SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM)

SELF ASSESSMENT REPORT (MULTI-DISCIPLINARY TEAM) Network Trust MDT MDT Lead Clinician 3CCN WORCESTERSHIRE ACUTE HOSPITALS Worcestershire Acute Hospitals NHS Trust Local Upper GI MDT (11-2F-1) - 2011/12 Mr M Wadley Compliance Self Assessment LOCAL UPPER GI MDT 87.1% (27/31) Key Themes Structure and function of the service Structure and Function of the Service The Upper GI MDT in Worcester functions well with good relationships between Upper GI Surgeons, Gastroenterologists, Oncologists, Radiologists, Pathologists, Palliative Care and Clinical Nurse Specialists. The MDT links with the Specialist Centre at Gloucestershire Royal Hospital within the Three Counties Cancer Network. Until April 2011 Kidderminster patients managed through the MDT requiring surgery were referred to Russells Hall Hospital. Since April 2001 Russells Hall Hospital is no longer a Resectional Centre for upper GI cancer. Patients are therefore managed through the Worcester MDT and offered surgery either in Gloucester or referral to the Upper GI Unit in Birmingham. This policy has been approved following discussion through the Worcester Cancer Locality Group with the Worcestershire Acute Hospital Team and the Worcestershire PCT. 1.All core members in place 2. Number of patient discussions was 827 at MDT over the year At WRH there are 2 UGI CNS's that act as key workers for patients diagnosed with UGI cancers. Both work closely with the UGI surgeons, Gastroenterologists and the Oncologists. Michelle Judge -- Macmillan Palliative GI CNS -- Key Worker for Pancreatic and Hepatobiliary Cancer patients including support during diagnosis, staging investigations, treatment and follow-up. Support for very symptomatic patients and for end of life care. Michelle Davies -- Upper GI CNS -- Key Worker for Oesophageal and Gastric Cancer patients, including support during diagnosis, staging investigations, treatment and follow-up. SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 1/6

Responsibilities include: -Patient Care -Patient /relative emotional and psychological support -Education of non-specialist staff -Contributing to the multidisciplinary discussion and patient assessment/care planning decision of the team at their regular meetings. -Providing expert nursing advice and support to other health professionals in the nurse's specialist area of practice. -Involvement in Clinical Audit. -Leading on patient and carers' communication issues and coordination of the patient pathway for patients referred to the team -acting as the Key Worker or responsible for nominating the Key Worker for the patient's dealings with the team. -Utilising research in the nurses specialist area of practice -Patient information -Patient satisfaction survey -Attendance on National Advanced communication skills course -Facilitating access to members of the MDT where requested by patients or their Carers. -Service development -Maintaining high standards of care 3.Cancer waiting times : Between 1st April 10 and 31st March 11, there were 893 2ww referrals seen by the Upper GI Team at Worcester/Kidderminster of which 79 (8.85%) eventually proved to have cancer. Out of these 893 referrals 16 breached the 14 day target giving an overall achievement of 98.21% Worcester/Kidderminster 2 week waits seen 01/04/10-31/03/11 Sex Total Seen Diagnosed % with cancer Male 391 38 9.72% Female 502 41 8.17% Total 893 79 8.85% Age 0-20 21-40 41-60 61-80 >80 Total Male 0 5 90 213 83 391 Female 0 7 109 263 123 502 Total 0 12 199 476 206 893 Between 1st April 10 and 31st March 11, there have been 162 recorded treatments for the Worcester/Kidderminster team under the 31 day target of which there were no breaches giving an overall achievement of 100%. Of these 162 treatments 85 were treated at WRH/KTC, 60 went to Cheltenham/Glos, 10 went to Dudley, 5 went to the QE and 2 were treated in the community. There were 75 patients treated under the 62 day target of which there were 7 breaches giving and overall achievement of 90.67%% for this standard 4. MDT attendance as follows for the time period of April 2010 to March 2011 6.The core MDT members meet compliance with cover apart from the GMCN oncologist who is unable to attend at present 7. Attendance at Advanced communication skills course - two members of the team are to attend SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 2/6

Coordination of care/patient pathways The Worcestershire Royal Hospital Upper GI Multidisciplinary Team (MDT) is a multi-professional group serving the city of Worcester and the surrounding area in the Worcestershire PCT. It is part of the Three Counties Cancer Network (3CCN) although the MDT will discuss patients from other network localities. The Worcester Royal MDT discusses all patients with a diagnosis of Upper GI cancer from South Worcestershire and Wyre Forest/ Kidderminster area.the Kidderminster patients discussed at MDT are managed through the 3CCN pathway although, since the closure of the resectional unit at Russels hall Hospital, are offered referral to Birmingham for surgery if they wish. Patients with hepato-pancreatic biliary malignancies are discussed at MDT; any patients with potentially operable disease are referred to the Queen Elizabeth Birmingham liver Unit in the Pan Birmingham cancer network (PBCN). An HpB surgeon from The Birmingham Liver Unit attends the WRH Upper GI MDT evry 3 months to discuss difficult/interesting cases and update the team on patients from Worcestershire who have undergone resections. 3CCN guidelines were reviewed and agreed to at the annual operation meeting on 13/07/11. (Please see Agenda below) 1.The recording of treatment planning decisions is made live in MDT using the Somerset's cancer register 2.The CNS continues to be the main key worker for the team 3.Both CNS's have started to use the Somerset Cancer Register to record the GP 24 Hour notification of diagnosis. An audit was completed in July of the medical notes of patients diagnosed in February- April 2011. Ten sets of notes were checked by the CNS and 60% of the patients had documentation in to say the GP had been faxed within 24 hours of the patient being told their diagnosis. 4.A member of the MDT has attended 100% of NSSG meetings from April 2010 to March 2011 A referral of patients from South Worcestershire to the Specialist Unit at Gloucestershire Royal Hospital works seamlessly between the two Units. There are close links. Mr Wadley, Consultant Upper GI Surgeon is a core member of the Gloucestershire Royal Hospital Specialist MDT. He also works as an In Reach Surgeon at Gloucester managing Worcester patients through that Unit. Links are established between Surgeons, Secretaries and Specialist Nurses on both sites and co-ordination of patient flow is managed by a Resectional Centre MDT Co-ordinator who links with the local MDT's in Hereford, Worcester and Cheltenham. Until recently the pathway for Wyre Forest patients has been more complex. They have received surgery at Russells Hall Hospital, diagnosis and MDT discussion in Worcester and Kidderminster and diagnosis in Worcester and Kidderminster and a somewhat fragmented follow up either in Dudley or in Worcestershire. More recently these patients have been managed by members of the Worcester Upper GI MDT. By integrating them into the Three Counties Cancer Network pathway, the pathway has been simplified. Although the travel to Gloucester for the small proportion of patients requiring surgery involves a longer journey their diagnosis, management and follow up is now all locally within Worcestershire. This allows the Upper GI MDT to keep a more careful track of their cancer journey. Should they require further treatment or emergency management after surgery continuity of care can be established. These patients are offered surgery in Birmingham. Many patients, once they have met the Upper GI Team are happy to stay in the above described pathway. SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 3/6

Patient experience 1.The MDT took part in both a local MDT and national Cancer patient survey (numbers were small from the national survey. Both surveys were discussed at the annual operational meeting held on 13/07/11. Annual Business Meeting Agenda UGI MDT 13/07/11 Date: 13/07/11 Time of meeting: 08.30 Location: MDT meeting room WRH 1.Apologies 2.Peer review documentation - self assessment report 3.Agreement to Network Guidelines 4.Clinical Lines of Enquiry data discussed 5.NSSG audit a.discuss progress and presentation of NSSG audit as appropriate b.acknowledge any local trust audit work in progress or upcoming c.data presentation - Mr Wadley & Dr Candish 6.NSSG agreed Trials implementation a.any NSSG agreed remedial action required 2 The local patient satisfaction survey showed excellent compliance with 93% of patient had been given a named key worker and detail 45% of patients had been offered a permanent record and this will be the focus of our MDT members to improve on. 76% of patients were offered or given printed and written local/national information about their condition and treatment, and support services available. In conclusion the overall survey results were positive with 72% of patients being completely satisfied with the overall treatment and care they have received and 17% of patients responding yes, with reservations. Action Points : Improve the offering of a permanent record or summary of treatment to all patients Improve the offering of a patient personal folder to all patients 3. The Trust will be in the first wave of the information prescriptions scheme and the MDT will be taking part 4. The MDT use the resources provided by the Macmillan pods situated in the Hospital Foyer Clinical outcomes/indicators The MDT has contributed to the NSSG audits as follows: PET CT audit - Mr A Torrance, Mr M Wadley (WRH) on behalf of 3CCN Upper GI NSSG. Recent audit undertaken of assess the impact of the introduction of PET CT scanning to clinical outcomes following its introduction to the Three Counties Cancer Network in 2006. 726 cancer patients audited. PET CT scan changed the management in 10% of patients. It had no impact on patient survival. In addition it did not reduce the incidence of early recurrence 12 months after surgery. Evaluation of the oncological standard of minimally invasive oesophagectomy (MIO) in a UK Specialist Unit. Data presented by Mr James Rink, Specialist Registrar, Gloucestershire Royal Hospital and Mr SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 4/6

Martin Wadley, Consultant Upper GI Surgeon, Worcestershire Royal Hospital Audit of the lymph node retrieval of patients undergoing laparoscopic oesophagectomy at Gloucestershire Royal Hospital since its introduction in 2008. This project was selected for a presentation of distinction at the recent Society of American Gastro-intestinal and Endoscopic Surgeons meeting in San Antonio Texas in March 2011. It showed that the introduction of minimally invasive techniques in oesophageal cancer surgery resulted in no significant reduction in lymph node harvest. The medium number of lymph nodes retrieved were actually higher after laparoscopic surgery compare to open surgery. In light of the findings in this study were are proceeding with our minimally invasive oesophagectomy programme within the Three Counties Cancer Network. Oesophago-Gastric: 2010/11-86 patients diagnosed., 22 resections (25%) -The proportion of patients in whom stage of disease is recorded- - 100% in those undergoing resection, otherwise not available -Local workload data supplementing national data on percentage of patients having a surgical resection- See above -The percentage of patients having palliative interventions (supplementing national data)- Not available -Postoperative length of stay - median stay 14 days (open surgery),(9 days MIO) Oesophageal resections Pancreatic: 55 patients diagnosed - 5 resections (9%) -Number of new cases treated and recorded in National Audits- See above -The proportion of patients in whom stage of disease is recorded- unavailable -Local workload data supplementing national data on percentage of patients having a surgical resection- See above -The morbidity and mortality following surgery-- Unavailable data at QEH Birmingham -The percentage of patients having palliative interventions (supplementing national data)- > 90% (palliative chemotherapy or ERCP stent) -Postoperative length of stay- - - Unavailable data at QEH Birmingham Trials information Below are the numbers of patients who have been entered into clinical trials. *BOSS -13 patients *REAL 3-5 patients OEO5-4 patients *COG - 2 patients *STO3 is also now open. * trails currently recruiting at WRH Good Practice Good Practice/Significant Achievements Achieving IOG compliance Excellent working relationships with Gloucester Specialist Unit SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 5/6

Excellent clinical outcome Low post operative mortality and complication rate as described in the AUGIS national oesophageo-gastric cancer audit Development of a local EUS service Recent development of an EUS proforma to aid standardisation and entry into upper GI cancer trials Excellent Clinical Nurse Specialists with specific roles involving oesophago-gastric cancer\surgery and hepatobility cancers\palliative care The CNS has been involved in finding a suitable patient for helping to record a radio advert for an awareness campaign for the 3CCN. A WRH patient who underwent surgical treatment for an oesophageal tumour in 2010 was chosen and the team hope the radio advert will be successful in trying to raise awareness of this type of cancer. Concerns Immediate Risks Serious Concerns Concerns -Clinical oncologist has excellent attendance however still requires named cover -Lack of CNS support for Kidderminster patients who have local oncology treatment. -Fragmented pathway for Wyre Forrest patients. Now improved (see above) but still concerns regarding lack of Wolverhampton oncologist at MDT (this will change after implementation of Worcestershire Oncology project in 2013) General Comments The evidence to support the self assessment has been checked by the team and would be available if a peer review team were to visit. Organisational Statement I, Mr M Wadley (Lead Clinician) on behalf of WORCESTERSHIRE ACUTE HOSPITALS agree this is an honest and accurate assessment of the Local Upper GI MDT. SELF ASSESSMENT REPORT for Worcestershire Acute Hospitals NHS Trust - Local Upper GI MDT (published: 29th September 2011) Page: 6/6