West Cancer Alliance Cancer Trust Managers and Lead Nurses Expert Advisory Group Meeting

Held on: 3 December 2019: 10.00 am – 12.30 pm At: Birmingham Treatment Centre, Room 1, City Hospital, Dudley Road, Birmingham B18 7QH

ACTION TRACKER & NOTES

Attendees Kathryn Poli KP Chair and Cancer Trust Manager, The Shrewsbury and Telford Hospital NHS Trust Jessica Greenwood JG Lead Cancer Nurse, The Shrewsbury and Telford Hospital NHS Trust Denise Crouch DC Macmillan Cancer Lead Nurse, University Hospitals and Burton NHS Foundation Trust Jenny Donovan JD Cancer Services Manager, Sandwell and West Birmingham Hospitals NHS Trust Tracy Beese TB Lead Cancer Nurse, The Dudley Group NHS Foundation Trust Stephanie Connell SC Lead Cancer Nurse, South Warwickshire NHS Foundation Trust Dorinda Palmer DP Macmillan Lead Cancer Nurse, University Hospital of North Midlands NHS Trust Joan Lythgoe JL Cancer Manager, University Hospital of North Midlands NHS Trust Carole Bailey CB Lead Cancer Nurse, University Hospitals Coventry and Warwickshire NHS Trust Tina Wright TW Cancer Manager, Worcester Acute Hospitals NHS Trust Alison Robinson AR Lead Cancer Nurse, Worcestershire Acute Hospitals NHS Trust Lynn Reaper LR Lead Cancer Nurse, University Hospitals Birmingham NHS Foundation Trust Shareen Juwle SJ Deputy Lead Cancer Nurse, University Hospitals Birmingham NHS Foundation Trust Joanna Clutterbuck JC Cancer Services Manager, Wye Valley NHS Trust Tracey Wheetman TW Lead Cancer Nurse, The Royal Wolverhampton Trust Kerry Lakin KL Advanced Nurse Practitioner, The Royal Wolverhampton Trust Angela Morgan AM Consultant Respiratory Physician, The Royal Wolverhampton Trust

Andrea Gordon AG Program Director, Cancer Alliance Debra Palmer DeP Senior Transformation Manager, West Midlands Cancer Alliance Tina Holmes TH Project Delivery Manager, West Midlands Cancer Alliance Sue Ward SW Senior Quality Improvement Manager, West Midlands Cancer Alliance Carolyn Parker CP Quality Improvement Officer, West Midlands Cancer Alliance Apologies Rob Gornall RG Clinical Director, West Midlands Cancer Alliance Helen West HW Cancer Manager, University Hospitals Coventry and Warwickshire NHS Trust Anita Killingworth AK Lead Nurse, The Royal Orthopaedic Hospital NHS Foundation Trust Wendy Steele WS Cancer Manager, University Hospitals Derby and Burton NHS Foundation Trust Jane Gritton JG Cancer Operations Manager, The Dudley Group NHS Foundation Trust Helen Milward HM Directorate Manager Cancer Services, The Royal Wolverhampton NHS Trust Sara Lee SL Cancer Manager, South Warwickshire NHS Foundation Trust Hannah Wingfield HaW Cancer Manager, Birmingham Women’s and Children’s Hospital

Agenda Item Discussion Action Lead To be completed by Welcome, The Chair welcomed all those in attendance at the meeting. Introductions & Introductions done. Apologies

Minutes and The Chair reviewed the minutes of the last meeting. All present actions of the agreed these as a true and accurate reflection of the meeting. The last meeting Chair reviewed the actions from the last meeting. It is noted that all dated 8 actions have been completed except for: October 2019 • LWBC Finance Modelling and Business Case for remote DeP 31/12/19 monitoring • Worcester to share letter templates used for informing TW 31/12/19 patients they haven’t got cancer

4 Cancer Alliance update: November’s performance report to be circulated after the meeting. Circulate November 2019 SW 31/12/19 Alliance performance acknowledged by the group as the worst across performance report. for September at 69.7%. AG updated on how the new regional cancer performance group chaired by Nigel Sturrock, Regional Medical Director, will be the team responsible for supporting trusts in making improvements and that she attends this meeting. The group were asked for feedback regarding approaches already taken and thoughts on how to do things differently. KP and JL reported that they did not feel they were getting anything back from the performance calls and felt it was a platform to inform and discuss the challenges, but there were no actions being taken forward by the support teams that seemed to be making a difference for Trusts. The group discussed the improvement work from Frimley Health: • referral process- group agreed that primary care education was essential to improve the quality of referrals and regarding the use of e-RS appropriately when booking 2ww appointments or regarding redirection. Clarity around cancer waiting times rules needed on this. SW stressed the need to Clarify cancer waiting times SW 31/12/19 revisit the appropriate use of e-RS regarding clinical and rules regarding redirection of administrative triage. JC advised that in Wye Valley, primary 2ww referrals. care had taken the triage of referrals into primary care with the recruitment of a cancer co-ordinator to vet all cancer referrals without causing delays to referral. They will also be looking at how many times patients had seen GPs before being referred and making sure all relevant tests were being done. It was also noted that in Hereford and Worcester practice nurses were referring into 2ww cancer pathways which the group questioned as not being allowed. • cancer waiting times training- group agreed how important in To share cancer waiting times JL/JD 31/12/19 house training was to all members of the cancer team and that training package. this needed to be extended to clinical teams and consultant secretaries. The group felt support with standardising and To scope ways of supporting SW 31/12/19 delivering a training package would support improvements in delivery of a standard training package across the alliance.

performance. JL and JD both advised they have a training package developed. • Tracking- it was acknowledged the work that had been done Tracker benchmarking All 31/12/19 previously on the best practice tracking process, and how template to be completed and regionally and nationally this role was seen as pivotal in returned to making improvements in performance. Most trusts had [email protected] responded and completed the tracker benchmark. Those who hadn’t were asked to so the information could be fed back. • Radiology- group discussed how 7 day request to report had been achieved and sustained and asked how many confirmed cancers Frimley Health have.

SW asked the group if it would be of value to arrange another Arrange conference call with SW 31/12/19 conference call with Frimley Health for everyone to join to further Frimley Health. discuss the work. The group agreed this would be of benefit.

5 Masterclasses Louise Donovan did not attend meeting as planned.

6 Best Practice Pathways: Presentation from Kerry Lakin and Angela Morgan on the Circulate presentation. SW 31/12/19 Wolverhampton Lung service and Wolverhampton Intervention in Lung Cancer (WILS) project.

8 Living with and beyond cancer (LWBC): DeP provided an update on colorectal and prostate follow up guidelines. Being presented to board on 10 December for sign off. Outpatient assessment tool- modelling by STP LWBC leads required. Need to do best estimates for breast, colorectal and prostate using the tool to see what capacity will be released to be able to reinvest back into the system. Repeated webinar on the use of the tool 12 December- invites sent out. Remote monitoring- challenges with implementing this have been escalated to the national team and accepted as an issue. A summary of the challenges and delays for trusts have been fed back to the

national team. DP stressed the importance of not waiting for remote monitoring to be in place before implementing the breast follow up guidance and that all the existing ways that trusts have been monitoring patients can still be used in the interim. DP advised that UHNM had 92 patients on the breast self-managed pathway. All consultants use a code to keep them open on the pathway on partial booking. They have their mammogram and dexa appointments sent out to them with a list created on Somerset to track patients. The Band To share SOPs for processes. DP 31/12/19 4 support worker is managing this list. HNA and end of treatment summary is done. It was felt that the only difference in the use of the remote monitoring system would be the list would transfer to the new system. The system does not send the appointments out to patients. There had been very positive comments made from patients who were on the new pathway. Breast audit tool- the group were reminded that they would be expected to report to the alliance in Q4 and that it was important to review the tool in Q3 and do a stock take in readiness for this. SPRING- Macmillan are changing their learning and development To circulate Macmillan email. SW 31/12/19 offer. Explanation regarding this will be circulated. The support for the Band 4 support worker will still continue but in a new format.

9 Operational: National patient experience cancer collaborative- TB gave an update on the program and the project Dudley will be Circulate presentation. SW/TB 31/12/19 delivering. Overall care and patient experience regarding delays for diagnostics was being looked at with the project. The launch day was in October where the team had some training on quality improvements tools, how to review baseline data and process mapping. In August the trust had a new electronic vetting system which they are going to use to support the project. Patient and carer forum already held to obtain qualitative information. Data for forty patients will be used. Unfortunately, there has been a delay in implementing the system which will impact on the method used. Escalated internally with executive project sponsor. Next meeting in February. To feedback learning and results.

PET scans- SW asked the group if Alex Ridgeon, Head of Acute Supplier To keep as an agenda item. SW/TB 31/12/19 Management, Specialised Commissioning had contacted them individually following the recent email communication between the group. Alliance Medical were presenting their recovery action plan at the next cancer alliance board on 10 December. JD advised that she had arranged a weekly conference call with Alliance Medical which was working well to address delays and know when the machine was broken. Actions agreed: • email re urgent PET-CT slots at RWT; • what the current turnaround times are for referral to distribution of report; • reminder of who the ARSAC holders are for vetting referrals; • being copied into comms about rejected patients so they can be followed up; • email when there are machine failures at RWT and how many patients have had to be rebooked; Sandwell and West Birmingham are completing an audit on times from when PET is requested to booking to report.

28 day faster diagnosis- Group discussion regarding the continuing challenges in delivering 28 day standard for completeness of reporting. SW acknowledged the increase in administrative resource required as increased work load created to deal with patients who do not have cancer. Trusts where this resource was available were managing to achieve compliance. SW reminded the group that Simone Smith was available to visit trusts who required any additional support. AG updated the group following their previous feedback on the 28 day pathway audits for the four best practice pathways. It is acknowledged that the process for obtaining the information has varied between STPs and therefore questions the value of the reports and what the alliance has been feeding back to the regional and national teams. A

more robust method for obtaining information will be through the clinical teams via the EAGs.

Any Other AO telephone helpline benchmarking- trusts reminded to submit Business results. COSD event in January- trusts to attend. SC asked if the alliance knew when the 2ww target would be abolished. This has not been clarified yet, but the alliance was involved with the working group regarding this. Date of Next 18 February 2020 10.00am -12.30pm Meeting Birmingham Treatment Centre, First Floor, Room 1, City Hospital, Dudley Road, Birmingham B18 7QH.

Dates for 2020: 14 April 2 June 28 July 6 October 15 December