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System wide approach to improving Cancer Waiting Times performance The London Cancer Alliance West and South London Cancer Alliance • One of 2 Integrated Cancer Systems established within London in 2011 • Covered North West and South London, covering 5.7m local population • Separate commissioning support function provided by Transforming Cancer Services for London • Focus of LCA has been pathway improvement rather than performance management of trusts The London Cancer Alliance West and South London Cancer Alliance • Work focused through 12 tumour specific & several cross cutting pathway groups • Additionally work through clinical board, and members board, whose membership consisted of the 14 CEOs of the member organisations. • LCA transitioned into RM Partners part of the National Cancer Vanguard on the 1st April 2016. Plan now is for informatics including Cancer Waits analysis to be panLondon +/- Manchester The London Cancer Alliance West and South Approach to improving Cancer Waiting Times performance • Tumour specific analysis and improvement • Analysis and focus on quarterly performance – To ensure case volumes are high enough to be significant – To make best use of analytical resource The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance Overview of performance - Cancer Waiting Times Overview of all targets since 2008/09 - LCA • 7/8 standards generally met across LCA • 62 day urgent GP referral to 1st treatment standard has not been achieved for 3 years The London Cancer Alliance Cancer Waiting Times - Comparison to England The London Cancer Alliance West and South Trend in 2 week wait and 62 day volumes 2 week wait urgent GP referral to 1st seen Tumour type Brain/CNS Breast Children’s Gynaecology Haematology Head and Neck Lower GI Lung Other Sarcoma Skin Upper GI Urology Total 2014/15 1115 28714 720 15189 1996 12812 20237 5499 613 400 27476 14159 16079 145009 2013/14 941 25511 600 12494 1664 11436 17429 4692 365 379 22572 11247 13907 123237 % Change from 2013/14 to 2014/15 18% 13% 20% 22% 20% 12% 16% 17% 68% 6% 22% 26% 16% 18% 62 day urgent GP referral to 1st treatment Tumour type Brain/CNS Breast Children’s Gynaecology Haematology Head and Neck Lower GI Lung Other Sarcoma Skin Upper GI Urology Total 2014/15 12 1879 2 670 573.5 483 952 881 96 93 1446.5 628.5 2456.5 10173 % Change from 2013/14 to 2013/14 2014/15 11.5 4% 1769 6% 5.5 -64% 656.5 2% 485.5 18% 424 14% 823.5 16% 890.5 -1% 97 -1% 91 2% 1254 15% 587.5 7% 2353.5 4% 9449 8% • Overall 2 week wait referrals increased by 18% and 62 day cases treated increased by 8% from 2013/14 to 2014/15 • Further increases expected with revised NICE guidance introduced in summer 2015 The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance West and South Tumour specific scorecards • Tumour specific metrics developed including tumour specific Cancer Waiting Times performance and analysis • Additional sections (with examples) • Data quality – COSD, SACT dataset, National audits • Patient experience – NCPES • Prevention/early diagnosis – Screening, routes to diagnosis • Diagnosis - 6 week diagnosis waits, stage distribution • Treatment – Laparoscopic rates, emergency re-admissions • Incidence/Mortality/Survival • Cancer Research – Recruitment to trials Lung pathway group metrics Last updated November 2015 Log of updates 1. Cancer Waiting Times 3. Patient experience 5. Diagnosis 1.2. 31 day decision to treat to 1st treatment 3.1 NCPES – Q12 - Patient felt they were told sensitively they had cancer 5.4 – Stage at diagnosis 5.4.1 By CCG (from NCRS data) 5.4.2 By provider (LUCADA) 1.3. 31 day subsequent surgery 3.2 NCPES Q21 – Patient given name of the CNS in charge 5.5. – CT before 2 week wait OPA 1.4. 31 day subsequent drugs 3.3 NCPES Q22 – Patient finds it easy to contact CNS 1.5. 31 day subsequent radiotherapy 3.4 NCPES – Q30 – Cancer Research discussed with patient 1.1. 2 week wait GP urgent referral to 1st seen 1.6. 62 day GP urgent referral to 1st treatment 1.7 62 day consultant upgrade to 1st treatment 1.8 62 day GP urgent referral to – distribution of week treated 1st treatment 2. Data collection /Numbers 2.1. COSD MDT feed data quality (Level 2) 2.1.1 Staging 2.1.2 Basis of diagnosis 2.1.3 Performance status 2.1.4 CNS indicator 3.5 NCPES – Q38 – Patient had confidence in doctors treatment patient 3.6 – NCPES Q44 – Enough/nearly enough ward nurses on duty 3.7 NCPES Q53 – Patient given clear written information about what should/should not do post discharge 3.8 NCPES Q67 - Patient given right amount of information about condition and treatment 3.9 NCPES Q70 – Patient’s rating of care ‘very good’/’excellent’ 2.2 COSD completeness all feeds combined (Level 3) 2.2.1 Staging 2.2.2 Basis of diagnosis 2.2.3 Performance status 2.2.4 CNS indicator 2.2.5 Discussed at MDT 4.1 % emergency presentation 2.3 SACT data completeness 5.1 Patients receiving CT scan prior to bronchoscopy (LUCADA) 2.4 LUCADA data quality 5.2 Histological diagnosis (LUCADA) 4. Prevention/Early diagnosis 5. Diagnosis 5.3 CNS involvement in the pathway Collated by Stephen Scott [email protected] In strictest confidence – For NHS internal use only 5.6 – Proportion of NSCLC with a PET scan by stage 5.7 Performance status at diagnosis (LUCADA) 6. Treatment 6.1 SACT top 10 regimens 6.1.1 Overall England – NSCLC 6.1.2 By Trust – NSCLC 6.1.3 Overall England – SCLC 6.1.4 – By Trust – SCLC 6.1.5 – Overall England – Mesothelioma 6.1.6 – By Trust – Mesothelioma 6.2 – SACT chemotherapy mortality 6.2.1 – All lung cancers – All treatment intents 6.2.2 – All lung cancers – Curative intent 6.2.3 – All lung cancer – Palliative intent 6.2.4 – Mesothelioma – All treatment intents 6.2.5 – Mesothelioma – Palliative intent 6.2.6 – SCLC – All treatment intent s 6.2.7 – SCLC – Curative intent 6.2.8 - SCLC – Palliative intent 6.2.9 – NSCLC – All treatment intents 6.2.10 – NSCLC – Curative intent 6.2.11 – NSCLC – Palliative intent 6.3 Lung cancer resection rates 6.3.1 – Resection rates (NCRS) by CCG 6.3.2 – NSCLC (LUCADA) by provider 6.4 Chemotherapy rates 6.4.1 – SCLC chemotherapy rates (LUCADA) 6.4.2 - Stage 3b and 4 NSCLC rates with performance status 0 or 1 (LUCADA) 6. Treatment 6.5 AHP access (NCPES) 6.5.1 - Physiotherapist 6.5.2 - Occupational Therapist 6.5.3 – Dietician 6.6– HNA/Recovery package 6.6.1 HNA At Diagnosis 6.6.2 HNA At End of Treatment 6.6.3 End of treatment summary 6.6.4 Health and Wellbeing event 6.7 – Numbers of surgical procedures by provider 7. Incidence/mortality/survival 7.1 – Incidence rates Trachea, Bronchus and Lung (C33-34) Mesothelioma (C45) 7.2 - Mortality rates Trachea. Bronchus and Lung (C33-34) Mesothelioma (C45) 7.3 – Population Survival rates - Trachea, Bronchus and Lung (C33-34) - 1 year survival by cancer network - 1 year survival by age group 7.4 – Provider level survival rates (LUCADA) 7.4.1 - Median Survival of patients 7.4.2 - 3 month survival 7.4. 3 - 1 year survival 7.5 – Number of cases 7.6 Number of deaths 7.7 – Prevalence rates Male Female 8. Cancer research 8.1 – Details of NCRN badged trials 11 The London Cancer Alliance West and South Trust scorecard • Tailored trust specific quarterly scorecard produced & circulated via LCA members board (i.e direct to Trust CEOs) • Includes 12 key cancer measures including:• 2 week wait urgent GP to 1st seen standard • 62 day urgent GP referral to treatment standard • Comparable position for each measure including ranking within LCA • Trust specific breakdown of performance by tumour type included • Brief commentary included for all measures Cancer Scorecard Example NHS Foundation Trust Area Measure Operational Effectiveness Clinical Outcomes Benchmark Period Trust value Previous period reported Change since last last period report England average LCA average LCA ranking 1. 2 week wait: Urgent suspected cancer GP referral to 1st seen 93% Q3 2015/16 88.2% Q2 2015/16 +10.4% 94.8% 94.6% 18/18 2. 62 day: Urgent suspected cancer GP referral to 1st treatment (DH position) 85% Q3 2015/16 85.9% Q2 2015/16 +3.1% 83.4% 83.1% 9/18 57.8% 2/15 3. 1 year survival by trust Awaiting data to be made available from National Cancer Registration Service 4. 30 day mortality after chemotherapy Data Quality 2013 10.7% N/A 5. COSD – MDT feed - % of cases with full stage 70% 2015 74.3% 2014 -12% 6a.SACT – Data completeness – Treatment intent 70% 2015 100% 2014 0% 91.9% 88% 4/13 6b – SACT – Data completeness – Performance status 70% 2015 96% 2014 +6% 60.3% 74% 3/13 7. NCPES 2013/14 – Q21 – Patient given name of CNS in charge of care 80% 2013/14 89% 2012/13 +3% 89% 89% 5/16 8. NCPES 2013/14 - Q38 – Patient had confidence and trust in all doctors treating them 80% 2013/14 88% 2012/13 +5% 85% 85% 3/16 9. Holistic Needs Assessment (Completed) - Within 31 days of diagnosis 60% Q2 2015/16 50% Q1 2015/16 48% 6/15 10. Risk stratified pathways implemented –Breast/Colorectal/Prostate (number of services implemented) All June 2014 3/3 N/A Research 11. NCPES 2013/14 – Q30 – Taking part in cancer research discussed with patients 30% 2013/14 37% 2012/13 -3% 41% 5/16 Workforce 12. COSD – MDT feed – % of cases seeing a CNS 70% 2015 7% 2014 -2% 40.8% 12/15 Patient Experience -8% 31% 1. Two week wait urgent GP referral to 1st seen – Tumour breakdown Example NHS Foundation Trust 2 week wait performance by Tumour Type Q3 2015/16 Q2 2015/16 Q1 2015/16 2014/15 overall Number Breaches Q3 2015/16 Change from last quarter Other 1 0 100.0% 100.0% 0.0% 100.0% 75.0% Sarcoma 1 0 100.0% 100.0% 0.0% 0.0% 50.0% Childrens 11 0 100.0% 20.0% 80.0% 100.0% 98.5% Lung 98 3 96.9% 5.8% 91.1% 98.1% 96.8% Urology 412 14 96.6% -0.6% 97.2% 96.2% 94.3% Lower GI 358 17 95.3% 4.4% 90.9% 92.4% 96.8% Haematology 61 4 93.4% 10.1% 83.3% 98.5% 98.6% Breast 709 48 93.2% 5.9% 87.3% 88.8% 96.0% Head and Neck 366 29 92.1% 6.3% 85.8% 96.8% 98.2% Brain/CNS 23 2 91.3% -0.4% 91.7% 100.0% 100.0% Upper GI 366 49 86.6% 13.7% 72.9% 91.3% 95.7% Skin 660 138 79.1% 22.6% 56.5% 93.6% 94.6% Gynaecology 282 90 68.1% 13.1% 55.0% 81.5% 97.7% Trust overall 3348 394 88.2% 10.4% 77.9% 92.4% 95.9% Collated by Stephen Scott [email protected] In strictest confidence – For NHS internal use only 14 1. Two week wait urgent GP referral to 1st seen – Tumour breakdown Example NHS Foundation Trust 62 day performance performance by Tumour Type Q3 2015/16 Number Brain/CNS 0.5 Breast 35.5 Skin 18 Urology 70 Lower GI 17 Upper GI 12 Head and Neck 13 Haematology 8.5 Lung 13 Gynaecology 14 Trust overall 201.5 Change Q3 from last Q2 Q1 2014/15 Breaches 2015/16 quarter 2015/16 2015/16 overall 0 100.0% 0.0% 100.0% 0% 100.0% 0 100.0% 13.2% 86.8% 97.0% 94.4% 1.5 91.7% 3.9% 87.7% 93.1% 92.2% 6.5 90.7% 11.0% 79.7% 71.7% 80.9% 2.5 85.3% -4.7% 90.0% 62.5% 82.1% 2.5 79.2% -2.7% 81.8% 76.2% 79.5% 3.5 73.1% -1.3% 74.4% 77.8% 78.8% 2.5 70.6% -23.4% 93.9% 100.0% 92.0% 4 69.2% -10.8% 80.0% 57.5% 78.4% 5.5 60.7% -7.3% 68.0% 85.7% 80.2% 28.5 85.9% 3.1% 82.7% 80.0% 84.9% Collated by Stephen Scott [email protected] In strictest confidence – For NHS internal use only 15 The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance West and South Measure beyond CWT standards Surgery to radiotherapy (H&N cancer) • Guidance states that radiotherapy should commence 6 weeks after surgery for head and neck cancer • LCA Head and Neck pathway group set a standard of 80% to allow for patients where clinically not possible or patient choice factors • Measure could be influenced by many factors • Surgical complications (e.g wound infection) • MDT wait • Referral between surgeon & oncologist • Radiotherapy planning • Radiotherapy wait The London Cancer Alliance West and South Measure beyond CWT standards Surgery to radiotherapy (H&N cancer) • Methodology to measure • Extracted patients who had surgery between 1st April 2014 and 30th September • Next 6 months of CWT dataset searched for each patient to see if chemo/radiotherapy or radiotherapy received and if so time lapse from surgery. The London Cancer Alliance West and South Measure beyond CWT standards Surgery to radiotherapy (H&N cancer) - Results Trust of subsequent chemo-radiotherapy or radiotherapy % of patients chemo-rad or radiotherapy within 6 weeks of surgery (80% target) Weeks and days after surgery that 80% of patients treated Imperial College Healthcare NHS Trust Imperial College Healthcare NHS Trust 67% (4/6 patients) 7 weeks, 3 days Guy’s and St Thomas’ NHS Foundation Trust Guy’s and St Thomas’ NHS Foundation Trust 57% (13/23 patients) 8 weeks, 0 days St George’s University Hospital NHS Foundation Trust The Royal Marsden NHS Foundation Trust 43% (3/7 patients) 8 weeks, 1 day London North West Hospital NHS Trust East and North Hertfordshire NHS Trust 14% (3/22 patients) 9 weeks, 6 days LCA (all trusts) LCA (all trusts) 37% (25/67 patients) 8 weeks, 3 days Trust of 1st surgery Routes to diagnosis Overview • Routes to diagnosis work produced by National Cancer Intelligence Network (NCIN) within PHE. • Looks at Cancer Waiting Times (CWT) Dataset, Screening dataset and Hospital Episode Statistics (HES) to identify presentation route for new cancers. • National reports produced published on NCIN website http://www.ncin.org.uk • PHE have also produced a London version for use within London 20 Routes to diagnosis Route distribution 2006-2013 21 The London Cancer Alliance West and South Survival by route of diagnosis – 3 years 19 tumour types Breast Cancer (Male) Head and Neck – Hypopharynx Head and Neck – Larynx Head and Neck – Oropharynx Hear, mediastrium and pleura A. Tumour types were 2 week wait referrals have better 3 year survival than other GP referrals Non- Hodgkin Lymphoma Kidney Other and unspecified urinary Leukaemia – Acute lymphoblastric B. Tumour types were 2 week wait referrals have similar 3 year survival than other GP referrals C. Tumour types where 2 week wait referrals have worst 3 year survival than other GP referrals Leukaemia – Acute myeloid Leukaemia – Chronic Lymphocytic Other heamatology malignancies Biliary tract cancer Multiple Myeloma Nasal Cavity and Middle Ear Penile Sarcoma (Bone) Uterus Vagina The London Cancer Alliance West and South Survival by route of diagnosis – 3 years 19 tumour types Breast Cancer (Male) Head and Neck – Hypopharynx Head and Neck – Larynx Head and Neck – Oropharynx Hear, mediastrium and pleura A. Tumour types were 2 week wait referrals have better 3 year survival than other GP referrals Non- Hodgkin Lymphoma Kidney Other and unspecified urinary Leukaemia – Acute lymphoblastric Leukaemia – Acute myeloid B. Tumour types were 2 week wait referrals have similar 3 year survival than other GP referrals Leukaemia – Chronic Lymphocytic Other heamatology malignancies Biliary tract cancer Multiple Myeloma Nasal Cavity and Middle Ear Penile Sarcoma (Bone) Uterus Vagina C. Tumour types where 2 week wait referrals have worst 3 year survival than other GP referrals The London Cancer Alliance West and South Survival by route of diagnosis – 3 years 23 tumour groups Anus Brain Meninges Cervix Gall Bladder A. Tumour types were 2 week wait referrals have better 3 year survival than other GP referrals Head and Neck – Nasopharynx Head and Neck – Oral Cavity Head and Neck Palate Head and Neck – Salivary glands Head and Neck - Thyroid B. Tumour types were 2 week wait referrals have similar 3 year survival than other GP referrals Head and Neck - Non specific Liver (exc intrahepatic bile duct) Lung Mesothelioma Oesophagus Other malignant neoplasms Ovarian Pancreas Prostate Sarcoma (Connective and soft tissue) Small intesting Stomach Vulva C. Tumour types where 2 week wait referrals have worst 3 year survival than other GP referrals The London Cancer Alliance West and South Survival by route of diagnosis – 3 years 23 tumour groups Anus Brain Meninges Cervix Gall Bladder A. Tumour types were 2 week wait referrals have better 3 year survival than other GP referrals Head and Neck – Nasopharynx Head and Neck – Oral Cavity Head and Neck Palate Head and Neck – Salivary glands Head and Neck - Thyroid B. Tumour types were 2 week wait referrals have similar 3 year survival than other GP referrals Head and Neck - Non specific Liver (exc intrahepatic bile duct) Lung Mesothelioma Oesophagus Other malignant neoplasms Ovarian Pancreas Prostate Sarcoma (Connective and soft tissue) Small intesting Stomach Vulva C. Tumour types where 2 week wait referrals have worst 3 year survival than other GP referrals The London Cancer Alliance West and South Survival by route of diagnosis – 3 years 8 tumour groups Bladder Breast Cancer (female) Unknown primary Colorectal Hodgkin Lymphoma A. Tumour types were 2 week wait referrals have better 3 year survival than other GP referrals Leukaemia – Chronic Myeloid Melanoma Testicular B. Tumour types were 2 week wait referrals have similar 3 year survival than other GP referrals C. Tumour types where 2 week wait referrals have worst 3 year survival than other GP referrals The London Cancer Alliance West and South Survival by route of diagnosis GP survival better (23 tumour groups) Survival the same for 2 week and routine referrals (19 tumour types) Survival better for 2 week wait patients ( 8 tumour groups) Anus Breast Cancer (Male) Bladder Brain Head and Neck – Hypopharynx Breast Cancer (female) Meninges Head and Neck – Larynx Unknown primary Cervix Head and Neck – Oropharynx Colorectal Gall Bladder Hear, mediastrium and pleura Hodgkin Lymphoma Head and Neck – Nasopharynx Non- Hodgkin Lymphoma Leukaemia – Chronic Myeloid Head and Neck – Oral Cavity Kidney Melanoma Head and Neck Palate Other and unspecified urinary Testicular Head and Neck – Salivary glands Leukaemia – Acute lymphoblastric Head and Neck - Thyroid Leukaemia – Acute myeloid Head and Neck - Non specific Leukaemia – Chronic Lymphocytic Liver (exc intrahepatic bile duct) Other heamatology malignancies Lung Biliary tract cancer Mesothelioma Multiple Myeloma Oesophagus Nasal Cavity and Middle Ear Other malignant neoplasms Penile Ovarian Sarcoma (Bone) Pancreas Uterus Prostate Vagina Sarcoma (Connective and soft tissue) Small intesting Stomach Vulva The London Cancer Alliance West and South Survival by route of diagnosis – colorectal example The London Cancer Alliance West and South Survival by route of diagnosis – colorectal example The London Cancer Alliance West and South Survival by route of diagnosis –prostate example The London Cancer Alliance West and South Survival by route of diagnosis –prostate example The London Cancer Alliance West and South Routes to diagnosis • Important to remember not all cancer patients present via 2 week wait and many will be on the 18 week pathway • Being referred via a 2 week wait does not necessary mean you have a better prognosis • Where worse survival seen for 2 week wait referrals this could be due to differences in stage distribution so further analysis is required at tumour level The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance West and South Radiotherapy guidance 2013/14 distribution of 1st treatment where teletherapy treatments by radiotherapy centre The London Cancer Alliance West and South Radiotherapy guidance 2013/14 distribution of subsequent teletherapy treatments by radiotherapy centre The London Cancer Alliance West and South Radiotherapy guidance • Discussion with LCA radiotherapy pathway group identified that the main difference was actually in data recording rather than difference in waits for radiotherapy • Differences in application of start data radiotherapy (E.g CT planning scan) • Differences in recording of ECAD • Reviewing national guidance identified there were some areas open to interpretation • Guidance produced by pathway group in collaboration with commissioners and IST to ensure consistent approach to recording across LCA • Published on LCA website http://www.londoncanceralliance.nhs.uk/media/124400/lca-radiotherapy-cwtpolicyfinal.pdf The London Cancer Alliance West and South Active monitoring usage audit • In March 2014 the LCA clinical board reviewed 62 day performance and the potential variation in active monitoring usage was raised particularly for prostate cancer. • Additionally it was noted that this was one of the issues raised in the Colchester CQC report • Methodology - reviewed all 62 day urgent GP cases for 6 month period, separating out Prostate Cancer and all other cancers • Part 1 – Calculate proportions of patients with 62 day clock stop recorded as active monitoring • Part 2 - For those patients with a clock stop recorded as active monitoring look for a subsequent treatment of surgery, chemotherapy, radiotherapy within 3 months of the clock stop and look at if this made a difference to compliance The London Cancer Alliance West and South Active monitoring usage audit - Results Part 1 - Rates of active monitoring for 62 day patients • Prostate cancer – Rates of active monitoring varied from 59% to 18% by 1st seen trust (35% overall) • All other cancers – Rates of active monitoring varied from 11% to 1% by 1st seen trust (4% overall) • Trust with highest rates in both was the same trust The London Cancer Alliance West and South Active monitoring usage audit - Results Part 2 – Treatments with 3 months of a 62 day clock stop for active monitoring • Prostate cancer – • Overall 205 active monitoring clock stops • 25 had an active treatment within 3 months (17 at same trust) • 18 of these would have been recorded as a breach if active monitoring not used (15 at same trust) • All other cancers • Overall 133 active monitoring clock stops • 22 had an active treatment within 3 months (11 at same trust) • 19 of these would have been recorded as a breach if active monitoring not used (10 at same trust) The London Cancer Alliance West and South Active monitoring usage audit - What we did? • Presented to cancer managers to raise awareness of issues (Cross referencing to CQC Colchester report) • Circulated details of cases starting treatment within 3 months of active monitoring to trusts to review locally • One outlier trust identified with highest rate of active monitoring for both prostate and all other cancers, and largest numbers of cases where active treatments then commenced within 3 months • Wrote to Medical Director and trust conducted local audit The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance Distribution analysis Distribution of when patients treated on 62 day pathway – LCA 2014/15 The London Cancer Alliance Alternative way of looking at performance Point at which 85% of patients are treated on 62 day pathway by tumour type 2014/15 – LCA providers Tumour type Brain/CNS Skin Breast Haematology Sarcoma HPB OG Urology (Excluding prostate) Head and neck (Excluding thyroid) Lung Gynaecology Lower GI Other Cancers (including unknown primaries) Prostate Thyroid All cancers Day at which 85% of patients are treated Day 39 Day 52 Day 57 Day 66 Day 66 Day 70 Day 75 Day 75 Day 79 Day 80 Day 80 Day 84 Day 88 Day 89 Day 104 Day 70 The London Cancer Alliance West and South Treatment modality analysis The London Cancer Alliance West and South Treatment modality analysis The London Cancer Alliance Sector comparisons Sector comparisons – 62 day performance Q3 2015/16 England overall South East London South West London North West London Tumour Type LCA Overall Complian Number Complian Number Complian Number Complian Number Complian Breaches Breaches Breaches Breaches ce of cases ce of cases ce of cases ce of cases ce Brain/CNS 93.8% 0 0 n/a 1 0 100.0% 2 0 100.0% 3.0 0 100.0% Childrens 76.5% 0 0 n/a 0.5 0 100.0% 2 0 100.0% 2.5 0 100.0% Skin 94.8% 124 4 97.0% 107 6 94.0% 108.5 4.5 96.0% 387.5 19.5 95.0% Breast 95.1% 153.5 6.5 96.0% 161 5 97.0% 118.5 8 93.0% 482.5 25.5 94.7% Haematology 81.2% 41 8.5 79.0% 27 4.5 83.0% 35.5 3.5 90.0% 123 19 84.6% Other 72.1% 6 2 67.0% 11 2 82.0% 6.5 1.5 77.0% 30 6 80.0% Gynaecology 80.7% 52 13 75.0% 44 11.5 74.0% 59.5 7.5 87.0% 171 35 79.5% Urology 78.7% 240.5 65 73.0% 240.5 34 86.0% 171 29.5 83.0% 721 152.5 78.8% Lower GI 75.2% 76 21 72.0% 76 10.5 86.0% 77.5 15 81.0% 253.5 56.5 77.7% Upper GI 75.4% 54.5 17 69.0% 46.5 11.5 75.0% 40.5 7 83.0% 158.5 38 76.0% Lung 75.2% 93 36.5 61.0% 68.5 11 84.0% 76 19 75.0% 263.5 69 73.8% Head and Neck 70.3% 41.5 15.5 63.0% 37 15.5 58.0% 54.5 5 91.0% 148 40 73.0% Sarcoma 74.6% 5 1 80.0% 14 5.5 61.0% 2.5 0.5 80.0% 22.5 7.5 66.7% Total 83.4% 887 190 79.0% 834 117 86.0% 754.5 101 87.0% 2766.5 468.5 83.1% • • Target met in both NWL & SWL Tumour comparisons of note • Gynaecology – NWL 87% vs SEL/SWL – 74% • Head and Neck – NWL – 91% vs SEL – 63%, SWL – 58% • Lung – SWL – 84%, NWL – 75%, SEL – 61% • Urology – SWL – 86%, NWL 83% - SEL – 73% The London Cancer Alliance West and South Breakdown of Urology into tumour types Urology performance – LCA providers Q3 2015/16 Tumour type Number of accountable cases Number of accountable breaches Performance Prostate 517 131 75% Bladder 81.5 6 93% Kidney 79 29 63% Testicular 36 1.5 96% Penile 7 1 86% Total 720.5 168.5 77% The London Cancer Alliance West and South Analysis by 2 week wait referral type Haematology 62 day urgent GP referral to 1st treatment performance by 2 week wait referral type 2014/15 2 week wait referral type Haematology Head and Neck Upper GI Lung Breast Urology Lower GI Skin Gynaecology Sarcoma Brain/CNS Total (non-haematology) Total % of total haematolo gy patients treated on Number of Number of 62 day patients breaches % in target pathway 366 35 90% 72% 57 16 72% 11% 18 6 67% 4% 17 4 76% 3% 16 4 75% 3% 13 1 92% 3% 8 4 50% 2% 6 1 83% 1% 6 1 83% 1% 3 1 67% 1% 1 0 100% 0% 145 38 74% 28% 511 73 86% 100% The London Cancer Alliance Overview • Overview of Cancer Waits performance within LCA • Embedding cancers waits within cancer metrics • Clinical engagement – wider CWT context • Examples of data improvement work • Examples of performance comparisons • Pathway specific initiatives to improve performance The London Cancer Alliance West and South Prostate best practice pathway Case for change - Prostate 62 day Urgent GP referral to 1st treatment performance by 1st seen trust - 2012/13 Site St Mary’s Hospital - Imperial Charing Cross Hospital - Imperial Croydon University Hospital Chelsea and Westminster Hospital West Middlesex University Hospital Central Middlesex Hospital – The North West London Hospitals NHS Trust Queen Elizabeth Woolwich - SLHT St George’s Healthcare NHS Trust Northwick Park Hospital – The North West London Hospitals NHS Trust St Helier Hospital Hillingdon Hospital Princess Royal University Hospital - SLHT Guy’s and St Thomas' NHS Foundation Trust Epsom Hospital East and North Hertfordshire NHS Trust King's College Hospital London Cancer Alliance Overall Number % in of target breaches (62 day Number Median 62 standard of cases Wait standard ) 29 81 18 37.9% 39 75 24 38.5% 96 58 32 66.7% 13 58 5 61.5% 55 55 14 74.5% 13 50 1 92.3% 129 48 27 79.1% 84 46.5 19 77.4% 88 45 2 97.7% 55 45 14 74.5% 12 44 2 83.3% 99 43 27 72.7% 211 42 33 84.4% 71 42 13 81.7% 50 39.5 2 96.0% 88 39.5 8 90.9% 1138 48 243 78.6% The London Cancer Alliance West and South Prostate best practice pathway Prostate best practice pathway • Already in place at King’s and Guy’s and St Thomas’ which had relatively good performance • Main issue highlighted 4-6 weeks required between TRUS biopsy and MRI scan due to prostate swelling • Main elements of pathway are:• 1st OPA within 7 days • MRI before TRUS biopsy where clinically appropriate • Biopsy by day 14 • Biopsy results & MDT by day 21 • Staging completed and treatment decision by day 42 • Treatment by day 62 The London Cancer Alliance West and South Prostate best practice pathway Prostate best practice pathway Metrics defined to support delivery Metric No. Metric What are we measuring? LCAPP1 Date from referral to first appointment is to be <8 days LCAPP2 First 2ww appointment for prostate cancer patients 62 day first treatment LCAPP3 Decision to treat Date from referral to decision to treat <31 days LCAPP4 First 62 day treatment modality % of patients receiving active monitoring as their first treatment LCAPP5 Biopsy Date from referral to biopsy <20 days LCAPP6 MRI Date from referral to MRI <10 days LCAPP7 Pre biopsy MRI Date of MRI to be before date of biopsy LCAPP8 % complete for all COSD items To assess the validity of the data received as the COSD dataset is likely to be incomplete Date from referral to first treatment <63 days http://www.londoncanceralliance.nhs.uk/media/109454/lca-best-practice-prostatepathway-december-2013-updated-september-2015-.pdf The London Cancer Alliance West and South Colorectal straight to test pathway Standard pathway without straight to test model for patient starting radiotherapy Treated on day 68 if all timescales met !!! The London Cancer Alliance West and South Colorectal straight to test pathway With straight to test Treated on day 58 if all timescales met The London Cancer Alliance West and South Colorectal straight to test pathway • LCA has been aiming to role this out across sector • In July 2015 survey identified that • 7/15 had fully implemented pathway • 2/15 had partially implemented pathway • 6/15 had not implemented • Main challenges • Resource to undertake telephone consultation to triage patients • Difference in agreements with commissioners for telephone consultation • Do you roll this out just for 2 week wait patients or for all referrals Next steps The London Cancer Alliance West and South Next steps • Work to continue through delivery units of National Cancer Vanguard • Potential replication nationally by Cancer Alliances • Challenges • Increased demand on system • Including increase in usage of 2 week wait target • Competing demands with other targets • New targets (e.g 28 days from referral to diagnosis) • Access to Cancer Waiting Times data The London Cancer Alliance Questions? Contact details Stephen Scott – [email protected] Hilary Wilderspin – [email protected]