1. 28 Day Faster Diagnosis Standard
08/03/2017

2. Overview Introduction and background Aims and objectives
Timeline for rollout
Areas highlighted by testing so far
Questions

3. Introduction Recommendation from independent Cancer Taskforce:
95% of patients should receive a definitive diagnosis or ruling out of cancer within 28 days of a referral
‘Early priority’ and a Secretary of State commitment
Aims:
Speed up access to diagnosis for those with cancer
Ensure that patients who aren’t diagnosed do not wait and worry
Fit with new NICE referral guidance lowering the threshold of suspicion for ‘cancer’ referral
Some big ambitions:
‘All patients’ whatever their suspicion
Include primary care requested diagnostics

4. Opportunities Big opportunities: Centre the pathway on the patient
Focus on better communication
Speedier and more efficient diagnosis, encouraging links between primary and secondary care
Greater flexibility than the current 2WW
Potential barriers
Data not currently collected and difficult to define end point consistently
New national CWT system required to capture and report data
Capacity in diagnostics and administration
Potentially large changes in practice

5. Approach
Five test sites: Leeds, East Lancs, Kingston, Bournemouth, Ipswich
Two main objectives:
Robustly test and develop rules (16/17)
Explore impact on services of delivery of the FDS (17/18)
Work collaboratively across test sites to develop approach
Shared learning
Build new standard from the ground up
Develop and streamline good practice – set standard on that basis
Alliances key in moving towards national rollout

6. Faster Diagnosis Standard
Timeline
2016/17
2017/18
2018/19 Q1 Q2 Q3 Q4
Faster Diagnosis Standard
Test site bid process
Test site selection (07/16)
Data set, exclusions and rules agreed
Phase 1 – data development
Test site close and evaluation
Phase 2 – exploration of impact on services
ISN, Framework for national rollout agreed with alliances
Ongoing alliance support, working towards full compliance by 2020.
Procurement process – new CWT system
Project
setup
Development and testing
of new CWT system
Ongoing data collection for 28 Day FDS
NHS Digital named supplier
Development phase start
Implementation of new system
Further development

7. Develop and agree rules
Agreed core dataset with test sites
Set of clear rules, as well as exclusions and scenarios being developed e.g. patient death, dealing with misdiagnosis, how to apply DNA rules
Now iterating with test sites – test and learn
Still looking at primary care requested tests and how we might be able to include them
Aim to keep as clear and simple as possible – will keep core principles of existing cancer waiting times standards
‘Complete pathway’ standard
No adjustments or pauses

8. Rollout data
New CWT system critical – collect additional data items that will also implement the new breach policy nationally
Expect to have a phased collection – new items in shadow form initially (time tbc, 6 months?)
Once data quality consolidated, begin working towards meeting new standard
Early data collection will inform rollout schedule
Significant change, priorities are:
Minimise burden
Integrate to existing systems and processes
BUT make sure that the new data reflects the strategic priorities and importance of this new standard

9. Rollout performance
Final ‘performance standard’ will be informed by results from test sites
Taskforce suggested 95% but will keep under review
Expect regions, alliances and other local networks to have a key role
Links with ACE, transformation funding, diagnostic capacity fund
28 Day standard doesn’t exist in isolation
Will be strongly informed by test site evaluation and feedback, but keen to engage more widely than that
Test sites as ‘early adopters’ in each region

10. Milestones so far Test sites began collecting data c.October 2016
Consolidating data collection and definitions 16/17
Reviewing pathways and planning for changes in 17/18
Data set now going through SCCI approvals process – keep changes to minimum
Discovery phase for new CWT system complete – development phase beginning

11. Reflections from test sites
Relatively early in the process, however, some key reflections
Diagnostic capacity is already clearly a challenge, in particular pathology and radiology
Primary care must have a large role and be engaged
It is going to take some time for this data collection to get off the ground – will need to have good support in place
BUT
Overall, performance is not as far away from the taskforce ambition as you might think
Buy-in from clinicians and managers so far has been strong
Patients have been well engaged in the project

12. 28 Day Faster Diagnosis Standard – key considerations
Tightly define cohort of patients
How to deal with direct access referrals
How to define and link ‘whole pathway’ related to one set of symptoms
Key objective to reduce patients ‘bouncing around’ the system
How to adjust for incorrect diagnoses and revising performance over time
Avoiding perverse incentives
Ensuring there is capacity in the system to allow providers to succeed

13. Summary
Focus on the strategic goals – patient centred, faster, more flexible
Carefully testing the approach and developing it ‘from the front line’
Dependent on data collection
Inter-connected with wide range of other diagnostic initiatives which will be the focus for performance