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Improving experience for people with cancer in Croydon Presentation on the finding of the national cancer patient survey 2012-13 Claudia Tomlinson Jackie Green Tuck Kay Loke How cancer services are organised at CHS • CHS is part of the London Cancer Alliance . • Partnership with LCA, Macmillan Cancer Relief etc. • Cancer and Core Functions Directorate (CCF) • CAB, Macmillan Information Centre, Counselling & complimentary services Type Treatment Cancer Centre Breast Surgery Chemotherapy & Radiotherapy at RMH Colorectal Surgery Chemotherapy & Radiotherapy at RMH Dermatology Surgery Complex surgery requiring plastic at ST Georges Gynaecology Diagnostic & Low risk endometrial surgery Chemotherapy, radiotherapy and surgery at RMH Haematology Level II service Level III and Level IV at RMH Lung Diagnostics and Palliative Care and follow up for radiotherapy Chemotherapy at RMH and surgery at St Georges. Paediatrics POSCU Levl1 GOS and RMH Urology Surgery and Bladder chemotherapy Radiotherapy at RMH/Complex surgery at St Georges. Upper GI Diagnostics Surgery at RMH Executive Lead for Cancer COO Clinical Director for CCF Clinical Lead for Cancer Site Specific Clinical Leads General Manager Nurse Consultant/Lea d Cancer Nurse Cancer Manager Cancer Nursing Team Cancer Admin Team Background and context National Cancer Patient Experience Survey 2012/13 CHS • Annual survey undertaken by Quality Health • All patients 16 + who had received treatment for cancer during September – November 2012 are eligible • National number of patients included 116,525. Average national response rate was 64% . • CHS number of patients included 66 with a 68% (44 patients) response rate • Trusts are ranked in top 20% and lower 20% in all questions and the intermediate group 60% Survey methodology 2010/11 2011/12 2012/13 Sample month 01 Jan – 31 March 2010 01 Sept – 30 November 2011 01 Sept – 30 November 2012 Sample size (eligible patients) 199 81 66 Responses 103 50 44 Response rate 58% 66% 68% Changes since the survey began: Sampling month Sample size Reducing number of responses Response rate stable over two years Survey methodology - respondents Top 5 Tumour group respondents Tumour Group 2010/11 2011/12 2012/13 Breast 18 19 20 Colorectal/Lower GI 20 12 11 Haematological 19 10 6 Urological 22 Lung 6 5 Survey methodology sampling issues for CHS • Low numbers of eligible patients identified on PAS • Possible sampling issues due to difficulty in identifying cancer patients • Information services rely on clinical service to identify cancer patients by diagnosis Last 3 years results 2010 / 11 CHS in bottom 10 in the country x 35 fell in bottom 20% and 4 x in top 20% 2011/ 12 CHS no longer in the bottom 10 X 21 fell in bottom 20% and 19 in top % 2012/13 CHS in bottom 10 in the country x 38 fell in bottom 20% and 4 x in top 20% 1 of the 9 London Trusts in the bottom 10 Questions rated in top 20% (‘green’ rated) No Question Score 11 Patient told could bring a friend 81% 13 Patient completely understood what was wrong 81% 19 Patient told how treatment side effects could affect them in the future 62% 63 GP given enough information about patient's condition/treatment 100% Questions improved since last survey No. 6 11 13 16 20 28 44 47 48 49 55 63 64 Table 2: Summary of thirteen indicators showing improvement in 2012/13 Staff explanation purpose of tests Patient told could bring a friend Patient completely understood what was wrong Patient's views taken into account/treatment Patients involved in decisions about care and treatment Patient informed they could get free prescriptions Enough nurses on duty Staff asked patient name they preferred to be called by Privacy when discussing treatment/condition Privacy when examined/treated Family given information to help care at home GP given enough information about patient's condition/treatment Practice staff did everything they could to support patient CHS 2012/13 Score (%) 76% 81% 81% Highest Trust’s score 2012/13 93% 89% 85% 69% 76% 84% 85% 70% 37% 31% 83% 88% 89% 84% 96% 92% 58% 100% 100% 77% 100% 64% 82% Questions significantly worsened since last survey No Table 3: Specific indicators significantly worsened in 2012/13 2 CHS Score 2011/1 2 88% CHS Score 2012/13 90% 73% 62% 31% 87% 64% 96% 70% 89% 64% 68% Patient thought seen as soon as possible 4 Patient health the same/better while waiting 30 Discussing taking part in cancer research with patient 35 Staff explained how the operation had gone 67 Given the right amount of information about condition/treatment 70 Patient rating of care 'excellent/very good' Key Actions No Period Action Lead Deadline 1 S Disseminate survey results to all directorates and key forums in CHS Clinical Lead for Cancer & Lead Cancer Nurse December 2013 2 S Meet the CNS team posters CNS/Keyworker business cards Lead Cancer Nurse December 2013 3 S December 2013 4 S Root Cause Analysis exercise to Lead Cancer Nurse be conducted using the 5 Whys & General Manager technique All patients with cancer have Lead Cancer Nurse access to a CNS/ key worker and Holistic Needs Assessment business case developed to facilitate 5 S Deliver a listening event with stakeholders January 2014 Clinical Lead for Cancer & Lead Cancer Nurse December 2013 Key Actions No Period Action Lead Deadline 6 M Providing financial advice Continuation General Manager of partnership working with Croydon and Lead Cancer CAB service funded for 1 more year. Nurse Requires sustainability plan and pick up funding from October 2014 June 2014 7 M Responding to patient feedback (including real time) Clinical Lead for Cancer & Lead Cancer Nurse April 2014 8 L Work with Macmillan and the London Cancer Alliance pathway groups in improving the patient experience Clinical Lead for September Cancer Lead 2014 Cancer Nurse & Cancer Manager 9 L Taking Patients views into account – implementing action from the listening event 10 L To review expanding the cancer and palliative care nursing service Clinical Lead for Cancer Lead Cancer Nurse & Cancer Manager Lead Cancer Nurse September 2014 September 2014 Summary • Picture of findings of cancer patient experience for past three years presented, showing fluctuating performance • Methodological issues discussed including identification and sampling of patients • Although an overall worsening since last survey, there is evidence of good performance in many areas • Improvement actions will focus on: Listening to patients and stakeholders Sharing and learning from the results Promote a multidisciplinary response