Agenda item
IMPROVING SPECIALIST CANCER AND CARDIOVASCULAR SERVICES - UPDATE ON IMPLEMENTATION
Minutes:
6.1 Members gave consideration to a report providing an update on the implementation of the changes to specialist cancer and cardiovascular services which had been requested by the Chair. The Committee had given consideration to this formal case for change proposal on 20 November 2013 and NHS North East London Commissioning Support Unit had been invited back to present a short update.
6.2 The Chair welcomed to the meeting Sarah Mcilwaine (Senior Consultant, NHS NEL CSU) who took Members through the report. Ms Mcilwaine added that the Commissioners would only give final sign-off on the moves when all the services involved were deemed safe and quality assured.
6.3 Ms Mcilwaine and Dr Steve Ryan (Medical Director, Barts) responded to detailed questions from Members and in the responses the following points were noted:
(i) The three JHOSCS who considered the Case for Change were all broadly supportive of the proposal. Issues had been raised for example by clinicians on the impact on clinician training. Dr Ryan pointed out that at Barts they had engaged with ‘The Deanery’ on updating the curriculum for their brain-cancer surgeon training to take account of the changes.
(ii) Dr Ryan pointed out that concerns by neuro-surgeons about sufficient cover at the Trauma Centre at the Royal London (following movement of brain cancer surgeons to Queen’s Square) were one of the many quality assurance issues taken on by Barts’ Unification Board, which had the job of implementing the changes within their Trust. This Board had senior cancer surgeons on it and checks were made on all treatment gateways and ensuring that trauma services were safe. No moves would be signed off until the Operational Steering Group, led by senior clinicians, were assured that all systems remained safe.
(iii) In relation to the metrics being set to judge the performance of the new system, Dr Ryan pointed out that for Barts these would include the results from the National Cancer Survey, reductions in waiting times and reaching the benchmarks for England, Europe and the World on outcomes.
(iv) Across all the changes ‘gateway 6’ would be the key milestone and it would assess how long after the switch round could benefits be realised. The focus here would be on the whole pathway not just on trauma. The key focus overall was to reduce late diagnosis of cancer and CVD.
(v) The changes were cost neutral but resources would move around within the system. The vast majority of care would remain where it was currently provided. In terms of Barts own Cancer Centre, this represented a large investment and there would be analyses of when a surplus could be made on that long term investment.
(vi) The claims made for how the changes would impact on early diagnosis and prevention related to the fact that in large trusts such as Barts, the whole pathway was being looked at. The organisation was called ‘Barts Health’ not ‘Barts Hospitals’ and the focus was in saving lives through general health improvements not just by putting in place a state of the art cancer centre. The Trust took an active interest in issues such as improving air quality and diet and worked with the Mayor and the boroughs on these. The changes would enhance specialisation and the world class work being done needed to be promoted locally as part of a wider public health campaign directed at not just GPs but also at local communities. The focus started from the fact that given the high calibre of staff and equipment outcomes were still not good enough e.g. 30% of cancers being diagnosed at A&E. The Chair commented that one advantage of the changes would be that Trusts would be in a better position to gather data.
(vii) In relation to transport issues the focus all along was that patients would only have to travel for the specialist part of their treatment but the majority of the treatment would continue to be provided locally.
(viii) Another element of the proposals was to give patients more choice in treatment pathways as often there was no black and white solution on offer. People could decide on waiting out for one aspect of their treatment or on having an element of it delivered more locally but it was important that, with very specialist robotic surgery for example, that this be concentrated in fewer locations so clinicians could gain more experience and thus improve outcomes.
(ix) Members continued to stress to Dr Ryan that a crucial part of implementing these changes was to ensure that the follow-up care pathways worked properly and that, for example, medical notes were transferred efficiently. Dr Ryan replied that the intention was to make this process as paperless as possible (using Cloud storage) and that they were examining innovative solutions here.
(x) In relation to whether the NHS’s assurance processes have sufficiently robust data to pick up important demographic information, Ms Mcilwaine stated that they were currently limited in terms of what data was being collected. Data on disability had not been collected and this had posed a problem in relation to the transport planning aspect of the changes. She undertook to take up this issue with the Academic Health Partners.
6.4 The Chair thanked Ms Mcilwaine and the CSU for its update report.
RESOLVED: |
That the report and discussion be noted. |
ACTION: |
Ms Mcilwaine to raise with the Academic Health Partners, the issue of improving demographic data collection as part of the implementation of the specialist cancer and cardio changes. |
Supporting documents:
- 1-8319841-item_6_cover_sheet_-_cancer_and_cardio_update, item 6. PDF 69 KB
- 1-8319804-item_6_NELCSU_presentation_on_cancer_and_cardio, item 6. PDF 574 KB
- 1-8320007-item_6_letter_to_Cllr_Vaughan_confriming_cancer_and_cardio_changes, item 6. PDF 266 KB