Download Going Further on Cancer Waits – Background

Going Further on Cancer Waits – Q&A
What was the performance against the previous standards?
The previous standards proved successful to thousands of patients suffering with
specific cancers:
 99% of patients are seen within 2 weeks from urgent GP referral to outpatient
appointment;
 99% of patients are treated within 1 month from diagnosis to treatment for
breast cancer;
 99% of patients are treated within 2 months from urgent GP referral to
treatment for breast cancer;
 99% of patients are treated within 1 month from diagnosis to treatment for all
cancers.
 97% of patients are treated within 2 months from urgent GP referral to
treatment for all cancers.
What has changed?
The Cancer Reform Strategy, published in December 2007, observed that the
existing standards did not apply to all cancer patients or treatments. Therefore,
following the successes above, new standards have been implemented to allow all
cancer patients to be monitored. This will provide faster diagnosis and treatment for
many more patients presenting with cancer related signs and symptoms, including:
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the two week wait standard, so that it benefits any patient referred with breast
symptoms, who will be seen within two weeks, whether cancer is suspected
or not;
o to be implemented from the end of 2009;
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the 31 day standard, so that it covers subsequent treatments for all cancer
patients, including those diagnosed with a recurrence;
o implemented from the end of 2008 for surgery and chemotherapy, and
from the end of 2010 for radiotherapy and other treatments;
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the 62 day standard, so that it includes patients:
 referred from NHS cancer screening programmes (breast, cervical and
bowel), or,
 whose consultant considers cancer a possible diagnosis;
o implemented from the end of 2008.
Will removing these adjustments impact on recorded performance?
In improving compatibility with the 18-weeks system, the new cancer waiting times
data collection will produce slightly different performance figures for the existing
standards. Currently:
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performance against the existing 14 day standard (for urgent referral to a
specialist) is 99+%, against a threshold of 98% - we expect performance to
move to approximately 93%
performance against the existing 31 day standard (from diagnosis to
treatment) is 99+%, against a threshold of 98% - we expect performance to
move to approximately 98%
performance against the existing 62 day standard (from referral to treatment)
is 97+% against a threshold of 95% - we expect performance to move to
approximately 86%.
It is important to note that to the casual observer, the introduction of these new
standards may appear to have a negative effect on the overall performance of cancer
care. The reality is that there is no reduction in care or treatment; it is this statistical
change in measurement parameters that creates the impression of a reduction of
service provision.
How were these standards developed?
Working with stakeholders, the DH has developed a new dataset to support the
implementation of these new standards within the NHS. This is a simpler, more
transparent version of the existing dataset – and will cover three to four times the
amount of treatment activity.
DH consulted and collaborated extensively with a wide variety of stakeholders
(SHAs, cancer networks, clinical leads, cancer service managers, data experts and
software suppliers) to align the cancer waiting times measurement system with the
one used for the 18-week standard.
The new dataset was finalised last summer, and then approved by the Information
Standards Board for Health and Social Care (ISB HaSC) for use within the NHS.
When did the new dataset come into use?
Local monitoring systems began on January 1, 2009.
How is the new dataset different?
It is compatible with the existing processes used for the 18 week standard.
Adjustments, mainly for medical suspension and patient deferral have also been
removed.
What adjustments were previously used?
There were three points along the cancer care pathway (outpatient waits, diagnostic
waits and treatment waits) where adjustments can be made to take account of:
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Did Not Attends (DNAs);
Patient Cancellations;
Deferrals of Admission;
Medical Suspensions;
Social Suspensions; and,
Patient Choice.
In effect, these adjustments are clock pauses i.e. periods of time that can be
removed from the calculation of how long a patient waited. This enables us to
measure the time spent waiting unnecessarily for treatment, by taking out the
suspensions etc. that account for complex clinical pathways, co-morbidities, and
patient choice.
Why make these changes?
This is an improved way of recording and reporting performance. It is:
 more transparent;
 easier to explain to patients;
 reduces the burden on the NHS of data collection;
 allows for readier comparisons of performance;
 explicitly acknowledges the need to allow for patent choice and case
complexity.
What is the new performance standard?
The standard remains that, as previously, 100% of cancer patients who are willing
and able to do so, and for whom it is clinically appropriate, will be treated within the
timescales set out in the Cancer Reform Strategy.
What about patient choice and medical fitness?
We know not all patients want to be treated this quickly – a significant proportion of
them want time to think about their treatment and the life-changing consequences
that it might have. Others may have to take time out to recover between courses of
treatment, and for them it would not be clinically appropriate to treat them so quickly.
As previously, we will allow for patient choice, the co-morbidities that make cancer
patients unable to access faster treatments, and the complexity of some care
pathways. The key change therefore is in the accounting methodology; we will
change from a system of retrospective adjustment, which is time-consuming and
difficult to explain to either clinicians or patients, to one that allows for these other
factors in setting the thresholds.
What is the process for setting the operational threshold?
DH will set the threshold for the operational standards following consultation with the
Healthcare Commission. The HCC will set the achievement threshold for the Annual
Health Check. We expect these to be set at a similar level.
Will you set different thresholds for different tumours?
No, but we will work with national clinical leads to identify what is realistic for each
tumour area before setting the national operational standard.
What does this mean for treatment providers?
The NHS should focus on measuring and improving cancer waiting performance
against the new standards wherever possible. The application of new clock rules to
the current standards is likely to mean a reduction in reported performance of some
10 or 11 percentage points on the 62 day standard. Trusts below the average
performance should look at their own data and tracking systems in order to identify
areas for improvement.
What about pathways that start before 1 January 2009?
Data uploaded for activity up to the end of December will need to abide by the
previous data set. Data for patients seen or treated on/after 1 January will follow the
new data set rules. Any necessary modification for pathways started before 1
January will be carried out centrally when the data is uploaded. Treatment providers
therefore:
 do not have to amend “old” (i.e. pre-1 January 09) data themselves as this will
be done centrally;
 do not have to ‘double run’ the two systems side by side.
What are the implications for services?
The change in reporting methodology has very little impact on the 31 day standard,
but does have a more significant impact on the 62 day standard. The impact on the
62 day standard also varies between tumour types – with relatively minimal impacts
being observed for breast and skin cancers and much larger ones in lower
gastrointestinal cancer, sarcoma and head and neck cancers. However, this does
mean that if current performance is maintained, the standard will be met, at the level
of the new, revalued operational standard. There should therefore be no pressure on
providers to treat patients before it is clinically appropriate to do so, or before they
are ready to agree.
It is important to emphasise this point as feedback from clinicians throughout the
policy development process has consistently highlighted a key concern on their part
that the reporting of performance data might put pressure on them to change their
clinical practice. The care pathways for patients with different tumour types can be
very different and whatever national operational standard is set this will be for
performance as a whole i.e. all tumours taken together. It not expected that all
tumour groups would meet that level of performance.