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Highland NHS Board 3 April 2007 Item 6.1 CANCER WAITING TIMES UPDATE Christine McIntosh, Cancer Network Manager The Board is asked to: 1 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. 2 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. 2 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. 3 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. 4 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. 3 5 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 4