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Cancer SummitPlymouth Hospitals NHS Trust
12th 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 www.mycancertreatment.nhs.uk;
Plymouth over the years
Breast
Colorectal CUP
Haemato
logyLu
ng
Neuro
scien
ce MDT
Panc/L
iver
Sarco
ma
Spec
Gynae
Spec
Panc
Spec
Skin
Spec
UGI
Spec
Uro
Thyro
id
UAT/Thyro
id0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Tumour MDTs across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
Plymouth over the years
AO IP M
DT
AO MDT
Genera
l AO M
DT
Chemo se
rv
Onc Pharm
acy ITC
Highter
Inten
sity C
hemo
Radiothera
py Gen
eric
EBRT
Brachy
IMRT
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Cross Cutting across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
Plymouth over the years
Level 3 POSCU TYA Hospitals POSCU MDT0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Plymouth Children's and TYA across 2011/12, 2012/13, 2013/14 and 2014
2011/122012/132013/142014
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 -2014 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 2014. 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 WestHospitals included:PlymouthRoyal CornwallSouth DevonRoyal Devon & ExeterNorth DevonYeovilTauntonWestonRoyal United Hospitals BathNorth BristolUniversity Hospital BristolGloucesterCheltenham
Plymouth Compared to the South West and National Average
MDTs Plymouth SW National Plymouth SW National Plymouth SW National Plymouth SW National
Breast 84% 88% 90% 84% 92% 92% 88% 88% 88% 94% 88% 85%
Colorecta l 86% 85% 85% 86% 90% 90% 98% 93% 91% 86% 92% 87%
CUP 19% 44% 58% 54% 43% 59%
Haematology 41% 66% 81% 72% 84% 83%
Lung 78% 77% 89% 79% 87% 90% 60% 79% 80% 54% 74% 80%
Neuroscience MDT
62% 69% 66% 53% 57% 60% 61% 71% 80% 59% 81% 78%
Panc/Liver 88% 88% 79% 88% 94% 94%
Sarcoma 69% 73% 80% 59% 58% 69% 79% 85% 94% 78% 77% 83%
Spec Gynae 69% 80% 90% 83% 91% 95% 97% 80% 89%
Spec Panc 79% 81% 79% 79% 82% 84%
Spec Skin 76% 80% 82% 71% 79% 87% 88% 73% 80% 80% 81%
Spec UGI 85% 85% 85% 85% 85% 85% 88% 87% 85% 88% 84%
Spec Uro 81% 87% 88% 89% 92% 91% 91% 92% 93% 84% 85%
Thyroid 74% 72% 81% 84% 88% 88% 82% 73% 84% 72% 74%
UAT/Thyroid 74% 69% 77% 72% 83% 90% 79% 85% 87% 75% 66% 78%
2011/12 2012/13 2013/14 2014Tumour MDTs across 4 years -Plymouth compared to SW and National
Plymouth Compared to the South West and National Average
Cross Cutti ng 2011/12 SW National 2012/13 SW National 2013/14 SW National 2014 SW National
Genera l AO MDT 9% 40% 55% 18% 45% 55% 82% 72% 82% 77% 81%
AO IP MDT 0% 8% 25% 0% 10% 25% 75% 43% 50% 47% 57%
AO MDT 0% 22% 33% 0% 17% 50% 67% 62% 67% 45% 66%
Radiotherapy Generic
86% 78% 77% 81% 80% 89% 88% 92% 92%
IMRT 100% 78% 100% 100% 94% 100% 100% 100% 100%
EBRT 93% 94% 94% 95% 96% 96% 90% 97% 100%
Brachy 100% 98% 100% 93% 99% 100% 100% 98% 100%
Chemo serv 64% 83% 83% 79% 79% 81% 83% 89% 90% 92% 91% 87%
Onc Pharmacy 100% 96% 100% 100% 94% 100% 100% 100% 100% 100% 98% 98%
Highter Intens i ty Chemo
100% 84% 86% 100% 83% 86%
ITC 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
2013/14 20142012/132011/12Cross Cutting Teams across 4 years -Plymouth compared to SW and National
Plymouth Compared to the South West and National Average
Chi ldrens and TYA 2011/12 SW National 2012/13 SW National 2013/14 SW National 2014 SW National
Level 3 POSCU 88% 89% 89% 92% 95% 93% 98% 98% 98% 100% 96% 95%
TYA Hospita ls 83% 89% 71% 67% 90% 71% 100% 90% 100% 100% 97% 88%
POSCU MDT 89% 83% 79% 95% 93% 92% 100% 96% 95% 100% 90% 86%
2011/12 2012/13 2013/14 2014
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?
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Breast MDT
2011/122012/132013/142014
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Lung
2011/122012/132013/142014
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Colorectal MDT
2011/122012/132013/142014
Plymouth Gloucestershire Hospitalsst North Bristol Royal Cornwall Royal Devon & Exeter Taunton0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Skin MDT
2011/122012/132013/142014
Plymouth Gloucester Royal UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Upper GI MDT
2011/122012/132013/142014
Plymouth North Bristol Royal Cornwall Royal Devon & Exeter
RUH South Devon Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
UAT and UAT/THYROID MDT
2011/122012/132013/142014
Plymouth Royal Cornwall Royal Devon & Exeter0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Thyroid Only MDT
2011/122012/132013/142014
Plymouth Gloucestershire Hospitals North Bristol Royal Devon & Exeter70%
75%
80%
85%
90%
95%
100%
Specialist Urology MDT
2011/122012/132013/142014
Gloucestershire Hospitals
Plymouth Royal Cornwall Royal Devon & Exeter
RUH Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Gynae MDT
2011/122012/132013/142014
Plymouth UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Specialist Pancreatic MDT
2011/122012/13
Plymouth UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pancreatic / Liver MDT
2012/132011/12
Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
10%20%30%40%50%60%70%80%90%
100%
Haematology
2013/142014
North Bristol Plymouth0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Neuroscience MDT
2011/122012/132013/142014
Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CUP MDT
2013/142014
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Acute Oncology MDT
2011/122012/132013/142014
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
General Acute Oncology MDT
2011/122012/132013/142014
Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oncology Pharmacy Serv MDT
2011/122012/132013/142014
Plymouth
Chelten
ham Gen
eral
Gloucester
Royal
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Acute Oncology In-Patient
2011/122012/132013/142014
Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB
West
onYe
ovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Chemotherapy Serv MDT
2011/122012/132013/142014
Plymouth Gloucestershire Hospitals
Royal Cornwall Royal Devon & Exeter
RUH South Devon Taunton UHB0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Higher Intensity Facility
2013/142014
Plymouth
Gloucester
shire
Hospita
ls
North Bris
tol
North Dev
on
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHBYe
ovil92%
93%
94%
95%
96%
97%
98%
99%
100%
Intrathecal Chemotherapy ITC MDT
2011/122012/132013/142014
Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
External Beam Radiotherapy
2011/122012/132013/14
Plymouth Cheltenham General
Royal Devon &
Exeter
RUH UHB0%
10%20%30%40%50%60%70%80%90%
100%
Brachytherapy
2011/122012/132013/14
Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
Radiotherapy Generic
2011/122012/132013/14
Plymouth
Chelten
ham Gen
eral
Royal C
ornwall
Royal D
evon &
Exete
rRUH
South Dev
on
Taunton
UHB0%
20%
40%
60%
80%
100%
IMRT Radiotherapy
2011/122012/132013/14
Plymouth Gloucestershire Hospitals NHS
Foundation Trust
Royal Cornwall Royal Devon & Exeter
RUH Taunton Yeovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSCU Level 3
2011/122012/132013/142014
Plymouth Gloucestershire Hospitals NHS
Foundation Trust
Royal Cornwall Royal Devon & Exeter
RUH Taunton Yeovil0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
POSCU MDT
2011/122012/132013/142014
Plymouth
Gloucester
shire
Hospita
ls NHS F
oundation Tr
ust
Royal C
ornwall
Royal D
evon &
Exete
rRUH
Taunton
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TYA Hospitals
2011/122012/132013/142014