cancer summit plymouth hospitals nhs trust 12 th february 2015 ruth bridgeman - programme director,...
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Cancer SummitPlymouth Hospitals NHS Trust
12th February 2015
Ruth Bridgeman - Programme Director,
National Peer Review Programme
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Patients, Regulators, Clinicians, Providers and Commissioners
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The Benefits of the Peer Review Programme
• Provision of disease specific information across the country together with information about individual clinical teams which has been externally validated
• Provision of a catalyst for change and the monitoring of service improvement• Provision of a directory of services • Speedy identification and resolution of immediate risks and serious concerns
to patients and or staff each year• Engagement of a substantial number of front line clinicians in reviews
(approximately 5000)• Rapid sharing of learning between clinicians, as well as a better understanding
of the key recommendations in the NICE guidance, National Service Specifications or National Standards.
• Provision of timely national benchmarked data, trend analyses and reports that provide accessible public information about the quality of cancer services www.mycancertreatment.nhs.uk;
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Plymouth over the years
Breast
Colorectal CUP
Haemato
logyLu
ng
Neuro
scien
ce MDT
Panc/L
iver
Sarco
ma
Spec
Gynae
Spec
Panc
Spec
Skin
Spec
UGI
Spec
Uro
Thyro
id
UAT/Thyro
id0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Tumour MDTs across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
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Plymouth over the years
AO IP M
DT
AO MDT
Genera
l AO M
DT
Chemo se
rv
Onc Pharm
acy ITC
Highter
Inten
sity C
hemo
Radiothera
py Gen
eric
EBRT
Brachy
IMRT
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Cross Cutting across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
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Plymouth over the years
Level 3 POSCU TYA Hospitals POSCU MDT0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Children's and TYA across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
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Key Issues for Plymouth
• Issues of configuration for services in South West i.e. Sarcoma and Head & Neck
• Working relationship with Royal Cornwall Joint working for Gynae appears to be a success.
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Key Issues for Plymouth
• Acute Oncology – Very good service now in place – they were finalist in the HSJ -2014 Patient Safety and Care Awards.
• Anal – There is no specialist Anal MDT in the Peninsula.
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Key Issues for Plymouth
• Brain & CNS – South West regional centre covering the Peninsula. It is a combined Surgical and Non-surgical MDT – Low self-assessed compliance (59%) due to
the lack of AHPs including dietician and speech and language therapist.
– Irregular attendance and no cover for palliative care core member.
– Numbers of benign and malignant patients supported by three nurses across the peninsula (five trusts) means the nursing service is stretched.
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Key Issues for Plymouth• CUP Service - Combined AOS/CUP Service, the
CUP MDT was established in April 2014. Low compliance (MDT = 54% Hospital = 33%) due to lack of networking CUP group; it’s unclear if the group is meeting yet.
• Haematology – Self assessment stated that there was no regional networking group and standards relating to these measures could not be met. However, the networking group is being reconvened with a new chair appointed. Not sure if they have met yet?
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Key Issues for Plymouth• Head & Neck - West Peninsula MDT – Joint
MDT with Royal Cornwall • Non IOG compliant as all surgical resections are
undertaken on both hospital sites . • Areas of concern identified at the self
assessment include;– Poor attendance from the Royal Cornwall
members of the MDT.– No cover arrangements for the CNS’s on both
sites and no cover for the oncologist at RCHT. – No restorative Dentist at RCHT.
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Key Issues for Plymouth• HPB - MDT for the South West covering the
Peninsula with a population of approx. 1.7 million.
• Gynae – All patients including low risk
endometrial cancers are discussed at the West Peninsula Specialist Gynae MDT. This is a joint MDT hosted by Royal Cornwall; surgery is undertaken on both sites. Brachytherapy is only provided at Plymouth.
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Key Issues for Plymouth• Lung – Low compliance (54%) with poor
attendance by palliative care (7%) and oncologist (37%), the latter was raised at self assessment as a serious concern. The network group has not met.
• Sarcoma (soft tissue) – This is a joint MDT with
Royal Cornwall. They are slightly below the minimum workload of 100 new cases with 92 in 2013/14but that’s increased from 68 in 21012/13.
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Key Issues for Plymouth
• Thyroid – Visited March 2014 (There are also Thyroid only MDTs at RDE and Royal Cornwall)– Two Serious Concerns
• MDT do not meet the IOG recommendation of a minimum catchment population of one million as they currently give their population as 450K
• Support offered to patients is compromised due to the dual role of the CNS, also covers Sarcoma cancers.
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Key Issues for Plymouth
• UGI - Specialist OG MDT for the Peninsula. Serious concern identified at self assessment regarding breaches – These were multifactorial but essentially down to higher demand than capacity within all areas of the pathway.
• Urology – Specialist MDT with tertiary referrals from Cornwall and East Devon. It also provides a variety of penile operations under the direction of the supra regional MDT at North Bristol.
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Plymouth and the South WestHospitals included:PlymouthRoyal CornwallSouth DevonRoyal Devon & ExeterNorth DevonYeovilTauntonWestonRoyal United Hospitals BathNorth BristolUniversity Hospital BristolGloucesterCheltenham
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Plymouth Compared to the South West and National Average
MDTs Plymouth SW National Plymouth SW National Plymouth SW National Plymouth SW National
Breast 84% 88% 90% 84% 92% 92% 88% 88% 88% 94% 88% 85%
Colorecta l 86% 85% 85% 86% 90% 90% 98% 93% 91% 86% 92% 87%
CUP 19% 44% 58% 54% 43% 59%
Haematology 41% 66% 81% 72% 84% 83%
Lung 78% 77% 89% 79% 87% 90% 60% 79% 80% 54% 74% 80%
Neuroscience MDT
62% 69% 66% 53% 57% 60% 61% 71% 80% 59% 81% 78%
Panc/Liver 88% 88% 79% 88% 94% 94%
Sarcoma 69% 73% 80% 59% 58% 69% 79% 85% 94% 78% 77% 83%
Spec Gynae 69% 80% 90% 83% 91% 95% 97% 80% 89%
Spec Panc 79% 81% 79% 79% 82% 84%
Spec Skin 76% 80% 82% 71% 79% 87% 88% 73% 80% 80% 81%
Spec UGI 85% 85% 85% 85% 85% 85% 88% 87% 85% 88% 84%
Spec Uro 81% 87% 88% 89% 92% 91% 91% 92% 93% 84% 85%
Thyroid 74% 72% 81% 84% 88% 88% 82% 73% 84% 72% 74%
UAT/Thyroid 74% 69% 77% 72% 83% 90% 79% 85% 87% 75% 66% 78%
2011/12 2012/13 2013/14 2014Tumour MDTs across 4 years -Plymouth compared to SW and National
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Plymouth Compared to the South West and National Average
Cross Cutti ng 2011/12 SW National 2012/13 SW National 2013/14 SW National 2014 SW National
Genera l AO MDT 9% 40% 55% 18% 45% 55% 82% 72% 82% 77% 81%
AO IP MDT 0% 8% 25% 0% 10% 25% 75% 43% 50% 47% 57%
AO MDT 0% 22% 33% 0% 17% 50% 67% 62% 67% 45% 66%
Radiotherapy Generic
86% 78% 77% 81% 80% 89% 88% 92% 92%
IMRT 100% 78% 100% 100% 94% 100% 100% 100% 100%
EBRT 93% 94% 94% 95% 96% 96% 90% 97% 100%
Brachy 100% 98% 100% 93% 99% 100% 100% 98% 100%
Chemo serv 64% 83% 83% 79% 79% 81% 83% 89% 90% 92% 91% 87%
Onc Pharmacy 100% 96% 100% 100% 94% 100% 100% 100% 100% 100% 98% 98%
Highter Intens i ty Chemo
100% 84% 86% 100% 83% 86%
ITC 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
2013/14 20142012/132011/12Cross Cutting Teams across 4 years -Plymouth compared to SW and National
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Plymouth Compared to the South West and National Average
Chi ldrens and TYA 2011/12 SW National 2012/13 SW National 2013/14 SW National 2014 SW National
Level 3 POSCU 88% 89% 89% 92% 95% 93% 98% 98% 98% 100% 96% 95%
TYA Hospita ls 83% 89% 71% 67% 90% 71% 100% 90% 100% 100% 97% 88%
POSCU MDT 89% 83% 79% 95% 93% 92% 100% 96% 95% 100% 90% 86%
2011/12 2012/13 2013/14 2014
Children's and TYA Teams across 4 years -Plymouth compared to SW and National
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How do Plymouth Services compare with others in the
South West?
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Breast MDT
2011/122012/132013/142014
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Lung
2011/122012/132013/142014
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Colorectal MDT
2011/122012/132013/142014
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Plymouth Gloucestershire Hospitalsst North Bristol Royal Cornwall Royal Devon & Exeter Taunton0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Skin MDT
2011/122012/132013/142014
Plymouth Gloucester Royal UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Upper GI MDT
2011/122012/132013/142014
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Plymouth North Bristol Royal Cornwall Royal Devon & Exeter
RUH South Devon Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
UAT and UAT/THYROID MDT
2011/122012/132013/142014
Plymouth Royal Cornwall Royal Devon & Exeter0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Thyroid Only MDT
2011/122012/132013/142014
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Plymouth Gloucestershire Hospitals North Bristol Royal Devon & Exeter70%
75%
80%
85%
90%
95%
100%
Specialist Urology MDT
2011/122012/132013/142014
Gloucestershire Hospitals
Plymouth Royal Cornwall Royal Devon & Exeter
RUH Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Gynae MDT
2011/122012/132013/142014
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Plymouth UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Pancreatic MDT
2011/122012/13
Plymouth UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pancreatic / Liver MDT
2012/132011/12
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Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
10%20%30%40%50%60%70%80%90%
100%
Haematology
2013/142014
North Bristol Plymouth0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Neuroscience MDT
2011/122012/132013/142014
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Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CUP MDT
2013/142014
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Acute Oncology MDT
2011/122012/132013/142014
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
General Acute Oncology MDT
2011/122012/132013/142014
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Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oncology Pharmacy Serv MDT
2011/122012/132013/142014
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Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Acute Oncology In-Patient
2011/122012/132013/142014
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Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Chemotherapy Serv MDT
2011/122012/132013/142014
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Plymouth Gloucestershire Hospitals
Royal Cornwall Royal Devon & Exeter
RUH South Devon Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Higher Intensity Facility
2013/142014
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Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHBYe
ovil92%
93%
94%
95%
96%
97%
98%
99%
100%
Intrathecal Chemotherapy ITC MDT
2011/122012/132013/142014
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Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
External Beam Radiotherapy
2011/122012/132013/14
Plymouth Cheltenham General
Royal Devon &
Exeter
RUH UHB0%
10%20%30%40%50%60%70%80%90%
100%
Brachytherapy
2011/122012/132013/14
Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
Radiotherapy Generic
2011/122012/132013/14
Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
IMRT Radiotherapy
2011/122012/132013/14
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Plymouth Gloucestershire Hospitals NHS
Foundation Trust
Royal Cornwall Royal Devon & Exeter
RUH Taunton Yeovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSCU Level 3
2011/122012/132013/142014
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Plymouth Gloucestershire Hospitals NHS
Foundation Trust
Royal Cornwall Royal Devon & Exeter
RUH Taunton Yeovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSCU MDT
2011/122012/132013/142014
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Plymouth
Gloucester
shire
Hospita
ls NHS F
oundation Tr
ust
Royal C
ornwall
Royal D
evon &
Exete
rRUH
Taunton
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TYA Hospitals
2011/122012/132013/142014