CANCER OVERVIEW GROUP Minute of the above meeting held at 2:00pm on Thursday 10 th March 2016 in Room B, Improvement Academy, Level 5, Ninewells Present Grace Ball (GB) Project Manager NOSPG Wendy Croll (WC) Clinical Services Manager Surgery Directorate Janice Caithness (JC) Head of Service ehealth Helen Dryden (HD) Project Lead TCAT Keith Farrer (KF) (via VC) NOSCAN Network Manager NOSCAN Lesley Forsyth (LF) Project Manager NOSPG Sarah Lowry (SLo) Business Unit Team Manager Business Unit Jackie Rodger (JR) Macmillan Lead Colorectal CNS & TCAT Surgery Directorate Clinical Lead Neil McLachlan (NMcL) (Via VC) NOSCAN MCN Manager NOSCAN Una Milne (UM) Head of Therapeutic Radiography Access Directorate Services Mark Parsons (MP) Macmillan Lead Cancer Pharmacist Pharmacy NoSPG Hazel Scott (HS) General Manager Public Health Sami Shimi (SS) Clinical Lead UGI Surgery Directorate Lynn Smith (LS) Interim General Manager Access Directorate Cara Taylor (CT) MacMillan Cancer Nurse Consultant Surgery Directorate Arlene Wood (AWo) General Manager Surgery Directorate Apologies Douglas Brown (DB) Clinical Lead Breast Surgery Directorate Peter Brown (PB) Clinical Lead Lung Medicine Directorate David Cameron (DC) Cancer Information Analyst Business Unit Frank Carey (FC) Clinical Lead Pathology Surgery Directorate Julie Cavanagh (JCav) Consultant in Public Health Medicine Public Health Jackie Davie (JD) Head of Nursing Oncology Jill Forbes (JF) Clinical Services Manager Medicine Directorate Mohammed Hossain-Ibrahim (MHI) Clinical Lead Neuro-oncology Surgery Directorate Hannah Lord (HL) Clinical Oncology Consultant Surgery Directorate Gavin Main (GM) Associate Medical Director Access Directorate Murdina McDonald (MMcD) Cancer Services Lead Nurse NHS Fife David Meiklejohn (DM) Clinical Lead Haematology Surgery Directorate Gulam Nabi (GB) Lead Urologist Surgery Directorate Christine Urquhart (CU) Audit and Information Manager NOSCAN Cara Taylor in the Chair 1. WELCOME AND APOLOGIES ACTION CT welcomed everyone to the meeting and apologies were noted as above. 2. MINUTE OF THE PREVIOUS MEETING HELD ON 14 TH JANUARY 2016 The minute of the previous meeting was agreed as an accurate record. 3. MATTERS ARISING Enhanced Recovery JR summarised the paper circulated prior to the meeting. There is strong evidence which supports ERAS following elective laparoscopic colorectal surgery for both benign and cancer cases. There is currently a National Programme being set up and there is a requirement to set up an NHST Project Board which is to consist of clinical and management staff in order to implement the programme. The Scottish Government have indicated that they plan to attend the Project Board meetings and these are to be set at 6 weekly intervals. 1
The programme has a national dataset and it is expected that reports would be provided on a regular basis. AWo also suggested that JR discuss this further with HC as Orthopaedics had experience in implementing national programmes of ERAS work. JR agreed to report back to the Group at the meeting scheduled for 14 th July 2016. IT functionality JC advised that the IT equipment had been fully tested within Ninewells and PRI. The IT team are to provide refresher training and SOP s to staff members who attend the MDT s regularly to support use of the equipment. It was noted that it would be challenging to have one staff member from IT available at all times to support each MDT. JC and SLo agreed to discuss support for the Lung MDT and equipment refreshers out with the meeting specific to the challenges with the Radiology meeting room. AWo agreed to review the availability of the Pathology Seminar Room to identify if the Lung MDT could be accommodated. JR JC, SLo AWo NMcL raised concerns in regards to the sharing of information via VC between Tayside and Grampian during the Lung MDT from the Radiology meeting room. It was noted that the equipment standard was not up to specification, the equipment was not situated in a suitable place within the room and on review each site may be looking slightly different images during the MDT which impacts on discussion, diagnosis and treatment plans. KF requested that equipment specifications for the Pathology MDT Room were shared in order to ensure that the equipment in the North of Scotland was compatible. JC agreed to provide this. JC Oncology Pathway CT clarified that this action related to a discussion that took place at the Sept 2015 meeting in regards to the proposed oral maxilla-facial surgical management of patients with head and neck cancer from out with Tayside including NHS Fife. CT confirmed there was no further update at present and this issue would be reviewed when Head and Neck clinical report was next presented. In addition, at the Nov 2015 meeting WMcM posed a question in relation to the pathway for patients with cancers of unknown primary (CUP) and whether the specialist nurse based within oncology may have a role for these patients in gynaecology? On further discussion the issue is particular to the diagnostic pathway for patients with abdominal CUP and implementation of NICE guidelines. A discussion is to take place with the specialist nurses for gynaecology and colonoscopy to progress this. Pathway of Care Options and Guidance for Clinicians DM provided a communication in regards of patient diagnosis and referral pathways and it was agreed that CT contact the Associate Medical Directors of the Surgery and Access directorates for this to be circulated to the appropriate clinical staff for information and action. It was suggested that it may be beneficial to have a Cancer microsite held on Staffnet in order to provide access to all cancer pathways etc. Concerns were raised as to how this would be managed and maintained and that cancer types and pathways were very broad. KF suggested that NOSCAN could possibly support this piece of work. CT agreed to discuss options further with KF and report back to the next meeting scheduled for 12 th May 2016. Robotic Service Business Case CT noted the draft business case which was circulated prior to the meeting. AWo advised that a meeting had been held with the Director of Acute Services and Medical Director Operational Unit in order to discuss and complete the business case. The Scottish Government had indicated that there may be a fourth robot commissioned within Scotland which could be used as a training robot within the University. KF suggested that as robotic surgery was relevant to the Regional Planning Group for the north boards that this be discussed with Jim Cannon as an additional robot in the North could impact on the planned number of patients to be treated at the existing robot centre in NHS Grampian. AWo agreed to contact Jim Cannon and provide an update at the next meeting scheduled for 12 th May 2016. 2 CT CT, KF AWo
It was agreed that the Group were supportive of the concept and would await the completed business case before full endorsement could be given. SABR Business Case WC highlighted that discussions had taken place at the previous meeting in regards to SABR within oncology. The work for this is currently underway; this is complex procedure but could reduce the number of treatments the patient would require to have. UM clarified that the necessary additional equipment required had already been received by the team and they are to familiarise themselves with the different scanning techniques and it was anticipated that this would take until the end of 2016. The Group were in agreement that due to the stage of implementation there was no requirement to provide a business case. WC agreed to discuss progress with PB and an update is to be provided to the Group in 12 months time. WC 4. CLINICAL REPORTS AND QPI S 4.1 COLORECTAL JR summarised the previously circulated report and the following was noted: The visit to Northern Ireland in December 2015 to review the follow up protocols used had been very useful and there is an opportunity to review follow up and release risk-stratified follow-up protocols within NHST which would benefit the patients and the organisation. JR, SLo and DC are to meet in order to identify the baseline data required to use as an evidence base. It was suggested that a culture change is required and it was essential for clinicians be invited to attend patient health and wellbeing events in order for patients to ask relevant questions and a way for clinical staff to see the positive outcome of the treatments/interventions used to treat their patients. AWo offered to discuss the issues within PRI with JR and Kerry Wilson AWo and JR to meet in order to identify timelines for follow up risk stratification development KF asked if the outcomes from the pilot study to increase participation in bowel screening could be shared over the north boards. JR, SLo, DC AWo, JR AWo, JR JR JR was thanked for the cancer site update and it was agreed that an update be provided to the Group in 6 months time. 4.2 UPPER GI SS summarised the previously circulated report and the following was noted: NHST refer the highest number of patients to the dietetics service than any other health board in Scotland. NHST are currently achieving 90% of the 100% standard and it was suggested that this may be due to data not being appropriately captured or that the patient passes away soon after diagnosis and prior to be seen by dietician. JB offered to discuss this further with the dietetics team to identify what the issues were. There are low volumes of complex surgery completed and a short life working group had been established by NOSCAN/NoSPG to try and identify a solution to this. KF advised that the Scottish Government may commission a review of the complex surgery numbers across Scotland. It is proposed that a Regional cancer resection service centre be set up for the north boards. This is currently on hold but it was agreed that the business case be completed by AWo and SS. JB AWo, SS SS was thanked for the cancer site update and it was agreed that an update be provided to the Group in 6 months time. 5. CANCER WAITING TIMES IMPROVEMENT PLAN It was highlighted that clarity was required in regards to the purpose and use of the Cancer Improvement Plan. Cancer waiting times and performance are reviewed on a regular basis from service level meetings, weekly conference calls with the Scottish Government and 3
submission of papers to SMT and SLT. The current plan was developed for a specific purpose and it was agreed that many improvements had been made since then. The plan was to be shared within the Waiting Times Group and Cancer Overview Group as part of the cancer performance governance structure and to share learning from cancer sites. After discussion it was agreed that the document was useful in order to support local and regional discussions. LS and SLo agreed to review this as part of the Waiting Times Group review which was being undertaken and provide an options paper for discussion at the next meeting scheduled on 12 th May 2016. LS, SLo 6. CANCER AUDIT DATA QUALITY IMPROVEMENT PLAN UPDATE SLo reported that over the last 18 months the Cancer Information Team had received positive feedback in regards to data quality. These improvements have been supported by the introduction of quarterly meetings with each cancer site. These meetings cover all aspects of data collection ie waiting times, QPI, MDT function and DCE if appropriate. In addition the clinical teams now had a greater understanding of the data and what was included within the QPI due to the ability to drill down to individual patient detail. SLo thanked all staff involved in the process for providing their support. The role of the Cancer Information Analyst had been funded from Cancer Modernisation monies and this funding was due to come to an end on 31 st March 2016. This role has supported understanding of the data information, improved the MDT sheets to support data collection and developed the mortality/survival dashboards. DC is to remain within the Business Unit to support other programmes of work and an element of this role would be to continue to provide support to the cancer sites. The training module for the cancer audit and information team was progressing. The modules required had been agreed but it was highlighted that this had been a slow and challenging process. SLo requested support from the clinical teams to deliver the training module to staff, but also asked for any additional information which could be accessed at local level ie training materials, training video s etc. SLo agreed to provide an update at the next meeting scheduled on 12 th May 2016. SLo It was agreed once NHST had developed and testing the training modules they would be shared at regional level. 7. MACMILLAN NURSE SPECIALIST RESOURCE CT advised that Macmillan specialist nurse resource had been raised by MIH for patients in the neuro surgery who had been diagnosed with low grade chronic tumours but still had complex needs and all patients who were in process of diagnosis. A role development framework has been established and discussions are ongoing in regards to sourcing funding for post. In addition specialist nurse resource had been raised at the previous meeting by the Skin team who have identified that they have only one specialist nurse who is due to retire later in the year and they suggest further resource required. With the retirement of the existing post holder there is an opportunity to review the current processes and identify how patients could be supported in alternative ways. Both these developments are being led by the Head of Nursing for Specialist Surgery and CT is involved. 8. TAYSIDE MDT TECHNICAL CHALLENGES Please refer to the IT update under agenda item 3. SLo advised that the NHS England MDT guidance had been circulated following the last meeting. It had agreed that a brief survey be collated for circulation to the clinical leads to get a benchmark for the current status of the MDT s to assist in identifying common themes and how these could be addressed. The survey questions have been drafted and require review prior to circulation. 4 SLo
9. TCAT UPDATE HD provided the Group with a brief progress update. Please refer to the embedded document below. Tayside_TCAT_Progr ess_up_to 31st_De This year the team plan to: Embed the holistic needs assessment and hope to get further staff engagement through health and well being events (bowel cancer, head and neck and prostate well being events) Progress patient treatment summaries JR advised that the phase 2 TCAT project on late effects pelvic radiotherapy was about to commence with the project lead taking up post later in the month. JR hopes to have patients referred to the service in order to provide holistic needs assessment and other procedures which may be required following treatment. It was noted that treatment summaries would assist and support patients in regard to what to expect whilst going through treatment, procedures which may be required and what may occur after treatment. As per agenda item 4.1, the team are to progress embedding the TCAT principles and complete the follow up risk stratification. Funding had been provided to NHST, NHS Grampian and NHS Highland to complete the risk stratification; if this funding is not used in the next 4-8 weeks NHST would not be able to request recurring funds next year. The priorities identified are as follows: NHS Grampian - Priority for change is the Colorectal pathway NHS Highland My cancer portal project JR asked the Group if they would be supportive of the TCAT project prioritising the Colorectal pathway changes within NHST? The Group agreed that there was a need to identify current practices and complete the risk stratification and endorsed this as a priority. JR advised that as part of the project there is an element of business analysis support required it was noted that due to the realignment of resource to organisational priorities and the current recruitment freeze it would be a challenge for the Business Unit to offer resource to support this. SLo requested that once further data was available in regards to what analysis would be required a review of Business Unit capacity could be undertaken. AWo suggested that JR discuss sharing the learning from the GI out-patients improvements with Jill Forbes and John Todd. JR, SLo JR 10. AOCB Move More CT advised that Simon Brady had been invited to attend the next meeting scheduled for 12 th May 2016 to give a brief presentation on Move More. NHS England Public Health Service SLo reported that the above visit took place the end of January 2016. The visit was very beneficial and it felt that there was potential for this in Scotland. Challenges were identified in regards to the technical interfaces and skill sets currently in place. A regional meeting is to be scheduled to identify what this would look like for the north of Scotland. Physical Activity Project HS advised that Mary Colvin Senior Health Improvement Practitioner has also been involved in the Physical Activity Project and had returned from the Scottish Government and HS agreed to invite her to attend the next meeting scheduled for 12 th May 2016. HS 5
11. For Information NOSCAN Update KF advised that the compliance with CEL Systemic Anti-Cancer Treatment (SACT) standards reviews had begun and 13 reviews were to be completed by the end of June 2016. Each review team comprises of an external team and there is a need to identify an oncologist to be involved in the reviews for the north of Scotland. SS and KF agreed to discuss this further out with the meeting. Regional Oncology Service Board GB and LF advised that the paper circulated prior to the meeting was due to be submitted to the NoSPG Executives Group, this would then be submitted to the board Chief Executives for review, any amendments would then be made and the paper would then be circulated for formal consultation. GB and LF asked that the Group review the document and comments are to be submitted to SS for collation and onward submission to Jim Cannon. It was agreed that this be discussed in more detail at the next meeting scheduled for 12 th May 2016. SS, KF ALL 12. DATE OF NEXT MEETING Thursday 12 th May 2016, 2pm-4pm in the Board Room, Level 10, Ninewells Thursday 14 th July 2016, 2pm-4pm in Room A, Improvement Academy, Level 5, Ninewells Thursday 15 th September 2016, 2pm-4pm in the Board Room, Level 10, Ninewells Thursday 17 th November 2016, 2pm-4pm in Room B, Improvement Academy, Level 5, Ninewells Cara Taylor 15 th March 2016 JOINT CHAIR DATE 6