CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Report of: Paper prepared by: Gill Heaton -Director of Patient Services/Chief Nurse - Assistant Director of Nursing Date of paper: February Subject: Purpose of Report: National Cancer Survey Indicate which by Information to note Support Resolution Approval Consideration of Risk against Key Priorities (Impact of report on key priorities and risks to give assurance to the Board that its decisions are effectively delivering the Trust s strategy in a risk aware manner) This report, which details progress in implementing key actions, should positively impact on the key priority of patient experience Recommendations The Board of Directors is asked to note the actions taken and planned to improve the quality of the patient experience for cancer patients 1. Introduction 1.1 The Board of Directors received a presentation from the Director of Patients services/chief Nurse in October 2012 on the results of the National Cancer Survey (2011/12) for CMFT and Trafford Hospitals at the Board of Directors Seminar. Future surveys will be provided as one Trust from April 2012. 1.2 Following the results of the 2011/12 survey an action plan was developed (see Appendix 1) in relation to the following core areas: Dissemination of 2011/12 Survey results Multidisciplinary Tumour Meeting Reviews Role of Clinical Nurse Specialist Promotion of the 2012/13 Cancer Survey Information Provision 1
1.3 The purpose of this paper is to provide an update to the Board of Directors with regards to the actions detailed in the paper presented to the Board in November 2012 to improve the outcome of future national cancer surveys results. 2. Progress To Date 2.1 The Trust Cancer Board The Board has been reconvened chaired by the Director of Patient Services/Chief Nurse. This group will ensure that all patients with malignant disease treated within the Trust have the best possible care, delivered in a timely fashion and in compliance with national guidelines for best practice. 2.2 Dissemination of 2011/12 Survey results Series of presentations led by the Director of Patient Services/Chief Nurse to Divisions and tumour specific groups demonstrating their individual results and highlighting areas for improvement have taken place. Analysis of the 2011/12 results to tumour level was difficult due to the low number of respondents, and therefore this information was only available for one tumour group (haematology). 2.3 Multidisciplinary Tumour Meeting (MDT) Reviews The focus previously both nationally and locally has been to ensure that Trusts established cancer MDT s for all relevant tumour groups. Since 2010 the National Cancer Action Team (NCAT) have turned their attention to how these MDT s are working and produced a set of characteristics that define how an effective MDT would work. The Trust has undertaken a review of all the adult MDT meetings against the core characteristics. This review has identified areas of good practice and areas for improvement within some MDT meetings. The results of the review have been shared with the relevant Divisional Director and Lead Clinician in order to address areas for improvement and will be monitored through the Cancer Board. It is planned that a similar exercise will be undertaken during the next six months to ensure that improvement has been made where required. 2.4 Role of Clinical Nurse Specialist (CNS/Key worker) Analysis of the survey data identified a need to re-focus the role of the CNS in the support of a patient with a diagnosis of cancer. The survey asks patients if they had a key worker, which for patients treated at the Trust is the CNS role. Work to promote the role of the CNS role as the key worker for patients with cancer has taken place. This work includes the revision of business cards to include the title key worker and the development of posters to promote the role within ward and out-patient areas. All cancer patients discharged from the Trust receive a follow up telephone call from the CNS within 2 weeks of discharge, which provides patients with an opportunity to discuss any concerns or fears. 2.5 Promotion of the 2012/13 Survey The patients eligible for receipt of the 2012/13 national survey are those treated as an in-patient or day case within the Trust between September-End November 2012, who have a primary diagnosis of cancer. The data in terms of eligible patients was shared with the survey provider (Quality Health) in January and patients have commenced receiving letters from mid-january onwards. 2
Prior to provision of the data to the survey provider a robust revised validation process of eligible patient has taken place lead by the Deputy Director of Nursing (Quality) and Head of Informatics. This revised process in line with the survey guidance has identified an increase sample size for the 2012/13 survey of 742 (2011/12 = 375). This increase in eligible patients is a result of the following: Introduction of Trafford patients Improvement in data collection systems i.e. Somerset Much improved validation and cross referencing of patients Final sign off of the sample by the senior nursing team Each eligible patient received a letter from the Chief Executive advising them that they would be receiving the survey, which provides them with feedback of the improvements the Trust has made since the last survey. 2.6 Information Provision A core area for improvement identified from the 2011/12 survey related to the provision of patient information to support patients during the diagnosis and treatment for cancer. The Trust is currently working with the Cancer Network to implement the Cancer Information Prescription model which will allow information provision to meet the individual needs of each patient. An information prescription is a detailed tool which provides patients and families with details of the all relevant information and sources of information and support. Patients are able to then select and receive the relevant information they require during their pathway to suit their specific needs. The information prescription for an individual patient is a patient held document and is share with all other providers of care for the patient. All tumour groups will have implemented the information prescription model by end of March and as part of this process all patient information will be reviewed and updated if required. 3. Providing On-Going Assurance/Monitoring 3.1 The implementation of the Somerset Cancer Database during 2012 provides a means to enable the specific tumour groups to monitor compliance with a number of standards i.e. cancer diagnosis and treatment targets. 3.2 During quarter 4 the use of this system has been further expanded to capture CNS contacts with patients (i.e. appointments, telephone calls, etc.) and will shortly be used to record evidence for other peer review standards (i.e. holistic assessments). 3.3 Patient Experience Tracker devices for each MDT tumour group will be provided from April, with key questions from the national patient survey. This will allow on-going tumour specific feedback to be provided as well as enable the monitoring of patient experience to take place Trust wide on a regular basis. 3.4 It is planned to work with informatics team to develop a reporting system that provides monthly feedback to Divisions in relation to key peer review and patient experience standards. 3
4. Conclusion 4.1. The Board of Directors are asked to note the actions taken and planned to improve the quality of the patient experience for cancer patients. 4.2. The Director of Patient Services/Chief Nurse will bring a progress report to the July Board of Directors meeting. 4
CMFT - CANCER EXPEREINCE IMPROVEMENT PLAN 2012/13 Appendix 1 Identified area for Improvement Review of all MDT functions and corporate accountability Actio n No. Action(s) to enable improvement Action Lead Deadline Evidence of completion Date of completion 1. Commission internal review of all MDT tumour groups using best practice guidance Anthony Middleton Director of Performance Pat Jones Lead cancer Nurse 2. Reconstitute Cancer Board Director of Patient Services / Chief Nurse 3. Communication skills training programme available. Scoping exercise to be undertaken to identify Core MDT members who have not attended training and agree plan to facilitate attendance. Lead Cancer Clinicians HoNs 30/11/12 Each MDT (with exception of Paediatrics, Specialist Palliative Care and acute oncology) has been reviewed by Corporate Cancer Service Team members. Outcome report and recommendations to be presented at Cancer Board 8 th January 2012 31/10/12 Meetings scheduled to commence from January 31/10/12 Review of core MDT membership to identify members who have not undertaken advanced communication skills training. Cancer Lead Nurse emailed outcome of review for each tumour group to MDT lead clinician and relevant Manager of service. 27/11/12 Cancer Lead Nurse currently working with Tumour groups to prioritise staff to attend 7 Network funded places, following which MDT will need to fund training. Promotion of 2012/13 Survey 4 Post card campaign to be given to all cancer patients treated during September-November 2012 Phil Parkinson Head Customer Experience 2/2/13 Report to be provided for Cancer Board February which details compliance with this standard for core MDT members. 30/9/12 Postcards distributed via CNS roles 28/9/12 5
5 Letter to eligible patients to promote completion of survey Phil Parkinson Head Customer Experience January Eligible patient sample identified by Head of Information and Deputy Director of Nursing (Quality). Letter to all patients by Chief Executive drafted for agreement with DDN 7 th January. Feedback and analysis of 2011/12 survey Short term actions to improve 2012/13 survey results Information provision aligned to patient pathway and needs 6 Presentation of survey results to OMG by Quality Health 7 Analysis of CMFT cancer survey results to be undertaken to provide key themes and trends, against 2010 and national position 8 Analysis of Trafford survey results to be undertaken to provide key themes and trends, against 2010 and national position 9 Dissemination of results to MDT teams within Divisions 10 Presentation of results to Cancer Nurse Forum 11 Heads of Nursing to ensure all Clinical Nurse Specialists (CNS) have contact cards and processes in place to pick up messages and respond within 24 hours 12 CNS to follow up all patients discharged between October December 2012 with telephone call, documenting completion within patients records 13 Development of project plan for Trust wide implementation of information prescription process (pilot currently in colo-rectal) Deborah Carter Deputy Director of Nursing Colin Hunter Divisional Analyst Colin Hunter Divisional Analyst Divisional Directors 6 Letter to be distributed to all patients week commencing 14 th January 28/9/12 28/9/12 28/9/12 Circulated to Divisional Directors and shared at MDT presentations 28/9/12 5/10/12 October 2012 Presentations completed to Surgery (colorectal, Upper GI, Head and Neck, Sarcoma), Trafford services. Meetings planned for Haematology, lung, gynaecology in January 27/9/12 27/9/12 Heads of Nursing 30/9/12 28/9/12 Heads of Nursing 30/9/12 Systems established by Heads of Nursing to ensure telephone calls are made. Pat Jones October 2012 March Pilot commenced with colo rectal teams at CMFT and TGH. Update paper to be presented to Cancer Board January.
14 Review within each MDT of information provision to ensure all information provided is configured to Trust standard 15 Review of CNS documentation in order to develop tool to capture type information provided and any supporting verbal explanation Divisional Directors and Cancer Lead Nurse Pat Jones March March Plan to implement Trust wide by end of March Cancer Lead Nurse currently undertaking review as part of the Information prescriptions implementation Proposal to use Somerset IT system to capture this data. Demonstration of system functionality at Cancer Nurse Forum 29/11/12. Currently being piloted by colo rectal team. 16 Implement systems to enable to provision of summary of consultation or copy of GP letter to all patients Cancer Lead Clinician January Exploring option for Trafford site who do not use Somerset System as patient tracking managed through the Cancer EPR Request made with PAS to be able to have mandatory question on PAS booking in system at OPD appointments linked to ICD codes for cancer which prompts clerk to ask if patient wants copy letter. Not possible to adapt PAS system. Currently reviewing alternative processes. Agreement at Cancer Board meeting in January that all patients should automatically receive copy letter. Divisional Directors and Clinical Leads to progress within each tumour group. June Audit to be planned for June On-going assurance to monitor delivery of improved patient experience 17 Develop and implement key standards/outcome measures for roles/services to enable improvement in patient experience (i.e. all patients received written record of consultation, Cancer Lead Clinician March Cancer Lead Nurse currently working with Informatics team to establish what reports can be obtained from Somerset database and provided to tumour groups on-going basis. 7
all patients have follow up phone call from CNS after discharge) 18 Establish process to allow monitoring of outcome measures, such as patient experience survey to sample patients from each MDT on monthly basis Pat Jones January Update to be provided to February Cancer Board Patient experience trackers ordered for tumour groups with the exception of acute oncology, specialist palliative care and chemotherapy. To be used by CNS s at OPD appointments following discharge. February and cancer lead nurse identifying key questions from survey for devices which will be agreed with members of Professional Forum and Lead Clinician prior to final approval at Cancer Board. April Implementation plan for commencement of surveys within each tumour group to be developed and agreed with Heads of Nursing. 19 Development of process/framework to monitor identified standards utilising principles of ward QCR process and ward accreditation 20 Development and monitoring of Divisional action plans through Cancer Service Board Pat Jones Divisional Directors April/May March October 2012 Development of reports to be provided monthly for each tumour group detailing patient survey information. See 17 above Somerset reports Cancer Services Board reestablished. Updated DP/AM 20 th February C A Lenney: Director of Nursing (Adults) : Assistant Director of Nursing 8