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21.1.      The Committee considered a report providing an overview of cancer performance in East Sussex.

21.2.      Jessica Britton, Chief Operating Officer, EHS/HR CCG; Joe Chadwick-Bell, Chief Operating Officer, East Sussex Healthcare NHS Trust (ESHT); Lisa Elliott, Senior Performance and Delivery Manager, EHS/HR CCG; Garry East, Director of Performance and Delivery, EHS/ HR CCG and Ashley Scarff, Director of Commissioning and Deputy Chief Officer, responded to questions from HOSC members.

2 week initial referral meeting

21.3.      Joe Chadwick-Bell explained that, where appropriate, patients will generally receive a diagnostic test before their initial referral meeting with a consultant, rather than this referral meeting being their first point of contact with secondary care. Lisa Elliott said that in the case of suspected lung cancer, for example, a patient would, where possible, not see a consultant until they had been for a CT Scan as it is more useful for the consultant to see the scan to determine next steps. She added that a suspected cancer patient will be fast tracked through diagnostics, indicating they are treated with some urgency.

21.4.      Joe Chadwick-Bell said that the aim is for patients to have the first consultant referral meeting within 7 to 8 days rather than the national target of 2 weeks. Lisa Elliott said that if a patient has not heard back from a hospital they can ask their GP to chase the referral status for them, or the patient can do this directly.

Patient Choice

21.5.      Joe Chadwick-Bell said that a significant number of the breaches of the 62-day time to treatment target are due to patient choice, i.e., patients choosing not to attend their appointments – sometimes because they forget and sometimes because they choose not to go. There is a specialist nurse whose role is to contact patients to explain the importance of attending the initial referral appointment and this helps to ensure that ESHT meets its 2 week referral time. Some of the very long wait time breaches are due to patients who are very anxious and for them attempts are made at alternative diagnostic methods. Lisa Elliott added that a root-cause analysis is conducted for each 62-day breach to determine the cause of the breach, and a clinical harm review of the patient is also carried out. Joe Chadwick-Bell clarified that a target of 85% of patients being treated within 62 days of diagnosis takes into account the number of patients who exercise patient choice. The failure to meet that target indicates that there are other reasons beyond patient choice that account for the target not being met.

One-stop consultancy visit

21.6.      Joe Chadwick-Bell explained that each cancer pathway has been reviewed in order to determine whether a ‘one-stop’ diagnostic clinic could be established for patients attending the initial consultancy meeting, enabling them to see all of the necessary specialists in one go, which is established practice in some hospitals. The feasibility of establishing these clinics is determined by clinical best practice and whether it is possible to concentrate specialist clinicians and nurses in one place. The breast cancer pathway is one that is considered suitable for a one-stop diagnostic.

21.7.      Garry East added that some 62-Day breaches occur due to people being on the waiting list for hospital services in London, however, when the patients are seen they may then be able to receive a one-stop diagnostic. There is a balance to be struck between seeing patients promptly and being able to provide a full diagnostic when they attend.

Recording stage at time of diagnosis

21.8.      Lisa Elliott said that although the staging is generally recorded by the consultant as 1, 2, 3 or 4, it is not always recorded in the right way (correct coding) so that this cannot be easily taken from the electronic system, which explains the low percentage of instances where the cancer stage has been recorded on diagnosis.  A considerable piece of work is being undertaken as part of ESHT’s Cancer Improvement Plan to ensure that the right code is used to improve the data collection. Jessica Britton added that this was a problem nationally.

Quality of scanners

21.9.      Joe Chadwick-Bell said that CT scanners and MRI scanners at EDGH and Conquest Hospital are going to be replaced. The CT scanner in Conquest Hospital is expected to be replaced early in 2018.

Cancer Quality Improvement Programme

21.10.   Lisa Elliot explained that the Cancer Quality Improvement Programme is carrying out a number of projects to raise awareness in Hastings and Rother.  Jessica Britton added that a large number of community volunteers have been trained to raise awareness about cancer, which is an effective way of raising awareness in some communities that may be less aware of cancer symptoms.

21.11.   The Committee RESOLVED to:

1) Note the report;

2) Request a future report on cancer care performance figures either as a committee report or by email;

3) Provide additional detail on the timescales for the programme to standardise the recording of cancer staging at the time of diagnosis; and

4) Request confirmation of whether mobile scanning facilities are able to undertake all types of scan, including those where enhanced detail is required.