Cancer Summit Plymouth Hospitals NHS Trust 12 th February 2015 Ruth Bridgeman - Programme Director, National Peer Review Programme

Patients, Regulators, Clinicians, Providers and Commissioners

The Benefits of the Peer Review Programme Provision of disease specific information across the country together with information about individual clinical teams which has been externally validated Provision of a catalyst for change and the monitoring of service improvement Provision of a directory of services Speedy identification and resolution of immediate risks and serious concerns to patients and or staff each year Engagement of a substantial number of front line clinicians in reviews (approximately 5000) Rapid sharing of learning between clinicians, as well as a better understanding of the key recommendations in the NICE guidance, National Service Specifications or National Standards. Provision of timely national benchmarked data, trend analyses and reports that provide accessible public information about the quality of cancer services

Plymouth over the years

Key Issues for Plymouth Issues of configuration for services in South West i.e. Sarcoma and Head & Neck Working relationship with Royal Cornwall Joint working for Gynae appears to be a success.

Key Issues for Plymouth Acute Oncology – Very good service now in place – they were finalist in the HSJ Patient Safety and Care Awards. Anal – There is no specialist Anal MDT in the Peninsula.

Key Issues for Plymouth Brain & CNS – South West regional centre covering the Peninsula. It is a combined Surgical and Non-surgical MDT –Low self-assessed compliance (59%) due to the lack of AHPs including dietician and speech and language therapist. –Irregular attendance and no cover for palliative care core member. –Numbers of benign and malignant patients supported by three nurses across the peninsula (five trusts) means the nursing service is stretched.

Key Issues for Plymouth CUP Service - Combined AOS/CUP Service, the CUP MDT was established in April Low compliance (MDT = 54% Hospital = 33%) due to lack of networking CUP group; it’s unclear if the group is meeting yet. Haematology – Self assessment stated that there was no regional networking group and standards relating to these measures could not be met. However, the networking group is being reconvened with a new chair appointed. Not sure if they have met yet?

Key Issues for Plymouth Head & Neck - West Peninsula MDT – Joint MDT with Royal Cornwall Non IOG compliant as all surgical resections are undertaken on both hospital sites. Areas of concern identified at the self assessment include; –Poor attendance from the Royal Cornwall members of the MDT. –No cover arrangements for the CNS’s on both sites and no cover for the oncologist at RCHT. –No restorative Dentist at RCHT.

Key Issues for Plymouth HPB - MDT for the South West covering the Peninsula with a population of approx. 1.7 million. Gynae – All patients including low risk endometrial cancers are discussed at the West Peninsula Specialist Gynae MDT. This is a joint MDT hosted by Royal Cornwall; surgery is undertaken on both sites. Brachytherapy is only provided at Plymouth.

Key Issues for Plymouth Lung – Low compliance (54%) with poor attendance by palliative care (7%) and oncologist (37%), the latter was raised at self assessment as a serious concern. The network group has not met. Sarcoma (soft tissue) – This is a joint MDT with Royal Cornwall. They are slightly below the minimum workload of 100 new cases with 92 in 2013/14but that’s increased from 68 in 21012/13.

Key Issues for Plymouth Thyroid – Visited March 2014 (There are also Thyroid only MDTs at RDE and Royal Cornwall) –Two Serious Concerns MDT do not meet the IOG recommendation of a minimum catchment population of one million as they currently give their population as 450K Support offered to patients is compromised due to the dual role of the CNS, also covers Sarcoma cancers.

Key Issues for Plymouth UGI - Specialist OG MDT for the Peninsula. Serious concern identified at self assessment regarding breaches – These were multifactorial but essentially down to higher demand than capacity within all areas of the pathway. Urology – Specialist MDT with tertiary referrals from Cornwall and East Devon. It also provides a variety of penile operations under the direction of the supra regional MDT at North Bristol.

Plymouth and the South West Hospitals included: Plymouth Royal Cornwall South Devon Royal Devon & Exeter North Devon Yeovil Taunton Weston Royal United Hospitals Bath North Bristol University Hospital Bristol Gloucester Cheltenham

Plymouth Compared to the South West and National Average Tumour MDTs across 4 years -Plymouth compared to SW and National

Plymouth Compared to the South West and National Average Cross Cutting Teams across 4 years -Plymouth compared to SW and National

Plymouth Compared to the South West and National Average Children's and TYA Teams across 4 years -Plymouth compared to SW and National

How do Plymouth Services compare with others in the South West?