Meeting documents

PH/15/31

Health and Wellbeing Scrutiny Committee

10 November 2015

ROYAL DEVON AND EXETER HOSPITAL REPORT

Cancer Treatment Waiting Times Position

The incidence of cancer is rising across the country and the number and range of treatments available to patients is increasing. The Trust has experienced increased levels of activity year on year with 13,500 patients being referred in 14/15 a rise of around 30% over the last two years. In addition, the number of patients diagnosed and treated with a cancer for the first time has also risen by almost a quarter from 2,435 in 12/13 to 3,019 in 14/15. Despite our best efforts to address deteriorating cancer waiting times performance, constraints on our capacity has resulted in failing to meet key cancer targets a situation that is replicated across England.

We acknowledge that longer waiting times can cause distress to patients and this is something that we regret. In order to ensure patient safety we have put in place measures to ensure every patient that waits longer than the target time is monitored by a consultant so that they do not come to avoidable harm as a result of the delay. The failure of the target is taken very seriously by the Trust but it is important to note the numbers of patients not receiving treatment within the 62 day timeframe is small. For example, approximately 1400 people or referred on a cancer pathway each month in August fewer than 8 people exceeded the target threshold.

The Trust has developed a robust plan to return to compliance and we expect to return to full compliance by April 2016. A number of steps have been taken to facilitate the required improvement including:

recruiting extra staff in a number of specialist areas including, consultants, nurse specialists and administrative support

committing significant resource into increasing operating theatre capacity on the Heavitree site in order to free up space at Wonford for the most clinically urgent patients

investing resources to increase capacity (physical space and staffing) within Endoscopy

the Trust has a comprehensive improvement plan targeted at the areas of greatest pressure within the cancer pathway

the Trust is working with Monitor, NEW Devon Clinical Commissioning Group (CCG) and the South West Cancer Network and the Intensive Support team to ensure it maximizes all available opportunities for improving cancer waiting times performance

In an effort to seek ways to improve our performance, the Trust has invited the NHS Intensive Support Team (IST) into the organisation to provide recommendations on three separate occasions, of which two visits were held in the past 12 months (October 14 and October 15). Following the 2014 visit it was acknowledged that the Trust has robust monitoring in place for cancer performance, allowing us to develop a 'forward look' to improve the management of Cancer Wait Times. The Trust is awaiting the formal report from the most recent IST visit held earlier this month - however informal feedback throughout the visit was positive with no significant causes for concern raised.

The Cancer Improvement Plan has not yet been formally agreed by the CCG. However the Tripartite, made up of NHS England, Monitor and the Trust Development Authority, have confirmed that they believe the plan is well aligned with realistic and appropriate actions (the full plan is available of you wish to see the detail). We are continuing to work with the CCG to agree our plan to achieve the target of meeting the 62 day cancer wait target as soon as possible.

Despite the capacity issues we are facing, the Trust has excelled in the most recent national patient satisfaction survey for cancer services. Our results have shown a year on year improvement to our current position, with 94% of our patients having rated the Trust as good or excellent for the care provided. It is important to note that our patients views on the standard of care provided within the Trust is very good despite current waiting time performance and has improved over the last 2 years.

The Trust is also a leader in the field of helping cancer survivors to live with the best possible quality of life for as long as possible through our "Living with and Beyond Cancer" programme. This is delivered through health and wellbeing clinics, electronic holistic needs assessments, remote monitoring of patients and end of treatment summaries; all designed to empower and improve the lives of those living with cancer.

In recent years the Trust has demonstrated real innovation through investing in more effective treatments for cancers to ensure that we offer the best possible treatments as close to home as possible. These include:

Robotic surgery for urological cancers

Better targeted local radiotherapy (brachytherapy)

Increased use of IMRT and IGRT planned radiotherapy treatment for cancers

Improved results and reduced complications. This has been achieved ahead of National target levels for this type of treatment

Reduced morbidity treatments for skin cancers

The Trust would be happy to provide a more detailed briefing for members of the Devon County Council Health and Wellbeing Scrutiny Committee, if this would helpful.

Adrian Harris

MEDICAL DIRECTOR