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Review of Cancer Services at Colchester Hospital University NHS Foundation Trust

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Review of Cancer Services at Colchester Hospital University NHS Foundation Trust Report into the Immediate Review of Cancer Services at Colchester Hospital University NHS Foundation Trust Report into the Immediate Review of Cancer Services at Colchester Hospital University NHS Foundation Trust First published: 19 December 2013 Publications Gateway Reference No. 00958 2 1 Contents Executive Summary ................................................................................................... 5 1 Introduction ........................................................................................................ 11 1.1 Governance of Cancer services .................................................................. 11 1.1.1 Clinical pathways .................................................................................. 11 1.1.2 Multi-Disciplinary Teams ....................................................................... 12 1.1.3 Handover between cancer teams or hospitals ...................................... 12 1.1.4 Corporate governance .......................................................................... 12 1.2 Information and record systems .................................................................. 13 1.3 Staffing levels, workload, training and accommodation ............................... 14 1.4 Specialist Cancer services arrangements ................................................... 14 1.5 The structure of Cancer services in England............................................... 15 1.5.1 Peer review levels of assurance ........................................................... 16 1.6 Cancer services in Colchester hospital ....................................................... 17 1.6.1 Networked Cancer services .................................................................. 18 1.6.2 Activity volumes .................................................................................... 21 2 The Care Quality Commission Report 5th November 2013 ................................ 21 3 Risk Summits ..................................................................................................... 22 4 Incident Management Team .............................................................................. 22 4.1 The national Intensive Support Team review .............................................. 23 4.2 The clinical site visits ................................................................................... 23 5 Actions taken concurrent to the immediate review of cancer services ............... 24 5.1 Colchester Hospital University NHS Foundation Trust ................................ 24 5.2 North East Essex Clinical Commissioning Group ........................................ 25 5.3 Essex County Council Adult and Children’s Services & NHS England ....... 25 5.4 Monitor ........................................................................................................ 25 5.5 Essex Police................................................................................................ 25 6 Summary of themes and issues identified ......................................................... 26 6.1 Governance of Cancer services .................................................................. 26 6.1.1 Clinical pathways .................................................................................. 26 6.1.2 Multi-Disciplinary Teams ....................................................................... 27 6.1.3 Handover between cancer teams or hospitals ...................................... 27 6.1.4 Corporate governance .......................................................................... 27 6.2 Information and record systems .................................................................. 28 3 6.3 Staffing levels, workload, training and accommodation ............................... 28 6.4 Specialist Cancer services arrangements ................................................... 29 7 Are arrangements in place to ensure the safety of cancer services? ................. 29 7.1 Explanation of summary assessments ........................................................ 30 7.2 General immediate risks ............................................................................. 32 7.3 Assessment by Cancer team ...................................................................... 44 7.3.1 Acute Oncology .................................................................................... 44 7.3.2 Brain & Central Nervous System .......................................................... 46 7.3.3 Breast ................................................................................................... 50 7.3.4 Colorectal (lower GI) ............................................................................. 51 7.3.5 Cancer of Unknown Primary origin (CUP) ............................................ 53 7.3.6 Gynaecology ......................................................................................... 56 7.3.7 Haematology ........................................................................................ 58 7.3.8 Head & Neck (incl. Thyroid) .................................................................. 60 7.3.9 Lung...................................................................................................... 62 7.3.10 Paediatric .............................................................................................. 64 7.3.11 Radiology .............................................................................................. 65 7.3.12 Radiotherapy ........................................................................................ 67 7.3.13 Sarcoma ............................................................................................... 68 7.3.14 Skin ...................................................................................................... 70 7.3.15 Teenage & Young Adults ...................................................................... 72 7.3.16 Upper GI ............................................................................................... 73 7.3.17 Urology ................................................................................................. 75 8 Recommendations and next steps ..................................................................... 79 8.1 Recommendations ...................................................................................... 79 9 References ........................................................................................................ 84 Appendix 1 – Glossary of Terms .............................................................................. 88 Appendix 2 – Terms of Reference for the Incident Management Team ................... 91 Appendix 3 – Report of the national Intensive Support Team review ....................... 94 Appendix 4 – Terms of Reference & methodology of clinical site visits .................. 133 Appendix 5 – Biographies / roles of clinical site visit teams .................................... 149 Appendix 6 – Clinical site visit reports .................................................................... 152 4 Executive Summary In this report, NHS England has addressed the question “Are the cancer services in Colchester safe? “ The report summarises the findings of an immediate review into the quality and safety of cancer services at Colchester University Hospital NHS Foundation Trust (CHUFT / ‘the Trust’). This review was initiated by the Incident Management Team (IMT), led by NHS England, in response to a Care Quality Commission (CQC) inspection into cancer standards at the Trust, published on 5 November 2013. The CQC report identified a number of failings in cancer services at the Trust including unwarranted delays to diagnosis and treatment which may have caused harm to patients. The IMT established a Clinical Oversight Group which together with the East of England Strategic Clinical Cancer Network organised and conducted clinically-led visits to each of the Cancer teams in the Trust. The purpose, summarised in this report was to determine if cancer services at the trust were safe. At the end of the visits, verbal feedback on the findings and any immediate risks identified was given to the Trust. A report on the visit findings, immediate risks and overall assurance of each pathway was provided to the Clinical Oversight Group for analysis and summarised in this report. For each pathway, the Clinical Oversight Group has agreed with lead clinicians from the Trust, the steps to be taken to improve pathways. Actions taken are summarised in sections 7.2 and 7.3. Some of the service improvements necessary will take several months, because of the scale or complexity of the changes to ensure that services are of the highest standard. The timelines are presented in detail in the report. At this stage: The Trust is co-operating with the Monitor-led review of Trust governance and implementing its recommendations, including the completion of an action plan The Trust has re-established the Trust Cancer Board which, as a sub-group of the Trust Board, will work across the clinical directorates in the organisation to implement the findings of this report, Trust developments which were already at the planning stage have been accelerated, The commissioners of the cancer services (Clinical Commissioning Groups and for those services designated as specialist cancer services, NHS England) have via the Clinical Oversight Group assessed each clinical site visit report and have determined whether each cancer pathway is currently providing a safe
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