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					                                                              June 2008 – Enclosure No. 06




                              Report to Board of Directors

DATE OF MEETING                          Thursday 19th June 2008
REPORT TITLE                             Cancer Peer Review Action Plan
REPORT SUBMITTED BY                      Judith Bell Director of Public Health and
                                         Sharon Palser Director of Commissioning and Redesign
RECOMMENDATION(S)                        The Board of Directors is requested:

                                         1. To be assured that the PCT has in place a process
                                            for responding to the Peer Review



1. Introduction

1.1   The Greater Midlands Cancer Network (GMCN) Peer Review and Remedial Action Plan were
      discussed by the Board of Directors at the April meeting. The main findings of the Review
      were presented to the Board and it was agreed that a PCT action plan would be brought back
      to the June meeting.

1.2   The final agreed Peer Review report has now been published on the Cancer Quality
      Information Network System website www.cquins.nhs.uk.

1.3   The Remedial Action Plan will also be made available shortly on the same site.


2. North Staffordshire Action Plan

2.1   The PCT based action plan is a subset of the overall GMCN Remedial Action Plan.

2.2   Attached to this paper are the two relevant sections from the overall plan covering the
      Network Board and the Locality (University Hospital of North Staffordshire NHS Trust).


3. Key actions

3.1   On a network-wide level, implementation of Improving Outcomes Guidance is the major
      challenge and the PCT is supporting the independent review of patient flows commissioned by
      the GMCN. This work has already commenced.

3.2   In order to forge stronger links with commissioning and the network the Cancer Local
      Implementation Team (Cancer LIT) is chaired by Sharon Palser, Director of Commissioning &
      Redesign.
3.3   In accordance with the Trust Board agreement at its May meeting to strengthen the capacity
      and capability of the PCT we will be appointing a lead manager to project manage Cancer,
      Palliative Care and End of Life Care developments and thus the detailed aspects of the Action
      Plan.

3.4   Regular progress reports from the LIT will be subsumed within the Governance arrangements
      for the PCT.

4. Recommendations

4.1   The Board of Directors is requested to be assured that the PCT has in place a process for
      responding to the Peer Review.




                                              -2-
                                                                                June 2008 – Enclosure No. 06



                                                                                                                                      Appendix 1
                                                             Greater Midlands Cancer Network Board

                          FORMAT FOR AGREED REMEDIAL ACTION FOLLOWING A CANCER PEER REVIEW VISIT

 Action     Report    Concerns and further action suggested by Peer Review              Organisational action plan           Director          Key         Date of     Date for
Number     page and   Team.                                                             details. (cross referenced to     responsible for   Milestones   completion    Review
            subject                                                                     Network action plans)                 Action

GMCN 1    20          The visiting team was seriously concerned about                   This issue was discussed at       Damian Murphy                  March 2008   March 2008
          Network     progress with implementing Improving Outcomes                     length at the November 2007
          Board       Guidance for several cancer sites:                                Network Board
                                                                                        A Board IOG Implementation
                      
                                                                                                                   th
                          Improving Outcomes Guidance for Patients with                 sub group is to meet on 11
                          Gynaecological Cancers has not yet been implemented.          January 2008 with
                          Patients are still being treated by the local team at         membership at a strategic
                          Shrewsbury and Telford Hospitals where Improving              level.
                          Outcomes Guidance indicates that they should be
                          referred to a specialist gynaecological MDT. The network      The remit of the sub group is                                    18.01.08
                          IOG plan is for these patients to be referred to University   to produce an options paper
                          Hospital of North Staffordshire but this decision has not     for the Network Board to
                          been implemented. Network guidelines are not clear            consider at January 2008
                          about which patients should be referred to the specialist     meeting regarding the
                          team. A plan for achieving implementation of IOG is           processes required for
                          needed in the near future. Robust monitoring of progress,     implementation
                          including involvement of commissioners, will be required.
                          The Board should not expect the NSSG to resolve this          Agree the process at GMCN
                          issue without support.                                        Board
                                                                                        Recommendations agreed
                         The catchment population of the Dudley oesophago-
                          gastric specialist MDT is less than 700,000 which is          Short term
                          considerably below the 1 million expected by Improving        Develop 2 sMDTs in Urology
                          Outcomes Guidance. This situation has arisen because
                          patients from Walsall are not being referred to the MDT.      For UGI - Action to be
                                                                                        undertaken to ensure that the
                         All three of the network’s specialist urology MDTs have       population, where appropriate
                          catchment populations of less than the 1 million expected     is kept within the Network.
                          by Improving Outcomes Guidance. The network has no
                          plan for achieving the expected catchment populations for     UGI NSSG Chair , to report full                     MD to
                          these teams. An option of two MDTs with three operating       outcome information for both                        attend
                          sites has been discussed with the Cancer Action Team.         Network surgical centres                            March
                          This option may not be sustainable given the current                                                              Network
                          numbers of radical procedures undertaken on each site         H&N activity to be monitored                        Board.
                        and the possible reduction in need for radical surgery in   and reviewed after 2 yrs , as                                           March 2009
                        future.                                                     previously agreed

                       The current configuration of head and neck MDTs,            Gynae issues to be resolved
                        although agreed by the Cancer Action Team, does not         operationally, at a Trust level
                        result in teams with a sustainable workload.         The
                        Shrewsbury and Telford MDT had seen only 60 new             Haematology workforce issues
                        patients with upper airways tract cancer in the last year   to be addressed through the
                        compared with the agreed minimum of 80 patients per         Cancer Strategic Planning
                        year. The number of new patients treated by the             Group as a WM regional issue
                        Wolverhampton / Dudley and UHNS MDTs were 107 and
                        104 respectively.                                           Long Term
                                                                                    External Panel to be                                        January
                                                                                    established to review                                       2009        March 2008
                                                                                    population flows and
                                                                                    geography , not individual
                                                                                    terms, of the various disease
                                                                                    sites

                                                                                    IOG sub group, on behalf of                                 29.02.08.
                                                                                    Board, to draft terms of
                                                                                    reference, principles and
                                                                                    breadth of review

                                                                                    Board to agree these at next                                14.03.08.
                                                                                    meeting




GMCN 2   21        The Network also needs to address a range of other
         Network   issues relating to Improving Outcomes Guidance:
         Board
                                                                                                       th
                   a.   The colorectal NSSG has made a positive decision not to     Agenda item for 7 March           Joan Jackson   07.03.08               June 2008
                        implement some aspects of Improving Outcomes                2008 NSSG
                        Guidance relating to the care of patients with anal         NSSG to agree plan and date
                        cancers. The Board’s leadership of and oversight of the     for implementation
                        work of the NSSG has not yet produced an agreed plan



                                                                                    -4-
                         for achieving implementation of IOG.

                    b.   The catchment population for the UHNS pancreatic MDT        UGI NSSG Chair reports on a       Damian Murphy   14.03.08.               March 2008
                         is approximately 1.5 million which is less than the two     regular basis to Network
                                                                                                              th
                         million catchment population expected by Improving          Board – next report on 14
                         Outcomes Guidance. The configuration of MDTs has,           March 2008
                         however, been agreed by the Rarer Cancers Group (now        A WM monitoring of outcomes                                               March 2009
                         West Midlands Cancer Strategic Planning Group) and the      review is also proposed over a
                         Cancer Action Team and the activity levels and referral     2 year period
                         patterns are being monitored.

                    c.   All MDTs in the network are currently treating patients     This issue is an agenda item at   Joan Jackson                            20.02.08
                         with salivary gland cancer. Improving Outcomes Guidance     the H&N NSSG to be held on
                                                                                       th
                         expects that only one MDT in the network will treat these   20 February 2008, to agree
                         patients.                                                   NGSSG approach
                                                                                                                                                               February
                    d.   The Network’s plans for implementing Improving              First meeting of the WM           Damian                                  2008
                         Outcomes Guidance for People with Sarcoma are in the        Sarcoma Supra Network             Murphy/Paul
                                                                                                           th
                         process of being discussed and agreed. It is important      Group to be held on 4             Cool
                         that the Network is clear about the services being          February 2008
                         provided at Robert Jones and Agnes Hunt Hospital NHS        Membership to include Clinical
                         Trust (in conjunction with the Greater Manchester           Team from RJAH
                         Orthopaedic Sarcoma Service) as part of implementation      Group will report to Rare
                         of Improving Outcomes Guidance across the Network.          Cancers Group

                                                                                     Awaiting External Review led
                                                                                     by GM&CCN to identify
                                                                                     centres for surgical services ,
                                                                                     relating to GMOSS
                                                                                                                 th
                                                                                     A paper will be taken to 18       Joan Jackson                18.01.08.
                                                                                     January Network Board,
                                                                                     setting out the GMCN patient
                                                                                     referral pathways


GMCN 3   21         Most MDTs and NSSGs in the network are not collecting the        Network Information Lead post     Joan Jackson    February                March 2008
          Network   agreed datasets. As a result, some NSSGs, for example,           to be re advertised at higher                     2008
         Board      urology, are not able to undertake the audit projects they       grade , incorporating
                    consider necessary. NSSGs and constituent MDTs will not be       responsibilities of governance
                    able consistently to review the outcomes of their care unless    and audit
                    data collection improves significantly.
                                                                                     Proposal to take Somerset         Sara Bourne     14.03.08.               March 2008
                                                                                     Data Register forward within
                                                                                     the Network – paper to go to
                                                                                     March 08 Network Board
                                                                                     This system would greatly



                                                                                     -5-
                                                                                     enhance the amount and
                                                                                     quality of outcome data
                                                                                     produced by clinical teams

                                                                                     WMCIU have indicated that                                     April 2008
                                                                                     some support for audit may be
                                                                                     provided to NSSGs following
                                                                                     their restructuring


GMCN 4   21         The staffing of the network team has been significantly          Financial paper taken to         Tricia Lowe     18.01.08.
         Network    reduced and is not sufficient to address the range and           November Board 2007 for
         Board      complexity of issues facing this network.                        consideration , supported by
                                                                                     letters to each CEO
                                                                                                             th
                                                                                     To be followed up at 18
                                                                                     January 2008 Board meeting
                                                                                     Agree budget on a recurring
                                                                                     basis

                                                                                     Network Board agreed future      Tricia Lowe     June 2008
                                                                                     funding for Network Nurse
                                                                                     Director and post to be
                                                                                     advertised asap




GMCN 5   22         The cancer research network faces a significant challenge in     A member of the GNCRN            Pauline Boyle                12.02.08.
         Cancer     ensuring access to new studies across the network and            management team will attend
         Research   addressing variations in access to trials across tumour types    all NSSGs and update the
         Network    and geographical areas. The research network is aware of         group on research. The
                    these issues and must continue to engage with NSSGs and          GMCRN steering group will be
                    MDTs to ensure progress is made.                                 responsible for horizon
                                                                                     scanning for potential trials.
                                                                                     Agenda item for Feb 08
                                                                                     Steering Group


GMCN 6   22         The networks links with commissioners are not yet sufficiently   TL working with the              Tricia Lowe     March 2008
         PCT CCGp   strong to ensure that commissioners are fully engaged with the   Specialised Commissioners to
                    network’s work to improve cancer services. The use of the two    be firmed up process for that
                    LCCBs as the network’s commissioning group may be an             level of commissioning.
                    appropriate mechanism for supporting the discussion of           Pathways for PbC to be
                    financial investment. LCCBs cover all specialised services and   confirmed.
                    are unlikely to bring the required focus on cancer services.     A commissioning paper will be                    March 2008
                    The network needs to ensure that IOG plan implementation is      taken to the Network board for



                                                                                     -6-
                       supported by primary care, hospital Trust and commissioner         agreement.
                       action, investment where required and service improvement          The need for a specific
                       work. The mechanism for linking LITs and LCCB discussions          Network Commissioning
                       in the current structure is also not clear. Commissioners need     Group to be debated
                       to be actively involved in the IOG implementation issues
                       identified in the network board section of this report.


GMCN 7    23                  The NSSG has not yet agreed follow up guidelines.          To be an agenda item at the          Tricia Lowe    22.01.08.   March 2008
          Breast              The NSSG is aware of variations in access to breast        January 2008 NSSG
                               reconstruction within the network but has not yet          Follow up guidelines to be
                               agreed actions to address this                             agreed
                                                                                          Reconstruction scoping to be
                                                                                          undertaken
                                                                                          Commissioning support to be
                                                                                          sought


                                                                                                                          th
GMCN 8    23                  Members of the visiting team were seriously                This was discussed at the 7          Joan Jackson   07.03.08.                March 2008
          Colorectal           concerned about progress with implementation of            December 2007 NSSG meeting
                               policies on stabilisation and handover of patients         and information is to be
                               admitted as emergencies to the care of the colorectal      brought regarding existing
                                                                                                                       th
                               team. This was identified as an immediate risk in two      policy to the next NSSG on 7
                               Trusts in the network (Dudley and Wolverhampton)           March 2008
                               and has been only recently resolved in a third
                               (University Hospitals of North Staffordshire). It is not
                               clear that the NSSG policy has, in practice, been
                               distributed by Trusts in the network or that it is being
                               actively implemented. NSSG leadership and
                               monitoring of this issue is needed.
                                                                                                                     th
                                                                                          Future agenda item for 7             Joan Jackson   07.03.08.                March 2008
                              The NSSG has agreed that all MDTs in the network           March 2008 NSSG
                               will continue to care for patients with anal cancer,
                               although the number of clinical oncologists and
                               plastic surgeons involved with these patients has
                               been reduced. Improving Outcomes Guidance
                               expects that only one MDT in the network will care for
                               these patients.


GMCN 9    24           Serious concerns about the implementation of Improving             As GMCN 1
          Gynae        Outcomes Guidance are included in the Network Board
                       section of this report

GMCN 10   24           See Network Board section of this report in relation to            As GMCN 1
          UGI          catchment populations for the Dudley oesophago-gastric MDT
                       and the UHNS pancreatic MDT.



                                                                                          -7-
GMCN 11   25                See Network Board section of this report for serious       As GMCN 1
          Urology            concern relating to the catchment populations of the
                             three specialist urology MDTs.

                            The visiting team was seriously concerned that visits      To be discussed at the next        Tricia Lowe    24.01.08.   March 2008
                                                                                                              th
                             to two of the three specialist MDTs in the network         Urology NSSG on 24 January
                             revealed serious issues about appropriate referral of      2008
                             patients for consideration by the specialist team.         This issue raised within Pan       Tricia Lowe                April 2008
                             These related to referrals from Dudley and Walsall to      Birmingham’s Peer Review
                             the Wolverhampton MDT and from Mid Staffordshire           visit
                             General Hospitals to the UHNS MDT. The NSSG                Discussions to take place
                             has considered auditing these patient pathways but         following full transfer of                                    March 2008
                             the local teams said that they would not be able to        Walsall to the Pan Birmingham
                             collect the data needed for these audits.                  Cancer Network

                            Referral of patients with testicular and penile cancer
                             to supra-network specialist MDTs has been agreed.
                             It is not clear that all patients are now being referred   To be discussed at the next        Tricia Lowe    24.01.08.
                                                                                                            th
                             to these teams. An audit of the care of patients with      Urology NSSG on 24 January
                             penile cancer has been agreed. The NSSG should             2008
                             also ensure that patients with testicular cancer are       Pathways to be identified
                             also being referred to specialist team.

                                                                                        WMCIU have indicated that                                     April 2008
                                                                                        some support for audit may be
                                                                                        provided to NSSGs following
                                                                                        their restructuring


GMCN 12   26        Immediate Risk                                                      SaTH have now appointed a          Joan Jackson   08.02.08.
          Haemo                                                                         further Haematologist
                    Senior medical staffing levels remain extremely low in several      The NSSG has workforce as a
                    parts of the network. This situation has improved only              standing agenda item and a
                    marginally since the last visit and, at the time of Trust visits,   nominated Workforce Lead
                    was an immediate risk at Walsall Hospitals and Shrewsbury           who is , with JJ, in the process
                    and Telford Hospitals and of significant concern at UHNS.           of discussions with WM
                                                                                        Deanery regarding workforce
                                                                                        issues including skill mix and
                                                                                        redesign
                                                                                        Progress Meeting between
                                                                                        Haemo NSSG Chair, Workforce
                                                                                        Lead and JJ due to take place
                                                                                        in January/February 2008

                                                                                        ZRG has agreed to formally



                                                                                        -8-
                                                                                          write to the Chair of the
                                                                                          Cancer Strategic Planning
                                                                                          Group to request that they
                                                                                          consider Haematology
                                                                                          workforce issues as a WM
                                                                                          regional issue
                                                                                          There is a need for the
                                                                                          Network to identify a
                                                                                          contingency plan for the short
                                                                                          term


                              There is a shortage of junior medical staffing in          To be discussed at the next       Joan Jackson   08.02.08.
                                                                                                           th
                               several of the network’s services, especially Royal        Haemo NSSG on 8 February
                               Wolverhampton Hospitals and Shrewsbury and                 2008
                               Telford Hospitals.

                              Arrangements for network-wide review of histological       To be discussed at the next       Joan Jackson
                                                                                                           th
                               diagnoses of solid tumour biopsies have not yet been       Haemo NSSG on 8 February
                               implemented.                                               2008

                              Although nurse staffing levels in haematology              To be discussed at the next
                                                                                                           th
                               services have improved slightly since the 2006 visits,     Haemo NSSG on 8 February          Joan Jackson
                               they remain barely adequate in most services in the        2008
                               network.

                              The combination of senior medical, junior medical          As above
                               and nurse staffing issues add to the vulnerability of
                               haematology services across the network. The NSSG
                               needs to develop and agree a robust workforce plan.
                               Innovative approaches, including the potential for
                               new roles and skill mix changes, should be
                               considered as part of this plan.


GMCN 13   26           See Network Board section of this report in relation to the        As GMCN 1
          Head &       configuration of MDTs for the treatment of patients with upper
          Neck         airways tract cancer.
                       See Network Board section of this report in relation to the        As GMCN 2
                       configuration of MDTs for the treatment of patients with
                       salivary gland cancer


GMCN 14   27                  There is no lead clinician for palliative care, although   Clinical Lead and new Chair of    Tricia Lowe
          Palliative           nominations for this role are being sought.                Palliative NSSG now appointed
          Care
                              The network does not yet have a palliative care            Clinical Lead and Chair to lead



                                                                                          -9-
strategy. Some work on needs assessment has been         on development of strategy
undertaken but this has not yet been translated into a                                June 2008
strategy plus implementation plan – with clear
commissioning and service improvement support for
implementation. The development of a strategy is
particularly important given the serious issues facing
palliative care services in several parts of the
network, for example, the shortage of palliative
medicine consultants.




                                                         - 10 -
                                                                                                                                     Appendix 2


                                          University Hospital of North Staffordshire NHS Trust

                    FORMAT FOR AGREED REMEDIAL ACTION FOLLOWING A CANCER PEER REVIEW VISIT

ACTION   REPORT          Concerns and further action                  Organisational action plan details.        Director       Key Milestones   Date of      Date for
NUMBER   PAGE AND        suggested by Peer Review Team.               (cross referenced to Network action        responsible                     completio    Review
         SUBJECT                                                      plans)                                     for Action                      n

UHNS 1   65              The Trust has only one session per           A business case is currently being         Jacki Wilkes   April 2008       April 2008   Sept 08
         Locality        week from a palliative medicine              developed on behalf of the Cancer LIT      commissionin
                         consultant. This amount of time is           for the development of palliative care     g lead N
                         grossly insufficient for a Trust of this     services across the economy. Within        Staffs PCT
                         size and range of specialist MDTs. This      this, UHNS have identified the need for
                         issue was identified in 2001, 2002 and       at least two additional sessions of a
                         2005. Progress has been made with            palliative medicine consultant and
                         appointing palliative care nurses,           provision of educational support
                         including a nurse consultant, but no
                         increase     in    palliative  medicine      A review of palliative care service will
                         consultant staffing has been achieved.       be included in N Staffs PCT
                                                                      commissioning intentions for 08/09 in
                                                                      line with the 5 year strategy and          Jacki Wilkes   April 08         June 08      April 09
                                                                      commitment to continue working in          commissionin
                                                                      partnership across the health economy      g lead


UHNS 2   65              There is no cover for the oncologist at      Business case written for an additional    DM for         approved on      January      April 2008
                                                                                                                                   th
         Locality        the haematology and gynaecology              Oncologist                                 Onc/haem       14 December      2008
                         MDTs. The need for additional                                                                          at business
                         oncologist support to the MDTs at Mid                                                                  planning
                         Staffordshire General Hospitals NHS          Exec Board for final approval
                         Trust was also identified during the visit                                              DM for         Jan 08
                         to that Trust. The skin MDT may need                                                    Onc/haem
                         additional oncology time depending on        Advertise and appoint to post
                         the agreed configuration of services to                                                 DM for         April 08         June 08      Oct 08
                         achieve implementation of Improving          Continue to support succession             Onc/haem
                         Outcomes Guidance. The Trust is              planning for the pending retirement of
                         considering the appointment of a             the existing Gynaecology Oncologist.
                         seventh oncologist and the visiting team
                         would support this appointment.




                                                                              - 11 -
                                                                                                                                          June 08    Sept 08
UHNS 3   65         The MDTs reviewed during this visit do    Review access to service through the         Cancer           April 2008
         Locality   not have access to clinical psychology    Cancer LIT                                   management
                    support for their patients. This was of                                                team
                    particular concern to the haematology     develop bid for the LDP to appoint a
                    and gynaecology teams but is relevant     cancer psychology team for UHNS                               Dec 07        April 08   Sept 08
                    to several others.
                                                                                                           Lung Cancer      March 08      June 08    Dec 08
UHNS 4   66         Attendance at MDT meetings by each        Ensure cross cover arrangements are          lead clinician
         Lung       of the individual surgeons is less than   in place, so that there will be 100%
                    50% (49%; 33%; 48%). Surgeons do          surgical presence at MDTs
                    cover each other and so one surgeon                                                    Lead clinician   March 08      June 08    Dec 08
                    was present at 86% MDT meetings           Review of attendance register                lung
                    since April 2007 and two surgeons were
                    present at 52% meetings. (See also                                                     Directorate      June 08       Sept 08    Dec 09
                    further consideration 1.)                 Review the Cardio-Thoracic Surgeons          manager-
                                                              work plans in order to support MDT           surgery
                                                              working.

UHNS 5   66         CNSs visit patients on the wards on       Following a visit from the National          Directorate      Sept 08       Sept 09    December
         Lung       only one day per week and there is no     Lead for Lung Cancer the focus is            managers for                              09
                    CNS support for patients on surgical      currently on medical inpatient care.         medicine and
                    wards.                                    The CNS workload will be reviewed in         surgery/Lead
                                                              order to ascertain the need for a            Cancer Nurse
                                                              business case for additional support

                                                              Continuation of major redesign work to       Director of
UHNS 6   67         The MDT is not collecting the agreed      incorporate cancer data collection within    Cancer
         Lung       (LUCADA) dataset.                         the EPR system:                              Services

                                                              New electronic MDT form developed            Director of      June 08       Spring     December
                                                                                                           strategy and                   2009       2009
                                                              Pathology, radiology and surgery             planning
                                                              elements of data collection developed        Director of      December 08   Spring     December
                                                                                                           strategy and                   2009       2009
                                                              Explore, with the Network, the possibility   planning
                                                              of the Somerset Cancer Registry System.
                                                              As per GMCN 3 (Proposal to take
                                                              Somerset Data Register forward within
                                                              the Network – paper to go to March 08                                                  March 08
                                                              Network Board                                Network SIL      14.03.08
                                                              This system would greatly enhance the
                                                              amount and quality of outcome data
                                                              produced by clinical teams)


UHNS 7   67         The   workload    of   the   consultant   Agreement for the appointment of a           DM surgery       Oct 07        April 08   April 08



                                                                      - 12 -
         Colorectal   colorectal surgeons is still very high.     fourth consultant.
                      This issue is closely related to                                                                        mid-November
                      implementation of the policy on             Commencement of Locum substantive            DM surgery     2007           March 08
                      handover of patients admitted as            appointment expected in the spring of
                      emergencies. The Trust has recently         2008.
                      implemented a ‘consultant of the week’
                      system which should reduce the              Review number of operations carried          DM surgery     Oct 08         December   Feb 09
                      number of patients treated by surgeons      out by non core MDT members                                                08
                      who are not core members of the MDT         following the commencement of the
                      – but increase the workload of the          surgeon of the week system (SOW).
                      colorectal surgeons. The Trust has also
                      agreed to the appointment of a fourth
                      consultant. A locum is due to start in
                      mid-November 2007 with a substantive
                      appointment expected in the spring of
                      2008. These changes are very recent
                      and the Trust should assure itself that
                      the new policy has had the expected
                      impact on operations by non-core
                      members of the MDT without imposing
                      an unreasonable workload on the
                      colorectal surgeons.

                                                                                                               Joan Jackson   7.3.08                    June 08
UHNS 8   67           The NSSG has decided that all MDTs          The NSSG has met and agreed that all
         Colorectal   will continue to treat patients with anal   patients with anal cancer will be
                      cancer. This approach does not comply       discussed via the use of a virtual MDT
                      with Improving Outcomes Guidance.           using a protocol and that salvage
                      The NSSG is, however, auditing the          surgery will be focussed within two
                      care of these patients. University          specialist teams across the network.
                      Hospital of North Staffordshire is
                      appropriately staffed for the care of       As per GMCN 2
                      these patients.


                                                                  Continuation of major redesign work to       Director of
UHNS 9   67           The MDT is not collecting the NSSG          incorporate cancer data collection within    Cancer
         Colorectal   agreed dataset or submitting data to the    the EPR system:                              Services
                      national audit programme due to limited
                      resources for data collection               New electronic MDT form developed            Director of    June 08        Spring     December
                                                                                                               strategy and                  2009       2009
                                                                  Pathology, radiology and surgery             planning
                                                                  elements of data collection developed        Director of    December 08    Spring     December
                                                                                                               strategy and                  2009       2009
                                                                  Explore, with the Network, the possibility   planning
                                                                  of the Somerset Cancer Registry System.
                                                                  As per GMCN 3 (Proposal to take



                                                                          - 13 -
                                                                      Somerset Data Register forward within
                                                                      the Network – paper to go to March 08                                              March 08
                                                                      Network Board                             Network SIL      14.03.08
                                                                      This system would greatly enhance the
                                                                      amount and quality of outcome data
                                                                      produced by clinical teams)


UHNS 10   68               The visiting team was seriously            Discussion will be held at the NSSG to    Chair of         4.2.08        June 08   Sept 08
          Gynae            concerned that this MDT is not yet         ensure that pathways are clear and        Gynae NSSG
                           receiving appropriate referrals from the   referrals follow the agreed pathways.
                           Shrewsbury and Telford Hospital NHS
                           Trust local gynaecology MDT. The MDT       Support will be sought through the        Chair of
                           is not, therefore, able to carry out its   Network IOG implementation Group          Gynae NSSG
                           specialist role for the agreed catchment
                           population. Referral guidelines are not
                           clear about the patients which should
                           be referred to the specialist team.



UHNS 11   68               There is no cover for the clinical         Business case written for an additional   DM for           approved on   January   April 2008
                                                                                                                                    th
          Gynae            oncologist                                 Oncologist which will support the         Onc/haem         14 December   2008
                                                                      Gynaecology workload.                                      at Trust
                                                                                                                                 business
                                                                                                                                 planning
                                                                      Exec Board for final approval             DM for           Jan 08
                                                                                                                Onc/haem

                                                                      Advertise and appoint to post             DM for           April 08      June 08   Oct 08
                                                                                                                Onc/haem

                                                                      Continue to support succession
                                                                      planning for the pending retirement of
                                                                      the existing Gynaecology Oncologist.



UHNS 12   69               One consultant surgeon has attended        Review the MDT commitments of core        Upper GI         April 08      June 08   Sept 08
          UGI specialist   only 26% of MDT meetings.                  surgical team members following the       Lead Clinician
                                                                                            th
                                                                      commencement of the 5 Upper GI
                                                                      consultant



UHNS 13   69               The MDT does not have the expected 2       As per GMCN 2
          UGI specialist   million catchment population expected



                                                                             - 14 -
                           by Improving Outcomes Guidance for                                                      Damian          14.03.08
                           the care of patients with pancreatic         UGI NSSG Chair reports on a regular        Murphy –                             March
                           cancer. The configuration of MDTs has,       basis to Network Board – next report       Network                              2008
                           however, been agreed by the Cancer                 th                                   Clinical
                                                                        on 14 March 2008
                           Action Team and the West Midlands            A WM monitoring of outcomes review         Director
                           Rarer Cancers Group and the activity         is also proposed over a 2 year period
                           and outcomes are being monitored.            care for pancreatic cancer management                                           March
                                                                                                                                                        2009


UHNS 14   69               The CNS has a high workload and no           A second UGI nurse post will be            DM Surgery      June 08    June 08   Dec 08
          UGI specialist   cover. The MDT is very dependent on          appointed to.
                           the CNS for managing the patient
                           pathway for patients with oesophago-         An appraisal of the role of the CNS will   Lead cancer     June 08    June 08   Dec 08
                           gastric and pancreatic cancers. She          be conducted to determine a further        nurse/CNS
                           has no specific cancer-related training      business case.
                           and no administrative support. She
                           also covers the organisation of the MDT
                           when there is no MDT coordinator
                           (MDT coordinator / cover had attended
                           70% meetings.)       Her workload is
                           already high (approximately 200 new
                           patients per year) and is increasing as
                           more patients are referred from
                           Shropshire.
                                                                        Agreement will be sought via the NSSG
UHNS 15   70               The visiting team was seriously              and Network Board to ensure                Chair of        24.1.08    Dec 08    July 09
          Urology          concerned that arrangements for              compliance with the IOG Action Plan        Urology
          specialist       referral    of   patients    from     Mid    submitted by GMCN to Cancer Action         NSSG
                           Staffordshire General Hospitals NHS          Team.
                           Trust are not robust and it is not clear
                           that the care of all appropriate patients
                           is discussed by the specialist MDT prior     Review the use of the tertiary referral    Clinical team   April 08   Sept 08   Dec 08
                           to their treatment. Where patients are       proforma in order to provide               and DM’s for
                           discussed by the specialist MDT, there       appropriate clinical information.          cancer
                           are sometimes delays in this discussion                                                 Stafford and
                           taking place. This issue was identified in                                              UHNS
                           2005 and has not been resolved. [This
                           issue was identified as an immediate
                           risk for the MDT at Mid Staffordshire
                           General Hospitals NHS Trust.]


                                                                                                                                              June 08
UHNS 16   70               The CNS has a high workload and no           The action plan following the CNS          DM for          March 08
          Urology          cover. The MDT treats approximately          audit will be put in place.                surgery/Urolo
          specialist       500 new patients per year. The CNS is,                                                  gy CNS



                                                                                - 15 -
                       in practice, unable to be present at the
                       haematuria and rapid access prostate        An appraisal of the role of the CNS will     DM for
                       clinics. This issue was identified in       be conducted to determine a business         surgery/
                       2005 and has not been resolved.             case for further support .                   cancer         June 08       Sept 08   Dec 08
                                                                                                                management
                                                                                                                team



UHNS 17   70           The MDT does not have the 1 million         As per GMCN 1
          Urology      catchment population expected for a
          specialist   specialist MDT. The MDT’s catchment         Revised IOG plan agreed by Cancer
                       population is less than 700,000. (The       Action team. No further action intended
                       configuration of MDTs has, however,         unless required by the Network.
                       been agreed by the Cancer Action
                       Team.)
                                                                   Continuation of major redesign work to       Director of
UHNS 18   70           The MDT is not collecting the NSSG          incorporate cancer data collection within    Cancer
          Urology      agreed dataset or submitting data to the    the EPR system:                              Services
          specialist   national audit programme due to limited
                       resources for data collection.              New electronic MDT form developed            Director of    June 08       Spring    December
                                                                                                                strategy and                 2009      2009
                                                                   Pathology, radiology and surgery             planning
                                                                   elements of data collection developed        Director of    December 08   Spring    December
                                                                                                                strategy and                 2009      2009
                                                                   Explore, with the Network, the possibility   planning
                                                                   of the Somerset Cancer Registry System.
                                                                   As per GMCN 3 (Proposal to take
                                                                   Somerset Data Register forward within
                                                                   the Network – paper to go to March 08                                               March 08
                                                                   Network Board                                Network SIL    14.03.08
                                                                   This system would greatly enhance the
                                                                   amount and quality of outcome data
                                                                   produced by clinical teams)


UHNS 19   71           The number of consultant                    As per GMCN 12
          Haemo        haematologists is low for the size of the
                       population served and the type of           On going review of job plans in place.       Onc/Haem DM    Spring 2009   Sept 09   July 2010
                       service provided. The service has an        Once the move into the new cancer
                       establishment of only 3.8 wte consultant    centre has taken place, and workload
                       haematologists. There is currently some     redesigned, a formal review of
                       additional support from an Associate        workload will take place.
                       Specialist but this is not funded beyond
                       March 2008. Two locum consultants
                       from Mid Cheshire Hospitals NHS Trust
                       share in the on call rota. There are



                                                                           - 16 -
                  plans to appoint a replacement
                  consultant who, if successful, will result
                  in 4.4wte available for the service at
                  UHNS and seven consultants on the on
                  call rota. This level of staffing will need
                  to be kept under review as the service
                  develops.



UHNS 20   71      There is no cover for the clinical            Business case written for an additional   DM for       approved on   January    April 2008
                                                                                                                          th
          Haemo   oncologist member of the MDT.                 Oncologist which will support this        Onc/haem     14 December   2008
                                                                workload.                                              at Trust
                                                                                                                       business
                                                                Exec Board for final approval                          planning
                                                                                                          DM for
                                                                                                          Onc/haem                              Oct 08
                                                                Advertise and appoint to post
                                                                                                          DM for
                                                                                                          Onc/haem


UHNS 21   71      CNS workload is high. There are 1.8wte        This arrangement will be reviewed         DM for       Summer 2008   Dec 08     June 09
          Haemo   CNSs who are required to cover shifts         once new ward appointments are in         Onc/haem
                  on the ward as well as their specialist       post.
                  nursing responsibilities.


                                                                                                                                     June 08    Sept 08
UHNS 22   71      The team does not have direct access          Review access to service through the      Cancer       April 2008
          Haemo   to clinical psychology support for its        Cancer LIT                                management
                  patients and has to rely on GP’s                                                        team
                  referring patients for this service.          develop bid for the LDP to appoint a
                  (Although the clinical psychologist is an     cancer psychology team for UHNS                        Dec 07        April 08   Sept 08
                  extended member of the MDT).



UHNS 23   71      The MDT has a catchment population of         Revised IOG plan agreed by Cancer
          H&N     less than 1 million expected by               Action team. No further action intended
                  Improving Outcomes Guidance. The              unless the Network require it.
                  team cares for a population of less than
                  700,000 but the configuration of MDTs         As per GMCN 1
                  has been agreed by the Cancer Action
                  Team.




                                                                       - 17 -
UHNS 24   72        The MDT has no restorative dentist or        The MDT has access to restorative          DM for           June 08   Sept 08     March 09
          H&N       ward nurse member and no cover for           dentistry by a visiting surgeon and        surgery /lead
                    these disciplines.                           there is dental care by the community      clinician for
                                                                 GDP’s. The Trust will re-visit the         head and
                                                                 supporting team for Head and Neck          neck
                                                                 services.


UHNS 25   72        There is no cover for the speech and         The role of the SALT is a specialist       DM for           June 08   Sept 08     March 09
          H&N       language therapist or dietician.             area of practice and whilst some           surgery /lead
                                                                 functions can be covered by the CNS        clinician for
                                                                 an exploration of cover requirements is    head and
                                                                 required.                                  neck

                                                                 There is a dietetic service for patients
                                                                 but the cover cannot attend MDT
                                                                 meetings.


UHNS 26   72        One oral maxillo-facial surgeon spends       Review job plans of surgeons to            DM surgery       June 08   Sept 08     March 09
          H&N       less than 50% of direct patient care         ensure appropriate allocation of cancer
                    sessions on the care of patients with        patients.
                    upper airways tract cancer.
                                                                 The surgeon is from Mid Staffs and not     Karen Morrey -             3.12.2007   Review
UHNS 27   72        Immediate Risk                               managed by UHNS, Mid staffs have dealt     Stafford                               complian
          Thyroid                                                with this as follows                                                              ce at ¼
                    One surgeon from Stafford who                Meeting arranged with surgeon and                                                 focus
                    operates on patients with thyroid cancer     lead clinician 3.12.07                                                            group
                    has attended only 9% of MDT meetings         Practice ceased – surgeon has stopped                                             meetings
                    and is not included on the network list of   undertaking procedure and has
                    designated clinicians.                       withdrawn from MDT

UHNS 28   72        The visiting team was seriously              The function and attendance at MDT         Lead clinician   Jan 08    June 08     Aug 08
          Thyroid   concerned that this MDT is not a fully       will be reviewed.                          Thyroid
                    functioning MDT for patients with
                    thyroid cancer. Attendance by individual     Radiology cover will be identified         Clinical         Jan 08    June 08     Aug 08
                    surgeons at MDT meetings is low (9%;                                                    Director/DM
                    18%; 36%). There is no cover for the                                                    for Radiology
                    surgeon from Stafford. The radiologist’s
                    attendance is 55% and there is no
                    cover for this role. Individual attendance
                    by the lead endocrinologist is 27%
                    (although attendance for the discipline
                    is over 90%.) The Trust should either
                    amalgamate this MDT with the upper
                    airways tract MDT or ensure that



                                                                         - 18 -
                    attendance improves significantly.

UHNS 29   73        This MDT does not have a catchment          Revised IOG plan agreed by Cancer
          Thyroid   population of 1 million expected by         Action team. No further action intended
                    Improving Outcomes Guidance for a           unless the Network wish to.
                    thyroid MDT. The MDTs catchment
                    population is less than 700,000.            As GMCN 1

UHNS 30   73        Endoscopic ultrasound is not yet            The PCT’s have now agreed to fund         DM for         December 07   Feb 08    March 08
          Imaging   available within the Trust. This is         this service.                             radiology
                    expected for a Trust hosting a specialist
                    upper GI team.                              Commencement of EUS service at
                                                                UHNS Feb 08


UHNS 31   73        The radiologist attending the thyroid       The cover will be reviewed.               Clinical       Jan 08        June 08   Aug 08
          Imaging   MDT has no cover and has attended                                                     Director/ DM
                    only 55% meetings.                                                                    radiology




                                                                       - 19 -

				
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