INTERNAL VALIDATION REPORT (NSSG 1C AND TUMOUR SPECIFIC 1A MEASURES) Network Cross Cutting Group SWSHCN SWSHCN Gynae NSSG (11-1C-1e) - 2011/12 Date Self Assessment Completed 11th August 2011 Date of IV Review 6th September 2011 Lead Clinician Mr Simon Butler-Manuel Compliance GYNAE NSSG GYNAE NETWORK BOARD Key Themes Structure and function of the service Self Assessment 87.5% (7/8) Self Assessment 100.0% (9/9) Internal Validation 87.5% (7/8) Internal Validation 100.0% (9/9) This is a well attended Gynae-oncology NSSG overall. A patient representative was present at 3 of the 4 of the meetings, and all four trusts were represented at all bar one of the meetings. The Group is well led by a committed Chair Peer Review 2010 had raised the issue that there was inadequate major pelvic surgical/theatre capacity at RSCH to fully implement the centralisation required by IOG. A third consultant (0.7 wte) in January 2011. Although there are currently no regular operating sessions, a list has been available every week. It is envisaged that the new theatre build at RSCH will allow a regular weekly all day operating list in Spring 2012. Coordination of care/patient pathways The Network supports the IOG centralisation for major pelvic surgery being carried out at RSCH. The capacity issues will be eased by the appointment by the RSCH of a third gynae-oncology surgeon, however this will require careful monitoring. The agreed tumour group audit of surgical data should highlight any continuing capacity issues. The third gynae-oncology surgeon requires a regular all day operating list, and it is envisaged that the new theatre build at RSCH will address this by Spring 2012. A series of Aftercare leaflets have been developed. These were originally developed by Sarah Pearce, CNS at SASH, and INTERNAL VALIDATION REPORT for SWSHCN - Gynae NSSG (published: 12th September 2011) Page: 1/5
modified for use across the Network by Fiona Thompson, Gynae-oncology Research CNS. Following consultation, these were endorsed at the October NSSG meeting for use across all SWSH organisations. The Da Vinci robot continues to be a successful initiative. Complex cases and some patients with a high BMI have undergone robotic procedures. HDU/ICU bed usage has been reduced, and patients have a reduced length of stay. The RSCH is the first unit to run robotics as part of its service, and has drawn on the laparoscopic experience of both gynaecological and colorectal colleagues. The Tumour Group will be asked to present this data to the Commissioners in September 2011. Peer Review 2010 raised the concern that currently there was no fast track diagnostic clinic at RSCH. There is still no uniform diagnostic pathway for Post Menopausal Bleeding or Assessment of Pelvic Masses. This issue will be taken forward by the Tumour Group. Pathways between MDTs, cross cutting groups and supranetwork referrals work well and are patient focused. One of the CNSs at St Luke's Cancer Centre has successfully completed the Lymphoedema course run by Royal Marsden Hospital. She is now able to offer an enhanced service to patients with lower limb lymphoedema, whereby an assessment, measurement and fitting of compression stockings and monitoring service is available for patients attending their end of treatment appointments. Patient experience The following is an extract of the questions that were asked in the NCPES (CNS related questions) and the percentage of positive responses received in the SWSH Cancer Network. These data were returned for RSCH patients (54 patients responded). Data could not be analysed for the remaining SWSH trusts as there were fewer than 20 patient responses, and the data was suppressed. Patient given the name of the CNS in charge of their care: 96.2% Patient finds it easy to contact their CNS; 68.9% CNS definitely listened carefully the last time spoken to: 95.9% Get understandable answers to important questions all/most of the time: 95.7% Last time seen, time spent with CNS about right: 97.9% RSCH has already developed an Action Plan as a result of the above. E-mails, answerphone services and Patient Information now indicate working hours for each CNS and anticipated response times. The NSSG has successfully recruited a second patient to the group and the group is committed to involving patients to improve the service. The patient representatives were directly involved in the development and production of the Aftercare leaflets. Clinical outcomes/indicators The Clinical Lines of Enquiry were discussed at the July meeting of the NSSG, and the information has been uploaded onto CQuINS. The NSSG have met all Cancer Waiting times standards and a full summary is available in the Annual Report. The NSSG remains committed to clinical trials and research, and has tabled and discussed trials and research throughout 2010/11. INTERNAL VALIDATION REPORT for SWSHCN - Gynae NSSG (published: 12th September 2011) Page: 2/5
Good Practice Good Practice/Significant Achievements A second patient representative has been recruited, and joined the group in April 2010. A series of Aftercare leaflets have been developed. These were originally developed a CNS at SASH, and modified for use across the Network by the Gynae-oncology CNS at Guildford. Following consultation, these were endorsed at the October NSSG for use across all SWSH organisations. The Da Vinci robot continues to be a successful initiative. Complex cases and some patients with a high BMI have undergone robotic procedures. HDU/ICU bed usage has been reduced, and patients have a reduced length of stay. The RSCH is the first unit to run robotics as part of its service, and has drawn on the laparoscopic experience of both gynaecological and colorectal colleagues. The Tumour Group will be asked to present this data to the Commissioners in September 2011. There has been a successful refurbishment of Outpatient facilities at Crawley Hospital, including improvement of disabled access. One of the CNSs at St Luke's Cancer Centre has successfully completed the Lymphoedema course run by Royal Marsden Hospital. She is now able to offer an enhanced service to patients with lower limb lymphoedema, whereby an assessment, measurement and fitting of compression stockings and monitoring service is available for patients attending their end of treatment appointments. Concerns Immediate Risks Serious Concerns The panel were concerned to hear that there continues to be a gap in the provision of the diagnosis fast track clinic at the RSCH, despite this being raised at the previous peer as a concern. All other units in the Network have fast track clinics, in line with the agreed Tumour Group clinical guidelines. This lack of provision is currently leading to an inequity of service for patients referred to the RSCH for diagnostic tests. This has the potential to delay diagnosis and inhibits access to the full range of INTERNAL VALIDATION REPORT for SWSHCN - Gynae NSSG (published: 12th September 2011) Page: 3/5
support services, including CNS support at a crucial time in the patient's pathway. This issue will be raised by the Network with the RSCH Chief Executive and Medical Director at the earliest opportunity. Concerns There is a concern that the current service provision may not provide sustainable capacity for major pelvic surgery to take place at the centre. This will need careful monitoring. It is envisaged that, should the Tumour Group data audit highlight a shortfall in surgical capacity, that the RSCH will develop a business case for additional surgical provision, and CNS support. General Comments This is a well functioning tumour group, led by a dedicated chair. The NSSG representives in attendance today were keen to impress upon the panel that the core members of the all the MDTs work well together, and share a desire for an equitable diagnostic pathway across the Network and sufficient surgical capacity at the centre to be addressed as a priority by the RSCH. Summary of validation process The internal validation process was an hour long meeting with the Gynae NSSG with a pre-meet to discuss the evidence and a post meeting to write the report. Panel members: Macmillan Nurse Director, SWSH (Chair) Information Lead, SWSH Cancer Programme Manager, NHS Surrey Patient Representative - sickness absence noted Gynae NSSG: Consultant Gynaecological Oncologist, RSCH (Chair) Consultant Gynaecologist, FPH Cancer Services Manager, RSCH Lead Cancer Nurse, RSCH Gynae-oncology CNS, SLCC INTERNAL VALIDATION REPORT for SWSHCN - Gynae NSSG (published: 12th September 2011) Page: 4/5
Organisational Statement I, Professor Christopher Marks (Validation Chair) on behalf of SWSHCN agree this is an honest and accurate assessment of the Gynae NSSG. Agreed by Dr John Omany, M.D (on behalf of A. Walker, CEO) (Chief Executive) on 6th Sep 2011. INTERNAL VALIDATION REPORT for SWSHCN - Gynae NSSG (published: 12th September 2011) Page: 5/5