Agenda item

(To receive a report from Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) which invites the Committee to consider and comment on the progress with regards to the development of Cancer services throughout Lincolnshire.  Sarah-Jane Mills (Director of Planned Care and Cancer Services – Lincolnshire West Clinical Commissioning Group) will be in attendance for this item)

A report by Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) was considered which invited the Committee to comment on the progress with regards to the development of Cancer Services throughout Lincolnshire.

 

Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) and Mark Brassington (Chief Operating Officer – United Lincolnshire Hospitals NHS Trust (ULHT) were in attendance for this item of business.

 

The Chairman reminded the Committee that Theme 3 of the Joint Health and Wellbeing Strategy focussed on Delivering High Quality Systematic Care for Major Cause of Ill Health and Disability.  A key priority in this theme was to reduce mortality rates from cancer and improve the take-up of screening programmes.

 

The provision of a comprehensive range of services to promote improved outcomes for people affected by Cancer remained a priority for Lincolnshire.  The prevalence and outcomes for local residents were in line with the national average and development of local services was coordinated by Lincolnshire West Clinical Commissioning Group.  The strategic framework for the development of local services reflected the recommendations of the National Cancer Strategy and had been developed to reflect local priorities, challenges and the outcomes of the Cancer Summit in February 2015.

 

The Lincolnshire Health and Care System remained committed to driving the continued improvement of cancer services and had established a network with key stakeholders, coordinated by Lincolnshire West CCG, to further promote the development of services for local people.

 

Overall patient experience had a national average of 88% and it was reported that Lincolnshire East CCG scored 83%, Lincolnshire West CCG 88%, South Lincolnshire CCG 89% and South West Lincolnshire 82%. 

 

United Lincolnshire Hospitals NHS Trust (ULHT) were the primary provider of Cancer Services for Lincolnshire and, on the basis of the number of patients treated, was in the top ten list of cancer treatment providers in England.

 

To further support the Improvement Plan, ULHT invited the National Intensive Support Team and secured additional service improvement capacity from the East Midlands Strategic Clinical Network.  The key themes of the improvement plan were:-

·       Improve access within 14 days;

·       Improve access to diagnostic tests;

·       Review and refresh systems and processes to facilitate efficient management of patients on a cancer pathway; and

·       Recruit to the Lead Cancer Nurse post

 

The national End of Life Care Strategy built on the recommendations outlined in NICE guidance for Supportive and Palliative Care. As a result,  a dedicated palliative and end of life care strategic development group had been established to support the continued improvement of services for people in Lincolnshire.  The work programme had included:-

·       Redesign of community service provision to provide 24 hour access to specialist support;

·       Introduction of EPaCCS (Electronical Palliative Care Coordination Systems) – an IT solution to support access to patients' advanced care plan in all settings;

·       Continued provision of education to staff in all settings;

·       Contributed to the development of a countywide/cross organisational Do Not Attempt Resuscitation Policy;

·       Developing arrangements to facilitate improved access to palliative care medicines in the community; and

·       Continued development of supportive palliative care services in the community.

 

During the last year, two new investments had been commissioned:-

·       Chemotherapy Bus – the development of Chemotherapy Closer to Home Services in Lincolnshire was being delivered and developed via a Chemotherapy Bus, with the potential to improve patient experience and choice by reducing travel and waiting times for chemo delivery.  The bus was equipped with four chairs, refrigerated storage for drugs, a toilet and a quiet seating area for patients and carers. Medical, nursing and pharmacy services were provided by ULHT and two chemotherapy trained nurses were required to staff the unit per day, working on a rotational basis from the chemo suite teams.

29 treatment regimes had been identified which were suitable for delivery in a community setting with risk stratified as 11 low and 18 medium and initial assessment and first cycle of treatment being made at the main centres.  The mobile unit was currently utilised at Grantham Hospital (and on the Lincoln Hospital site for additional capacity) and a roll out plan was in place once Louth and Skegness sites had established the electrical coupling required.  The plan had been somewhat delayed due to chemotherapy trained staffing shortages.

 

·       A new LINAC machine, used to provide radiotherapy treatment, had become operational  with a second machine scheduled in 2016

 

The main objectives of the improvement plan were:-

·       To work with local communities to increase the number of people who attend the screening programme;

·       To develop community services to support people affected by cancer so that they may be partners in their care and treatment, both during and beyond treatment;

·       To improve access to diagnostic services in order to support referral to diagnosis in four weeks;

·       To work with the East Midlands Clinical Network and other partners to support the development and implementation of best practice clinical pathways;

·       Continually improve the systems, processes and policies so as to facilitate the proactive management of patients on their cancer pathway; and

·       To support the continued development of palliative and end of life care services.

 

The key actions during the next six month were reported as:-

·       Support continued improved performance against the national waiting time standards;

·       Where appropriate, support direct access to diagnostic investigations;

·       Work with colleagues in public health to gather information which would further support our understanding of issues for the local population;

·       Secure funding to support the appointment of a Project Manager to lead the development of community based cancers support services;

·       Develop links with tertiary centres to facilitate the review of clinical pathways and where appropriate explore the development of formal alliances;

·       Review and consider the Danish model with respect to utilising different diagnostic strategies to facilitate access for patients at high risk of cancer; and

·       To work with key stakeholders to develop sustained improved access to breast services.

 

Members were given the opportunity ask questions, during which the following points were noted:-

·       Two elements of work were ongoing to encourage people to take up the opportunity of screening, following work undertaken with the screening team which highlighted some exceptions to the uptake of screening, especially in some areas which were below the national average.  The CCG were working to understand how to target that particular group and specific work was being done in relation to people with learning difficulties;

·       An observation had been made that if a GP practice endorsed the need to undergo screening then a patient was 10% more likely to have that done.  Some work was planned over coming months to find those gaps and work with local GPs, neighbourhood teams and community teams to promote screening and raise awareness;

·       There were two opportunities for older ladies to be self-motivated.  Education was the first, with a screening programme to continually reinforce the importance to be included as self-care and for them to take wider responsibility for their own healthcare.  Secondly, local GP surgeries could encourage patients to attend for screening on an individual basis;

 

Councillor Mrs S M Wray declared an interest at this point as she has a close connection with a current cancer patient.

·       Although the focus was on early access to services and diagnosis, there was an ongoing piece of work with the Cancer Improvement Group to improved continued access to diagnostics and the framework for reporting to ensure this was prioritised;

·       It was reported that CT and MRI were challenged areas which could work better internally and, due to this, there was a specific piece of work ongoing for CT, looking at improving the timeline for repeat scans and availability of reports;

·       MRI were working closely with the CCGs to identify providers and have 98% of the market but ULHT were aware of other capacity within the health service who could assist with that pressure.  A new MRI machine would also become available once all the necessary check and training had been completed;

·       The importance of talking to patients and clinicians to find the pressure points on the system was starting to work and improvements being made.  Diagnostics remained a national challenge and work was ongoing with the East Midlands Network on how this could be better delivered;

·       A programme of work in relation to radiology across the region and sharing resources in order to reduce delays was due to go live;

·       Historically, screening performance for a six month period was below expected standards but from an outcome standard nationally, the Trust were within target and the outcomes in line with the rest of the country.  Performance had improved and, in November, the Trust achieved 82.6% against 85% which was above the national average for performance;

·       Cancer outcomes were measured on two levels, one year survival and five year survival and all CCGs were within the national average for those outcomes.  It was acknowledged that those outcomes could be improved with early diagnosis;

·       A suggestion was made to include a date in the reminder letter for self-referrals as this may make people realise that it is for them in particular and not just a blanket reminder.  This would hopefully encourage them to diarise the date and be more likely to arrange screening.  This suggestion was welcomed and would be taken back to the screening team for further consideration;

·       It was unclear when there would be a programme for ovarian cancer screening but further investigation would be done and a response would be provided to the Health Scrutiny Officer to report back to the Committee;

 

At this point of the meeting, Councillor S L W Palmer advised that he had a serious investigation complaint lodged with ULHT from July 2015.

·       A request was made to include actual figures in the report rather than the national average.  It was explained that the information presented was how it was received from national colleagues following collation but that they would look at this further to ascertain if comparable figures could be provided;

·       Wherever patients felt there was extended waits, they were encouraged to escalate those to the PALS team for investigation;

 

RESOLVED

1.    That the report and comments be noted; and

2.    That a further update to the Committee be scheduled for April or May 2016.

 

 

NOTE:       At this stage in the proceedings, the Committee adjourned for luncheon and, on return, the following Members and Officers were in attendance:-

 

County Councillors

 

Councillors Mrs C A Talbot (Chairman), R C Kirk, S L W Palmer, Mrs S Ransome, Mrs J Renshaw, T M Trollope-Bellew and Mrs S M Wray.

 

District Councillors

 

Councillors C J T H Brewis (Vice-Chairman) (South Holland District Council), B Bilton (City of Lincoln Council), K Cook (North Kesteven District Council), Mrs P F Watson (East Lindsey District Council), G Gregory (Boston Borough Council) and Mrs R Kaberry-Brown (South Kesteven District Council)

 

Healthwatch Lincolnshire

 

Dr B Wookey.

 

Officers in attendance

 

Andrea Brown (Democratic Services Officer), Kakoli Choudhury (Consultant in Public Health), Simon Evans (Health Scrutiny Officer), Ian Hall (Senior Delivery and Development Manager – Trust Development Authority), Jim Heys (NHS England, Locality Director – Midlands and East (Central Midlands)), Lynne Moody (Director of Quality and Executive Nurse, South Lincolnshire CCG)