Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the national and local context regarding Lincolnshire's strategy for cancer; and details of the emerging option for oncology and haematology as part of the Lincolnshire Acute Services Review.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group, Louise Jeanes, Cancer Care Programme Manager, Lincolnshire West Clinical Commissioning Group, Dr Carl Deaney, Marsh Medical Practice, North Somercotes, and Dr Aurura Sanz-Torres, Consultant Clinical Oncologist and Clinical Director (Oncology and Haematology), United Lincolnshire Hospitals NHS Trust.

The report provided the Committee with an update on Cancer Lincolnshire's Long Term Plan 2019/24, and the vision and strategy for delivering effective and accessible haematology and oncology services for patients in Lincolnshire; it also provided details of the emerging option for oncology and haematology as part of the Lincolnshire Acute Services Review.

It was highlighted in Lincolnshire there were currently 27,500 people living with cancer and that this figure was expected to rise to 45,400 by 2030.  It was highlighted further that cancer prevalence was across the four locality areas and ranged from 2.7% to 3.2% (national average being 2.6%).  The Committee was advised that the most common cancers were Breast, Lung, Colorectal & Prostate and of these, colorectal was the most common cancer in Lincolnshire.  It was highlighted that although survival rate had improved for most cancers, the difference between survival rates for the most survivable cancers and the less survival cancers was significant at 55%.  It was highlighted that the strategy aimed to improve survival rates, and improve early diagnosis and prevention.

The Committee noted that over the next five years the Lincolnshire Sustainability and Transformation Partnership would be working with the East Midland Cancer Alliance provider trusts and McMillan towards building on progress and improvements already made on the Cancer Programme.  Details of the ambitions for survival, screening, early diagnosis, treatment, personalised care and workforce were detailed within the report. 

Reference was also made to interventions to be implemented from 2021 onwards, which included the Lung Health Check Programme, and Rapid Diagnostic Pathways.

The key areas of focus for transformation were detailed on pages 45 and 46 of the report and included improvements to screening, diagnosing cancers earlier and faster, and ensuring that there was universal access to optimal treatment and adopting faster, safer and more precise treatments; and offering personalised care for all patients. 

During discussion, the Committee raised the following issues:-

·         One member enquired why there was a predicted rise in the number of patients with cancer to 45,000 by 2030.  The Committee was advised that this figure was influenced by three factors: the ageing population; earlier diagnosis; and lifestyle choices which included obesity, smoking and alcohol consumption.  Confirmation was given that work was on-going with the public to tackle a number of these long term issues.  It was noted that all the measures to help improve the service would also increase the number of patients.  Details of the benefits of the Case for Change were shown in Section 3 of the report.  An example given to the Committee of smarter working was prostate triage, which involved looking at everyone connected to the process, to ensure that all efficiencies were being explored;

·         Presentation of patients at accident and emergency departments.  The Committee was advised that patients were often diagnosed at stages three and four, after presenting at an accident and emergency department; and that Lincolnshire was higher than the national average in this regard.  It was highlighted that changes to pathways and providing GPs with new tools would help to reduce these instances;

·         The role of the East Midlands Cancer Alliance.  The Committee was advised that the Alliance had a facilitating role to improve outcomes for cancer patients across the East Midlands area;

·         Children's cancer – It was noted that the responsibility for children's cancers was with the specialised commissioning team.  It was noted further that GPs would always refer children to specialist centres;

·         Workforce – A question was asked as to whether there was sufficient staff with the right skill set to deliver the improved outcomes.  The Committee noted that GP international recruitment was going well, with 80 GPs having been recruited into England, with a further round expected.  It was highlighted that staff would be developed to ensure there was an integrated approach from acute care to community services;

·         Patient data. The need to promote to patients the benefits of sharing data across health services;

·         Cancer diagnosis at stages one and two (page 48) a question was asked whether Lincolnshire would meet its target of diagnosing 75% of cancers at stage one and two by 2023.  It was agreed that patients needed to be encouraged to take part in screening programmes; this was a challenge, but with more collective working to encourage patients to take responsibility for their health,  the target could be achieved;

·         The location of the eleven radiotherapy networks.  The Committee was advised that this was part of a national programme; and the boundaries of the radiotherapy networks had not been finalised; and

·         Locations the mobile chemotherapy unit would be attending; and how patients would be made aware of this option.  The Committee was advised that there was one mobile unit and eligible patients were made aware of the service, which was not suitable for all patients.  The Committee noted that the service would be available at Grantham, Skegness, Louth, Spalding and that it was hoped to expand the service further.

In the second part of the presentation, the Committee was advised of the clinical speciality for haematology and oncology; and that at the Clinical Summit held in February 2018, the key concern highlighted had been the impact of workforce challenges limiting the ability to provide adequate cover across the county, which had resulted in the failure to meet performance against national waiting times standards for cancer and non-cancer.  The report presented provided details of current performance and provision; and also provided details of the Case for Change for Lincolnshire, with an emerging option for sustaining haematology and oncology services in Lincolnshire, details of which were shown on page 52 of the report. 

It was noted that consolidating haematology and oncology inpatient care at Lincoln County Hospital would provide the opportunity for a more consistent achievement of clinical standards, as well as supporting the ability to manage immunosuppressed patients in an appropriate setting; and addressing the concerns raised by the Care Quality Commission in April 2017.  The Committee noted further that it would also provide the opportunity to improve facilities as part of the wider change on the Lincoln Hospital site, thus meeting the NICE guidelines for the management of neutropenic sepsis patients; as well as providing an opportunity to accommodate the increase in outpatient activity.

It was also highlighted that in consolidating the services at Lincoln County Hospital would also help to attract and retain talented and substantive staff through the building of a successful service, which offered the opportunity to work in a centre of excellence model.

During discussion, the Committee raised the following points:-

·         A question was raised on the key challenges for the service and to the centralisation of the service.  Reassurance was given that the preferred emerging option would mean that outpatient facilities would be increased and Lincoln County Hospital would restore its specialist provision.  The Committee noted that the issue of transportation was currently being reviewed with the County Council, as to how family members and carers were to move around the county.  It was noted that if the service provided was efficient and effective, it would result in shorter lengths of stay in hospital;

·         Financial Resource - The Committee noted that capital investment would be required to increase the number of beds at Lincoln Hospital site; and

·         Patient Choice agenda – Reassurance was given that if patient choice was exercised for initial diagnosis by, patients opting to go out of county, they invariably remained with that provider throughout their treatment.  It was highlighted that where patients opted to go out of county, the funding would follow the patient.  It was highlighted further that the main thrust of the change was to make services in Lincolnshire the best they could be.

The Chairman extended thanks to the representatives for their informative presentation.

RESOLVED

That the Chairman be authorised to provide feedback on behalf of the Committee as part of the Healthy Conversation 2019 engagement exercise on the emerging option for haematology and oncology.