Download Cancer Access Standards - Northern Ireland Cancer Network

Regional Care Pathway Development_ Briefing for Colorectal Cancer Group
C AN CE R A C C E S S S T AN D AR D S & D E V E L O P M E NT
C AN CE R C AR E P AT H W AY S - B R I E F I N G
OF
NICaN
R E GI ON AL LY A G RE E D
This paper provides a briefing on the introduction of mandatory cancer access standards in
2007 and highlights a number of actions to help progress the development of a Colorectal
Cancer Care Pathway.
C AN CE R A C C E S S S T AN D AR D S
Definitions and Key Monitoring Points - Service Delivery Unit Presentation, 24th Nov 2006
Regional Quality Standards for Timely Access
 All patients diagnosed with cancer should begin treatment within a maximum of 31
days of the diagnosis (decision on treatment)
 All patients with suspected cancer who have been referred urgently by their GP
should begin their first definitive treatment within a maximum of 62 days
Key monitoring points
 Date referral received
 Date Patient discussed at MDT
 Date decision to treat (defined as the date the clinician and the patient agree on a
course of treatment, even if the treatment cannot be given)
 Date 1st definitive treatment commences
Achieving and Sustaining Cancer Access Standards
The following principles underpin the establishment of sustainability and standards for timely
access (as per experience and practice in England with the Cancer Services Collaborative):
Effective
Evidence
Based
Pathway
Design
Prospective
Patient
Management
and
Navigation
Robust Data
Information
and
Administrative
Systems
The Local Lead Cancer Teams, working with cancer executive leads, will be instrumental in
providing local leadership for the introduction and sustainability of the cancer access
standards. A baseline self-assessment questionnaire was forwarded to the Local Lead
Cancer Teams, their executive lead and others, on 22/23 November 2006. This includes a
checklist on the information and proactive patient management systems that need to be in
place and support to ensure the effectiveness of the MDT.
C AR E P AT H W AY S
A programme of work and timetable has been drafted for the development of evidence
based, quality and timed care pathways for all cancers. This is being progressed through
the established Tumour specific groups, with plans underway to develop those groups not
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Regional Care Pathway Development_ Briefing for Colorectal Cancer Group
NICaN
yet established. All available evidence and best practice will be drawn upon to support the
development of the care pathways.
The initial focus, based on evidence, will be on referral, diagnostics and the effective
functioning of MDMs.
Timed Access
Thinking
something is
wrong
Referral
Referral
Seeing
Someone &
having tests
Consultation
&
Investigation
Being told
what is
wrong
Getting better
& living with
condition
Diagnosis
Treatment
Diagnostics
Being
followed
up
Follow up
MDMs
Based on evidence, core elements of the pathways critical to
achieve the cancer access standards
The care pathways will provide a clear and concise account of the key stages, diagnostics,
treatments and follow-up arrangements that are expected for those, with, or suspected of
having a particular cancer.
The care pathways will provide the specification for
commissioning cancer services and the framework by which the service will be audited and
subject to continuous quality improvement. It will be important that the Network groups
secure public health and planning expertise to inform this work.
C O L O R E C T AL C AN C E R P AT H W AY
Referral
It is proposed that there are several elements necessary to clarify the referral process for
suspected colorectal cancer
 Agreement on the criteria for urgent referral
 Implementation / roll out of this guidance across Primary Care
 Ongoing education and monitoring of the use of the urgent referral route/process
 Agreed referral point, within each Trust, from Primary Care and other routes for
urgent referrals
 Trust mechanisms to capture the urgent referrals
At the November meeting of the NICaN Primary Care Group it was agreed that the NICE
referral guidance for suspected cancer be adopted for Northern Ireland. This is inline with
the Department’s adoption of NICE in June 2006. These guidelines can be discussed with
the Colorectal Group should there be any exceptions which need to be considered.
Diagnostics
Experience in achieving “cancer-waiting times” in England has shown that 20% of failures to
achieve the 31 and 62 day targets arise from inter trust transfers (predominantly those from
cancer unit to cancer centre). Their advice is to aim for the diagnostic stage of the pathway
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Regional Care Pathway Development_ Briefing for Colorectal Cancer Group
NICaN
to be completed within 25 days with the planning for treatment and date of first definitive
treatment spanning from day 26 – day 62, as shown below.
Referral
Diagnostics
MDM
Disclosure
< 25 days
Palliative Care
Surgery
Oncology
Beds, HDU/ICU
26-62 days
Inter-Trust Transfer
MDMs
A checklist (attached) has been developed for Colorectal MDMs based on the measures
within the Manual of Cancer Services Standards, 2004 (colorectal measures amended July
2006) (www.cquins.nhs.uk).
This Manual is the quality assurance mechanism for
implementing the Improving Outcome Guidance.
Additional resources/toolkits for supporting effective MDT meeting are currently being
compiled by the Network team based on work by the Cancer Services Collaborative.
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