Skin Cancer Network Group Audit of Clinical Performance Indicators: Data quality and treatment quality Anna Murray BSc Cancer Information Analyst

Standards for Better Health Clinical performance indicators Measurable and comparative data Progress assessment locally and at network level Merseyside and Cheshire CNG: Access to services Consistency of service provision Compliance with national targets

Clinical Performance Indicators I.The number of newly diagnosed patients referred by trust and ICD-10 code: i.31 day first definitive treatment ii.62 day standard i.Number of patients being treated ii.Waiting times for treatment II.Performance of radiotherapy:

Clinical Performance Indicators III.Clinical trial activity i.Accrual by MDT in to clinical trials IV. Sentinel lymph node biopsy i.Number of patients referred by Breslow score ii.Number of procedures performed V. Primary care excisions i.Number of primary care excisions taking place

I.The number of newly diagnosed patients referred by trust and ICD-10 code:

Data discrepancies Apparent between CWT data and local trust data Suggests issues across the network for data uploads Are performance figures inaccurate? Somerset Cancer Register should address this Must make sure that trusts are uploading all of their data Good quality data is the key Trust Cancer waiting times dataLocal trust data Southport and Ormskirk 4330 Warrington & Halton 1215 Arrowe park 5752 St Helens and Knowsley 4093 Aintree 6Awaiting data Countess of Chester 70Awaiting data RLBUHT 9190 Total Comparison of total numbers of patients first seen for Malignant Melanoma in Merseyside and Cheshire Cancer network by trust (January to December 2008)

V. Primary care excisions Research and audit: ‘…the planned treatment of low-risk BCCs should be restricted to approved doctors…, usually a GPwSI…or the LSMDT/SSMDT. All other skin cancers should be referred to the LSMDT in the first instance (National Institute for Clinical Excellence, 2006).’ If the lesion is not a BCC, then the patient should be urgently referred (National Institute for Health and Clinical Excellence, 2006) Abnormal growths/inflammations to be treated by GPs unless there is doubt with regards to diagnosis (National Institute for Health and Clinical Excellence, 2006)

V. Primary care excisions Trust C43 - Malignant melanoma of the skin C44 - Other malignant neoplasms of the skin (except basal cell carcinoma) Combined RLBUHT92332 WUTH22022 St. Helens & Knowsley61319 Southport & OrmskirkAwaiting data Countess of ChesterAwaiting data Network Malignant melanoma – 4.6% Squamous cell carcinoma – 7.2% Combined – 6.4%

V. Primary care excisions Findings: Not all patients diagnosed with either malignant melanoma or squamous cell carcinoma are urgently referred via 2 week wait What are the reasons for this? Can such cases be avoided in the future? Poorer patient experience?

What next? Clinical Performance Indicators Audit of excision completeness in primary care Monitoring uptake in to clinical trials Audit of patients referred for SLNB Breach analysis in CWT data