WHO WILL STAFF THE HOSPITALS OF THE FUTURE WHEN CANCER IS

CENTRALISED?

CANCER COLLABORATIVE INITIATIVES

– AN UPDATE

CSC brief history

• Started in 1999

• Phase 1: 51 projects in 9 cancer networks

• Phase 2: 275 projects in all 34 cancer networks

• Phase 3: To become long term and sustainable via trusts and cancer networks

CANCER SERVICES COLLABORATIVE

•Improve experience and outcomes of care for people with suspected or diagnosed cancer by improving the way care is delivered

•Program to support local teams in cancer networks to make significant changes for patients

•Key implementation strategy for NHS Cancer Plan

Cancer collaborative infrastructure

National cancer director

National clinical leadsand programme managers

34 cancer networksNetwork cancer leads

Service improvement lead

Trust levelService improvement

facilitators

April 2003 - CSC Partnership will see ……...

Service Improvement Leader in every cancer network– fourth member of network team - link to StHA

Clinical Lead - work alongside Service Improvement LeaderService Improvement Facilitators appointed by networks

– Trust / network based– focusing on improving whole system of care in each

tumour– link to peer review, service delivery plans, 3 year

planning cycleMandatory collection waiting times - (HSC)

– demonstrate patient journey times

Patients involved in modernising services

NATIONAL CANCER PLAN TARGETS

• One month from urgent referral Maximum one month wait from diagnosis to treatment for breast cancer by 2001 all cancers by 2005

• Maximum two month wait from urgent GP referral to treatment for

breast cancer by 2002all cancers by 2005

• to treatment for all cancers by 2008

CANCER SERVICES COLLABORATIVE

•Re-design

•Methodology

•Funded

£25M 2002-2003

CANCER SERVICES COLLABORATIVE

•Capacity and Demand

•Mapping Patient Pathway

•Implement Change

CSIP – PROGRESS SO FAR

69% of Upper GI Cancer Patients in CSIP projects treated within 62 days

of referral

CANCER SERVICES COLLABORATIVEPATIENT PATHWAY MAPPING

EPSOM/ST HELIER NHS TRUST

•Access

•Endoscopy

•Staging

•MDT

•Centre referral

NATIONAL ENDOSCOPY PROGRAMME

• Reduction in active waiting list

- flexibility- pooled waiting lists- changing case mix

(Aintree University Hospitals)

Diagnosis

Leicester• Consultant led single visit diagnostic and therapeutic clinic with

same day consultation and endoscopy • Capacity and demand study - led to reorganisation of

gastroenterology clinics• All procedures pre booked to use spare capacity

Mount Vernon• Notification of new diagnosis faxed to GP within 24 hours of

diagnosis

MDT

Leicester

MDT co-ordinator in post - facilitate and support team

Role• Prepares notes,results, attendance list and follow up actions

– GP fax back of MDT outcome

– Cross referral proforma following MDT

– Record MDT outcomes and treatment plans in case notes

Staging

East Somerset• Tertiary referral pro-forma with staging CT scan -

patients referred via fax to MDT on tertiary site with reported CT and histology slides

• Median wait from GP referral - treatment reduced from

79 days to 40 days

DRIVERS FOR CHANGE

• Modernising Medical Careers

• EWTD

• Seamless Training

• Peer review

• IOG Standards

SERVICE CHALLENGES

• Providing services for local population

• GI Service provision

IMPROVING OUTCOMES PROFESSIONAL CONCERNS

• Centralisation of Surgery

• Effect on DGH Surgery

• Effect on Benign Upper GI Practice

(AUGIS 2001)

IMPROVING OUTCOMES IN UPPER GI CANCERS

• Specialist Commissioning vs PCT Commissioning

IMPROVING OUTCOMES IN UPPER GI CANCERS

•Manpower Planning

Workforce Development Confederations

Training

IMPROVING OUTCOMES IN UPPER GI CANCERS

• Patient Involvement

PERSON SPECIFICATION

• General surgery training

• General GI training

• Endoscopy skills – JAG approved

• Trainer

• Upper GI Cancer diagnostic team skills