Agenda item

(To receive a report from Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group (CCG)) which provides an update on performance of cancer services across Lincolnshire and gives details of the progress made on specific improvement projects, previously described.  Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group CCG) will be in attendance for this item)

The Committee considered a report by Sarah-Jane Mills, the Director of Development and Service Delivery, at Lincolnshire West Clinical Commissioning Group, which was the lead Clinical Commissioning Group (CCG) in Lincolnshire for commissioning cancer services. 

The report to the Committee made reference to the incidence of cancer across Lincolnshire, with the highest number of new cases recorded in the South Lincolnshire CCG and South West Lincolnshire CCG areas.  Nationally, there had been a steady increase in the diagnosis of new cancers since 2009.  The report also referred to the importance of early detection, and the role of screening as part of this, in particular screening for breast cancer; cervical cancer; and bowel cancer.  In this regard, the support of the County Council's Public Health Department was emphasised in the presentation to the Committee. Overall, the early diagnosis of cancer was lower in comparison to the national averages.

The report referred to survival rates in relation to which it was reported that one-year survival rates for all cancers across Lincolnshire were comparable to the national average; only in the South Lincolnshire CCG area did one-year survival rates exceed the national average.  However, one-year survival rates for lung cancer were much lower in Lincolnshire, ranging from 30.5% to 39.4%. 

The Committee was advised in the report of the performance of four local hospital trusts in quarter 1 against two of the national cancer standards: (1) the two week wait – the percentage of patients seen by a specialist within 14 days of referral; and (2) the 62 day treatment measure – the percentage of patients receiving treatment within 62 days.  In relation to (2), United Lincolnshire Hospitals treated 71.4% of patients within 62 days. 

Progress with the Lincolnshire Cancer Improvement Plan was reported to the Committee, which had focused on United Lincolnshire Hospitals NHS Trust (ULHT).  This was because towards the end of 2015, the trajectory for cancer performance at ULHT had been improving month on month.  Performance at ULHT had dipped from January 2016 onwards, which had been expected.  However, the Trust's performance had not returned to the 2015 levels.  A review to explore the reasons for this had found that there were increased demand for diagnostic tests early in the cancer pathway; reporting issues relating to software; and most importantly workforce availability.

In relation to workforce, the Committee was advised that there had been vacancies in the Oncology Team at ULHT between January and July 2016, which had affected performance and all these vacancies had now been filled.  Similarly, there had been issues with staff vacancies in Chemotherapy, and these had now been addressed.  Over the last two months the two week wait performance had further deteriorated at ULHT, owing to reduced radiology capacity in the Breast Service.  Workforce availability remained the greatest risk to the service.  

Further mitigation measures had taken place at ULHT which included patient tracking to ensure the waiting time standards were met; and a bid for national funding to support capacity in CT. 

The Committee was advised of other improvements actions since January 2016, when cancer services had last been considered by the Committee.  These included a pilot of a triage service by a clinical nurse specialist of patients with lower gastrointestinal cancer; and work with the County Council's Public Health Department on developing an understanding of the issues of the local population. 

The Committee sought clarification on the following points:

·         A new software package had been implemented within the last four weeks, which would track patients through the cancer pathway;

NOTE: At this point in the proceedings, Councillor R Kirk re-entered the meeting at 1.15 pm.

·         It was confirmed that a dedicated project manager had been appointed to lead the development of community based services.  A separate project manager had also been appointed to lead the Find Out Faster initiative;

·         The Committee was advised that a piece of work would be carried out to focus on the support arrangements for patients who were transitioning between acute and palliative care;

·         A submission had been made for national funding.  The funding would be used to install a second CT scanner, which would be located at the Pilgrim Hospital in Boston.  This would increase capacity across United Lincolnshire Hospitals NHS Trust and allow for 7 day working at Lincoln County Hospital.  Further to this, Members were referred to the challenges in relation to radiology staffing;

·         Whilst treatment for patients was good at United Lincolnshire Hospitals NHS Trust, a significant issue was the availability of diagnostic results for oncologists, which ultimately led to patients having to rebook appointments with oncologists, who could not proceed without the results.  The Director of Development and Service Delivery agreed to follow this up;

·         In response to a question on bowel cancer screening, it was clarified that this screening was offered to people between the ages of 60 and 69 in accordance with national guidelines.  It was possible that the people over the age of 69 could receive screening, but this relied on their own vigilance in seeking appointments;

·         It was confirmed that a key focus of the work was on prevention and awareness.

RESOLVED

1. That progress with the Lincolnshire Cancer Improvement Plan be acknowledged, including the actions taken since the previous report to the Committee in January 2016; and

2.   That a further report be requested on cancer services in Lincolnshire on 15 March 2017. 

NOTE:   At 1.45pm, the Committee adjourned for lunch and reconvened at 2.20pm.  On return, the following Members and Officers were in attendance:-

County Councillors

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

District Councillors

Councillors J Kirk (City of Lincoln Council), Mrs P F Watson (East Lindsey District Council), Mrs K Cook (North Kesteven District Council) and Mrs R Kaberry-Brown (South Kesteven District Council)

Officers in attendance

Andrea Brown (Democratic Services Officer), Dr Kakoli Choudhury (Consultant in Public Health), Simon Evans (Health Scrutiny Officer), Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service (EMAS)), Gary James (Accountable Officer – Lincolnshire East CCG) and Blanche Lentz (Lincolnshire Divisional Manager – East Midlands Ambulance Service (EMAS))

Healthwatch

Mr P Keeling

Apologies for Absence/Replacement Members (Councillors who attended the morning session)

Councillors Miss E L Ransome