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Head and Neck NSSG Annual Report
2010/11
Agreement Cover Sheet
This Annual Report has been agreed by:
Position:
Chair of the NSSG
Name:
Alan Lamont
Organisation:
Colchester Hospital University Foundation Trust
Date Agreed:
6th may 2011
Position:
Chair of the Network Board
Name:
Sheila Bremner
Organisation:
NHS North Essex Cluster
Date Agreed:
6th May 2011
NSSG members agreed the Annual Report on:
Date Agreed:
5th May 2011
1
Category
Report
Introduction This annual report from the Head and Neck NSSG covers the period 1st April 2010 – 31st
March 2011.
The Head and Neck service in ECN is fully IOG compliant.
Key achievements in 2010/11 include: NSSG securing good cross network and user
representation, completing and formally approving comprehensive constitution/clinical
guidelines document (approved July 2010) running successful half day Head and Neck cancer
audit event and supporting Head and Neck MDTs and NSSG through new Peer Review
process , achieving a green rating in following external validation in Jan 2011.
Centralised services for both ENT and Max Fax are now established at MEHT.
This group met on three occasions during 2010/11 (business meetings) and held one audit
event. Minutes attached Appendix 1.
NSSG
Meetings
Schedule /
Attendance
11-1C-101i
Annual
Review
11-1C-102i
Key challenges where some progress made but additional work required next year, includes:
• Recruitment and integration of specialist and restorative dentistry practitioner staff.
• Establishment of Clinical Trials and research activity.
• Expansion of junior medical and other disciplines’ training in Head and Neck cancer.
• Evolution of the relationship with Base-of-Skull surgery MDT.
• Provision of routine IMRT (Specialist radiotherapy) at CHUFT, currently available at
SUHFT.
• Rationalisation of Thyroid cancer core membership.
• Maintenance of a reliable technological infrastructure for MDT video conferencing and
radiology image transfer
There have been four Head NSSG meetings during 2010/11, three dedicated to business and
one audit event. (Appendix 1)
The attendance demonstrates involvement from core members from each of the four Head
and Neck MDTs that serve the Essex Cancer Network (Appendix 2). However the
attendance is by a core group and some other members have poor attendance that the NSSG
may wish to review its membership.
Date: 14th May 2010
Conducted by: Tom Carr, Medical Director (Appendix 5)
2
Clinical
Lines of
Enquiry
National Data
Trust
Basildon and Thurrock
University Hospitals
NHS Foundation Trust
Colchester Hospital
University NHS
Foundation Trust
Mid Essex Hospital
Services NHS Trust
Southend University
Hospital NHS
Foundation Trust
Clinical
Clinical
Clinical
Indicator Indicator Indicator
1
2
3
Clinical
Indicator
4
% WHERE
INTERVAL
BIOPSY TO
REPORTING
>10 DAYS
(6)
> 40%
CASES
SEEN BY
CLINICAL
NURSE
SPECIALIST
(CNS) (9)
% OF
CASES
DISCUSSED
AT MDT (5)
%OF
CASES
WITH TNM
RECORDED
(4)
100
100
100
100
92
100
80
36
100
100
94
9
National Clinical indicator 5
SUHFT provided assurances that at least 40% of patients having treatment received pretreatment dietetic assessment.
Activity
Overview
Head and Neck Cancer Surgeries
MEHT
H&N surgical data
201011.xls
Waiting
Times
Network
Audit
11-1C-111i
See Appendix 3 for 2010/11 Data
A range of topics were presented at our Network audit event agreed via NSSG. The meeting
was highly successful and was well attended by members of the NSSG Audit flyer shown in
Appendix 4.
Audits presented:
•
•
•
•
•
Cytology Results post FNA
Completion rates for patients commencing radical non-surgical treatments
Resection Margins
Network-wide patient survey
Free flap reconstruction in Head and Neck Surgery
Agreed Actions:
3
There had been differences identified and, therefore, upfront chemo will be looked at again
next year.
Research
11-1C-113i
All patients with a diagnosis of head and neck cancer should be considered for inclusion in
clinical trials and other well designed research studies. Research nurses at each site are
encouraged to attend MDTs and out patients to facilitate recruitment into studies.
Dr. Imtiaz Ahmed is the clinician responsible for participation in trials and other well-designed
studies.
The Cancer Research Network Manager and or Clinical Lead for Research attend the NSSG to
provide reports on recruitment and the current portfolio of research trials available. The
NSSG will regularly review and agree head and neck studies available and have identified a
lead responsible for ensuring recruitment into clinical trials and other well designed studies is
integrated into the function of the NSSG
The NSSG, at its meeting on 1st October 2010 discussed and agreed the clinical trial list for
2010/11. Activity (as required by measure 1C-151) was reviewed at all future meetings and
action agreed as required during 2010/11.
The current list and recruitment into each clinical trial for 2010/11 is listed in Appendix 6.
Patient &
Carer
Feedback
and
Involvement
A Network wide patient satisfaction survey is currently underway to be presented in
September 2011.
The results of the 2010 national patient survey are to be discussed at the NSSG in May 2011.
Full results for the SMDT are embedded below, although the numbers were small at 28
respondants.
Head and Neck Pt
Survey.xls
4
Appendix 1
Head and Neck Cancer Network Site Specific Group
Friday 25th June 2010
11.00am – 1.00pm
Boardroom Kestrel House
Present:
Sue Maughn
SM
Associate Director, ECN
Tom Carr
TC
Medical Director ECN
Jonathan Philpott (chair)
JP
Head and Neck Surgeon, SUHFT
Imtiaz Ahmed
IA
Consultant Oncologist, SUHFT
Belinda Grant
BG
General Manager Cancer Services MEHT
Arcot Maheshwar
AJ
Consultant & Neck Surgeon, CHUFT
Sally-Ann Philpott
SP
Head and Neck CNS, CHUFT
Karen Robertson
KR
CNS MEHT
Anne Hill
AH
Head and Nick Oncology CNS, SUHFT
Mrs. K. Tzafetta
KT
Consultant Plastic Surgeon, MEHT
Lisa Oakley
LO
Specialist Dietician MEHT
Miriam Mitchell
MM
Service Lead, Adult SLT NHS SW Essex
Ashley Solieri
AS
Network Research Manager, ECRN
Chris Adams
CA
User Representative
Joanne Sirkett
JC
Speech & Language Therapist, MEHT
Peter Weller
PW
Consultant OMFS Surgeon, SUHFT
Karen Robertson
KR
CNS Head & Neck , MEHT
Felicity Megee
FM
Speech and Language Therapist, MEHT
Vivienne Loo
VL
Consultant Oncologist, MEHT
Julia Morley
JM
CNS BTUHFT
5
Peter Davis
PD
Pathologist MEHT
Ashley Solieri
AS
ECRN Manager
Karen Cook
KC
General Manager MEHT
Kate Patience
KP
AHP Lead ECN
Gavin Watters
GW
ENT SUHFT
Jo Sirkett
JS
Principal Speech and Language Therapist
CECS/MEHT
Bhagwat Mathur
BM
Consultant Plastic Surgeon MEHT
1.
Apologies
Rehman Khan, Mr A. Pace-Balzan, Pavel Kotoucek, Deborah Stokes, Adele Wisbey,
Mr. Jeddy, Jamal Siddiqi, Judy Molyneux
2.
Previous Minutes – 12th March 2010.
Minutes agreed as true record of proceedings.
3.
Matters Arising
3.1 Annual Report 2009/10
JP went through the annual report.
Page 20 the wording “entries in blue are core Breast MDT members” required to
be amended to read Head and Neck.
Page 19 two members of the breast MDT need to be removed.
Once these corrections have been made then the annual report can be signed off.
3.2 Work Programme 2010/11
JP reviewed the annual report section by section at the meeting.
Agreed that it could be signed off as the programme for the NSSG for 2010/11.
6
3.3 SMDT Functioning
Peer review Programme 2010/11.
It was reported that 3 staff had done advanced communication skills last year and
3 were planned for this year.
The CNS annual report is in progress but is still waiting for some activity data.
3.4 Joint Clinic Arrangements
It was reported that there are concerns by the AHP’s that some patients are going
home without seeing all of the healthcare professionals they need to, particularly
Dieticians or S&L therapists. KR reported that in order to avoid this all patients
should go through the clinic nurse who will see that no one is missed.
There was some question as to whether or not a psychologist needed to be
included in the remit of the clinic.
It was generally felt however that the clinic was generally working better. It was
felt however that there is some need to rationalise those patients that are sent to
the clinic because some are too frail. It was felt that all patients who are to be
offered some form of curative treatment should attend the clinic. It was felt that
guidelines for the use of the clinic should be included in the operational guidelines.
It was also felt that there needed to be some patient information given to explain
to them the need to attend more than one site and what the benefits of attending
the joint clinic are.
It was reiterated that the clinic is for both new patients and those with recurrence.
It is expected that the clinic will remain in its current location following the
completion of the PFI.
3.5 Surgical Centralisation at MEHT
Group confirmed that all in-patients surgery for ECN now centralised at MEHT.
Unfortunately, activity reports not available for NSSG review.
There has been some difficulty in getting plastic surgeon support on Tuesdays for
these cases. There had been an indication from MEHT that on the appointment of
a new plastic surgeon H&N cancer work would be supported on a Tuesday.
It was reported that consultants in other trusts had adjusted job plans to support
this.
7
However in practice there have been difficulties encountered in getting H&N
patients dated for surgery on a Tuesday. The group urged MEHT to provide some
degree of flexibility around this given the small number of cases per annum and
the length of notice given. An urgent meeting is to be held at MEHT to resolve.
This will be raised at the ECN board on 13th July and feedback is required before
then. This unresolved issue will result in non-compliance with peer review.
There are also some issues being experienced with some equipment availability.
There was concern about potential changes to ward provision and that both the
SMDT and NSSG should be kept up to date in MEHT Strategic Plans in this regard.
It has been requested that potential changes to ward provision are also discussed
at the same meeting.
3.6 DAHNO
Concern noted by those who have used system that it is extremely time
consuming to enter patient data however it was acknowledged that there needs to
be a greater input from the wider members of the MDT. There have been some
system problems, which has also compounded ability of teams to submit data.
There has been some slippage in the completeness of data in the most recent
report. The audit meeting in September will look at data completeness prior to the
next upload of data.
There was still concern amongst the group that what is recorded in DAHNO may
not provide an accurate reflection of what is done.
It was suggested that many of these difficulties could be overcome with the
introduction across the network of the SOMERSET system.
MEHT reported that they are in the pilot stage with the system and that the Head
and Neck MDT is planned to be in phase 2 which is expected in 6- 8 weeks time.
SUHFT reported that they are using the system already.
Neither CHUFT nor BTUHFT were able to provide an update.
The adoption of SOMERSET is seen as a priority by the network and is able to
provide some funding for project support should it be required.
3.7 2010 Audit Topic
NSSG was reminded of agreed audit topics discussed at the last meeting. These
include:-
8
•
•
•
•
•
Cytology results of post FNA - Lead: Jonathan Philpott
Audit of re-section margins - (Lead: Mr. Jamal Siddiqi)
Audit of completion rates for patients commencing radical non-surgical
treatment - Lead: Dr Alan Lamont
Network wide patients survey - Lead: Clinical Nurse Specialists
Free flap reconstruction in Head and Neck Surgery – Lead: Mr. Bhagwat
Mathur/Ms Kallirroi Tzafetta
The Audit half day will take place at Mid Essex Hospital Trust, Lecture Theatre 1
on Friday, 17th September 2010 between 9.00am-12.15pm. Ms Tzafetta has
agreed to make appropriate arrangements in partnership with Jill Butten, Network
Office Manager.
A study day is being planned by the CNS’s for all healthcare professionals working
in the field of Head and Neck. It is to take place on 11th November 2010.
3.8 Draft Constitution Document 2009/10:
There were some changes to be made. It was suggested that there should be a
requirement to provide photographs of larger samples.
Following feedback from other constitutions that had been subject to peer review
this year SM suggested that flowcharts of referral and imaging pathways could be
included.
Action:
SM/JP
3.9 Regular Agenda Items
3.9.1 Clinical Trial Recruitment
Ashley Solieri, ECRN Manager, circulated the ECRN approved list of Head &
Neck Cancer Trials for NSSG review. It was confirmed that Imtiaz Ahmed
was the research lead and this needs reflecting on P32 of the constitution
and added to the annual report. The current study list also needs
amending in the constitution. IA discussed the small number of studies
available however more studies are expected in the future and it is hoped
that recruitment would increase. VL and AM agreed to take part in the
PET-NECK study and AS would follow this up with R&D.
9
3.9.2 User Involvement
Nil to report.
3.10 Clinical Nurse Specialists Meeting/Service Improvement
A patient satisfaction survey is underway in the Friday am clinic. There is a South
Essex/Network wide patient experience project underway.
It was considered a bit too early to audit IMRT as there have only been 15
patients to date.
3.11 Consultant Appointment at MEHT.
Paper work had been presented to the HR department to enable the trust to readvertise.
MEHT are also to go out to advert to replace Mr Dev Roy who is retiring.
4.
New Business
4.1 Rehab pathways
NCAT has published standardised rehab pathways for each tumour site.
These will be peer reviewed as part of the Rehab measures.
These pathways will need to be adopted and placed within the constitution
document.
Discussions to be picked up through ECRN and review of NCRN trials list to ensure
SMDT in all localities contributing to this trial.
5.
Any Other Business
5.1 British Association of Head & Neck Nurses
10
SP has been elected on to the British Association of Head & Neck Nurses
committee.
5.2 Morbidity and Mortality
JP suggested that the NSSG needs to be formally reporting its morbidity and
mortality figures. This should be reported on a 3 monthly basis. Discussions were
had a to how to take this forward.
5.3 Pathology Reports
There is a wide variation seen in pathology reports, particularly in the case of Oral.
It was agreed that there should be some standardisation and a wider use of
photographs. Although the pathologists agree there is a requirement for a MDS
they also feel the need for the ability to free text. It was suggested that there is a
need to drive up standards and that this could be done through audit.
The pathology cross cutting group had worked out where the expertise lies within
the network but it had been difficult to drive items forward as they have not been
quorate.
PD described the difficulties in trying to move pathology services forward whilst a
decision on the centralisation of services was still outstanding.
5.4 Performance Reports
TC suggested that there should be performance information presented to the
NSSG. This should include performance against 31/62 day standards and activity
as well as any others that the group feels appropriate.
6.
Date of next meeting
Half Day Audit – Friday, 17th
Lecture Theatre 1, MEHT
September 2010
- 9.00am-12.15pm,
11
NSSG - Friday 1st October 2010 - 11.00am-1.00pm, Lecture Theatre 1,
MEHT.
Head and Neck Cancer Network Site Specific Group
Friday 1st October 2010
11.00am – 1.00pm
MEHT – Lecture Theatre 1
Present:
Dr Alan Lamont (Chair)
AL
Consultant Oncologist, CHUFT
Sue Maughn
SM
Interim Network Director, ECN
Adele Wisbey
AW
Divisional Nurse Manager, MEHT
Dawn Beaumont-Jewell
DBJ
Research Nurse Clinician, MEHT
Imtiaz Ahmed
IA
Consultant Oncologist, SUHFT
Maged Abdelkader
MA
Consultant Head and Neck Surgeon,
BTUHFT
Belinda Grant
BG
General Manager Cancer Services, MEHT
Sally-Ann Philpott
SP
Head and Neck CNS, CHUFT
Anne Hill
AH
Head and Nick Oncology CNS, SUHFT
Mrs. K. Tzafetta
KT
Consultant Plastic Surgeon, MEHT
Karen Robertson
KR
Head and Neck CNS, MEHT
Vivienne Loo
VL
Consultant Oncologist, MEHT
Michael Scanes
MS
User Involvement Facilitator
Miriam Mitchell
MM
Service Lead, BTUHFT
Julia Morley
JM
CNS, BTUHFT
12
Joanne Sirkett
JC
Speech & Language Therapist, MEHT
Sally Sanger
SS
Macmillan Information Network Manager,
ECN
Bhagwat Mathur
BM
Consultant Plastic Surgeon, MEHT
Jamal Siddiqi
JS
OMFS Surgeon, BTUHFT
Gavin Watters
KW
Head & Neck Surgeon, SUHFT
Jayne McCabe
1.
Psychotherapist, MEHT
Apologies
Ashley Solieri, Judy Molyneux, Arcot Maheshwar, Deborah Stokes, Albert PaceBalzan, Chris Adams, Denis Falconer
2.
Previous Minutes – 25th June 2010
Minutes agreed as true record of proceedings.
3.
Matters Arising
3.1 SMDT Functioning
Still experiencing problems with the radiology support at SMDT. 3 radiologists to
be recruited by April 2011.
The video link infrastructure seems better. Some problems, however, still occur
when multi-link required.
MEHT to install Image Exchange Portal (IEP) with initial funding from the network.
Histology usually present with sections to review.
Good overall attendance and high quality discussions taking place.
3.2 Surgical Centralisation at MEHT
The surgical centralisation of ENT from St John’s to MEHT has been delayed until
5th November. It is envisaged that when this move has taken place, MEHT
13
surgeons will be able to attend more of the SMDT to allow for a wider discussion
of all patients.
3.3 DAHNO Commitment
The CNS’s had attended a study day at DAHNO. From next year there will be new
requirements to collect 6 and 12 month reviews and also AHP data.
The NSSG agreed to commit to do this.
SOMERSET will support some of the data collection; but there will still be
commitment to DAHNO. The 4 trusts are at different stages with SOMERSET roll
out. The Network has a graduate trainee joining them to help bring all of the
trusts together.
3.4 2010 Audit Topics
The NSSG had held a successful Audit half day on 17th September. Mrs Tzafetta is
going to write up a report of the session.
There had been differences identified and, therefore, upfront chemo will be looked
at again next year.
Next year’s audit day will also be in September; hosted by CHUFT.
Members were asked to consider topics for 2011 audit and bring them to the next
meeting.
3.5 Draft Constitution Document
Approved by the Network Board on 14th September 2010. Will need to be
reviewed by June 2011 prior to Peer Review.
3.6 Regular Agenda Items
3.6.1 Clinical Trials
Trials already open on the list provided were approved by the NSSG. COSTAR still
in set up at SUHFT.
Other studies are open to recruitment:
The list to be revised and adopted at the next NSSG.
3.6.2 User Involvement Feedback
3.6.3 CNS/Service Improvement
14
At the joint Friday clinic all patients are asked if they would like a permanent
record of their consultation. At SUHFT all patients are sent this automatically.
There was some debate as to what the National Guidance actually is in relation to
providing patients with a record of their consultation. SM/AL to investigate.
Action:
SM/AL
3.7 Consultant Appointment at MEHT (Up-date)
Job description is still with the college, although a locum is trying to be recruited in
the interim.
4.
New Business
4.1. Information Prescription Project:
Project Manager Sally Sanger presented to the NSSG.
The Information Prescription Project aims to bring good quality pathway specific
patient information. The information can be tailored to the patient’s needs and
stage of pathways. It is a back up to verbal information and not a substitute for it.
It will be delivered electronically through NHS Choices and will be subject to Peer
Review from 2012.
Roll out takes place over 2 years from November 2010 and there are 2 beacon
sites in Essex 1 at CHUFT and 1 at BTUHFT.
Head and Neck pathways will be available from November.
Local site specific information can be uploaded to the system.
4.2
Rehab Pathways
NCAT has produced a number of rehab pathways. These pathways contain
triggers for referrals to an AHP along the patient pathway. They need to be signed
off by the NSSG and any comments should be referred to Kate Patience please at
[email protected].
If there are no adverse comments returned to Kate within 2 weeks of the
circulation of the minutes, the pathways will be approved.
5.
Any Other Business
15
5.1 Head and Neck Wards
The NSSG approves and supports the requirement for a dedicated Head and Neck
ward at MEHT. This should be properly resourced in both terms of staff and
facilities.
It is a requirement of Peer Review that the details of the dedicated ward are
included in the Constitution.
5.2 Operational Issues
A number of operational issues were discussed:•
•
•
•
•
•
Patients are discharged from the Hub without district nurse cover and any
equipment required.
Patients have to be admitted the night before surgery as notes not
available on the day.
There were delays in information getting back to the Hubs e.g data not
received by local oncologists before follow up.
Funding for psychological support withdrawn from April 2011.
Lack of CNS support at Basildon.
Possible change of date of thyroid MDT.
It was suggested that the discharge planning needs to be more comprehensive. It
was felt that these issues were not for the NSSG, but should be taken up in a local
operational business meeting which will be held between NSSG meetings.
6.
Dates of Next Meetings
Friday, 4th February 2011 following SMDT at MEHT 11.30-1:30pm – Olga
Rippon Room
Head and Neck Cancer Network Site Specific Group
16
Friday 4th February 2011
11.30am – 1.30pm
MEHT – Olga Rippon ROOM MAU
Present:
Dr Alan Lamont (Chair)
AL
Consultant Oncologist, CHUFT
Imtiaz Ahmed
IA
Consultant Oncologist, SUHFT
Jamal Siddiqi
JS
OMFS Surgeon, BTUHFT
Arcot Maheshwar
AM
Consultant ENT Surgeon, CHUFT
Rachael West
RW
Cancer Services Manager, CHUFT
Kate Petts
KP
Head & Neck General Manager, MEHT
Tom Carr
TC
Medical Director, ECN
Sue Maughn
SM
Interim Network Director, ECN
Belinda Grant
BG
General Manager Cancer Services, MEHT
Sally-Ann Philpott
SP
Head and Neck CNS, CHUFT
Anne Hill
AH
Head and Nick Oncology CNS, SUHFT
Kate Patience
KP
Macmillan AHP Lead, ECN
Karen Robertson
KR
Head and Neck CNS, MEHT
Vivienne Loo
VL
Consultant Oncologist, MEHT
Michael Scanes
MS
User Involvement Facilitator
Miriam Mitchell
MM
Service Lead, BTUHFT
Amy Brocks
AB
Staff Nurse, MEHT
Joanne Sirkett
JC
Speech & Language Therapist, MEHT
Joanna Gagola
JG
Staff Nurse, MEHT
Lesley-Ann Little
LL
Student Nurse, MEHT
Gavin Watters
KW
Consultant ENT Surgeon, SUHFT
Niresh Randive
NR
Consultant Anaesthetist, MEHT
A Pace-Balzan
APB
Consultant ENT Surgeon, MEHT
J Philpott
JP
Consultant ENT Surgeon, SUHFT
Judy Molyneux
JM
Dietician, MEHT
17
Skandadas Gangshalincam
1.
SG
Consultant Radiologist, MEHT
Apologies
Rehman Khan, Kallirroi Tzafetta, Jackie Gibson, Mr T Jeddy, Ashley Solieri
2.
Previous Minutes – 1st October 2010
Minutes agreed as true record of proceedings.
3.
Matters Arising
3.1 SMDT Functioning
AL said that the SMDT was working satisfactorily, but there were still issues
around image transfer, although he is of the opinion that this is part of a learning
curve.
SM said that the Network was looking at the issues and undertaking a baseline
assessment.
3.2 Surgical Centralisation at MEHT
A new surgeon has been appointed, but they are waiting for the Contract to be
finalised.
Several operations have been cancelled due to a lack of beds and also a lack of
ITU beds.
MEHT does not currently have a dedicated H&N Surgical Ward as required by the
NICE IOG Guidelines. KP said that the new Director of Operations has promised
that a dedicated H&N ward will be established at MEHT and would be publishing
the timescale next week.
MEHT had wanted to transfer a patient to Springfield Hospital (private) so that Mr
Faulkner could include the patient on his private list due to the unavailability of
beds at MEHT, but the Network team had stopped this as it would be completely
inappropriate as this was not an IOG compliant centre. It was stated that the
bottom line was that there are not enough beds, and unless more beds are made
available this will be an ongoing problem. AL said that this was an issue for the
Network and Trust to resolve. SM said that if an operation is cancelled perhaps the
patient should be offered surgery at another IOG compliant centre. JP said that
this would introduce delays as it would entail discussing the patient with another
MDT, and then the other centre finding a slot.
18
AL said that the group needs a Crisis Management Plan:
The SMDT should discuss whether a particular patient MUST be treated at an IOG
compliant centre or not. Patients should only be treated in an IOG compliant
centre and only if no timely slot is available after consultation with reasonable
accessible to IOG compliant centres (e.g. London, Cambridge, Norwich) should
use of a non compliant centre be considered.
IA suggested that the group should audit how many patients are having the
surgery cancelled.
AL said that the Network was not getting the resources from MEHT that had been
promised.
SM and TC are meeting with the Director of Operations at MEHT and would be
raising these issues at the meeting.
TC said that the network were looking at centralisation of the Upper GI service at
MEHT, but were planning a strict Service Specification before the centralisation will
take place.
3.3 DAHNO Commitment
SP said that the DAHNO report for 2010 was due in April 2011. CHUFT have two
data clerks helping uploading the data.
SUHFT are uploading data with IT support from MEHT
MEHT will be using Somerset by April 2011 and this will populate DAHNO.
AL said that we need to look at the next DAHNO Report to establish where the
gaps are. He suspects that non-surgical oncology is a likely gap.
3.4 2011 Audit Topics
The next audit day will be hosted by CHUFT. SP will try to find a room for the
proposed date (16th September 2011)
Topics to include:-
1.
2.
3.
4.
5.
6.
7.
Cancellations (JP will coordinate the results)
Nutrition
Laryngectomy: Speech and language outcomes.
PET Scan: does it meet standards
Kate Patience: Audit of rehab services for H&N patients across
Essex
Adherence to Cancer Drug Fund (AL)
Patient Satisfaction Survey (CNSs)
19
3.5 Draft Constitution Document
The Constitution document needs to be reviewed ready for the Peer Review visit in
June 2011.
The SMDT at Broomfield will be visited on 8th June 2011 and the NSSG on 16th
June 2011. AL and MS to look at the Constitution and amend as required.
The Annual Report 2010-2011 and 3 year Work Programme will be discussed at
the end of a future MDT meeting. These will need to be ready by end of April
2011 as they will need to be uploaded onto cquins in readiness for the Peer review
visits.
3.5.1 Teenage and Young Adults Peer Review Measures
MS reported that the TYA Peer Review measures are out for consultation. One of
the requirements of the Measures is that every NSSG in a Network should have a
TYA Pathway in their Constitution.
16-18 year olds have to be referred to the MDT at the Primary Treatment Centre
for discussion. Treatment will take place at the PTC;
19-24 year olds are to be discussed locally and the PTC advised. This group can
choose where they are treated.
The PTC for all Essex patients is UCLH.
MS said that the Network would prepare a paragraph for insertion into the
Constitution. This would have to be formally agreed at the next meeting.
3.6 Regular Agenda Items
3.6.1 Clinical Trials
See attached report from Ashley Solieri
3.6.2 User Involvement Feedback
AH said that the current User Representative did not feel that his presence was
useful. She added that there was another potential representative in Southend.
MS asked her to provide contact details so that he could discuss what would be
involved. He added that a H&N patient had just joined the User Group in
Colchester and would be approached about joining the NSSG when he had a little
more experience. He asked any other of the CNSs if they could identify potential
new patient/carer representatives to let him know.
4.
New Business
4.1 AOS Rapid Access Clinic
All Trusts with an A&E department will be required to channel cancer patients
20
directly to Cancer Clinicians. Each Trust needs a plan and this needs to be
documented. The Network has a Cross Cutting Group working on these issues.
The process will be subject to Peer Review this year.
4.2
Rehab Pathways
The Rehab Pathway, having been circulated, was accepted by the group and
signed off by the Chair
5.
Any Other Business
5.1 Maxillofacial service
There are currently 3 vacancies for Maxfac surgeons. MEHT are looking to recruit
to the vacancies. IA said that the service is suffering. JP said that they were
concerned that the oral surgery service in Southend is just oral surgery and not
supported by a Maxfac surgeon. He urged the Centre to recruit as soon as
possible.
Following discussion around the role, the NSSG agreed that in principle it supports
the concept of any Maxfac surgeon contributing to open flap surgery.
There are operational difficulties at CHUFT due to a lack of Maxfac input to the
Oral Surgery Service.
The NSSG supports a Hub and Spoke service for Maxfac surgeons based at MEHT.
5.2 Surgical Capacity
JS expressed concerns on access to MEHT operating capacity and urged MEHT
and BTUHFT to resolve the matter as soon as possible.
5.3 National Patient Satisfaction Survey
6.
BG expressed concern that MEHT had not done very well in the recently published
National Cancer Patient Satisfaction Survey. SM said that due to time constraints it
would be put on the agenda of the next meeting.
Dates of Next Meetings
Friday 13th May 2011, 12 noon – 2.00pm, Kestrel House CM2 5PF
Thursday 16th June SMDT peer review visit at Network Offices 1112:30pm ( a representative group of members from the NSSG needs to
attend)
Friday 4th November 2011 following SMDT at MEHT 11.30 – 1.30pm
Half Day Audit: Friday 16th September 2011 Venue : TBA
21
Appendix 2
Summary Attendance at Head and Neck NSSG 2010/11
Name
South Essex - Basildon
Title
ORG
Jamal Siddiqi
OMFS Surgeon
Taleb Jeddy
Consultant Surgeon
North East Essex
Donna Booton
Duncan McRae
Alan Lamont (chair)
Arcot Maheshwar
Michelle Bath
Philip Murray
Sally-Anne Philpott
Robert Skelly
25.6.10
1.10.10
4.2.11
BTUHFT
X
66%
BTUHFT
X
x
x
0
CHUFT
x
x
x
0
0
66%
CHUFT
x
x
x
Consultant Oncologist
CHUFT
x
Consultant H&N
Surgeon
CHUFT
Head & Neck CNS
CHUFT
CHUFT
CHUFT
CHUFT
x
x
x
x
x
x
Ruth Sterell
H&N Radiographer
CHUFT
x
Rachael West
Lead Cancer Manager
CHUFT
x
x
x
x
x
x
x
x
x
x
x
Consultant Oncologist
MEHT
MEHT
MEHT
MEHT
MEHT
x
x
Saad Tahir
CHUFT
x
x
x
66%
0
0
100%
x
0
x
0
x
33%
0
Mid Essex
Basil Abdi
Khalid Al-Janabi
Hilary Armstrong
David Cunnah
Dr. Vivienne Loo
Denis Falconer
Lynn Thomas
Judy Molyneux
Bhagwat Mathur
Neville Davidson
Albert Pace-Balzan
Mahir Petkar
Karen Robertson
Joanne Sirkett
OMFS Surgeon
Dietetic Lead
Consultant Plastic
Surgeon
Lead Cancer Clinician
Histopathologist
Head and Neck CNS
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
Speech & Language
Therapist
MEHT
Adele Wisbey
Nurse Matron
MEHT
Kalliroi Tzafetta
Consultant Plastic
Surgeon
Speech & Language
Therapist
Consultant
Anaesthetist
Dietetic Lead
(alternate)
MEHT
Felicity Megee
Paolo Baraggia
Lisa Oakley
x
x
x
x
0
0
0
0
100%
x
x
x
x
x
0
0
33%
x
x
x
x
x
x
x
x
x
33%
0
33%
0
100%
100%
x
x
33%
x
66%
x
x
33%
x
x
x
0%
y
y
x
66%
x
x
x
0%
66%
x
x
x
x
x
x
x
x
x
x
x
MEHT
MEHT
x
South Essex - Southend
Audrey Loos
Anne Hill
Jonathan Philpott (deputy
chair)
Karl Metcalfe
Krishnaswamy Madhavan
Mike Salter
Sreekanth Palvai
Lead Cancer Manager
Head & Neck CNS
Head & Neck Surgeon
SUHFT
SUHFT
SUHFT
SUHFT
SUHFT
SUHFT
SUHFT
x
x
x
x
100%
0%
0%
0%
0%
22
Imtiaz Ahmed
Consultant Oncologist
SUHFT
Gavin Watters
Peter Weller
Head & Neck Surgeon
Consultant OMFS
Surgeon
Head & Neck Cancer
CNS
Consultant Head &
Neck Surgeon
SUHFT
SUHFT
Julia Morley
Maged Abdelkader
Miriam Mitchell
Rehman Khan
Jackie Gibson
Lead Cancer Manager
100%
100%
33%
BTUHFT
x
x
x
BTUHFT
x
x
BTUHFT
BTUHFT
BTUHFT
x
x
x
x
x
x
33%
100%
0
0
x
x
33%
66%
User Representation
Chris Adams
Cancer Network
Sue Maughn (from June
2010)
Tom Carr
Netty Wood
Michael Scanes
Network Director
ECN
Medical Director
Network Pharmacist
User Involvement
Facilitator
ECN
ECN
ECN
x
x
x
x
Manager
ECRN
x
100%
66%
0%
66%
Essex Cancer Research
Network
Ashley Solieri
x
x
33%
Entries in Blue are Core Head and Neck MDT members
23
Head and Neck Cancer Activity and
Waiting Times
2010/11
Essex Cancer Network Patients where primary diagnosis was Head and Neck
Cancer by PCT. (100 patients were diagnosed at trusts outside the network)
Purchaser
Mid Essex PCT
North East Essex PCT
South East Essex PCT
South West Essex PCT
Total Patients from Essex Cancer Network
PCTs
25
20
23
31
29
23
19
31
44
12
34
24
32
23
18
31
39
19
35
29
48
11
40
42
26
15
25
46
29
19
22
50
Dec
emb
er
2010
33
29
32
32
99
102
114
104
122
141
112
120
126
April
2010
May June July August
2010 2010 2010 2010
Septe
mber
2010
October
2010
Novem
ber
2010
Janua
ry
2011
Febr
uary
2011
YTD
(11/12)
29
25
23
34
36
12
14
19
370
292
285
369
111
81
1232
24
Cancer Wait times data
(Source Open Exeter)
Two Week Waits
Total
Seen
referrals
within
seen during
14 days
the period
BASILDON
AND
THURROCK
UNIVERSITY
HOSPITALS
NHS TRUST
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Total
31 Day First
Treatment
62 Day Standard
Treated
Total
Total
Total
on or
over
treated within treated
target
31 days
21
39
25
36
32
35
22
29
29
33
47
21
38
24
34
32
33
22
29
28
33
47
3
1
4
3
1
4
2
0
5
1
1
1
1
1
1
7
3
4
1
0
0.5
0
1.5
0.5
0.5
0
348
341
9
9
25
4
25
COLCHESTER
HOSPITALS
UNIVERSITY
FOUNDATION
TRUST
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Total
Two Week Waits
Total
referrals
Seen
seen
within
during
14 days
the
period
34
34
32
32
43
42
39
34
36
34
35
33
46
44
37
37
33
33
29
25
43
43
407
391
31 Day First
Treatment
Total
treated
62 Day Standard
Treated
on or
Total
within treated
31 days
Total over
target
5
1
2
1
7
1
3
3
5
1
2
1
7
1
3
2
3
0.5
1
2
2
1
2
0
0.5
0
0
1
2
3
2
2
2
1
0.5
0.5
28
26
14
3
26
Two Week Waits
Total
Seen
referrals
within
seen during
14 days
the period
MID ESSEX
HOSPITAL
SERVICES
NHS TRUST
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Total
31 Day First
Treatment
62 Day Standard
Treated
Total
Total
Total
on or
over
treated within treated
target
31 days
43
36
34
28
37
44
31
37
43
34
39
39
34
32
28
35
42
27
36
38
33
38
9
13
9
4
12
12
11
13
10
11
5
9
13
9
4
12
12
11
13
10
9
5
2
3
4
2
5
4
4
8
3
6
4
0.5
0
0
0
1.5
0
0
1.5
0.5
1
0.5
406
382
109
107
45
5.5
27
SOUTHEND
HOSPITAL
NHS TRUST
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Total
Two Week Waits
Total
referrals
Seen
seen
within
during
14 days
the
period
38
36
48
47
53
53
52
52
33
33
52
51
43
43
62
60
42
40
43
43
56
53
522
511
31 Day First
Treatment
Total
treated
62 Day Standard
Treated
on or
Total
within treated
31 days
Total over
target
1
4
5
6
9
6
2
4
6
6
5
1
3
5
6
7
6
2
4
5
6
5
1
3
3
2
4
3
2
4
3
2
0
0
1
1
1.5
0
1
0
0
0
54
50
27
4.5
28
29
Appendix 4
Sponsored by:
TIME
TITLE OF PRESENTATION
09.00
09.05
09.30
Coffee and Biscuits
Cytology Results post FNA
Mr. Jonathan Philpott
Resection Margins
Mr.Jamal Siddiqi
10.00
Completion rates for patients commencing radical non-surgical
treatments
10.30
Refreshment Break
10.45
11.15
11.45
PRESENTER
Network-wide patient survey
Dr. Alan Lamont
Clinical Nurse Specialists
Free flap reconstruction in Head and Neck Surgery
Mr. Bhagwat Mathur/Ms Kallirroi
Tzafetta
Buffet Lunch
30
For more information please contact Sue Maughn,
Associate Director/SIL, Essex Cancer Network
(tel: 01245 397647)
If you plan to attend, please e-mail:
[email protected]
31
Appendix 5
Essex Cancer Network
NSSG Chair Annual Review
Name: Alan Lamont
Date of Review:
NSSG Site: Head and Neck
14th May 2010
Structure:
Alan has had the role of chair of the NSSG for 2 years and is happy to continue. His deputy is Jonathan Philpot.
Strengths:
The NSSG has a good attendance across all disciplines and from each Trust in the Network.
The agenda for the meetings is written by the chair.
Areas for Improvement:
Centralisation of the service to become IOG compliant has been a struggle but is now progressing well.
There is currently a challenge in the centralisation and organisation of the Essex maxillofacial service.
Expansion of junior medical and other disciplinary training in Head & Neck cancer is essential.
The integration of ENT services from St John’s to Broomfield is long overdue and when completed will help the
service delivery.
Establishment of research and clinical trials activity is essential.
There are concerns regarding the facilities after the service moves into the new PFI Hospital.
Documentation: The NSSG has produced the following documents:
•
•
•
Constitution including treatment guidelines
Annual Report
Work Programme
Peer review outcomes and concerns:
No major concerns. The transfer of imaging is difficult and IT needs to be improved. It does not appear to be a
priority and might need to be pushed.
Data and audit:
DAHNO is supported but it is complex and needs clerical support which is not available.
Network wide audit has been conducted and reported at an Audit meeting.
32
Personal development needs and plans:
Nil.
Mr T W Carr
Medical Director
Essex Cancer Network
14th May 2010.
Next Review Due by 14th May 2011
33
Appendix 6
Essex Cancer Network – Head and Neck Cancer Trial activity and Recruitment Accrual 2010/11
Trial Name and
Short Description
Southend
10/11
COSTAR / A randomised study of cochlear sparing intensity modulated
radiotherapy vs conventional radiotherapy in patients with parotid tumour
PET NECK / A randomised trial comparing PET-CT guided watch and
wait policy vs planned neck dissection for the management of locally
advanced (N2/N3) nodal metastases in patients with head and neck
squamous cancer
TCUK IN / Thyroid Cancer Genetic investigation in the UK
Non-NCRN Studies
Basildon
Total
0
1
10/11
Chelmsford
Total
10/11
Total
Colchester
10/11
Total
0
3
In set
up
In set
up
0
0
34
35