Date of completion
Tumour Type
Organisation
Concerns and further action suggested by Peer Review Team
Key Director responsible Mileston for Action es Network Director, Network Executive Board Oct-08 Network Director, BSUH Cancer management team, Network Executive Board
Date for Proposed Review Organisational Original Action Plan Details (2005) Report as of by March 08 Network Feb-08 There is full sign up to the IOG action plan. A business case is being undertaken by BSUH cancer management to ensure the process of relocation is managed effectively. Feb-08 The business case being undertaken by BSUH should include a risk assessment of the process. However, full sign up to the plan includes BSUH Chief Executive and a risk assessment of the plan should have been inherent within this sign up. Oct-08 date for full implementation of the IOG plan is October 2008, and it is this date that was agreed to have full local support services in place. However, work is in progress to ensure the key services are supported. Jan-08 Work is ongoing around ensuring the number of surgeons is efficient for the number of patients. A complex job plannign process has been underway to ensure a fair process. The final number of surgeons has not yet been agreed. Jan-08 The clinical lead for thyroid has drafted some management guidelines for thyroid cancer which include follow up. It is anticipated that this will help address the lack of consistency in this area across the network Jan-08 The thyroid teams are undergoing a process of rationalising the number of surgeons carrying out thyroid cancer work, both "non-complex" and "complex" work. Once this process is done, there will be governance arrangements in place to ensure that only non-complex work is carried out locally, and any complex work is referred into the thyroid MDT.
Report Ref
Reference
Action outstanding required?
SCN
HN1
Head & p9, para timescales for implementation of IOG Neck 2 plan due to relocation of surgical services Head & p15, para carry out risk assessment of Neck 1 implementation plan addressing what process is such implementation slip
Oct-08
SCN
HN2
Feb-08 Feb-08
SCN
HN3
Head & p15, para local support services lacking in key Neck 1 roles
Oct-08 Oct-08
Acute trust management teams, SCN HN4 Head & p15, para Neck 2 concern around rationalisation of surgeons SCN HN5 Thyroid p15, para 5 disparate arrangements for follow up of thyroid cancer patients across the network SCN HN6 Thyroid p15, para dissections for thyroid cancer carried out Clinical lead for thyroid, 5 locally NSSG Chair, Network Clinical director Jan-08 Jan-08 Network Clinical Director, BSUH cancer management team, Network Executive Board Clinical lead for thyroid, NSSG Chair Jan-08 Jan-08
Jan-08 Jan-08
SCN
HN7
Thyroid p15, para further endocrine surgeon required 7
Clinical lead for thyroid, Network Clinical director
Jan-08 Jan-08
Jan-08 There is more than one surgeon carrying out thyroid cancer work, and this is to be addressed through the process being undertaken around thyroid surgical work.
BSUH BSUH BSUH BSUH BSUH BSUH BSUH
HN8 HN9 HN10 HN11 HN12 HN13 HN14
Head & p19, para dietetic support pre and post operatively Cancer Management Neck 2 not sufficient Team Head & p19, para histopathology uspport to MDT Neck 2 pressurised Head & p19, para level of psychological support services Neck 2 available insufficient Head & p19, para lack of specialist ward for Head & Neck Neck 3 cancer patients Head & p19, para lack of specialist nursing support, Neck 3 especially with trachestomy expertise Head & p19, para key worker policy not fully embedded Neck 3 within MDT Head & p19, para nursing workforce impacting on patient Neck 4 pathway and inability for development opportunities Head & p19, para follow up clinics not sufficiently frequent, Neck 5 and should consider nurse-led clinics to reduce pressure on consultant team Thyroid p19, para thyroid surgeon overloaded and 7 unsustainable. Consider additional endocrine surgeon post Thyroid p19, para lack of nursing support for thyroid 7 patients Elective/Specialist and Emergency Division Elective/Specialist and Emergency Division Lead Cancer Nurse Emergency Division
New Dietician in post now NO Business Case to be worked up on the pressures on the department
There is currently a business case completed to address these needs There is currently a business case completed to address these needs New referral guidelines have been developed to ensure the key worker role Member of staff does have training opportunities, winwin and chairing meetings etc
Lead Cancer Nurse
No
BSUH
HN15
BSUH
HN16
BSUH BSUH
HN17 HN18
CNS lead for thyroid Lead Cancer Nurse New referral guidelines have been developed to ensure the key worker role To change details to Max Facial
Thyroid p19, para key work policy needs to be clarified 7 currently is Head & Neck nurse which is inadequate Lead Cancer Nurse Head & p19, para network/MDT documentation contains Lead Cancer Manager Neck 9 references to oral surgeons - to be and Co-ordinator removed to read maxillo facial surgeons Head & p19, para infrastructure available for specialist Neck 10 Head, Neck & thyroid cancer work Elective/Specialist and Emergency Division
BSUH
HN19
BSUH BSUH
HN20 HN21
There is currently a business case completed to address these needs Regular feedback to Lead managers group and the NEB Feedback to the cancer action group Jan-08 Aug-08 Dec-08 Engage with Cancer Action Groups. Review of Cancer Action Groups commenced September 2007. Dec-08 This will be undertaken through the network wide review of thyroid surgery Dec-08 This will be undertaken through the network wide review of thyroid surgery
Head & p20, para project manage impelemntation process Lead Cancer Manager Neck 1 carefully through SCN management team and PcT commissioners Head & p20, para improve PCT and hospice involvement in Cancer Action Group Neck 6 the locality Head & p22, para improve primary care involvement and Neck 2 understandign of the local service Cancer Management Team, David Fordham
BSUH ESHT
HN22 HN23
ESHT ESHT
HN24 HN25
Thyroid p22, para number of surgeons undertaking thyroid Nick Violaris, Paul Rowe 4 surgery work needs to be rationalised Head & p22, para consolidate surgical work at RSCH in line Nick Violaris, Chair of Neck 5 with IOG plan NSSG
Jan-08 Aug-08 Jan-08 Aug-08
ESHT
HN26
Head & p23, para increase visibility of peer review process Cancer Management Neck 1 within hospital Team Head & p23, para lack of CNS concern Neck 1 Head & p23, para appropriate support for patients being Neck 1 given significant news Mark Collins Mark Collins
Jan-08 Aug-08
Dec-08 Meetings planned with MDT Leads and Cancer Management Team to improve visibility of Peer Review process Dec-08 Advert shortly to be placed for Head and Neck CNS Dec-08 To be addressed by appointment of CNS Dec-08 Implementation of Somerset Cancer Registry to unify and normalise recording of MDT decisions Dec-08 Specialist Oncology dietician to support all MDTs in LDP Dec-08 Review of services to patient to be undertaken by Clinical Nurse Specialist. Dec-08 Work to be commenced with SPT to establish referral pathways for Head and Neck Patients. Work will build on the Psychological and Psychiatric Services Project hosted by the Sussex Cancer Network. Now resolved. Clarity of the complexity of the pathway has been agreed with managers and clinicians.
ESHT ESHT ESHT
HN27 HN28 HN29
Jan-08 Aug-08 Jan-08 Aug-08 Aug-08 Aug-08
Head & p23, para address level of communication following Nick Violaris, Michael Neck 1 MDT meeting and ensure decisions are Watson recorded accurately Head & p23, Neck para2 no dedicated dietician Sara Tisdall Nick Violaris Sussex Partnership Trust
ESHT ESHT ESHT
HN30 HN31 HN32
Aug-08 Aug-08 Aug-08 Aug-08 Aug-08 Aug-08
Head & p23, para no dental hygienist Neck 2 Head & p23, para lack of access to psychological support Neck 2
WASH HN33
Head & p28, para disparaty in understanding of local N/A Neck 2 services between management team and clinical team Head & Neck Head & Neck p28, para 3 p28, para3 communication between local clinicians and specialist MDT lack of access to supportive roles for patients Sue Carter / Heather Rogers Maggie Morley / Sue Carter Mar-08
WASH HN34 WASH HN35
The role and function of the locality clinicians and the communication pathways require further development.pathway needs to to Allied Healthso that As HN35 the Particularly links be developed patients know how to access the appropriate professional. The Trust does not intend to increase the CNS hours at the present time.
WASH HN36 WASH HN37 WASH HN38 WASH HN39 WASH HN40
Head & p28, para reduction in CNS hours for head and Neck 5 neck cancers Head & p28, para consultant cover as single handed Neck 5 Head & p28, para lack of implementation fo key worker Neck 5 policy Head & p28, para lack of understanding around tariff and Neck 6 how applied to head and neck cancer Head & p28, para lack fo implementation of lump clinic Neck 7 Jerry Grant Head & p28, para poor data quality Neck 8 N/A N/A Maggie Morley / Sue Carter N/A Dec-07
This is under review by the cancer centre.
Key worker policy to be implemented. This process has been clarified. Lump clinic is established. Haematology attendance and same day results are under review but considered to be working well. Information is now being collected.
WASH HN41