 12/06/2014 15:30 Person was very knowledgeable empathetic on practical and life issues 12/06/2014 15:30 Exceptionally helpful reassuring and understanding 12/06/2014 15:30 I really needed a massage there was a cancellation they rang me up. I really appreciated it. I was in 05/06/2014 15:27 terrible back pain The people in the centre are very friendly and caring. Anna is very nice and gives a wonderfully relaxing massage 22/05/2014 15:17 Explanation and helpful character 13/05/2014 15:04 Helpful considerate and kind 07/05/2014 15:04 This centre is very supportive when needed most 07/05/2014 15:03 Because she was extremely helpful and empathetic 01/05/2014 15:40 After 1 hour with Benny I felt better than I had for weeks 01/05/2014 15:40 The advice given completely put my mind at rest 30/04/2014 15:39 Incredibly friendly kind and supportive team. A great service 29/04/2014 15:41 Understanding how it affects families living with cancer 25/04/2014 15:41 Very helpful information and advice 22/04/2014 16:05 Appreciated the warm friendly explanation from centre manager 16/04/2014 16:02 Very friendly reassuring approach and informative talk with the centre manager 16/04/2014 16:02 So helpful information and emotion focussed on us as a family 14/04/2014 16:04 Because Benny is awesome and speaking to her has really helped 14/04/2014 16:00 Benny has been fantastic in helping our family to understand my mum\'s cancer diagnosis. Thank you 14/04/2014 16:00 so much Came to get help for myself and wife 11/04/2014 16:05 I have visions of Paul working alongside Bernard 11/04/2014 16:00 8

So very helpful and understanding so good to have someone to turn to 11/04/2014 16:00 Relaxing helped me with the stress 09/04/2014 15:59 She was very friendly and understanding 08/04/2014 15:59 Service information was very good 07/04/2014 15:58 Got useful advice and suggestions and contact ideas 01/04/2014 15:56 Visited Macmillan was knowledgeable kind understanding and very helpful advice 01/04/2014 15:56 Very helpful advice and information 01/04/2014 15:56 Was given very clear and comprehensive information 31/03/2014 15:53 Came to support my best friend whose mum has pancreatic cancer 31/03/2014 15:53 Kind warm friendly excellent advice and listener 31/03/2014 15:53 Very informative and kind and helpful. I felt relaxed by the time I left 31/03/2014 15:53 Great massage made me feel very good 27/03/2014 15:52 Because they make me happy 26/03/2014 15:49 Very helpful genuine lots of information and support 26/03/2014 15:49 The service is quite unique and supportive 26/03/2014 15:49 Kind caring service and with good communication 21/03/2014 15:54 Massage was amazing everybody there was lovely 20/03/2014 15:53 You are offering a great service that is needed you have a lot of services that you offer 19/03/2014 15:52 Very friendly very helpful 18/03/2014 15:52 Professional warm welcoming centre 13/03/2014 15:52 Compassion 12/03/2014 15:52 Relaxing and positive 07/03/2014 16:50 Bernard is such a lovely man. He is calming and considerate to individual s needs. I look forward to 07/03/2014 16:50 visiting him. Because it is so relaxing 06/03/2014 16:51 Because it is so relaxing 06/03/2014 15:59 Good advice 04/03/2014 15:59 Cancer information service staff were so welcoming 28/02/2014 16:30 Because there are going to be more people who will be told they have cancer and people need to 26/02/2014 16:28 know about the service Because here they are all very caring and friendly. They do their best to help in everyway 20/02/2014 16:17 Pleasant surroundings and a good therapists with nice bedside manner 20/02/2014 16:17 Excellent service and advice very relevant to my needs 20/02/2014 16:17 They treatment very relaxing. It\'s good to have my time. Very relaxed and friendly environment 20/02/2014 16:17 The manager is wonderful 19/02/2014 16:16 They welcome my daughter who is my main carer 19/02/2014 16:16 It\'s my first appointment 18/02/2014 16:15 I am in remission my sister has secondary cancer and I needed someone to discuss this with. Very 14/02/2014 16:14 kind advice Very helpful 13/02/2014 16:13 The positive support and advice offered. I can see would be very helpful to cancer patients 13/02/2014 16:13 9

Very helpful and informative 10/02/2014 16:12 Very friendly and helpful making me understand 05/02/2014 13:05 I have received excellent help and advice from all staff 05/02/2014 13:05 Friendly helpful and very good information 03/02/2014 13:04 The care support and attention I have received has been excellent 03/02/2014 13:04 Bernard puts you at ease and relaxes you 24/01/2014 13:07 Someone listened and cared 20/01/2014 13:06 Staff extremely helpful 20/01/2014 13:06 Because they were fantastic 17/01/2014 16:47 Very caring very informative very understanding 17/01/2014 16:47 The massage treatment is very pleasant and well done. They all have a very friendly manner 16/01/2014 16:48 Healthier timing greater mobility 15/01/2014 16:49 Very helpful advice 15/01/2014 16:49 So patient and helpful listens what you have to say 09/01/2014 16:46 Endless patience and understanding 09/01/2014 16:46 Very relaxing just what I needed 08/01/2014 16:44 Excellent listening all the time in the world 08/01/2014 16:44 Benny shared her experiences with me gave very useful advice and materials and encouraged me all 06/01/2014 16:43 in a very friendly manner. How can we improve? The centre is great Benny the advisor showed me some plans to make improvements to the 14/07/2014 16:29 Can\'t see how extremely helpful 01/07/2014 16:33 Not much to improve on 19/06/2014 15:37 You have done well easy access is great and not complicated 17/06/2014 15:36 Keep the work up 16/06/2014 15:35 Excellent job it\'s already being done 12/06/2014 15:30 Unsure 12/06/2014 15:30 It\'s fine. I m very happy 05/06/2014 15:27 Very high standards already 22/05/2014 15:17 No need for improvements. Thanks 07/05/2014 15:04 More funding so they can do the same for more people 29/04/2014 15:41 More centres 14/04/2014 16:04 I m blown away by the services offered and have no suggestions for improvement 14/04/2014 16:00 Be open more often 07/04/2014 15:58 More funding for opening hours 01/04/2014 15:56 More adverts as to how to contact for help 01/04/2014 15:56 I don\'t how you could improve. It is a wonderful service 31/03/2014 15:53 You can\'t. The service is outstanding 31/03/2014 15:53 10

You can\'t 31/03/2014 15:53 You can\'t 27/03/2014 15:52 Doing what you re doing 26/03/2014 15:49 Someone with medical advice or knowledge and procedures in the centre 26/03/2014 15:49 More space in the treatment rooms 21/03/2014 15:54 You can\'t everything is so nice 20/03/2014 15:53 More staff 07/03/2014 16:50 You cannot improve perfection 06/03/2014 16:51 You cannot improve perfection 06/03/2014 15:59 Keep giving good advice and support 04/03/2014 15:59 By making sure if you do have new staff that the training that takes place should always be 26/02/2014 16:28 ofessional standards that are in place already No improvements needed 20/02/2014 16:17 Just keep going 20/02/2014 16:17 Keep the service going 20/02/2014 16:17 Needs to be promoted 19/02/2014 16:16 Very helpful. Thank you 14/02/2014 16:14 Increase awareness as medical student I will do my best to do this 13/02/2014 16:13 Just keep doing what you are doing it\'s fantastic 03/02/2014 13:04 I wish I had more time 24/01/2014 13:07 More funding 20/01/2014 13:06 Perfect 20/01/2014 13:06 You can\'t you do everything now 17/01/2014 16:47 You don\'t need to 16/01/2014 16:48 You can\'t in this filed 09/01/2014 16:46 Everything was just fine 09/01/2014 16:46 Don\'t think you could from what I have seen so far 08/01/2014 16:44 A longer session please. 08/01/2014 16:44 More publicity about the centre in Croydon and services provided 06/01/2014 16:43 FFT Results for Life Blood Suite: What was the reason for your comments? The staff are amazing 30/04/2014 11:37 Excellent service over some 17 years 30/04/2014 11:37 Great service. Team genuinely care. Efficient and no time wasting 14/02/2014 15:28 Lovely staff at all times 13/02/2014 15:28 Everybody was great nice people 05/02/2014 16:06 Very friendly and efficient clinic 04/02/2014 16:04 Friendly staff 04/02/2014 16:04 Always someone to relate too 04/02/2014 16:04 Professional and pleasant staff made the visit easy 04/02/2014 16:04 Kind nurses 03/02/2014 16:03 Caring staff 03/02/2014 16:03 11

Caring helpful and friendly 03/02/2014 16:03 The kindness and help received was brilliant 20/01/2014 16:51 Very friendly and good work team 20/01/2014 16:51 Excellent treatment care and courtesy at all times 28/08/2013 16:02 Seen on time staff lovely made whole process easy 08/08/2013 16:02 Alison Fernando and her team are wonderful 30/07/2013 15:55 Understanding friendly welcoming supportive willingness to go the extra mile to 23/07/2013 16:03 omfortable The staff of this department were truly outstanding. The level of professionalism duty 19/07/2013 16:05 consideration given was highly commendable. Thank you Seemed very efficient and friendly 11/07/2013 16:03 Excellent staff 02/07/2013 16:08 The friendliness of the service 25/06/2013 16:01 The care is gold standard with a staff team of 2 people who always put patients at 20/06/2013 16:08 st wonderful Belonged to lifeblood approx. 13 years 20/06/2013 16:08 We are always treated very well always on time 18/06/2013 16:07 Treatment is brilliant nurses first class cannot fault them they are lovely 17/06/2013 15:58 Staff treat patients with care and dignity 17/06/2013 15:58 Have been receiving treatment in the lifeblood suite for several years and high level 24/05/2013 15:56 t care from the staff of the unit How can we Improve? Offering extra privacy when receiving treatment 30/04/2014 11:37 A bigger room please 30/04/2014 11:37 Bigger rooms more staff comfortable seats 14/02/2014 15:28 Need a bigger room 13/02/2014 15:28 More space recliner chairs 04/02/2014 16:04 Depends on management 04/02/2014 16:04 More room with better facilities 28/08/2013 16:02 Need bigger room and more staff are very busy 15/08/2013 16:00 She really could do with more room 30/07/2013 15:55 Make the section larger so more people can benefit from this service 23/07/2013 16:03 Ensure all NHS staff are trained to the exceptional level as staff within this 19/07/2013 16:05 department i.e. Alison and Caroline Large facilities 02/07/2013 16:08 Move to larger premises 25/06/2013 16:01 No comment give the lifeblood more recognition and space 20/06/2013 16:08 Keep going as you are 17/06/2013 15:58 Maybe some bigger rooms would be great beneficial to all 17/06/2013 15:58 12

The unit is often completely full and it is not so efficient to have it in two places even if it is opposite each other especially if only one of the staff are present ideally should be in one large room maybe more staff as always very busy 24/05/2013 15:56 13

1 Action Plan October 13 updated July 14 No Key recommendation Comments Action Lead for action Due by Update on action Undertake a cause/analysis to identifying underpinning cause, significant changes since 2011/12 Need to agree tool 5 whys. Need to obtain patient comments from QH Look at patient pathways and areas they may impact significantly on the patient experience - initially in breast and colorectal and haematology General Manager and Lead cancer nurse Dec 13 Pathway review for colorectal cancer has been undertaken. The London Cancer Alliance site specific pathway groups are reviewing patient pathways 2 Identify other sources of feedback National Survey small sample size, Agree format: Real time feed back Focus group Local surveys CT/JG Dec 13 Listening event held 1/4/14 FTF in haematology day care Undertake further feedback with agreed tool (s) and implement action from the outcome 3 Engage key stakeholders CHS predominantly a diagnostic service 9 trusts in the bottom 10 London are in London PAN London response and CHS will part of this: Pan London work streams are : Real-time Feedback Patient Transport Patient Information Other projects are: Schwartz rounds Deliver a listening event with stakeholders Meet with GP Macmillan lead, cancer CCG lead to identify areas of investment/ community care that will influence the cancer patient experience Attend the PAN London patient experience events Consider how CHS utilise the work stream and projects. Utilise the PAN London analysis Clinical cancer lead and Lead cancer nurse January 14 November 2014 Listening event held 1 /4/14 Discussion with tertiary centre started to discuss improving access to CNS London Cancer Alliance and London cancer patient experience events held and attended by Croydon Health Services 14

Patient-led Projects Collaborative Working Value Based Standard presented by Theresa Wiseman 4 Ensure all trust staff are aware of the survey 5 Reported that CNS make a difference to results The report identifies on p125-127 the impact of the CNS Prepare presentation & identify staff groups and appropriate forum Present findings Meet with Cancer CNS team to discuss the results and identify ways to improving the patient experience Patient Experience Manager/ Lead Cancer Nurse Oct 13 Cancer Board Cancer Nursing team had results presented to them and asked to disseminate to MDT members Clinical cancer lead Dec13 and Lead cancer nurse Lead Cancer Nurse Dec 13 November 2013 Met with CNS cancer team Oct 13 Poster showing the cancer nursing team on all wards and areas. Posters not placed on wards as trust implementing named nurse and consultant boards Ensure all staff have business cards Implement Holistic Needs Assessment All cancer CNS have business cards which patient are given which have contact details of the keyworker on. 6 Clinician engagement is essential to patient experience 7 Access to financial support and awareness prescriptions are free Target lead clinicians and collate their views on the report and how improvements can be made Providing financial advice and continuation of partnership Clinical cancer Lead Oct 13 Oct 13 Lead Clinician spoke with lead clinicians General manager and lead cancer nurse June 14 Feb 14 15

working with Croydon CAB service funded for 1 more year. Requires sustainability plan and pick up funding from October 2014 Trust is involved in partnership with Macmillan and SW London Trusts in providing access to CAB service. 8 Staff and patient experience are linked 9 Communication and treating patients as individuals commented to make major impact on the patient experience. Presentation at PAN London event demonstrates this Reported in patient interviews, patient comments. Working with HR / listening into action to work with staff and patients how we can improve the cancer patient experience Implementing actions from the listening event. Share and discuss the findings with key stakeholders Lead Cancer nurse and Lead cancer clinician September 2014 Trust is considering the implementation of Schwartz Rounds. March 2014 Event held 1/4/14 A follow up event is to be planned for October 2014 16