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