Improving experience for people with cancer in Croydon Presentation on the finding of the national cancer patient survey Claudia Tomlinson Jackie Green Tuck Kay Loke

How cancer services are organised at CHS TypeTreatmentCancer Centre BreastSurgeryChemotherapy & Radiotherapy at RMH ColorectalSurgeryChemotherapy & Radiotherapy at RMH DermatologySurgeryComplex surgery requiring plastic at ST Georges GynaecologyDiagnostic & Low risk endometrial surgeryChemotherapy, radiotherapy and surgery at RMH HaematologyLevel II serviceLevel III and Level IV at RMH LungDiagnostics and Palliative Care and follow up for radiotherapy Chemotherapy at RMH and surgery at St Georges. PaediatricsPOSCU Levl1GOS and RMH UrologySurgery and Bladder chemotherapyRadiotherapy at RMH/Complex surgery at St Georges. Upper GIDiagnosticsSurgery at RMH. CHS is part of the London Cancer Alliance Partnership with LCA, Macmillan Cancer Relief etc. Cancer and Core Functions Directorate (CCF) CAB, Macmillan Information Centre, Counselling & complimentary services

Executive Lead for Cancer COO Clinical Director for CCF Clinical Lead for Cancer Site Specific Clinical Leads General Manager Nurse Consultant/Lea d Cancer Nurse Cancer Nursing Team Cancer Manager Cancer Admin Team

Background and context National Cancer Patient Experience Survey 2012/13 CHS Annual survey undertaken by Quality Health All patients 16 + who had received treatment for cancer during September – November 2012 are eligible National number of patients included 116,525. Average national response rate was 64%. CHS number of patients included 66 with a 68% (44 patients) response rate Trusts are ranked in top 20% and lower 20% in all questions and the intermediate group 60%

Survey methodology 2010/112011/122012/13 Sample month01 Jan – 31 March Sept – 30 November Sept – 30 November 2012 Sample size (eligible patients) Responses Response rate58%66%68% Changes since the survey began: Sampling month Sample size Reducing number of responses Response rate stable over two years

Top 5 Tumour group respondents Tumour Group2010/112011/122012/13 Breast Colorectal/Lower GI Haematological19106 Urological22 5 Lung6 Survey methodology - respondents

Low numbers of eligible patients identified on PAS Possible sampling issues due to difficulty in identifying cancer patients Information services rely on clinical service to identify cancer patients by diagnosis Survey methodology sampling issues for CHS

2010 / 11 CHS in bottom 10 in the country x 35 fell in bottom 20% and 4 x in top 20% 2011/ 12 CHS no longer in the bottom 10 X 21 fell in bottom 20% and 19 in top % 2012/13 CHS in bottom 10 in the country x 38 fell in bottom 20% and 4 x in top 20% Last 3 years results 1 of the 9 London Trusts in the bottom 10

Questions rated in top 20% (‘green’ rated) NoQuestionScore 11Patient told could bring a friend81% 13Patient completely understood what was wrong81% 19Patient told how treatment side effects could affect them in the future 62% 63GP given enough information about patient's condition/treatment 100%

Questions improved since last survey No. Table 2: Summary of thirteen indicators showing improvement in 2012/13 CHS 2012/13 Score (%) Highest Trust’s score 2012/13 6 Staff explanation purpose of tests 76%93% 11 Patient told could bring a friend 81%89% 13 Patient completely understood what was wrong 81%85% 16 Patient's views taken into account/treatment 69%84% 20 Patients involved in decisions about care and treatment 76%85% 28 Patient informed they could get free prescriptions 70%88% 44 Enough nurses on duty 37%89% 47 Staff asked patient name they preferred to be called by 31%84% 48 Privacy when discussing treatment/condition 83%96% 49 Privacy when examined/treated 92%100% 55 Family given information to help care at home 58%77% 63 GP given enough information about patient's condition/treatment 100% 64 Practice staff did everything they could to support patient 64%82%

Questions significantly worsened since last survey No Table 3: Specific indicators significantly worsened in 2012/13 CHS Score 2011/1 2 CHS Score 2012/13 2 Patient thought seen as soon as possible 88%68% 4 Patient health the same/better while waiting 90%73% 30 Discussing taking part in cancer research with patient 62%31% 35 Staff explained how the operation had gone 87%64% 67 Given the right amount of information about condition/treatment 96%70% 70 Patient rating of care 'excellent/very good' 89%64%

NoPeriodActionLeadDeadline 1S Disseminate survey results to all directorates and key forums in CHS Clinical Lead for Cancer & Lead Cancer Nurse December S Meet the CNS team posters CNS/Keyworker business cards Lead Cancer Nurse December S Root Cause Analysis exercise to be conducted using the 5 Whys technique5 Whys Lead Cancer Nurse & General Manager December S All patients with cancer have access to a CNS/ key worker and Holistic Needs Assessment - business case developed to facilitate Lead Cancer Nurse December S Deliver a listening event with stakeholders Clinical Lead for Cancer & Lead Cancer Nurse January 2014 Key Actions

NoPeriodActionLeadDeadline 6M Providing financial advice Continuation of partnership working with Croydon CAB service funded for 1 more year. Requires sustainability plan and pick up funding from October 2014 General Manager and Lead Cancer Nurse June M Responding to patient feedback (including real time) Clinical Lead for Cancer & Lead Cancer Nurse April L Work with Macmillan and the London Cancer Alliance pathway groups in improving the patient experience Clinical Lead for Cancer Lead Cancer Nurse & Cancer Manager September L Taking Patients views into account – implementing action from the listening event Clinical Lead for Cancer Lead Cancer Nurse & Cancer Manager September L To review expanding the cancer and palliative care nursing service Lead Cancer Nurse September 2014 Key Actions

Summary Picture of findings of cancer patient experience for past three years presented, showing fluctuating performance Methodological issues discussed including identification and sampling of patients Although an overall worsening since last survey, there is evidence of good performance in many areas Improvement actions will focus on:  Listening to patients and stakeholders  Sharing and learning from the results  Promote a multidisciplinary response