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Cancer Waiting Times (CWT) 2 weeks (14days) and 62 days Loraine Turner National target of concern NPI07a - All cancers: two weeks (14 days) wait

Appendix 1 The number of patients first seen by a specialist within two weeks when urgently referred by their GP or dentist with suspected cancer, Apr 09 to Mar 10

Current risks

What plans are in place –

Action required

Across a number of the cancer indicators patient choice is having an impact on the CWT targets. In particular the 14 day target.

Both MYHT and CHFT are micro managing the daily tracking and activity of all patients with cancer and the CWT targets through the MDT coordinators, service managers and the cancer managers. GP’s and patients are being directly contacted to ensure patients are wherever possible seen within the 2 week wait.

The cancer local implementation group of which I am cochair has developed a leaflet to be used by GP’s at the point of referral for Urgent Suspected Cancers. This will be available and issued to all GP’s as of December 09. The Lead Cancer Nurse at CHFT will monitor its use in the first three months of use.

Board members are asked to note that MYHT have progressed the appointment of a substantive lead cancer manager/clinician to commence March 2010.The Acting Deputy Chief Nurse has stepped into this role with the support of the AD for operations. Performance is being monitored daily by Jacqui Simpkin (SHA secondment)

CHFT hold monthly Planned Care meetings where the root cause analysis of breaches creating concern are individually discussed and managed accordingly.

Board are asked to acknowledge this progress

Patients are often unaware their referral is on a urgent suspected cancer (USC) and consequently are on holiday, fail to attend their appointment or change it for a day outside of the target There is currently no Lead Cancer Manager, or Clinical lead at MYHT. However, we do know that an appointment has been made and this will commence March 2010 Data from MYHT is improving and in more detail. However, to provide enough information for actioning we still need to see NHS Kirklees data separated from the Wakefield district. Work is progressing on this

LT/Board/CWT/16 December 2009

Cancer performance is now an agenda item for each MYHT board meeting and they have received the improvement plans developed by the operational managers. The Wakefield PCT (who act as host for cancer services across Wakefield and Kirklees) Executive Contract Board (ECB) now receives regular performance improvement assurances.

Lead and Timescales Loraine Turner, Cancer Programme Manager continues to monitor performance, liaise with the Contract and Performance Team, with the host PCT lead and report back to SMT

The reduction in 2 week waiting times over the last 2 months is evident and this should be acknowledged

Jacqui Simpkins from the SHA cancer performance team is working with MYHT for one day each week and has vastly improved tracking and data processes. The Acting Deputy Chief Nurse has taken responsibility for the

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National target of concern

Current risks

What plans are in place –

All risks at present with CHFT are closely monitored by the planned care board and all directorates are held to account. Dialogue is open and transparent. Attached is their current serious concerns report.

management of all clinical aspects with the support of the AD for operations.

Action required

Lead and Timescales

MYHT now provide an improved performance report for the fortnightly access meeting. It includes progress towards their predicted December delivery of their action plans indicated by the use of red, amber and green ratings (RAG Ratings). The Host PCT senior commissioning manager and performance manager receive a verbal report from the MYHT associate director of operations responsible for cancer services on the day of the access meeting about the detail behind the areas rated red and amber. MYHT now submit the formal feedback to ECB as previously requested. A joint audit of 2 week wait referrals will be undertaken led by the host PCT primary care lead cancer clinician. The YCN agreed to develop a policy and guidelines for GP’s and hospitals around referrals for USC and patients cancelling or failing to attend their appointments. This went to all Kirklees GP’s, lead cancer managers, clinicians, trackers and appointment clerks at CHFT and MYHT in September. This has proven to be very helpful and current data demonstrates an improved performance. Clinics held on Mondays are affected by the bank holidays in particular over the summer months. The summer period also sees a number of clinicians on annual leave and the lead cancer managers at CHFT and LTHT are aware that this needs to be addressed by working with the directorate managers and lead clinicians to ensure all clinics are covered and maintained or additional clinics are in place. Work is underway for the Christmas holiday period. Directors at MYHT have also had similar discussions with the host PCT

LT/Board/CWT/16 December 2009

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National target of concern NPI07a Proportion of patients with any breast symptoms referred to a specialist who are seen within two weeks of referral (YTD) Appendix 1 January to March 2010 (live). Shadow Indicator April to December 2009. 2009/10 Performance for Q4 January to March 20010 target is 93%

Current risks

What plans are in place –

Action required

The Breast 2 week waits remains below the anticipated VSA08 trajectory although there have been some significant improvements in the last 2 months at both CHFT and MYHT.

CHFT are now providing fully completed data.

Board are asked to acknowledge local progress with both CHFT and MYHT against regional and national progress which is in general below target. Both trusts are aware the target goes live in January 2010 and are endeavouring to develop sustainable systems to maintain the targets

Data collection for CHFT patients with breast symptoms referred to a specialist who are seen within 2 weeks of referral has been limited and as a result the information we received until October has been for MYHT only with partial information from CHFT in September.

Choose and book gives patients the choice of appointment date The above two and clearly has a bearing on the measures will be target if patients choose an combined in a appointment outside of the 14 matrix to day target. Patients referred are determine a level not necessarily referred with a of performance. potential diagnosis of cancer However we and are not always fully have not informed of the new two week received this wait initiative and target by their detail to date and GP there are no indications as to when this will happen LT/Board/CWT/16 December 2009

At CHFT Audits are currently reviewing capacity and demand to determine if the real problem is lack of appointment space or inadequate use of outpatient capacity. Early indications show the latter and this will be resolved with additional clinics created and an additional breast surgeon by December 2009 to reduce backlog and reduce the CWT. MYHT are taking similar action in reviewing their capacity and demand and are carving out appointment slots to accommodate patients within target. CHFT and MYHT continue to give verbal assurance that they will deliver the target as outlined in their remedial action plan. Cancer performance is now an agenda item for each MYHT board meeting and they have received the improvement plans developed by the operational managers.

Lead and Timescales Loraine Turner, Cancer Programme Manager to monitor performance, liaise with the Contract and Performance Team, the host PCT lead and report back to SMT Loraine Turner to attend the access meetings at MYHT with contract team

Whilst this target still appears a poor performance currently, the waiting time for symptomatic referrals is decreasing and, after the USC capacity, there is no further carve-out of appointment slots. This means that the continued reduction in waiting time can be managed in a relatively steady trajectory in relation to the waiting time (in weeks) element. Going further on Cancer Waiting Times and LEAN Lung process

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National target of concern NPI06b Proportion of patients with suspected cancer detected through national screening programmes or by hospital specialists who wait less than 62 days from referral to treatment

Current risks

What plans are in place –

Action required

At MYHT Non admitted care tumour type breast and urological are under performing against target. Present systems and processes are not adequate to manage the pathway.

The ‘Going Further On Cancer Waiting Times’ NHS Wakefield, Leeds and Kirklees commissioner led programmes will support the revised pathways for lung, upper GI and Urology to some extent and has identified some of the gaps creating the concerns. This work commenced in March 09 supported by the SHA.

Board are asked to acknowledge the progress being made with this target with CHFT and MYHT and to monitor its sustainability through regular reports from Loraine Turner, Cancer Programme Manager. Both trusts are micro managing this target to ensure breaches are kept to a minimum. Where breaches do occur they are down to patient choice and patient deterioration and not systems and processes

The cancer peer review (CPR)Internal validation process at MYHT identified:

Appendix 1

Failure to recruit to the vacant consultant radiology post - will have an adverse impact on both the quality of the services & delivering CWT. Radiology department struggles to fully support the breast cancer team.

Isotope Service patients travelling to Leeds for isotopes then return to the trust for wire insertion. On occasions patients have to travel with wires in situ to Pontefract site. Opening of new hospital in Wakefield -plans for a

LT/Board/CWT/16 December 2009

Stakeholder workshops to walk the pathways and identify blockages and potential risks to the Cancer Waiting Times are underway. These have been well received and subsequently lung cancer services have also undergone a LEAN programme supported by the Yorkshire Cancer Network. The GFOCWT programme and the LEAN programme for lung cancer at both MYHT and CHFT have clearly identified areas which can achieve ‘quick wins’ in terms of reducing the steps in the pathway and ultimately reducing the CWT. Improvements in the CWT should be seen by the end of the calendar year and early indications at CHFT in particular are already evident. The longer term areas of concern identified are more complex and will require reconfiguration of services, working arrangements and further investment at both CHFT and MYHT.

Lead and Timescales Loraine Turner, Cancer Programme Manager to monitor performance, liaise with Contract and Performance Team, the host PCT lead and report back to SMT Loraine Turner to attend the access meetings at MYHT with contract team

Cancer performance is now an agenda item for each MYHT board meeting and they have received the improvement plans developed by the operational managers. The host commissioners for cancer services meet regularly with Simon Nahk Director Lead at MYHT to

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National target of concern

Current risks local isotope service, all surgery will be carried out on the Pinderfields site there will be no further requirement for women to travel with a wire in situ. •

Poor attendance of the thoracic surgeons at the Lung MDT. Issue does need resolving to ensure sustainable support and comprehensive patient management plans. MDT administration requires a Trust wide approach to ensure consistency across all tumour sites.

Serious issues about the current level of Urology CNS resource

What plans are in place –

Action required

Lead and Timescales

discuss the action plans, performance improvement and monitoring processes. The outcomes are: •

MYHT provide an improved performance report for the fortnightly access meeting. It includes progress towards their predicted December delivery of their action plans indicated by the use of red, amber and green ratings (RAG Ratings). The host PCT senior commissioning manager and performance manager receive a verbal report from the MYHT associate director of operations responsible for cancer services on the day of the access meeting about the detail behind the areas rated red and amber.

MYHT now submit the formal feedback to ECB as previously requested.

A joint audit of 2 week wait referrals is being undertaken led by the primary care lead cancer clinician for NHS Wakefield.

I meet monthly with the lead cancer manger, CHFT to realize any difficulties and abate any potential breaches.

The host trust now meets with the directors and there is a clear process of feeding into the meetings Breast and urological patients at and receiving information through the lead MYHT are now being micro commissioner for cancer for the host trust. tracked I attended as one of the internal validators for CHFT who LT/Board/CWT/16 December 2009

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National target of concern

Current risks

What plans are in place –

Action required

Lead and Timescales

demonstrated no areas of real concern and had adequate plans in place to give assurance to the CPR panel of any potential concerns The host commissioner attended for MYHT.

LT/Board/CWT/16 December 2009

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http://www.kirklees.nhs.uk/fileadmin/documents/meetings/20091612/KPCT-09-234_Cancer_Waiting_Times_Pe