the macmillan cancer care coordinator in south tees · the macmillan cancer care coordinator in...
TRANSCRIPT
The Macmillan Cancer Care
Coordinator in South Tees
Cancer Alliance Launch Workshop
Workforce – Current Challenges and
changing needs
Carol Taylor:
Macmillan Integration of Cancer Care
Programme Manager
MacICC Programme
Aim:
To integrate cancer care by promoting patient
choice and streamlining working practice
across the South Tees and Hambleton,
Richmondshire & Whitby health economy.
• Discovery interviews
• Process Mapping (approx. 50)
• Thematic analysis to identify main areas of
concern
• Triangulation of data inc. patient stories
• Statistical Process Control (SPC)
• Value Stream Mapping
Methodology
LUNG
Lymphoma
Brain & CNS
STFT Improvement
NATIONAL NICE Guideline: Suspected cancer: recognition and referral (2015)
5 year Forward View (2014)
Achieving World-Class Cancer Outcomes. A strategy for England (2015)
Care Act (2014)
Better Care Fund Regional NESCN, NSSG, Cancer in the Community
Local Draft Tees Cancer Strategy
South Tees Cancer Strategy (under development)
Middlesbrough Tackling Cancer Together
Cancer in the Locality
Teesside Hospice Strategy (publication imminent)
1 2 3 4 5 7-10 DAYS
6 8 9 11
10
3.1 5.1 6.1 7 7
11.1
12
3.2 5.2 10.1
11.2
3.3 5.3
10.2 11.3
3.4
10.3
6.2 11.4
8.1 10.4
11.5
3.5
15
16
SPC input
CPD
Specia l i sed Regional
Treatment Centressurvivorship meetings
Living with cancer
events
Pleura l Disease
cl inics Exercise on
presecription referra ls
Other agencies
Earlier referral from
tertiary servicesNon Ca Radiology
outsourcedClinical Trials Treatment summaries
Diagnostics:
Planned Investigation &
Assessment Unit
LUNG PATHWAY- FUTURE STATE
ENVIRONMENT
Referral Diagnostics (Early Access) Treatment pathway stay same Follow up
Referral to 2WW clinic 7-14 days
21 -31 days from referral to final staging 42-62 days from referral to 1st Treatment
Difficult conversations start and continue - patients aware this may be cancer
GP
Ed
uca
tio
n E
arly
su
spic
ion
an
d r
efe
rral
Co
mm
un
icat
ion
: Pri
mar
y an
d s
eco
nd
ary
care
inte
rfac
e
Standard GP Referra l :
seen in 7 days
Ad
min
istr
ato
r
Reorganisation of 2
WR clinicsAll requests
ordered
Lun
g C
ance
r In
vest
igat
ion
s P
ath
way
- s
ee
alg
ory
thm
Integrated
MDT
results
cl inic and
Cl inica l
Tria l
planning
On
colo
gy o
r su
rgic
al C
linic
ass
essm
ent
One / two
Rapid
Access
Clinic
Referral from other
specialities
Brain & CNS: FUTURE STATE
Pre - diagnosis
Internal Hospital
ReferralsBookable
appointments
Diagnostics capacity
Open Access Chest
X-Ray
Tracking
starts
Abnormal CX-Ray
Holistic Needs Assessment / Recovery Package
Choose and Book \ NHSE referral
CANCER CARE CO-ORDINATOR
Successful consultant recruitment and retention
TIME: Referral - MDT Wednesday - Diagnostics Thursday and Friday following MDT
REF
ERR
AL
RO
UTE
S IN
EDUCATION
One stop shop: Thursday &
Friday following MDTScans reported with full
information
Quality of referral
information
Therapeutic radiographer
IMAGING NEEDED
GP: Benign / pituitary tumours
Referral
TechnologyRegional
CentresSurgery/Radiotherapy
/ chemotherapy:
Follow up closer to
home Strati fied pathways of
care Community cl inics
Go to urgent pathway NOT 2wwMay be a two stop shop for
patients that need it
STANDARD PROTOCOL: Locally and local
hospitalsSCAN POSITIVE
Online referral proforma
Wil l work across whole of
Neuroscience divis ion not just Ca
Self management
Every space occupying lesion Make CNS awareSINGLE POINT OF ENTRY.
Patients come to one place /
Neuro-oncology - MDT Access to CNS (Key Worker) To
support throughout recoverySpecialist Nurse not
in clinicReferra l from a l ternative
cl inicians
All patients over 70 should be
assessed by DN
Identify a specific individual to pick up
referrals on a regular basis Radiology Oncology OT Single
handed practitionersWill inform/standardise information
for referrals, pts, carers, families
Back to referrer, GP
etc. for on-going care
Referral for urgent imagingPre assessment nurses,
Anaesthetists, Social workerPalliative Care
Environment recourse's
HNA
Assessment for Community
Support - Screening Tool
Treatment summary needed for
ful l MDT input
Representation from pal l iative
care consultant to faci l i tate pa l
care pathway
Training and Development: Junior staff induction and Nurses on ward 14 / 24 A& E MAU
LYMPHOMA - FUTURE STATE
Front end of the pathway quicker Treatment pathways same Follow up
Sub-specia l i s t cl inics
GP
Ed
uca
tio
n -
de
tect
ion
an
d d
iagn
osi
s
Strati fied
appointments Community clinics
Treatment closer to
home
Earlier access to
diagnostics
Diagnostics capacitySpeeding up surgica l
access Technology
Earl ier referra l from
tertiary services
Earl ier referra l from
tertiary services
Reviews need to be less
medical or medical &
holistic ? Different system
MDT
WEDNESDAY Clinic
MDT Date for
1st Tx given
Cancer survivorship
initiative Vision
Diagnostics
• Variable waits • Sequential
testing • Appropriateness • Medical Model • Workforce • Seasonal
MDT
• MDT Process
• Right level of professional
• Attendance at MDT
Treatment
• Wait time variation for 1st treatment
• Discharge infrastructure to best met complex needs.
• Pharmacy • *Workforce • *Care out of
Hospital
Referral In/new *Diagnostics MDT Treatment
Living with and Beyond Cancer
Problem statements
Problem statements Problem statement
Ch
alle
nge
s
* 1.1: GP Referrals i.e. timeliness and appropriateness. (WS1)
2.1: New Patient appointment
3.1: Variable waits 4.1: MDT Process 5.1: Wait time variation for 1st Treatment
*6.1: EoL & PC (WS5)
1.2: Administrative e.g. faxed and dictated referrals getting lost.
2:2: Patient waits 3.1: Sequential testing
4.2: Right level of professional
5.2: Supportive Care (right care, right time, right place, right professional
*6.2: Referral to supportive services (Social Care/ PC/MH)(Connectivity (WS6)
*1.3: Signs & Symptoms (WS2)
2.3: Non Urgent 3.2: Appropriateness 4.3: Attendance at MDT
5.3: Discharge infrastructure to best meet complex needs
*6.3: Hospice provision – variation (WS7)
*6.4: IT & Technology (system one) Sharing information (WS8)
1.4: Appropriateness – emergency presentation
2.4: Vague symptoms 3.3: Medical model 5.4: Pharmacy 6.5: Mixed provision of on-going Health and wellbeing support
1.5: GP link into H&R 3.4: Workforce *5.5: Workforce (WS3)
6.6: Economic impact of cuts across H&SC services.
3.5: Seasonal *5.6 Care out of hospital ( closer to home) (WS4)
6.7: Limited business intelligence across the pathway.
The role in summary • Support the Cancer Nurse Specialists (CNS)/AHP’s to provide coordination
of high quality patient throughout the whole patient journey.
• Work with the wider Health Care Team to ensure the provision of
appropriate services improve quality of life of cancer patient and the quality
and efficiency of health care delivery.
• Work as a member of the Cancer Nursing/ Allied Healthcare Professionals
(AHP) team providing coordination of care and support for cancer patients,
their carers and families.
• To act as a point of contact for patient and their carers and the wider health
care team, signposting enquires to the appropriate department within
hospital or community settings.
• Work closely with MDT coordinators and cancer trackers to ensure timely
and efficient progress of patient care to avoid breaching cancer targets.
• Work with the wider team to improve the current pathway and processes
resulting in better quality care.
KEY
1st Seen
Day 1 CXR CT 4 days - friday 5 days PET 8 Days MDT 13 Days 8 days MDT 14 Days
Day 11 Day 15 Day 20 Day 28 Day 41 Day 49 Day 63
1st Seen
Day 1 CXR 7 days MDC CTGB MDT
1 day 7 days
Day 7 Day 9 Day 16 Day 20 Day 22
4 days
DIAGNOSIS
11 days CTGB, CT
head
CTGB
Repeate
OPA
Cardiothora
cics
SAME PATIENT - LUNG FUTURE STATE APPLIED: 6 days of 22 is value added 28%
ACTUAL PATIENT JOURNEY: DIAGNOSTIC CYCLE TIME 8 days out of 63 is value added 13%
41 day saving
Repeat
CTGBOPA
Value added
Non value added but essential
Non Value added
Value Stream Mapping
0
5
10
15
20
25
Acting
as a
patient
advocate
/ fa
cili
tato
r
Adm
in
Audit D
ata
Co
llectio
n
Ch
asin
g r
esults
Co
nne
cting
se
rvic
es
De
ve
lop
men
t of
leaflets
an
d / o
r…
EC
G
Endo
scop
y
Escala
tion t
o H
CP
Face t
o fa
ce
co
nta
ct
with
care
rs
Face t
o fa
ce
co
nta
ct
with
pa
tie
nts
Fa
cili
tating e
arlie
r dis
ch
arg
e f
rom
…
Faxin
g G
P
Ho
listic N
ee
ds A
ssessm
ent
MD
T a
tte
nda
nce
MD
T C
oo
rdin
atio
n
MD
T R
efe
rra
l
Observ
ations
Oncolo
gy r
efe
rra
l
Org
an
isin
g a
ppoin
tmen
t
Org
an
isin
g c
olle
ction o
f e
quip
ment…
Org
an
isin
g e
quip
me
nt fo
r dis
cha
rge
Oth
er
Pro
ce
ss d
iscu
ssio
ns
Re
co
ncile
clin
ic
Re
ferr
al to
sup
port
ive
se
rvic
es
Rig
ht
Pro
fessio
na
l, r
ight
pla
ce r
ight…
Sig
nposting a
nd
Info
rmation
giv
ing
Spiro
metr
y
Tele
ph
one
calls
with c
are
rs
Tele
ph
one
calls
with p
atie
nts
…
Ward
rou
nds
Lymphoma & Myeloma Pathway: Number of Interventions
0
20
40
60
80
100
120
Lymphoma & Myeloma: Number of Interventions where time was
saved
0
10
20
30
40
50
60
70
80
90
Acting
as a
patient
advocate
/ fa
cili
tato
r
Adm
in
Audit D
ata
Co
llectio
n
Ch
asin
g r
esults
Co
nne
cting
se
rvic
es
De
ve
lop
men
t of
leaflets
an
d / o
r oth
er…
EC
G
Endo
scop
y
Escala
tion t
o H
CP
Face t
o fa
ce
co
nta
ct
with
care
rs
Face t
o fa
ce
co
nta
ct
with
pa
tie
nts
Fa
cili
tating e
arlie
r dis
ch
arg
e f
rom
hospital
Faxin
g G
P
Ho
listic N
ee
ds A
ssessm
ent
MD
T a
tte
nda
nce
MD
T C
oo
rdin
atio
n
MD
T R
efe
rra
l
Observ
ations
Oncolo
gy r
efe
rra
l
Org
an
isin
g a
ppoin
tmen
t
Org
an
isin
g c
olle
ction o
f e
quip
ment
post…
Org
an
isin
g e
quip
me
nt fo
r dis
cha
rge
Oth
er
Pro
ce
ss d
iscu
ssio
ns
Re
co
ncile
clin
ic
Re
ferr
al to
sup
port
ive
se
rvic
es
Rig
ht
Pro
fessio
na
l, r
ight
pla
ce r
ight tim
e
Sig
nposting a
nd
Info
rmation
giv
ing
Spir
om
etr
y
Tele
ph
one
calls
with c
are
rs
Tele
ph
one
calls
with p
atie
nts
…
Ward
rou
nds
Lung Pathway: Number of Interventions
0
10
20
30
40
50
60
70
80
90
100
AH
P
CN
S A
cu
te
Co
mm
unity N
urs
e
Dis
tric
t N
urs
ing
GP
Ho
sp
Con
su
lta
nt
Path
way
Socia
l W
ork
er
Lung Pathway: Number of Intervention where time
was saved
Quote from a CNS
Please explain: XXX has become a valuable member of our team in a short period of time. The
patients, staff and consultants all recognise XXX as a valuable resource and as such they do not
expect that I am the solution to every problem which previously was a cultural issue within our
team, but this developed out of the analogy that if you wanted something done give it to a busy
person, and I did oblige. Now I am able to share our busy workload and the interventions are more
appropriately distributed and I feel happy that our patients continue to get a high quality service
from our team and my own personal job satisfaction is improving as I am able to realise again why I
love this job. Thank you
Contact: THE TEAM:
• Dr Angela Wood (MacICC Programme Sponsor)
• Carol Taylor (MacICC Programme Manager)
• Dr Spencer Robinson (PhD) (MacICC Service Improvement Lead)
• Charlotte Lambert (MacICC Programme Support Officer)
• Dr Anisah Tariq (PhD) (MacICC Clinical Audit Facilitator)
