Download 6.1 Cancer Services

Highland NHS Board
3 April 2007
Item 6.1
CANCER WAITING TIMES UPDATE
Christine McIntosh, Cancer Network Manager
The Board is asked to:

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Note the update on progress against the action plan.
Background and Summary
The most recent ISD data set (July to September 2006) has shown that NHS
Highland has more work to do in some specialties in order to ensure a maximum wait
of 62 days for treatment for patients that have been referred urgently by a General
Practitioner.
Following the SEHD Cancer Performance Support Team diagnostic visit in December
2006 good progress has been made against the agreed actions which are having a
beneficial impact on current wait times.
As a key priority for NHS Highland, the improvement work related to Cancer Waiting
Times remains highly focused on specific problem areas, engaging managers and
clinicians and support staff at all levels. A rigorous action-oriented approach is at the
center of the improvements achieved.
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Cancer Performance Support Team Action Plan
The weekly support visit by the Cancer Performance Support Team (CPST)
continues, with actions and progress against the CPST high-level Action Plan closely
monitored. Progress against the action plan is attached for information (Appendix 1).
2.1
Breach reviews
Further development of the Cancer Tracking tool has allowed Patient Targeted lists
(PTLs) to be issued to all specialties every week. The lists now are now compiled
weekly for any patient who has been on the tool for 30 days to ensure that an early
diagnosis is made. This allows either de-selection of the patient from the tool, where
they do not have a cancer diagnosis, or an opportunity to expedite treatment with 62
days.
The review of PTLs in all key locations are now well established with detailed
feedback every Tuesday morning, in order to populate the weekly 12.00hrs
submission of performance against the 62-day cancer waiting times target. Senior
Managers remain accountable for the delivery of this target and are fully engaged in
both the scrutiny of the PTLs and action when any problems are escalated for their
attention.
Working with you to make Highland the healthy place to be
This attention to detail, and engagement with clinical teams, has resulted in
improvements in the wait times for some patients, with treatment plans being brought
forwards whenever possible.
The look-back of case studies for breach cases continues and is informing the clinical
pathways in development. Major delay themes identified have been within the
Radiotherapy and Urology pathways with improvement action prioritized in both
areas.
2.2
Monitoring performance
The use of a four week rolling average of compliance with the target and coverage of
expected cancers give a proxy measure of progress towards achievement of the
target, and give a direct comparison against the comparable Scottish average
performance. Graphs with the most up to date position will be provided to the Board.
Coverage is a measure of the number of cancers that have been treated in the last
seven days, within and outside 62 days compared with the number of cancers it is
expected should have been treated in the same period. Compliance shows the
relationship between the number of cancers treated within 62 days against the total
number of cancers treated in the same seven day period. For both proxy measures
the small numbers require an average over a four week period to become
meaningful.
The Board should note that there has not yet been an opportunity to compare the
national validated ISD data with the weekly information to understand the relationship
between the two sets of data. This will still not be possible with the quarter 4 data
(October to December 2006) and, as the intensive input only commenced in January
2007, board members should anticipate limited demonstrable improvement in the
next published data set.
It is expected, however, that Boards that are now showing a high percentage
coverage, and that successfully maintain compliance, should see an improved
performance against the national target when the validated ISD data is released for
the January to March quarter 1 for this year.
2.3
Clinical Pathways
There has been further development of detail in the Clinical Pathways which
formalise timely inter-hospital moves, led by Lead Clinicians in local areas. In
addition pathways from other Board areas are under consideration for adaptation
locally by clinical teams.
Following a recent letter to GPs advocating the use of the new referral guidance for
cancer, further work has been identified with lead clinicians from all areas invited to
participate.
2.4
Oncology Review
Significant attention and support has been given to the Oncology department to assist
in relieving pressures in the system and on the clinical teams, which have had an
impact on waiting times.
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Radiotherapy waiting times have been given the highest priority, with the
Radiotherapy Waiting Times Group moving to weekly action meetings. Extra capacity
for treatment will be met through the funding of further posts from the new Linear
Accelerator Business case.
A draft paper is now awaiting comment on the development of NHS Highland
minimum standards for Chemotherapy Services which will support the safe
development of practice.
The job outline and description has now been agreed for the Directorate Manager for
the new Cancer Directorate within the Specialist Services Unit with recruitment to be
expedited.
2.5
Breast Review Visit
The final report following the Breast Review visit is pending, and will reflect activity
and recommendations relating to the delivery of Breast care across all patient
pathways at Raigmore, Caithness General and Belford Hospitals.
2.6
Theatre Capacity
The Highland service planning team continue to support the capacity-planning for
Theatres to model the extra capacity required to meet the cancer agenda. Currently
additional weekly session is being made available in main theatre suite while trialing
use of A & E room with an extension planned for the visiting Vanguard mobile theatre
unit.
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Governance Implications
The Cancer Steering Group continues to meet under the Chairmanship of Leo
McClymont. In addition, a Cancer Waiting Times management meeting to discuss
progress against the action plans is now led by the Chief Operating Officer.
Regular update reports on progress are provided to the DHS Management Team,
Corporate Team and Fair to All Group which provide additional governance and
ensure direction of priority actions.
It has been agreed that the next Clinical Governance committee will receive a trend
report of the patients that have breached 62 days.
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Financial Implications
Priority has been given to bring forward posts from linear Accelerator business case
which will support extra capacity in Radiotherapy. There is also an anticipated need
for further support to the medical staffing of the Oncology Department which is
currently been assessed.
There are also likely to be financial implications from the Breast Review in order to
provide increased capacity for one-stop clinics. This will be evaluated in more detail
when the review is formally received by NHS Highland.
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Summary
With the practice of review of Patient Targeted Lists firmly established, the priority
focus now is to ensure early first out-patient appointment, rapid diagnostic tests to aid
diagnosis within 30 days, and the achievement of the necessary increase in capacity
in radiotherapy and theatres.
Whilst there may be early signs of improvement in some areas, there is much work
still to be undertaken which requires strong clinical and managerial leadership in
order to reduce the wait times for all patients who have, or think that they may have
cancer to within 62 days.
Christine McIntosh
Cancer Network Manager
Elaine Mead
Chief Operating Officer
23 March 2007
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