cancer improvement plan update - west hertfordshire ... · (chief operating officer) cancer...

Cancer Improvement Plan

UpdateJanuary 2015

1

Introduction

This document summarises the actions required as part of WHHT’s cancer improvement programme. It builds on

previous work so that there is a single action plan showing what is needed in response to external recommendations, to

ensure achievement of national cancer standards and to promote continuous improvement of cancer services.

The following sections are included in this updated document:

1 Current Performance

2 Cancer Programme Governance Structure

3 Latest Cancer Action Plan

4 Current Management Structure for Cancer Services

5 Key Risks

The cancer action plan is expected to continuously evolve, particularly given that a new improvement and new service

manager are both shortly to take up post. It will be used by the Cancer Improvement Group to assess progress and will

also be regularly discussed with the CCG. Please note that this is a draft version and so is not yet for further circulation.

Document Authors:

S Davey, D Foster & E Moors

Notes: Some completed actions are included in this version so that the broad direction of travel can be seen. Also, the

master plan from which these snapshots have been taken can be easily organised so that progress against the external

recommendations made by S Ramsden et al can be seen.

2

1. Latest Cancer Services Performance

3

2. Cancer Improvement Programme Governance

Executive Steering

Committee

Project 5:

Divisional

Cancer Action

Plans

Project 3:

Information

Quality

Project 4:

Infrastructure

& Admin

Project 2:

Cancer Care

Pathways

2.1 Cancer Governance Structure & Existing Operational Governance Structure

Transformation CommitteeSubcommittee of WHHT Trust Board

TLEC

Divisional Management Committees

Trust Access Meeting

Weekly Divisional Access Meetings

Cancer Improvement

Group

Programme Structure, in Place for Duration of RTT Programme Operational Structure, Remains after Cancer Programme Closes

Project 1:

Peer Review

CCG Cancer

Action Group

4

Executive Steering CommitteeMeeting Frequency: Fortnightly

Chair: Chief Executive

Remit: To provide overall strategic direction for the Trust’s Transformation Programme; to receive updates from each

programme, to consider links and wider implications to remove any obstacles that are impeding progress.

Membership: All Executive Team

2.2 Cancer Programme Meetings & Membership

Cancer Improvement GroupMeeting Frequency: Weekly

Chair: Cancer Programme Senior Responsible Owner ie Deputy CEO

Remit: To deliver the cancer improvement programme according to plan, identify dependencies between projects and ensure coherent

approach.

Membership: Clinical Lead for Cancer, Medicine Divisional Manager, All Project Leads, Women & Children’s Divisional Managers, Surgery

Divisional Manager, Clinical Support Divisional Manager, Associate Director for Performance & Information.

Transformation Committee

(as Sub-Committee of WHHT Trust Board )

Project team meetings for each individual project as required.

A dedicated weekly meeting is already in place for the cancer information & quality project.


5

Please note that this is a programme management structure, not a line management structure.

Lead Executive: Senior Responsible OfficerL Hill

(Chief Operating Officer)

Cancer Improvement Lead

[Oversees Overall Cancer Action Plan]

Project 1:

Peer Review

Scope:

Ensuring that peer

review process is robust

and any

recommendations made

are delivered.

Management Lead:

M Sorley

Clinical LeadDr A Barlow

(Cancer Clinical Director)

Project 3:

Information

Quality

Scope:

Delivery of robust

governance structure

for managing cancer

waiting lists and care

pathways, with reliable

underlying information.

Management Lead:

Information lead tbc

Project 2:

Cancer Care

Pathways

Scope:

Ensure the care

pathway for each

tumour site is reviewed

and streamlined, eg with

1-stop clinics or direct

access diagnostics.

Management Lead:

Cancer Improvement

Manager

Project 4:

Infrastructure &

Administration

Scope:

Ensuring that booking

pathways are robust,

communication with

patients and GPs is

effective, the access

policy is adhered to

and standard operating

pathways in place.

Management Lead:

Cancer Service

Manager

2.3 Cancer Improvement Programme Leadership Structure

Project 5:

Divisional Cancer

Action Plans

Scope:

Ensuring that each

division delivers the

national cancer waiting

time standards and that

there are action plans in

place for specialties for

which there are

concerns.

Management Lead:

Cancer Improvement

Manager


6

3 Cancer Action Plan

3.1 Peer Review

Issue / Recommendation Actions Needed Action Owner Lead

Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

• Review current peer review process & capacity needed. Michelle Sorley WHHT -

Medicine

01-Mar-15 Green

• Generate timetable for peer review and reporting arrangements, so progess

is routinely fedback within WHHT appropriately.

Michelle Sorley WHHT -

Medicine

01-Mar-15 Green

Peer review needs to embedded, so that

action plans are adequately tracked and

recommendations delivered.

Further actions continued overleaf . . .

7

3.2 Care Pathways


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

Progress the recently initiated Beds and

Herts Cancer Forum review of all cancer

pathways between primary, secondary and

tertiary care providers using the National

Cancer Action Team Toolkit and

Commissioning Cancer Services Report

2011

• Map care pathways to policies on what should be happening and compare

with ECRIC data to see what is actually happening. Further update will be

provided at the CCG Cancer Action Group with representation from Beds and

Herts Cancer Forum who are a core member, as a precursor to further

review with MDTs.

Tonia

Dawson/Healt

h Awylward

CCG 01-Feb-15 Green

• Full-time cancer improvement manager in post D Foster WHHT -

Medicine

01-Feb-15 Offer made on

24/12/14 awaiiting conf

start date.

Green

• Confirm priorities and tumours sites to be completed in phases, linking with

work completed on capacity and demand. Plan is for capacity & demand work

to inform pathway development.

Cancer

Programme

Lead

WHHT &

CCG

01-Feb-15 Green

• Complete review of phase 1 tumour sites and confirm changes/actions

needed as result of phase 1.

Phase 1: Lung, head & neck and urology

Cancer

Programme

Lead

WHHT &

CCG

01-May-15 Need to confirm if this

is realistic timescale

Amber



Cancer

Programme

Lead

WHHT &

CCG

31-Aug-15 Need to confirm if this


Amber



Cancer

Programme

Lead

WHHT &

CCG

30-Nov-15 Need to confirm if this


Amber

• Confirm where straight to test pathways can be implemented. Cancer

Programme

Lead

WHHT &

CCG

01-May-15 Green

• Confirm where further one-stop clinics can be established Cancer

Programme

Lead

WHHT &

CCG

31-May-15 Green

Implementation of newly agreed pathways • Implement direct to test pathway for lung patients - will provide GPs direct

access to diagnostics for CT scan which would be available to the consultant

at 2ww appointment.

A Barlow / P

Sawyer

WHHT &

CCG

31 Nov 14 Done

Methodical care pathway review is required,

led by clinical teams and in liason with CCG.

8


3.3 Information Quality (1 of 2)Issue / Recommendation Actions Needed Action Owner Lead

Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

• The PAS supplier has confirmed that the system cannot be engineered in

the way described. The 2ww timeline is triggered by the referral data itself.

Femi

Odewale/ Sam

Ingram

WHHT -

Medicine

01-Dec-14 Red?

• Where referrals are made through Choose and Book, published slots are

controlled to prevent this happening.

Femi

Odewale/ Sam

Ingram

WHHT -

Medicine

01-Dec-14 Done

• An audit report detailing PAS clinic edit permissions has been produced for

review by divisions. Relevant actions will then be taken regarding and further

controls required – ongoing as part of out-patient transformation.

Femi

Odewale/ Sam

Ingram

WHHT -

Medicine

01-Dec-14 Ned to confirm that

clinic edit permissions

have been updated.

Green

• Change appointment slot type on the new outcome form with this will be

“2WW” instead of “VU” when the new PAS upgrade takes place next month.

Femi

Odewale/ Sam

Ingram

WHHT -

Medicine

01-Dec-14 Need to confirm

completion

Green

• 2ww, 31 and 62 day Cancer PTLs have been developed and are in use . Sandra Davey WHHT -

Medicine

In place Done

• Ensure newly agreed validation timetable is implemented & embedded Femi Odewale WHHT -

Medicine

01-Feb-15 Green

• Data quality reports have been developed and are available for use. These

compare Infoflex and PAS data for reconciliation purposes. Currently

undergoing validation prior to being fully utilised.

Sandra Davey WHHT -

Medicine

In place Done

• An Information Team resource attends the weekly Cancer access meetings to

provide support but this is variable and needs to be embedded.

Sandra Davey WHHT -

Medicine

01-Nov-14 Done

• Appoint a second Cancer Information Analyst post Debbie

Foster/Mark

Currie

WHHT -

Medicine/Infor

mation

01-Nov-14 6 month extension to

second analsyt post

agreed

Amber

• The Trust is currently transitioning to a new infrastructure managed service

which will include provision of secure email (nhs.net and Trust email within

single mailbox).

Mark Currie WHHT -

Information

01-Jun-15 Green

• As part of the infrastructure service transformation, fax is being phased out

and replaced by scan to email.

Mark Currie WHHT -

Information

01-Jun-15 Green

• Similarly all primary care are moving from practice specific email addresses

to nHS.net account and hence will complement this work.

Mark Currie WHHT -

Information

01-Jun-15 Green

Booking Safeguards:

Although patients referred as 2WW on the

PAS system have a code that distinguishes

them with “C”, the system will not prevent

these referrals from being booked into

routine, urgent or follow-up slots. It would

seem sensible to engineer the PAS system

(if possible) to prevent this, and/or to add a

flag or warning to the system to alert the

user when this operation is being performed.

In addition to this, there should be better

controls over who has permission and who

has training to perform the relevant

conversion of appointment slots on the PAS,

to ensure that this is fit for purpose.

Data quality:

A suite of reports to test compliance with

booking policies and recording outcomes

should be created and used regularly by

senior managers, identifying barriers to

compliance and regularly monitoring metrics

in these areas, building on the recent work of

the Intensive Support Team. The Board/sub-

committees should request assurance on

data quality regularly.

The Trust and local partners should move

over to secure NHS email accounts to

improve communication and information

governance, eliminating the need to use

facsimile communication.

9


3.3 Information Quality (2 of 2)


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

• The Trust IM&T Strategy is being refreshed to make recommendations

regarding future IT system requirements- cancer service requirements need

to be reflected in this.

S Gilchrist WHHT -

Information

On going Green

• As part of the infrastructure managed service, the supplier will be delivering

an integration engine and clinical data repository which will provide a single

portal view into the Trust’s clinical systems including Infoflex and PAS.

S Gilchrist WHHT -

Information

Late 2015 Green

• Data quality reports have been produced to assist with reconciliation

between PAS and Infoflex.

Lisa Emery WHHT -

Information

01-Oct-14 Done

• Monthly validation of breaches is in place for all cancer which supports

accurate data uploading.

Sandra Davey WHHT -

Medicine

01-Oct-14 Done

• However the progress on the visibility of service outcome and performance

data has been slow. There is patient level data but the MDTs are not aware of

the performance of their services as data collection remains fragmented. We

have requested a suite of reports for individual tumour sites but these are not

available.

Mark Currie WHHT -

Information

December

2014 to

February

2015

The cancer team have

escalated the on-going

concerns with data and

data collection.

Red

• The plan is for the new Data Manager to meet with all MDT Leads and MDT

Co-ordinators so that there is a greater understanding of what information by

tumour site is required.

Femi Odewale WHHT -

Medicine

December

2014 to

February

2015

Dependent on staff

time being available.

Amber

• Complete specification outlining what is needed from the cancer information

system.

Mark

Currie/Elizabet

h White

WHHT -

Medicine

01-Nov-14 Expected to complete

by end Dec 14.

Delayed exp mid Jan

Amber

• Reach a decision regarding immediate and longer-term strategy for cancer

information system.

Lisa Emery WHHT -

Information

tbc Amber

• Ensure routine validation of long-waiters is in place. Femi

Odewale/ADM

WHHT - Div

Teams

31-Jan-15 Amber

• Ensure sufficient dedicated information analyst support for cancer team. D Foster/Mark

Currie

WHHT -

Information

01-Dec-14 6 month extension to

second analsyt post

agreed

Amber

Visibility of service outcome and

performance data:

the accountability of all staff for providing

high quality services needs to be increased

by making staff across MDTs aware of the

performance of their services. Involve staff in

the design of performance reports and

provide regular opportunities to review these

and act on them.

The current cancer database (an addition to

infoflex) is not fit for purpose and future

plans need to be finalised.

IT systems: the use of parallel systems and

lack of information sharing between Infoflex

and PAS is a risk that should be addressed.

Infoflex is slow, unreliable and should be re-

examined in light of these issues above and

the external and internal reviews. This is part

of the Trust’s IT business case.

10


3.4 Infrastructure & Admin (1 of 2)


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

• This is included in the two week wait project group work stream. This is a

sub group of the cancer committee. The group consisting of senior managers

are implementing all the recommendations which have been made on 2 week

wait referrals, reducing paper and fax usage and ensuring that patients are

offered appointments in chronological order.

Sandra Davey WHHT -

Medicine

Complete Done

• Proposals are being agreed for the 2ww central booking team to be providing

the service between 8am to 7pm from the current provision of 9-5pm which

will enhance patient’s access outside the normal working hours.

Sam

Ingram/Femi

Odewale

WHHT -

Medicine

31-Jan-15 Proposals agreed,

need to be

implemented

Amber

• However other improvements include having generic emails addresses

particularly for straight to test patients internally so that diagnostics results are

available at the 2ww appointment

Sandra Davey WHHT -

Medicine

31-Oct-14 Done

• Standard Operating Procedures have been developed awaiting approval. Femi

Odewale/Sam

Ingram

WHHT -

Medicine

31-Dec-14 Not yet all completed. Amber

• All relevant staff have received cancer waiting times training including all

MDTs. A training lead has been allocated for outpatient training and

competency frameworks are being developed to provide assurance that these

processes are being followed.

Sandra Davey WHHT -

Medicine

31-Oct-14 Will need repeated in 1

year's time, at the

maximum.

Done

• All MDT teams and OPD administrative staff have received cancer waiting

times training.

Sandra

Davey/Sam

Ingram

WHHT -

Medicine

30-Sep-14 Done

• Upper GI team scheduled to receive training. Sandra

Davey/Sam

Ingram

WHHT -

Medicine

01-Dec-14 Awating conf. That

training hastaken place

Done?

• Pilot proposed for a cancer admin support to be based with the central

booking team in order to commence tracking of patients on infoflex at source.

Femi

Odewale/Sam

Ingram

WHHT -

Medicine

31-Jan-15 Not yet happened, but

imminent.

Amber

• Email accounts being created to allow email of referrals, to reduce the

reliance on paper and faxes for internal direct to test.

Sandra

Davey/Sam

Ingram

WHHT -

Medicine

31-Oct-14 Done

• Increase the use of choose & book for cancer referrals Femi

Odewale/Sam

Ingram

CCG 01-Feb-15 Need to confirm plans

with CCG.

Amber

Appointments processes need to be

improved, with a more patient focussed

approach, so that cancer 2WW referrals are

scheduled into appropriate appointment

slots and arranged to suit the patient’s

needs, encouraging attendance as a result.

Processes for developing, implementing and

assuring adherence to policy: future policies

will require better consultation and

engagement to reinforce best practice.

Standard operating procedures/individual

action cards should be co-developed to

support this.

Skills: training in systems and processes

relating to cancer patients, including national

guidance and local Trust policy, needs

addressing. All administrative staff in OPD

need to be trained in all aspects of the

booking pathway to increase flexibility,

continuity and understanding. Continue the

training started by the Intensive Support

Team and ensure this is sustained and

refreshed regularly.

Handling referrals:

review and improve the process within the

Trust for noting receipt and tracking

incoming 2WW cancer referrals. The

continuing reliance on a paper-based log

and email list is not sustainable. The Trust

should also review with the CCG the

potential for Choose & Book to be used

widely in managing 2WW

11


3.4 Infrastructure & Admin (2 of 2)


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

Changes to Choose and Book: enable direct

access for GPs to make referrals to

diagnostics on the 2WW pathways. The

paperwork should include advice to keep

people updated of decision changes and the

value of these appointments.

• Some diagnostic services have this facility enabled through Choose and

Book. Further diagnostic services will be reviewed as part of the two week

wait project group work stream. This will also be included in work undertaken

as part of upcoming Choose and Book system upgrades.

Femi Odewale WHHT -

Medicine

01-Mar-15 Dependent on Choose

& Book system

upgrade and on

diagnostic capacity.

Amber

Urgent non-cancer referrals and the

management of DNAs in this context need to

be considered too e.g. when patients are

referred to the Rapid Access Chest Pain

Clinic. Give the same attention to reviewing

non-cancer urgent referral DNAs as cancer

2WW DNAs.

• The 2WW DNA report currently only covers 2WWs – Urgent referrals could

easily be added into the same report/a separate one, however the trust is

currently exploring this further

Femi

Odewale/Mark

Currie

WHHT -

Medicine/Infor

mation

Complete

for 2ww

October

2014

Plan for review of rapid

access patients tbc

Red

• Priority is given to all 2ww outcomes following consultation with letters sent

to referrer within 48 ours following appointment.

Sandra Davey WHHT -

Medicine

Complete

October

2014

Done

• Further discussion underway to email the outcome letters via nhs.net and

confirm this is acceptable.

Sandra Davey WHHT -

Medicine

Discussion

25

November

2014

Done

• Implementation of emailing outcome letters is in the outpatient

transformation plan, but cancer improvement group need to be assured of

progress.

Femi

Odewale/Sam

Ingram/Mark

Currie

WHHT -

Medicine/Infor

mation

01-Mar-15 Plans need to be

confirmed.

Red

• CCG as part of the development of CCG GP IT strategy/Framework will be

implementing the E-Referral come April 2015. In the mean time as part of

good practice, we are developing standards for the use of choose and book

and regular audits around 2ww at General Practice

Avni

Shah/Shane

Scott

CCG 01-Feb-15 Amber

• Liaising with NHSE regarding agreeing standards for 2ww from Dental

Practices

Avni

Shah/NHSE

CCG 01-Jan-15 Amber

• New cancer services manager in post. D Foster WHHT -

Medicine

01-Feb-15 NB: There is an interim

gap.

Green

• Review Cancer Specialist Nurse stucture and confirm and actions needed Michelle Sorley WHHT -

Medicine

01-Feb-15 Green

• Review office arrangements for cancer service team - present

accommodation is inadequate.

Femi

Odewale/Debb

ie Foster

WHHT -

Medicine

01-Jun-15 Amber

Ensure adequate operational leadership &

support for cancer services

To review the governance of the two week

cancer pathway in primary care, including

dental practices, and agree standards for all

referring clinicians, including the use of “

Choose and Book”.

A standard response form at the hospital

would improve consistency of information

regarding the outcome of the referral. Faster

responses would also be beneficial, as

would clear guidance on response times to

achieve.

12


3.5 Divisional Action Plans


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

Establish a patient and public participation

forum for cancer services to help educate

the public and specifically focus on reducing

DNAs on the 2WW pathway

• Patient and Public Participation Forum is already set up across Bed and

Herts Cancer Forum. Work needed to ensure there are representatives from

Herts Valleys at this forum and how we engage with the forum on the various

aspects of work including work from Herts Valleys under Primary care

Transformation around Prostate cancer etc.

Tonia

Dawson/Healt

h Awylward

CCG 01-Dec-14 Needs ongoing review

to embed

Green

• Focus initially on lung, head & neck and urology, and complete capacity &

demand review.

Femi

Odewale/ADM

tbc 31-Jan-15 Approach to be

confirmed

Amber

• Review capacity & demand for all other tumour sites. Femi

Odewale/ADM

tbc 31-Mar-15 Approach to be

confirmed

Amber

Robust achievement of 2-week wait

standard

ie standard has been achieved for 6

consecutive months.

• Agree plan to ensure that 2-week wait is sustainable for the breast service. E Odlum WHHT -

Surgery

31-Jan-15 Green

Robust achievement of 31-day standard


consecutive months.

• Agree plans to ensure that 31-day standard is sustainable for all specialties D Foster(until

Prgramme

Lead in post)

WHHT -

Medicine

31-Jan-15 Green

• Agree plans to ensure that 62-day standard is sustainable for colorectal E Odlum WHHT -

Surgery

31-Jan-15 Green

• Agree plans to ensure that 62-day standard is sustainable for urology E Odlum WHHT -

Surgery

31-Jan-15 Green

• Agree plans to ensure that 62-day standard is sustainable for lung D Foster WHHT -

Medicine

31-Jan-15 Green

Robust achievement of 62-day standard


consecutive months.

Capacity & demand for cancer services

needs to be understood.

13


3.6 Governance


Service /

Organisatio

n

Target

Finish date

Comment RAG Rating

for

Completion

on Time

• Review all actions taken to ensure appropriate escalation of concerns and

sharing of good practice are embedded & reinforce messages made during

Oct 14.

Femi Odewale WHHT -

Medicine

28-Feb-15 Green

• WHHT Cancer strategy away day planned for February 2015. Cancer

Programme

Lead

WHHT -

Medicine

28-Feb-15 Will take place once

new improvement lead

in post

Red

The NHS Trust Development Authority,

Monitor and NHS England should require

Boards to assure themselves of the quality

of data used to measure compliance with

national targets in cancer and other NHS

Standards.

• Any actions required of WHHT need to be confirmed. D Foster/Lisa

Emery

WHHT -

Medicine

01-Oct-14 D Foster to confirm

with L Hill if further

action is required.

N/A

• With the formation of the Herts Valleys Cancer Action Group, focus on

Cancer has been raised across the organisation and a development of work

plan around Cancer is currently being developed which will include the

proposed work on:

Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

a.Early diagnosis Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

b.Education and training for primary care on Cancer Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

c.Regular audits in general practice around cancer Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

d.Development of local pathways with providers to support direct access

to diagnostics such as lung cancer

Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

e.Wider system end to end pathways in collaboration with Beds and Herts

Cancer Forum

Avni Shah/Phil

Sawyer

CCG 01-Jan-15 Green

Ensure governance changes made as a

result of external review are embedded.

Leadership capacity and continuity to

transform

14


Acute Oncology

Service –

note that this doesn’t come

under WHHT line management arrangements

Michelle Sorley

Lead Nurse for Cancer & Palliative

Care

Cancer & Palliative Care

Clinical Specialist Staff

Cancer Programme

Lead

Cancer Service Manager

Breast MDT Facilitator

Breast MDT Assistant

Colorectal & Data

MDT Facilitator

Colorectal/Urology MDT Assistant

Urology MDT Facilitator

Dermatology and Upper GI /CUP MDT Facilitator

Dermatology/Lung MDT Assistant

Lung and CNS MDT Facilitator

Gynae Paeds and Colp MDT

Facilitator

Gynae, Haem and H&N MDT Assistant

Haematology & Head and Neck

Pathway Facilitator

Band 4

Admin MDT Manager

Audit & Data Manager

Audit & Data Assistant

Medicine Divisional Director

Medicine Divisional Manager Cancer Clinical Director

4. Operational Cancer Service Management Structure

Please note that this is a newly established structure – vacant posts are shown in italics and interim cover arrangements have been put into place.

until substantive staff are in post.15

5. Key Cancer Improvement Programme Risks

• Breast clinic capacity increased, backlog cleared, patient choice is key risk to

compliance going forwards. Identifying best practice to implement locally, to reduce

this risk to a minimum, with HV CCG.

• Tumour site capacity issues being addressed and recovery plans are being

developed with support from IST. Current focus are urology and colorectal, work will

shortly begin on lung.

• Data input and clinical systems issues identified in internal and IST reviews,

impacting on accuracy of reporting of cancer performance. Cancer Informatics

Group in place to address immediate issues and deliver data quality improvement

plans. The option appraisal is due for completion in December.

• Increase in validation capacity and capability until software solutions in place.

• Due to staff turnover within the Cancer Management team interim support has been

appointed.

16

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