Primary Care Network: Directed Enhanced Service and Quality Outcomes Framework Quality Improvement Annex August 2020

1 How we developed this pack

We have created this guidance and resource pack in collaboration with a number of partners and would like to thank them for providing information and insight.

2 Contents

Appendix 1 – SSCA data insights (supplementary to SSCA PHE data pack Slide 4 Appendix 2 - Cancer Case Analysis Slide 16 Appendix 3 – Sign posting Slide 17

3 Appendix 1 – SSCA data insights SSCA Cancer incidence 2016:

SSCA performs in-line with the national average for cancer incidence (SSCA = 602.6, England Average = 602.2 : 2016 data) measured as age standardised rate per 100,00 population

Incidence age-standardised rate (per 100,000 population) in 2016 by Cancer Alliance (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA Cancer prevalence 2017/18:

SSCA cancer prevalence is above the national average as measured by GP QOF prevalence. The national average is 2.7% and SSCA contains 10 CCGs above this figure, the highest being 3.9%. Only 3 CCGs have prevalence below the national average with the lowest at 2.2%. (2017/18 data)

Incidence age-standardised rate (per 100,000 population) in 2016 by Cancer Alliance (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA Under 75 mortality position 2016:

The under-75 cancer mortality rate (per 100,000 population) for Surrey and Sussex is significantly lower than the national average (123.0 vs 135.3 : 2016 data) and is the 3rd lowest mortality rate in the country SSCA Under 75 mortality position by CCG/STP 2016:

When analysing age- standardised mortality rates in the under 75s, SSCA performs markedly better than the national average, with 10 CCGs outperforming the national figure. Again, there are high performing CCGs in each ICS/STP footprint and individual CCG performance is such that the average mortality rate for each ICS/ STP is also lower than the national average

Under 75 cancer mortality age-standardised rate – 2016 – by SSCA, CCGs and STPs (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA One year survival position 2016:

The one year survival rate in Surrey and Sussex is better than the national average (73.8% vs 72.8%: 2016 data). However, the aggregated figures mask a disparity across the different alliance CCGs. The chances of surviving one year after diagnosis are less than 70.9% in Hastings and Rother but greater than 77% in Surrey Heath. SSCA one year survival position by CCG/STP: 2016 Following diagnosis of a cancer, one-year survival performance across the Cancer Alliance of 73.8%, is higher than the national average (72.8%). However, there is variation across the Alliance CCGs with one-year survival performance.

In Surrey Heath CCG it is 77.1% compared with 70.9% in Hastings & Rother CCG, a difference of 6.2%. Nine CCGs perform above the national average and there are high performing CCGs in each STP footprint from which good practice can be spread. One-year cancer survival index (%) – 2016 – by SSCA CCGs and STPs (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA One year survival position by tumour group: 2012-2016

One-year survival rates vary from high nineties for breast and prostate to lower than 50% for stomach, oesophagus and lung. For three cancers (breast, colorectal and colon) SSCA perform better than the national average and are in the top 3 performing Alliances. SSCA survival rate is worse than the national average for cervical cancer and would merit further investigation with a view to improving performance SSCA five year survival position:

The five-year survival rate in Surrey and Sussex is better than the national average (54.3% vs 53.2%: 2012 data) and is the 6th best ranked alliance in the country SSCA position – Early Diagnosis by stage: 2017

Across all CCGs there is a difference in performance of 17.3%, with North East Hampshire & Farnham CCG performing well below the national average at 45.0% and Surrey Downs CCG performing well above the national average at 62.3%. Altogether, six CCGs across the Alliance are performing above the national average and seven are performing below. The net result of individual CCG performance is that Surrey Heartlands ICS, largely influenced by the performance of Surrey Downs CCG, is the top performing ICS within the Alliance at 55.7%, followed by Sussex Health and Care Partnership at 53.0% and Frimley Health ICS at 47.8%.

Early stage diagnosis (%) in 2017-Q4 by SSCA, CCGs and STPs (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA position – Cancers staged: 2017

Performance of staged recording varies between 68.2% (North West Surrey CCG) and 82.3% (Coastal West Sussex CCG), with an alliance average of 77.5%. This is markedly down on the national average of 81.4%. Early diagnosis is therefore an example of where the Alliance needs to drive an improvement in overall cancers staged and also support learning across ICS/STPs to improve earlier diagnosis performance in the lower performing areas.

Cancers staged (%) in 2017 by SSCA, CCGs and STPs (Source: CADEAS Alliance Indicator Summary Grids 2019 August) SSCA position – Routes to Diagnosis: 2018

The proportion of cancers diagnosed via emergency presentations varies significantly across the Alliance, from 10.2% in East Surrey CCG to 22.7% in Brighton & Hove CCG, a difference of 12.5%. Brighton & Hove CCG and Crawley CCG, two of the lower performing CCGs for emergency presentations, are also consistently some of the lowest performing CCGs across the Alliance for screening coverage and uptake. However, the link between screening effectiveness and emergency presentations does not correlate so well across all CCGs, meaning that other factors must be influencing the route to diagnosis. One such influence is the significant variation that is seen in the route to diagnosis when broken down by tumour site, with lung cancer seeing much higher levels of emergency presentation (33-45%) than breast cancer (3-5%). It is therefore likely that the proportion of cancer types in an area is also having an impact on the overall level of emergency presentations e.g.. areas with relatively high levels of smoking and lung cancer are likely to have higher overall emergency presentations. Further work is therefore needed to fully understand the root causes in each area and target our work accordingly. SSCA position – Early Diagnosis by stage: 2017

Early stage diagnosis (%) in 2017-Q4 by SSCA, CCGs and STPs (Source: CADEAS Alliance Indicator Summary Grids 2019 August) Appendix 2 Cancer Case Analysis:

Source Resource

How to conduct a Cancer Case Analysis– with acknowledgement and thanks to Dr Alessandra Dale Surrey Heartlands Cancer Workstream

16 Appendix 3: Signposting East Surrey Macmillan Cancer Support Centre

The East Surrey Macmillan Cancer Support Centre is at East Surrey Hospital in Redhill. The centre offers a wide range of information and support services in one place for patients and their carers. The following are live sessions patients can join: Counselling Art Therapy Journalling Pranic Relaxation 1-1 1-1 Workshop Healing 1-1 Zoom & Zoom & 2-3 People 1-1 Zoom & Telephone Telephone Zoom & Zoom & Telephone Telephone Telephone

Yoga Distant Reiki NLP/ Life Financial 8-10 People 1-1 Relaxation Coaching Advice Zoom Telephone 1-1 1-1 1-1 Zoom Zoom Telephone

Contact the centre for further information on: Head 01737 304176 Wrappers [email protected] 1-1 Telephone

17 The Fountain Centre

The Fountain Centre is located within the Royal Surrey County Hospital offering care and support for the physical, emotional, social and spiritual needs of those affected by cancer in Surrey and the surrounding areas. The following are live sessions patients can join:

Yoga Carers Bereavement Coaching Meditation Counselling Group & 1-1 Support Support Group & 1-1 Group & 1-1 1-1 Zoom & Group Group Zoom & Zoom & Zoom & YouTube Zoom & Zoom & Telephone YouTube Telephone Telephone Telephone

Hand Aromasticks Accupressure Information & Exercise Hair/Wigs/ Massage 1-1 1-1 Support Group & 1-1 Scarves 1-1 YouTube You Tube 1-1 Zoom & 1-1 YouTube Email & YouTube Zoom Telephone Contact the centre for further information on: 01483 406618 Podcasts [email protected] Unlimited You Tube

18 Macmillan Horizon Centre

The Macmillan Horizon Centre in Brighton offers support for local people facing the toughest fight of their lives. The following are live sessions patients can join:

Counselling Coaching Horizon Accupressure Mindfulness 1-1 1-1 Connect Drop In 1-1 10 People Telephone Telephone 2-6 People Microsoft Teams Microsoft Teams Microsoft Teams

Yoga Pilates Managing Breathing Welfare 10 People 10 People Anxiety Workshop Benefits Advice Microsoft Teams Microsoft Teams 2-6 People 2-6 People 1-1 Microsoft Teams Microsoft Teams Telephone

Contact the centre for further information on: 01273 468770 [email protected]

19 Other local resources

Macmillan Integrated Cancer Care Wexham Park Macmillan Information Team Centre

Coffee Morning Counselling 10 People 1-1 Microsoft Teams Telephone Fatigue/Diet/Sleep Workshops Anxiety/Sleep/Coping Strategies 10 People 1-1 Microsoft Teams Telephone Healthy Hormones 10 People 01753 634886 Microsoft Teams [email protected] Additional Support 1-1 Attend Anywhere

07813 997004 [email protected]

20 Other local resources

The Olive Tree Look Good Feel Better

The Pink Ribbon Group Virtual Workshop 10 People 8-10 People Zoom Various

01293 534465 07545551531 [email protected] [email protected]

West Sussex Citizens Advice Bureau Macmillan Butterfly Centre Welfare Benefits Advice Psychological Support 1-1 Welfare Benefits Support Telephone 1-1 Telephone [email protected] 01372 735456

21 National resources

A number of national organisations provide health and wellbeing information and support online:

Albion in the Bowel Cancer UK Brains Trust Cancer Care Map Community Coronavirus Advice & Living Well with a Directory of local Recipes & Exercise Guidance Brain Tumour support services https://bit.ly/3j6ZhL1 https://bit.ly/3h2uy04 https://bit.ly/3gTfHVE https://bit.ly/3eCOXax

Jo's Cervical Lymphoma Action Macmillan Cancer Myeloma UK Cancer Trust Online Support Support Living with Myeloma Living with Cervical https://bit.ly/30bZWSP SafeFit https://bit.ly/399d2Vj Cancer https://bit.ly/3fwiow4 https://bit.ly/3ev3EfB

Pancreatic Cancer Prostate Cancer UK Teenage Cancer The Brain Tumour UK Fatigue Support Trust Charity Living with Diet & Exercise Wellbeing Support Living with a Brain Pancreatic Cancer Support https://bit.ly/30bPwTl Tumour https://bit.ly/3fwj5FG https://bit.ly/2ZrIYRg https://bit.ly/2CyOB7i

22 Videos

Pre recorded videos are useful for getting information across directly with a personal touch. They can be accessed at times which are convenient to the patient and re-watched as needed Macmillan Cancer Support The Fountain Centre Look Good, Feel Good Top Tips Introduction to meditation https://bit.ly/30r6v4n https://bit.ly/2WiQGuX Coping with Financial Worries Reframing negative thoughts https://bit.ly/2WhWgOk https://bit.ly/2DH55e5 Sex, Relationships & Cancer Seated Yoga https://bit.ly/2B0Bzz7 https://bit.ly/2B1dXu5 Physical Activity & Cancer https://bit.ly/3fxNrYb Balanced Breathing Cancer in the Workplace https://bit.ly/2ZvA3hW https://bit.ly/3fCf3M8 Caring for someone with Cancer https://bit.ly/32jGOFf

23 Videos

NE Hampshire & Farnham CCG The Olive Tree Managing a Cancer Diagnosis Self Massage for Arm and https://bit.ly/3h5PqDH Hand General Coping Strategies https://bit.ly/32lK6aT https://bit.ly/395zXAM Yoga Breathing Practice Stress Management https://bit.ly/2OqaXup https://bit.ly/2ZuApoP Deep Relaxation Coping with Fatigue https://bit.ly/2CcVueJ https://bit.ly/38WZXOA