DEVELOPMENTS IN ACUTE ONCOLOGY DR ERNIE MARSHALL CLATTERBRIDGE CANCER CENTRE

DEVELOPMENTS IN ACUTE ONCOLOGY DR ERNIE MARSHALL CLATTERBRIDGE CANCER CENTRE

AO: WHERE WERE WE? (2009) NCEPOD 2008: Lack of Expertise Leadership Dislocated care Lack of oncologists Poor communication Lack of information Safety FN pathways NCAG: AO 5 day 5 PA s of oncology 1WTE Nurse specialist Admin support Inpatient care

NCAG THEMES Patients ALL emergency presentation including suspected cancer Teams Access to oncology but in context of teams Metrics Safety & quality Promote early referral/review Reduce inpatient stay Responsible for developing policies, procedures, training& education, audit, overseeing capacity planning, pt info, financial management and IT support Encourage new roles Training Royal colleges should develop competencies and training programmes for all involved in AO PCTs should ensure that AOSs are available in all hospitals Non Malignant Anticipated that Trusts will use the report for Chemo services in non-malignant disease

WHERE ARE WE NOW? NPRP REPORT 2012/13 Measures below 50% compliance: Core team Staffing Induction training Electronic flagging MSCC coordinator role There are still many non functioning and totally non compliant AOS s without sufficient planning to address the issues

AO FUNDING? No new money Efficiency Savings Spec comm Secondary Care CCG Macmillan

AO Survey 2015 AOTs well established Innovation & enthusiasm Reduced LOS, improved comms, pt experience Differing models 52% insufficient resource

STAFFING Nursing 221 WTE AO nursing (7% of total) ANP, CNS, Nurse consultant, AO Matron AO and Haem/AO and SPCT Medical ACP, RCR Strategy CO RCR Census 2014-13% include AO role AO Survey?Admin Roles ~60% Oncology leads are MO 25% non oncology leads: Nursing Acute medicine, ED Consultant, Haematologist Palliative Care

AO DATA? Nationally: Urgent Care (NAO 2013) 47% increase in admissions -past 15 years ¼ of ED presentations result in admissions Reduction in LOS: 9.7 to 5.8 days Picture dominated by short stay (<2day) 4hr waiting time target, aging population & frailty Lack of effective alternatives to admission 0.83 million acute beds lost due to delayed discharge

AO- MCCN NEVILLE WEBB ET AL CLIN MED (2013) 12 mth review (2010-11) : 7 Trusts 2010/11 2014/15 Total Patients 3031 5241 lung 26% - Breast 16% - CRC 14% - Type 1 19% 19% Type II 30% 33% Type III 51% 48% Median time to referral/review 1 day/1 day 1day/1day LOS 9.7days -

AO MCCN NEVILLE WEBB ET AL (2015) Patterns of AO admissions. Exploratory analysis >7000 pts Median LOS 10.9days Type I 15.7 Type II 6.7 Type III 10.2 Two Grps : median LOS 5 days and 25 days (82% type I/III) Inpatient deaths 13% Type II 5.6% 41% sepsis 8% GI Type I/III 12.1/14.7% Review of long stay, type 3 69% complex medical, 31% discharge delay

AO: WHAT DO GPS & PHYSICIANS THINK? 24/7 advice Is it cancer? Acute Medicine & Primary Care AO: what s that? Give us some options! AO beds? We are experts.. but need support & advice

Aims CRG Subgroup Multi professional First meeting April 2014 Remit: AO Specification Draft delivered June 2015 In context changing NHS AO WORKING GROUP & SERVICE SPECIFICATION

AO SPEC. THEMES Multi professional AO team Competency based, increasingly Nurse led Emphasis on Admission avoidance Aligned with Acute medicine Comprehensive, joined up Help line 7 day services Minimum data set Local Commissioning & Network performance monitoring

SPECIFICATION UPDATE IT S STUCK! NHS E Specialised Commissioning CCG & locally commissioned service Can NHS E deliver a Spec? OR is it Best Practice Guidance Still requires wider and more formal NHS Consultation (via CRG?)

AO WORKING GROUP NEXT STEPS Metrics Minimum Data Set Catherine Donnelly Education & training Philippa Jones Primary Care Sinead Clarke IT innovation Tom Newsom-Davis

AO CONFERENCE 2015 7 Day Services Nurse led collaborative weekend working AO/SPCT Emergency Presentation Acute Diagnostic clinic is it cancer, Collaborative working with AMU/ambulatory care 24/7 AO nurse-led admission unit Metrics AO database Pathway innovation CUP, MSCC & NS Training AO modules, e learning Integrating AO/SPCT/AMU/Haem 24/7 triage & help lines http://learnzone.macmillan org.uk

CAN WE DEVELOP A NATIONAL MINIMUM DATA SET? Currently stand alone Ongoing collaboration with SCR, NCIN and NHS QS Catherine Donnelly leading Aligned with NHS QST Quality Indicators/portal Outcome measures Structure & process measures Patient experience Potential KPIs Number Emergency admissions by type LOS by type, Time to review Admission avoidance NS mortality, (according to risk) MSCC definitive treatment & function

Patient Discharge Outcome & Outcome Discharged Details Discharged from AOS Discharged from Hospital Discharge Destination Patient Died Outcome Remains Inpatient Active Oncology Treatment Supportive/Palliative Care No further AO input planned Overall AO Intervention Date of Discharge from AOS Date of Discharge from Hospital RIP Date Palliative Care Referral Taken over by On-call Consultant Taken over by Site Specific Team 01/01/2015 Early Discharge Recommended? Admission Avoided? Length of Stay days Palliative Care Referral Date GP Follow up Attending an OPA Other On surgical pathway for MSCC MSCC Follow-up & Outcome of Definitive Treatment 3 Month Function Outcome 24 Month Function Outcome Pain Improved Pain Same Mobility Same Mobility Worse Continent Yes Continent No Discharge/ Outcome Comments Somerset AO module 2 nd quarter 2016

NETWORK FUNCTIONALITY REMAINS ESSENTIAL Performance Monitoring Data set Business Case Development Network Alliance Helpline Triage MSCC Primary Care Education Professionals Patients

Beatson Cancer hospital told to improve care for critically ill patients Scotland s Largest Cancer hospital has been told to improve the way it cares for acutely ill patients - 7 October 2015 NHS Scotland Report Who I best placed to deliver urgent Care? Ambulatory Care Admission Units Inpatient Care Step up beds Oncology Strategic Ceiling of Care Acute Medicine Sick patients

AO SUMMARY AO is alive & kicking and well placed to be the vehicle for delivering the Urgent Care Strategy for cancer patients AO is both generic and subspecialist AO needs national leadership and direction We need to evolve the Spec into a framework for good practice We will aim for an annual National conference MASCC workshop Washington 2017 We have developed a powerful collaboration with Cancer Macmillan National database of contacts now exceeds 400 AO clinicians Stakeholder engagement is essential - Forthcoming AO website