1. health and fitness
2. disease
3. cancer

Urology NSSG Annual Report
2010/11
Agreement Cover Sheet
This Annual Report has been agreed by:
Position:
Chair of the NSSG
Name:
Mr Richard Lodge
Organisation:
Southend University Hospitals NHS Foundation Trust
Date Agreed:
5th 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
Urology Cancer Network Site-Specific Group
Annual Report 2010/11
Category
Report
Introduction
This annual report from the Urology NSSG covers the period 1st April 2010 to 31st March
2011.
The Urology NSSG was established following merger of South Essex and Mid Anglia
Cancer Networks in 2007. Key emphasis at the outset in 08/09 was of consolidation of
the group and implementing the agreed network plans for delivering IOG compliant
Urology Cancer services.
Key achievements include:
•
NSSG meeting regularly with good cross network and user representation,
•
Commitment to network-wide audit,
•
Establishment of Single Specialist MDT serving all 4 x PCT localities in ECN,
•
IOG compliant penile cancer arrangements with all fours sites referring penile
cancer to Professor N Watkins at St George’s hospital.
•
The Urology Constitution including referral, diagnosis and management
guidelines have been agreed.
•
Centralisation of complex renal surgery as per manual for cancer standards in
Feb 2011.
•
Agreement of a standard template to agree service developments across the
network
Key challenges where some progress made but additional work required next year:
includes:
•
A formal Peer Review visit of the SMDT;
•
continued commitment to network-wide audit,
•
Agreement of minimum dataset (MDS) and local data collection arrangements.
•
Consideration of the requirement for robotic surgery in Essex.
•
Adoption of acute oncology practices where appropriate in line with AOS
measures.
•
Roll out of Enhanced recovery programmes in urology.
The Macmillan Allied Health Professional Lead for the ECN will also be developing local
rehabilitation pathways and introducing service developments from the National Cancer
Survivorship Initiative to the NSSG.
NSSG Meetings
Schedule /
Attendance
(11-1c-101g)
There have been 4 Urology NSSG business meetings during 2010/11 plus one audit
event. Appendix 1 presents the attendance summary for the meetings that have taken
place during 2010/11. All the minutes for 2010/11 NSSG meetings are collated in
Appendix 5.
The summary clearly demonstrates attendance and involvement from core members of
each of the Urology MDTs within the Network.
There have also been meetings of a number of NSSG subgroups:
Peer review group
IOG implementation group
Clinical Guidelines Group.
2
Network
Configuration
The configuration has been transformed in 2009/10 with establishment of single SMDT
serving all four ECN PCT localities (hosted by Southend Hospital). Three Local MDTs still
operate and these include: 1. South Essex (joint Basildon and Southend), 2. Mid Essex
and 3. Colchester Hospital serving their respective populations; and in 2010/11 with the
centralisation of complex renal surgery to the designated cancer centres.
Activity Overview
See Appendix 2
Annual Review
(11-1c-102g)
The chair’s annual review was carried out 2010/11 by, Mr. Tom Carr. Date: 25.3.2011
Detailed in Appendix 6.
Clinical Guideline
During 2010/11 the NSSG updated the comprehensive constitution document which
includes the clinical guidelines for management of urology cancer in ECN under the
leadership of the new chair Mr Richard Lodge; appointed in Jan 2011.
The NSSG has a separate sub group that reviews the guidelines on behalf of the NSSG
and then presents to the wider NSSG for agreement and sign off.
Network Audit
(11-1c-104g)
The NSSG had a network wide audit event during 2010/11. The programme for the half
day event and the follow up actions are discussed in Appendix 3.
Audit will continue to be a priority in 2011/12 and presented in half-day audit event in
the autumn. Potential Audit topics include:
•
•
•
•
Clinical Trials
(11-1c-105g)
Access to radical treatments in 2010/11
CNSs in BTUHFT and MEHT to survey the patient satisfaction of patients visiting
the centres.
Radiotherapy
Network wide audit of the use of BCG treatment.
The urology NSSG agreed their list of clinical trials during 2009/10 which was reviewed
and updated during 2010/11 by the attendance at NSSG of the newly appointed ECRN
manager.
A summary of MDT recruitment levels into each clinical trial for the 2010/11 (up to 31st
Jan 10) is listed in Appendix 4.
Service
Improvement &
Service Delivery
Plan
Clinical trial activity is discussed at every NSSG meeting and any remedial actions to
improve recruitment are discussed. The list of trials was approved on 14.2.2011.
The Urology NSSG has discussed their Service Delivery Plan priorities during 2010/11 for
advice to the commissioners and the Network Board.
The key service development priorities for the next 3 years are identified in the 2011/14
work programme/service delivery plan including reference to QIPP and the national
cancer patient experience survey. It will include addressing any shortfalls identified in
Peer Review. A roll out of enhanced recovery practices where possible is planned with
SUHFT receiving funding from the network to pursue this.
The Urology CNSs meet separately as a group and are looking at a range of Service
Improvement initiatives including:
Review of intra-network referrals and pathways
3
Patient & Carer
Feedback and
Involvement
Standardised mitomycin instillation protocols
Standardising Patient Information
Standardising Patient Surveys
There are three active Patients/User Members on the ECN Urology NSSG; one from
Colchester and two from Southend. Two chair their respective Cancer Services User
Groups in NE (Colchester) and SE (Southend) Essex; they are also members of the ECN
User Partnership.
All three users feel fully integrated into the NSSG: User Involvement is a standing
agenda item and their views are welcomed and input encouraged.
Users applaud progress made by the SMDT and the NSSG, but they are frustrated by
what they believe to be unnecessary delays in the centralisation of specialist surgical
facilities and the expansion of radiotherapy capacity; both decisions made by the ECN
Board where users were represented.
Some clinicians have been slow to reorganise their diaries to accommodate the NSSG
schedule; so, attendance is spasmodic. Similarly, failure to adopt national datasets
means that audit information is sometimes incomplete.
The Local Urology Support Groups in Colchester and Southend are very active and well
supported; the new group in Chelmsford is gaining momentum.
The results of the national patient experience paper will be discussed at the May 2011
NSSG. Results for ECN trusts are embedded below:
Urology Pt
experience survey.xls
Minimum Data
Sets
The NSSG have yet to formally agree a minimum dataset for all patients discussed in
MDTs. MDT proformas exist across all MDTs and will be evident in respective
Operational Policies identifying the MDS information collected for each patient
discussed.
The NSSG 2010/11 work programme included agreement of MDS for inclusion in
Constitution document; however agreement is still required. The MDS was circulated for
approval on 15.4.2011. It will be signed off formally by the NSSG on 5th May 2011.
4
Appendix 1
Attendance at Urology NSSG 2010/11
Name
North East Essex
John Corr (Chair)
Alan Lamont
Maggie Braithwaite
Lucy Powell
Bruce Sizer
Gerald Rix
David Galvin (from
1.1.11)
Rachael West
Title
ORG
11.5.2010
8.9.2010
6.12.2010
14.2.2011
%
Consultant Urologist
Clinical Oncologist
CNS
CNS
Clinical Oncologist
Consultant Urologist
Consultant Urologist
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
75
0
50
75
25
0
Lead Manager
CHUFT
Y
25
50
Consultant Urologist
Consultant Urologist
Consultant Oncologist
CNS
General Manager
MDT Coordinator
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
75
0
50
50
0
0
Consultant Urologist
Consultant Urologist
SHUFT
SHUFT
75
Consultant Urologist
Consultant Urologist
Consultant Urologist
CNS
CNS
Clinical Oncologist
Medical Oncologist
Clinical Oncologist
SHUFT
SHUFT
SHUFT
SHUFT
SHUFT
SHUFT
SHUFT
SHUFT
75
0
75
25
25
25
0
Consultant Urologist
Consultant Urologist
Consultant Urologist
CNS
Lead Cancer Manager
BTUHFT
BTUHFT
BTUHFT
BTUHFT
BTUHFT
25
75
50
100
25
100
100
100
Mid Essex
Ranjan Thilagarajah
Henry Lewi
Priscilla Leone
Christine Stubbings
Karen Hall
Valerie Ramsay
South Essex - Southend
Tom Carr
Richard Lodge ( chair
from December 2010)
Helen Heggarty
Sampi Metha
Mohantha Doolideniya
Ann Tull
Sarah Barnicoat
David Tsang
Narveed Sarwar
Imtiaz Ahmed
South Essex - Basildon
Peter Ewah
Anil Vohra
Ramachandran Ravi
Petra Orebanwo
Jackie Gibson
User Representation
Roger Bassett
Brian Liversidge
Aubrey Shinn
Cancer Network
Sue Maughn (from
1.6.10)
Carol O’Leary
User Rep
User Rep
User Rep
Network Director
ECN
Nurse Director
ECN
50
25
Entries in Blue are Core Urology MDT members
5
Appendix 2
Activity Overview
Number of cases discussed at the SMDT
Since the 1st April 2010, 995 cases, which include 412 new cases, have been discussed by the SMDT
Radical Resection Numbers
Total number of radical prostatectomies performed by the SMDT (1st April 2010 to 31st March
2011)
Name of surgeon
Mr
Mr
Mr
Mr
Mr
J Corr
H Lewi(retired 15.03.11)
T Carr
M Doolideniya(Commenced 18.10.10)
D Galvin (Commenced 03.01.11)
Number of radical prostatectomies
13
14
19
5
5
Total number of cystectomies performed by the SMDT (1st April 2010 to 31st March 2011)
Name of surgeon
Mr J Corr
Mr H Lewi(retired 15.03.11)
Mr T Carr
Mr M Doolideniya
Miss H Hegerty
Mr D Galvin (Commenced 03.01.11)
Mr R Lodge (stopped this operating in
Aug 2010
Number of cystectomies
17
6
28
2
4
2
7
st
Complex Operations (1 April 2009 to 31st March 2010)
ST
ST
Baus Data – Complex Operations 1 April - 31 March 2011
Southend University
Basildon and
Hospital NHS
Thurrock
Foundation Trust
University NHS
(SUHFT)
Foundation Trust
(BTUHFT)
Nephrectomy
38
21
Colchester
Hospital
University NHS
Foundation Trust
(CHUFT)
35
Mid Essex
Hospital Service
NHS Trust
(MEHT)
46
Cystectomy
41
0
25
0
Radical
Prostatectomy
24
0
32
0
Prostate
Brachytherapy
28
21
5
6
6
7
Essex Rivers
Healthcare NHS
Trust
7
1
30
31
25
32
21
70
24
15
Urological Neoplasm
12
Total Excision of Kidney Total
Total Excision of Kidney
No Urological Neoplasm
2
Partial Excision of Kidney
Total Excision of Kidney Total
Total Excision of Kidney
Partial Excision of Kidney Total
Partial Excision of Kidney
Partial Excision of Kidney Total
Urological Neoplasm
No Urological Neoplasm
Urological Neoplasm
Total Excision of Kidney Total
Total Excision of Kidney
7
7
35
35
Urological Neoplasm
2
No Urological Neoplasm
No Urological Neoplasm
Urological Neoplasm
24
2
No Urological Neoplasm
6
Partial Excision of Kidney Total
Urological Neoplasm Partial Excision of Kidney
No Urological Neoplasm
2009/10
total
8
4
4
4
49
29
20
14
7
21
4
1
Basildon and
Thurrock
University
Hospitals NHS
Foundation Trust
6
1
Trust
200809
total
39
2010/11
April to
November
14
21
39
47
8
3
25
9
12
10
2
31
23
8
34
34
46
30
32
24
6
2
2
31
28
42
3
40
11
1
39
6
5
46
2
7
1
38
32
8
1
Southend
University Hospital
NHS Foundation
Trust
26
12
3
5
Mid Essex Hospital
Services NHS Trust
Please note that complex renal surgery was centralised from 4.2.2011.
Renal data source NCIN.
9
Cancer Wait time data:
Two Week Waits
Total
Seen within
referrals
14 days
seen during
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
Apr-10
62 Day Standard
Total
treated
Treated on
or within 31
days
Total
treated
Total over
target
30
43
40
37
42
47
30
24
28
27
41
29
38
37
34
41
45
28
23
26
26
36
16
15
25
18
18
15
22
19
11
23
20
16
15
25
18
18
15
22
19
11
23
20
11
6
14
8
12
10
10
14
5
8
14
2.5
2
3.5
2.5
2.5
2
2
4
1.5
2.5
4
389
363
202
202
112
29
Two Week Waits
Total
Seen within
referrals
14 days
seen during
the period
COLCHESTER
31 Day First Treatment
60
58
31 Day First Treatment
62 Day Standard
Total
treated
Treated on
or within 31
days
Total
treated
Total over
target
35
33
18
3.5
10
HOSPITALS
UNIVERSITY
FOUNDATION
TRUST
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Total
60
75
46
43
54
47
52
32
52
52
60
68
44
43
48
38
51
31
48
45
27
32
51
31
29
41
27
27
29
34
27
32
50
30
29
41
26
25
27
32
12
11
31
13
11
16
11
13
11
17
3
2
3
1
1
2.5
3.5
2
2.5
2.5
573
534
363
352
164
26.5
Two Week Waits
Total
Seen within
referrals
14 days
seen during
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
63
42
54
55
62
57
57
54
65
67
61
37
51
54
59
56
55
53
61
65
31 Day First Treatment
62 Day Standard
Total
treated
Treated on
or within 31
days
Total
treated
Total over
target
32
25
29
27
23
28
27
18
16
26
30
24
28
26
20
27
26
18
16
26
20
16
20
20
12
16
12
11
12
20
6.5
1
10
8.5
5
8.5
4.5
4.5
0
4.5
11
Feb-11
Mar-11
Total
62
59
29
26
4
4
638
611
280
267
163
57
Two Week Waits
Total
referrals
Seen within
seen during
14 days
the period
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
31 Day First Treatment
62 Day Standard
Total
treated
Treated on
or within 31
days
Total
treated
Total over
target
45
47
57
52
52
51
58
50
57
33
47
42
45
57
51
51
49
56
50
54
32
45
50
31
42
49
35
31
31
40
25
31
30
50
31
42
49
35
30
31
39
25
31
30
13
8
14
11
11
10
10
13
8
6
11
1.5
1
0
1.5
3
2
1
2
1
2.5
3
549
532
395
393
115
18.5
12
13
14
To be held at: The Waterfront Place, Chelmsford, CM2 6LU in
the Horizon Suite
sponsored by:
TIME
TITLE OF PRESENTATION
12.30pm
PRESENTER
Buffet Lunch
1.15pm
Welcome
Mr. John Corr
1.30pm
Patient Pathway Audit on 3 radical Prostatectomy, 3 Renal and 3 Radical
Urology Cases
Ann Tull
2.00pm
2.30pm
Radical Prostatectomy
Audit based on the Informed Decision Making DVD for Prostate cancer: How
do men make their choices.
3.00pm
3.15pm
4.00pm
4.15pm
Mr. John Corr/Mr. Tom Carr
Lucy Powell
Refreshment Break
Strategy Plans at the Cancer Centres
Mr. John Corr/Mr. Tom Carr
Closing Remarks
Mr. John Corr
Close
15
Agreed Actions following the Audit Event
Network wide patient pathway audit is embedded below:
network pathway
audit (2).ppt
Actions agreed:
Action points from
CNS Pathways Audit 2010.doc
Audit based on the Informed Decision Making DVD for Prostate cancer: How do men make their choices?
informed
decision making netwo...
Conclusion•
Most pt’s appeared to use the tool effectively for the purpose it was designed for- i.e
Informed decision making. Therefore continue its use within the network.
Action:
•
Lucy Powell and Ann Tull to publish finding of audit.
NSSG actions will be picked up within the work plan and considered during the review of clinical
guidelines due to take place in April 2011.
CNS actions will be picked up within the CNS group and progress fed back through the standing CNS
agenda item at the NSSG business meetings.
16
Essex Cancer Research Network – Urology Cancer Trials and Recruitment 2010/11
Trial Name and
Short Description
Southend
10/11
BEP-Continuous Infusional Bleomycin - TE3 - A randomised phase III
toxicity study of day 2, 8, 15 short (30 minute) versus day 1, 2, 3 long
(72 hours) infusion bleomycin for patients with IGCCCG good prognosis
germ cell tumours
SORCE - A phase III randomised controlled study comparing sorafenib
with placebo in patients with resected primary renal cell carcinoma at
high or intermediate risk of relapse
LAMB - A phase II/III randomised two are comparison of maintenance
lapatinib versus placebo after first line chemotherapy in patients with
HER1 and/or HER2 overexpressing locally advanced or metastatic
bladder cancer
COSAK - A randomised phase II study evaluating cediranib vs cediranib
and saracatanib in patients with relapsed metastatic clear cell renal
cancer
*NCRN 111 - A Randomized, Double Blind, Phase 3 Trial Comparing
Ipilimumab vs. Placebo Following Radiotherapy in Subjects with
Castration Resistant Prostate Cancer That Have Received Prior
Treatment with Docetaxel
Total
Basildon
10/11
Chelmsford
Colchester
Total
10/11
Total 10/11 Total
1
0
4
0
1
Unable to
support IP
chemotherapy
3
7
1
1
In set up
In set
up
1
1
1
1
In set up
In set
up
In set up
In set
up
Not
open
to
other
sites
2
Not
open
to
other
sites
0
0
Not
open
to
other
sites
RADICALS - Radiotherapy and androgen deprivation in combination
after local surgery
1
7
Ethics
refused
Stampede - Systematic therapy in advancing or metastatic prostate
9
49
0
10
3
2
2
0
9
In set
17
up
cancer: Evaluation of drug therapy
UK Genetic Prostate Study
4
46
6
9
9
65
Non Portfolio Studies
*READY – Commercial. CHUFT
*PANTHER – Commercial. BTUHFT/SUHFT
*Commercial
18
Appendix 5
NSSG Minutes
ESSEX CANCER NETWORK UROLOGY NSSG MEETING
Tuesday 11th May 2010
2.00pm – 4.00pm
Channels Golf Club, CM3 3PT
Essex Barn
Mr. John Corr (Chair)
JC
Consultant Urologist, CHUFT
Mr Tom Carr
TC
Consultant Urologist SUHFT
Aubrey Shinn
AS
User Representative
Brian Liversidge
BL
User Representative
Mr Peter Ewah
PE
Urologist, BTUHFT
Petra Orebanwo
PO
Urology CNS, BTUHFT
Ann Tull
AT
Urology CNS, SUHT
Robin Fussell
RF
Urology MDT Co-ordinator, CHUFT
Lucy Powell
LP
Urology CNS, CHUFT
Roger Bassett
RB
User Representative
Debbie Stokes
DS
Acting Cancer Service Manager, BTUHFT
Mr Ranjan Thilagarajah
RT
Consultant Urologist, MEHT
Anil Vohra
AV
Consultant Urologist, BTUHFT
Maggie Braithwaite
MB
Urology CNS, BTUHFT
Mr Sampi Mehta
SM
Consultant Urologist, SUHT
Mr Peter Ewah
PE
Consultant Urologist, BTUHFT
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1.
Dr Priscilla Leone
PL
Consultant Urologist, MEHT
Ashley Solieri
ASO
Cancer Research Network Manager, ECRN
Apologies
Claire Dixon, Neville Davidson, David Tsang, Richard Lodge, R. Ravi, Belinda Grant, Naveed
Sarwar, Christine Stubbings, Michelle Bath, Teresa Bell, Sally King
2.
Previous Minutes – 8th February 2010
The minutes were agreed as a true record of proceedings
3.
Matters Arising
3.1 IOG Compliant Renal Cancer Arrangements
TC presented the results of renal audit which concluded that the type of operation and site
where it was undertaken had no bearing on the outcome. There followed a discussion on the
Peer Review Report from Mike Bellamy and the meeting with the Peer Review Zonal Leads
held on 4th March. AT questioned the IOG compliance of other Networks and was informed
that Essex was the only Network that was not compliant; some members disputed this. There
was also discussion on the validity of the evidence supporting this measure due to age of the
guidance being used. It was agreed that TC would write to National Cancer Peer Review Team
outlining the audit results with supporting evidence from a larger sample of partials from RT.
The members would also get evidence of other networks non-compliance. RT would also like
a response to what the process is for those patients that are referred to MEHT from outside
the network. RB will provide a letter from the Network User Group supporting the status
quo. AT pointed out that paragraph four on page 6 on the letter should read “at Mid Essex
there were parallel clinics” and not Colchester and that parallel clinics were acceptable. RB
enquired whether the high level of brachytherapy was due to patients not receiving
information on all possible treatment options. AT said they do although it is difficult to
evidence how the clinical “sells” treatment options. TC will draft a response and circulate to
members for comment/additions.
Action:
TC
3.2 ECN Clinical Guidelines/Constitution
JC thanked MB, AT and all those who have contributed for all their hard work completing the
document. AT requested that the clinicians check that the guidelines for OSHC, RAC and TRUS
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biopsy clinics were up to date as they were required for peer review evidence.
ACTION:
All Clinicians
AT outlined the amount of work being undertaken by the CNS’s uploading evidence for peer
review and that some information was being uploaded twice for SMDT and local MDT. The
SMDT information will be uploaded and individual Trusts can select their information. JC has
requested administrative support for peer review at CHUFT. DS commented that there
should be a multidisciplinary approach. It was suggested that the CNS’s discuss this with Carol
O’Leary at their next meeting
3.3 Network-wide Audit – 11th November 2010
AT reported she will be undertaking a Patient Pathway Audit on 3 radical prostatectomy, 3
renal and 3 radical urology cases.
Other agreed topics were:
•
•
•
•
Erectile Dysfunction
BCG in bladder cancer
Audit of the patient information centre at CHUFT
PSA levels after radical prostatectomy – JC
3.4 “Informed Decision making” Localised Prostate Cancer Information
The CNS team confirmed this was happening
3.5 Peer Review Programme 2010
Feedback from 2009 previously discussed in section 3.1 and workload and difficulties in
section 3.2.
AT, MB and JC will be present for the 2010 visit on 11th June 2010.
Other key date to note: 21st May for Self Assessment upload onto CQINS.
4.0
Standing Agenda Items
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Research Trial Activity:
ASO introduced herself and provided the background to the ECRN. A list of current studies
being undertaken across the network and other available portfolio studies was tabled for
discussion. AS outlined that Peer Review required the NSSG to identify a Research Lead
(?Naveed Sarwar) and agree a portfolio of studies and inform the SMDT who would provide a
written response. The SMDT are also required to identify an individual Research Lead. The
NSSG then receive recruitment reports from ASO and discuss remedial action with the SMDT
where required. It was agreed that ASO would circulate the list to the Oncologists requesting
a response as to why they would not be participating in particular studies, then a definitive
list could be agreed at the next meeting.
ACTION:
AS
AT reported that Peer Review had raised the question of why not all sites were participating
in all trials and ASO suggested that ideally patients should be referred to a site in the Network
who were participating in that study. However, an agreed referral pathway for clinical trials
was not yet in place and this will take some time. Financial and resource difficulties were
highlighted and ASO reported that this is a national problem and that a process for submitting
business cases to the commissioners will be developed. ASO stated that the ultimate goal
was that all patients in the ECN have an equal opportunity of participating in a research study
wherever they live in the Network.
User Involvement:
BL reported he had attended user Peer Review training. It was also reported that the ECN
User Group had formally responded to the excessive Peer Review standards required for the
User Group and it was acknowledged that users are unpaid volunteers and could not,
therefore, be subject to any sanctions.
The volume of papers that required printing for these meetings was discussed and it was
agreed that the ECN would circulate hard copies to the User Representatives.
RB reported the User Group work on Patient Information Centres and the progress of this at
SUHFT. The group has been in discussion with MacMillian and is hopeful of some funding and
a business case will be submitted to SUHFT Board. The information centre at CHUFT was
discussed and it was reported that the post of Manager is currently being advertised.
RB also tabled the Patient Information Guide developed by the Partnership Group and
outlined the work to disseminate this to hard to reach groups. The Group commented on
what an excellent document it was.
5.0
New Business
5.1 NSSG Annual Report 2009/10
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Approved
5.2 Work programme 2010/11
AT requested clinical input to completing the work programme
5.3 Proposed Staging Guidelines (D Tsang)
The proposed guidelines were discussed and JC will discuss CT and MRI requirements with
radiography at CHUFT. PL reported that radiology at MEHT would have a resource issue with
reporting. Guidelines to be reviewed again at the next meeting.
5.4 NCIN Clinical Leads Urology Workshop, 2nd July 2010
TC will be attending.
5.5 Mitomycin maintenance for high risk TCC
Following discussion it was agreed that current practice should be audited.
5.6 Active Surveillance and Template Biopsy
This is currently carried out at SUHT, BTUHFT and CHUFT but not MEHT. PL will enquire at
MEHT pathology. It was agreed that as numbers requiring this would be small, there should
not be a resource issue
Any Other Business
A guideline for choice of hormonal treatment in prostate cancer was tabled and it was
highlighted that the guideline recommended the “cheapest” option and individual Trust
choice should be discussed with appropriate PCT.
6.0
Date of next Meeting and for rest of 2010
NSSG – Wednesday 8th September, 2.00pm-4.00pm – Kestrel House Board Room
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Audit – Thursday 11th November, lunch 12.30 followed by audit, Waterfront
NSSG – Monday December 6th, 10.00am-12noon – Kestrel House Board Room
ESSEX CANCER NETWORK UROLOGY NSSG MEETING
Tuesday 8th September 2010
2.00pm – 4.00pm
Kestrel House Board Room
Chelmsford CM2 5PF
John Corr (Chair)
JC
Consultant Urologist, CHUFT
Roger Bassett
RB
User Representative
Aubrey Shinn
AS
User Representative
Brian Liversidge
BL
User Representative
Jackie Gibson
JG
Commissioner NHS Mid Essex
Petra Orebanwo
PO
Urology CNS, BTUHFT
Ann Tull
AT
Urology CNS, SUHFT
Richard Lodge
RL
Consultant Urologist SUHFT
Belinda Grant
BG
GM Cancer Services MEHT
Naveed Sarwar
NS
Consultant Oncologist
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1.
Michael Scanes
MS
User Facilitator ECN
Ranjan Thilagarajah
RT
Consultant Urologist, MEHT
Anil Vohra
AV
Consultant Urologist, BTUHFT
Maggie Braithwaite
MB
Urology CNS, BTUHFT
Sampi Mehta
SM
Consultant Urologist, SUHFT
Sue Maughn
SMn
Interim Director, ECN
Bruce Sizer
BSr
Consultant Oncologist CHUFT
Chris Davidson
CD
Associate Director, CHUFT
Gerald Rix
GR
Consultant Urologist, CHUFT
Christine Stubbings
CS
Urology CNS, MEHT
Sarah Barnicoat
SB
Urology CNS SUHFT
Priscilla Leone
PL
Consultant Urologist MEHT
Ashley Solieri
ASi
Network Manager, ECRN
Apologies
Tom Carr, Michelle Bath, David Tsang, Lesley Peacock, Matt Riddleston. Lucy Powell,
Tracey Camburn.
Previous Minutes – 11th May 2010
2.
The minutes were agreed as a true record of proceedings
3.
Matters Arising
3.1
Peer Review
SMn reported that considering all the hard work that had gone into preparing for the
review, the results were particularly disappointing. For the Network Board measures the
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score was 2/17 (12%), which was the same as the previous year.
There were four Serious Concerns, which require a response within 4 weeks. These were:
1. The Clinical Guidelines were not satisfactory, the needed reviewing and should include
patient pathways. It was suggested that the Lung guidelines should be used as a
template.
2. A three year work plan needed to be developed which included Service Development
and Workforce Development Plans.
3. Renal Surgery is being performed at too many sites and was therefore non compliant.
4. The number of pelvic operations at Southend were below the minimum of 50 and the
service was therefore non compliant.
SMn said that she had produced a report on the Renal and Pelvic Surgical numbers for the
network Board. She then threw it open to discussion, and said that if the NSSG could not
come to an agreement then it would have to be decided by the ECN Board.
The question which needed to be resolved is whether there should be one centre or two,
and where this (these) would be located.
Points from the lengthy discussion:
RT said that he was part of a specialist renal group which was challenging NICE guidelines.
MS said that he had been a member of two NICE Guideline Development Group (MSSC and
Ovarian cancer), and that he had been appointed to the NICE Cancer Topic Selection Panel
and proceeded to explain the procedure involved in challenging a guideline. Firstly the
proposal to look at the Renal Guidelines would go to the Topic selection panel which meets
three times a year, so it could take up to 8 months to be discussed by this panel. If it was
agreed then there would be a stakeholder event organised at which all the issues would be
discussed. The project would then go to the National Collaborating Centre for Cancer who
would recruit to the Guideline Development Group. It would take up to 12 months from
NICE giving the go ahead.
The Guideline Development group would take two years to produce the Guideline. There
would be another nine months of stakeholder consultation before the guidelines would be
published. In other words it could take up to 5 years before the guideline would be
published; in the meantime the Essex Service would be non compliant.
MS added that next year Peer Review results would be used by the Care Quality
Commission to assess Hospital services, so suggested that it was imperative that the
current situation should be resolved.
BS suggested that the group should agree a proposal for one or two centres and then
decide where the centres should be.
RT said the decision should be made by the Network Board
SMn said that the Network Board was establishing an IOG resolution group
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BS said that when the two centre solution had been established after the formation of the
Essex Cancer Network, it was believed that the figure of 50 procedures was “between” the
two centres and not each. MS said that the guidelines state that a team should perform 50
procedures.
While the number of pelvic surgical procedures at Southend was under 50 last year, it was
expected that they would be above 50 this year.
As Brachytherapy becomes more popular then it is inevitable that surgical numbers will
fall.
AT said that patients generally choose to be treated as locally as possible.
She added that while they refer patients to Colchester for laparoscopic surgery, but the
DVD they give to patients that explain all the options to prostate patients is produced by
Addenbrookes and refers to their service, hence some patients opt for treatment in
Cambridge.
BS said that active surveillance should be one of the options offered to patients and asked
if anyone knew the numbers who were offered this option and what the outcomes are for
patients given this option
AT asked how many partial / complex kidney cancer procedures were performed in the
Network each year. The answer was around 50.
It was finally agreed that three proposals be taken to the Essex Cancer Network Board as
follows:
•
•
•
Complex renal surgery is performed at both Cancer Centres by the specialist
Urology teams
Complex renal surgery is performed at one of the cancer centres
Complex renal surgery is performed at another single trust which is designated
as a specialist renal surgery team.
The members of the NSSG agreed to accept the Board decision as final and
binding.
4.
Standing Agenda Items
4.1
Research Trial Activity:
At the previous meeting it was agreed that ASi would circulate a list of open trials to the
Oncologists requesting a response as to why they would not be participating in particular
studies, then a definitive list could be agreed at the next meeting. ASi reported that she
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had not had any responses.
The chair asked if the oncologists would respond as soon as possible.
Action: NS, BSr, DT, ND
It was agreed that NS would be the NSSG Research Lead
4.2
User Involvement:
RB reported that the group in Southend had produced a Business Plan for the proposed
Cancer Information Centre at Southend Hospital which had been submitted to the Trust
Board. A meeting between the Trust and Macmillan had been arranged for later in the
month. The Trust Facilities Manager was currently looking for a suitable area in the
Hospital to locate the unit.
BL said that he was now Chair of the NE Essex User Group, and they were currently trying
to recruit new members. The aim was to recruit at least one patient or carer from each
Tumour site, to ensure that the group was fully representative of all patients in the area.
4.3
CNS Meeting :
AT said that they were concerned about the transfer of scans. Patients are being delayed
because of difficulties in reading scans, and she is concerned who is accountable. JC said
that MEHT IT had an encryption problem.
SMn said that 3/4 Trusts have IEP, but MEHT do not. The Network has agreed to support
implementation at MEHT.
AT requested clarification on which anti LHRH injections they should be using. It had
previously discussed at the NSSG but was advised that the pricing was all wrong. Southend
have agreed to use Zoladex for neo adjuvant prior to radiotherapy and Prostap or
Decapeptyl as the pricing is similar. Dr Ahmed is hoping to introduce Firmagon into
pharmacy which has a role in advanced disease as it does not cause a flare.
AT said that there needs to be one drug sheet for the Network which would ensure equity
across the Network.
Action: BSr, NS et al
5.
New Business
5.1 Circulation List
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JC said that a circulation list has been circulated and asked if it could be updated and
agreed by the next meeting.
5.2 Approval of Minutes
To ensure that the minutes are as accurate as possible it was agreed that they would be
circulated to all attendees as soon as they had been produced with a request of accuracy
corrections to be notified within 14days. If no comments are received within 14 days it will
be assumed that they are correct.
5.6 Any Other Business
AV asked what the period of office is for Chair of the NSSG. SMn said that it was initially
three years with an option for a further two years extension. JC would have been chair for
three years in January 2011. RL proposed that JC be asked to remain as Chair for a further
2 years. It was agreed that the position of Chair would be discussed at the next meeting in
December 2010
6.
Date of next Meeting and for rest of 2010
Audit – Thursday 11th November, lunch 12.30 followed by audit, Waterfront
NSSG – Monday December 6th, 10.00am-12noon – Kestrel House Board Room
ESSEX CANCER NETWORK UROLOGY NSSG MEETING
Monday 6th December 2010
10.00am – 12.00 Noon
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Kestrel House Board Room
Chelmsford CM2 5PF
1.
Martin Nuttall
MN
Consultant Urologist MEHT
Roger Bassett
RB
User Representative
Aubrey Shinn
AS
User Representative
Brian Liversidge
BL
User Representative
R Ravi
RR
Consultant Urologist BTUHFT
Petra Orebanwo
PO
Urology CNS, BTUHFT
Ann Tull
AT
Urology CNS, SUHFT
Richard Lodge
RL
Consultant Urologist SUHFT
Rachael West
RW
Cancer Service Manager CHUFT
Lucy Powell
LP
Urology CNS, CHUFT
Michael Scanes
MS
User Facilitator ECN
Ranjan Thilagarajah
RT
Consultant Urologist, MEHT
Anil Vohra
AV
Consultant Urologist, BTUHFT
Tom Carr
TC
Medical Director, ECN
Sampi Mehta
SM
Consultant Urologist, SUHFT
Sue Maughn
SMn
Interim Director, ECN
Victoria Dawson
VD
SIL ECN
Mohantha Dooldeniya
MD
Consultant Urologist SUHFT
Christine Stubbings
CS
Urology CNS, MEHT
Sarah Barnicoat
SB
Urology CNS SUHFT
Priscilla Leone
PL
Consultant Urologist MEHT
Ashley Solieri
ASi
Network Manager, ECRN
Apologies
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David Tsang, Bruce Sizer, Belinda Grant, Jackie Gibson, Nicola Lacey, Sally Sanger, Maggie
Braithwaite
Previous Minutes – 8th September 2010
2.
AT asked that the following corrections be made to the minutes:
Page 3: Should read: AT reported that previous CNS Audits have shown that patients prefer
to be treated locally, and Southend current practice is to refer Southend and Basildon
patients who want a laparoscopic or robotic radical prostatectomy to Addenbrookes.
Page 4: AT requested clarification and review regarding the use of LHRH analogues. Since
the Network produced guidance on the use of LHRH analogues, she has been approached
continuously be the Drug Company Representatives who feel our guidance is not based on
research, licensing and efficacy, and that the costing indicated is not correct. She has
suggested that the Representatives contact the Network Pharmacist direct as it is not in
the CNS’s remit to make changes to pharmacy issues. If they have dropped their prices in
response to our change in use of their drug they should contact the Network Pharmacist
and not the CNSs. In line with the Network Guidance, Southend had changed its practice
and has been using Zoladex for all neo-adjuvant treatment and Prostap for all other
patients. Decapeptyl could be used instead of Prostap, but as yet it is not in the Hospital
Pharmacy. Dr Ahmed is hoping to introduce Firmagon into the Pharmacy, which has a role
in advanced disease as it does not cause flare. She also suggested that the Network also
look at the use of anti-androgens across the Network.
AT said that there needs to be one drug sheet for the Network which would ensure equity
across the Network.
With these changes, the minutes were agreed as an accurate record of the previous
meeting.
Chair: As JC the Chair had been delayed in returning from holiday, SM agreed to act as
Chair for this meeting.
3.
Matters Arising
3.1
IOG Compliant Renal Cancer Arrangements
SM reported that following the agreement at the previous NSSG, a paper listing 4 options
for Complex Renal Surgery were submitted to the Network Board who decided that Renal
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Surgery could only be performed at the Urology Centre(s). SM had written to the London
Zone Peer Review Team, who had confirmed that complex Renal Surgery must be
performed at the designated Urology Centre(s).
The Commissioners have agreed that they will only commission Renal Surgery from the
two designated centres from 1st January 2011.
RL suggested that a small group of clinicians should meet away from the NSSG to plan the
implementation of this decision. RL, RT, JC and AV agreed to form this group. In addition
there would be a Network Representative who would facilitate the meetings, the first of
which would take place in early January 2011. RR suggested that this group should also
look at the possibility of having just one renal Surgery Centre in Essex if this was likely to be
recommended in the future.
It was agreed that for practical reasons the implementation date for the service should be
1st April 2011, and that the Commissioners should be advised of this decision.
Action: Network
TC suggested that the Guidelines in the Constitution needed to be amended, and asked
whose responsibility this should be. MS said that it should be the responsibility of the
NSSG/SMDT Lead clinicians to amend the Clinical Guidelines as appropriate. It was agreed
that the Sub-group would discuss the revision of the Guidelines.
3.2
Peer Review
SM reported that the London Zone Peer Review Team were visiting the Network on
Tuesday 7th December 2010 to discuss the results of the 2010 Self Assessments/Internal
Validation exercises and discuss the Peer Review visits for 2011.
LP said that the preparation for Peer Review was left to the CNSs, and they were
disappointed when they received a very poor Peer Review report.
MS said that the responsibility for the Peer Review documentation lies with the Chairs of
the SMDT, MDT and NSSG. Revisions to Clinical Guidelines must be undertaken by a
designated Clinician.
TC asked who the Lead Clinicians are:Southend: Richard Lodge
Basildon : TBA
Broomfield: Henry Lewi
Colchester: John Corr
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NSSG: John Corr
As Henry Lewi found it difficult to attend the NSSG meetings, RL questioned whether he
could be the Broomfield Lead Clinician as he was not attending the requisite number of
NSSG meeting. Mid Essex agreed to decide who would be the Lead Clinician in future.
MS said that there were changes planned for Peer Review in the future following a request
from Mike Richards to reduce the burden of Peer Review by 40%. This will mean a
reduction in number of visits, changes to the Internal Validation process and revision of
some measures. However it was almost certain that the Urology Teams would be visited
again in 2011.
RW said that the Measures would not change next year.
After a lengthy discussion it was agreed to establish a small working group to look at the
Peer Review measures and prepare for the probably visit in 2011.
SM said that she would send out possible dates for a meeting and a request for volunteers.
The first meeting would be planned for early 2011. Each team should nominate someone
to attend the meeting.
4.
Standing Agenda Items
4.1
Research Trial Activity
AS circulated the current list of research studies with the 10/11 recruitment. Also
circulated was a summary sheet that AS would forward to the MDT and request a
response. The need for Remedial Action Plans for poorly recruiting MDTs could then be
discussed by the NSSG. This would ensure compliance with the Peer Review Research
Measures. The MDTs will also need to nominate a Research Lead. AS had circulated the
current trial list to the oncologists to request reasons why not all sites were participating
(as requested by Peer Review) but had not yet received a response. AS to follow up.
*Post meeting update: Responses had been received from Southend and Broomfield
incorporated onto the recruitment report attached.
LP questioned the numbers reported for Genetic Trials as she said that she referred larger
numbers than were reported. AS said that not all patients who are referred for the Trials
are actually recruited. AS added that she takes the Essex numbers from Nationally reported
data and backed up by Trust Data managers.
4.2
User Involvement
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RB said that the Southend Group had supported the building of a Patient Information
Centre at the Hospital. The Centre would be funded by Macmillan who would also pay for
the services of an Information Manager for three years. A suitable location had been found
in the Hospital. The steering group were currently preparing and Operation Policy and
hoped to meet before Christmas to finalise.
In addition the group were assisting the Network Partnership in recruiting patient/ carer
representatives to NSSGs. He added that they had recruited two new members to the
group.
BL said that the Colchester Group were trying to recruit members from each tumour site
and had been relatively successful so far and were also looking to help recruit to NSSGs.
The Macmillan Patient Information Centre was now operational at Essex County Hospital
and the Information Manager would be reporting to the Colchester user group next week.
The group were also working on an update of the Patient information Directory, but this
was proving a long drawn out exercise.
4.3
CNS Update
The CNSs have combined the Patient Information Leaflets from Colchester and Southend
which explain the reasons for referral to the Centre. There is now one Essex Cancer
Network Leaflet.
The CNSs would be carrying out a joint Network Audit in 2011, which would be managed
by the Colchester Audit Department.
The method of communication of a diagnosis to the patient’s GP was being updated and
will be fully operational by 1st April 2011. This would then be audited in line with the Peer
Review Measure
5.
New Business
5.1 NSSG Chair
SM said that John Corr’s term as Chair of the NSSG ends in January 2011. She added that
all Core Members of the NSSG could be nominated or nominate themselves for the role.
RL said that JC could extend his tenure by 2 years but all thought that it would be good to
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have an election.
TC said that the Chair did not need to be a Clinician. MS said that there is actually a Service
User Chair of a NSSG in another Cancer Network.
AV said he understood that the Constitution stated that the Chair should alternate
between a Centre and a Unit. RL said that this was never the case.
SM will circulate the list of NSSG Core members and asked that any changes should be sent
to her by return. An e-mail requesting nominations will go out on Monday 13th December
with a JD of the NSSG chair role.
Action: All nominations should be sent to SM by 23rd December
2010.
5.2 Gold Seed Insertion for Prostate IGRT
It was suggested that all service developments/new or innovative practices be discussed at
the NSSG to ensure that they are clinically appropriate and evidence based.
ACTION:
SM to draft a template.
5.3 Robotic Urology Surgery in Essex
RT said that Robotic Surgery for Prostate and Renal Cancer was not approved by NICE.
However, patients in Essex were routinely being offered robotic surgery at Addenbrookes
as an option, with about 40 per year taking up the option. As patients were asking for this
procedure, RT suggested that the Network should discuss the provision of this service at
one Centre before a Trust commits to purchasing a robot. He added that MEHT were using
their robot for other procedures.
RL suggested that the Renal Surgery Implementation Group should look at whether a robot
should be sited in Essex
5.4 At what stage should patients be added to the SMDT?
AT said that there had been a discussion at an SMDT regarding when patients should be
discussed at the SMDT, with some suggesting that patients need only be discussed once
after staging. It was agreed that this should be discussed at the NSSG.
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The current Operational Policy states that SMDT discussion should take place on receipt of
Histology and ideally before the patients are seen in clinic. The patient should then be
discussed again after staging is complete.
The NSSG agreed that all patients with a positive Histology will be referred to the SMDT, in
line with this policy. AT added that it should be made clear that the second discussion is
for review of staging, which means that there is no need to discuss the patient in full as the
previous SMDT outcome should already be on the proforma.
RL added that the Operational Policy was fine and that it was some practices which need
to change.
5.5 Any Other Business
•
•
•
•
6.
TC said that there should be a small group of clinicians to look at the NSSG Strategy
for the next 3 years, including Service Improvement and Workforce Development.
The group could also be responsible for updating the Clinical Guidelines when
necessary. It was agreed that the group looking at the Implementation of Renal
Surgery would take on this role. AV suggested that the group could look at the
possibility of establishing one centre in Essex if this was likely to be required by IOG
in the future.
RL said that the Peer Review Team had expressed concern that the numbers of
procedures at Southend were under the required level of 50 per annum. He added
that they had revised their procedures and changed theatre times, with the result
that they had performed 42 procedures to date and would meet the 50 by the end
of March 2011.
HIFU: AT/LP asked whether they should be offering HIFU routinely to all patients.
Currently it is offered to patients when radiotherapy has failed and for metastatic
disease. They added that there needed to be clarification of the policy. RL suggested
that this be added to the work of the Clinical Group.
Audit: TC said that there had been a poor attendance by Clinicians at the recent
Audit meeting. He said that this meeting was an opportunity to discuss issues and
hoped that there would be a better attendance in 2011.
Date of next Meeting and for rest of 2011
NSSG
Monday 14th February 2011
Middle and Annexe Swift House: 2pm -4pm
Wednesday 11th May 2011
Middle and Annexe Swift House: 2pm -4pm
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Tuesday 13th September 2011 Board Room Kestrel House: 2pm – 4pm
Monday 5th December 2011
Middle and Annexe Swift House: 2pm -4pm
AUDIT
Thursday 10th November 2011 12.30pm – 5pm (Venue to be advised)
ESSEX CANCER NETWORK UROLOGY NSSG MEETING
th
Monday 14 February 2011
14.00 – 16.00 hrs
Kestrel House Board Room
Chelmsford CM2 5PF
Lisa Want
LW
Service Manager BTUHFT
Roger Bassett
RB
User Representative
Aubrey Shinn
AS
User Representative
Brian Liversidge
BL
User Representative
R Ravi
RR
Consultant Urologist BTUHFT
Petra Orebanwo
PO
Urology CNS, BTUHFT
Theresa Bell
TB
Divisional Manager MEHT
Richard Lodge (Chair)
RL
Consultant Urologist SUHFT
Rachael West
RW
Cancer Service Manager CHUFT
Lucy Powell
LP
Urology CNS, CHUFT
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1.
Michael Scanes
MS
User Facilitator ECN
Ranjan Thilagarajah
RT
Consultant Urologist, MEHT
Anil Vohra
AV
Consultant Urologist, BTUHFT
Tom Carr
TC
Medical Director, ECN
Carol O’Leary
CO
Nurse Director, ECN
Sue Maughn
SM
Interim Director, ECN
Maggie Braithwaite
MB
Urology CNS, CHUFT
John Corr
JC
Consultant Urologist, CHUFT
Christine Stubbings
CS
Urology CNS, MEHT
David Tsang
DT
Consultant Oncologist, SUHFT
Belinda Grant
BG
GM Cancer Services, MEHT
Ashley Solieri
AS
Network Manager, ECRN
David Galvin
DG
Consultant Urologist, CHUFT
V. Ramsey
VR
MDT Co-ordinator, MEHT
Apologies
Bruce Sizer, Matt Riddleston, Sampi Mehta, MD Dooldeniya, Nicola Lacey, Gerald Rix, Priscilla Leone,
Naveed Sawar,
th
Previous Minutes – 6 December 2010.
2.
Minutes were agreed as an accurate record of the meeting.
3.
Matters Arising
3.1
IOG Compliant Renal Cancer Arrangements
A sub group has agreed the arrangements for all renal surgery across Essex. It will only take place at
st
either of the two centres (Colchester and Southend). The arrangement will take place from 1
st
st
February 2011. RT said that it was 1 February for discussion at MDT, but 1 March for procedures.
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These arrangements will be presented to the next ECN Board meeting for approval.
3.2
Peer Review
Visit Schedule:
th
Contrary to earlier indications, the Peer Review Team will be visiting the SMDT and Network on 8
th
and 16 June respectively. The group needs to prepare and agree a Work Programme for the next
three years before the visit. The Constitution needs to be updated if necessary and an Annual
Report for 2010-2011 needs to be produced.
Work Programme:
SM circulated the draft Work Programme 2011/14. The following items were highlighted:
Enhanced Recovery:- CHUFT and SUHFT are currently developing enhanced recovery for urology
patients. The progress will be audited in 2012/13.
Follow up protocols:- It was agreed to set up a sub group to develop protocols. SM will email a
request for volunteers for this group. It is proposed to run a pilot of new methods and then roll out
across the Network
Action:
SM
Rapid access: RT to email procedure to SM for distribution.
Action: RT
Peer Review:- A sub group is meeting to address all the issues raised by the last Peer Review to
ensure a better result this year.
Guidelines:- SM will circulate the document for comments. Sub groups will be established to
write/amend the guidelines and a day will be set aside to pull all comments and amendments
together.
th
If anyone has anything to add to the Work Programme they should email SM by 7 March 2011.
This will then be forwarded on to the network board for approval. BL suggested that there should be
an Action Plan based on the results of the National Patient Satisfaction Survey.
3.3
NSSG Chair: Agreed at previous meeting
3.4
Service Development
SM has produced a Service Development Template for members to bring any ideas to this group.
The Template was agreed and any issues for inclusion should be brought to the next meeting.
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The Template will be circulated with the minutes
Action:
3.5
MS
Gold seed insertion for Prostate IGRT
Pricilla Leone to complete a Service Development Template and submit to the next meeting.
Action:
3.6
PL
Robotic Surgery in Essex
SM said that the Service Development would have to be discussed by the NSSG and if it was agreed,
the Network Board would have to ask one of the Centres to bid for the service. RL said that robotic
surgery was mentioned in the “Strategy for Cancer” Document.
4.
Audit Topics for 2011
•
•
•
•
5.
Patient Survey of access to treatment modalities for localised prostate cancer
Access to radical treatments in 2010/11
CNSs in BTUHFT and MEHT to survey the patient satisfaction of patients visiting the centres.
BL suggested we add an audit of radiotherapy. DT agreed.
AOS – Rapid Access Clinics
All Trusts with an A&E department will be required to channel cancer patients 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.
SUHFT: Currently no defined service: If A&E suspect cancer they fax to GP to
suggest an early referral.
CHUFT: If A&E suspect cancer they refer to the appropriate MDT
BTUHFT: It was thought that A&E may refer to MDT but not sure.
MEHT
RT said that there was a system in place for A&E to refer to the
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appropriate clinician.
SM said that the group need to add Generic AOS pathway into the Clinical Guidelines. Each Trust
lead should bring their pathway to the next meeting for discussion, and development of Network
Pathway.
6.
Standing Agenda Items
6.1
Research Trial Activity
The previously circulated list of approved studies and reasons why the studies were not open at
each site was agreed. AS informed the Group that Peer Review requires the Chair to inform the
MDTs of the list and they would need to formally acknowledge it. Remedial Action Plans could then
be agreed between the MDT and NSSG where recruitment was poor.
ACTION: AS/RL
RT requested details about the approval process and it was agreed that new studies should be
brought to the NSSG for their approval. AS re-iterated that individual Trust R&D approval would
also be required for each study.
Post meeting note – It has been suggested that a small e-mail group be convened to enable NSSG
approval of studies to prevent any delays.
6.2
User Involvement
RB reported that the Network had organised a Team Building day for patients, carers and
professionals from across the Network. The day was well attended and was found very useful by
those who did attend.
th
RB added that Macmillan surveyors were visiting Southend Hospital on 28 February to finalise the
design of the Patient Information Centre. A Macmillan Information Space at Basildon was due to be
installed shortly.
BL said that the revisions of the NE Essex Patient Information Directory were complete and were
now with the designer for preparation for printing.
nd
The Urology CNSs were holding a Men’s Health evening on 2 March 2011 at Essex County Hospital.
The NE Essex group now have three representatives on NSSG’s
6.3
CNS Update
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The CNSs from the 4 Trusts continue to meet on a regular basis. Other CNS issues are covered
elsewhere in the minutes
7.
Any Other Business
7.1
Teenage and Young Adults:
MS said that there were new Peer Review Measures for TYA currently out for comment.
They require that, for 16-18 year olds, ALL cases must be discussed and treated by the Primary
Treatment Centre, which for Essex is UCLH.
19-24 year olds have the choice of where they are treated, but must be reported to the PTC.
MS said that the Network would write a section describing the Pathways for TYA for inclusion in the
Urology Guidelines.
RL asked about orchidectomy, which is performed locally as part of the diagnostic procedure for
Testicular cancers. CO said that she was attending a meeting at UCLH to discuss these measures and
would ask the question.
Action:
7.2
MS/CO
Referrals from Outside the Network
RT asked if patients were referred to him from a hospital outside the network (eg Lister in
Stevenage) was it acceptable for him to treat the patient in MEHT. SM relied that Patients can only
be treated in IOG compliant Centres, which MEHT was not.
8.
Date of next Meeting and for rest of 2011
NSSG
th
Wednesday 11 May 2011
th
Tuesday 13 September 2011
th
Monday 5 December 2011
Middle and Annexe Swift House:
2pm -4pm
Board Room Kestrel House: 2pm – 4pm
Middle and Annexe Swift House: 2pm -4pm
AUDIT
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th
Thursday 10 November 2011
12.30pm – 5pm (Venue to be advised)
Appendix 6
Annual Review NSSG Chairman Essex Cancer Network
Name
Richard Lodge
NSSG Site
Urology
Date
25.3.11
Structure
Length in post: Jan 2011
To continue: Yes
Deputy:
Discussed at NSSG and decided against will be revisited as needs to be cover for absences –
an oncologist would be ideal to balance out any surgical bias.
Attendance, engagement and organisational issues:
Adequate/quorate attendance
Engagement is improving with sub group meetings for both Peer review Prep and clinical guidelines group.
Audit and business meetings:
Yes: Audit and SMDT business meeting LMDT business meeting with SUHT and BTUH needs arrangingStrengths:
Good engagement now. Good progress with pathways. Resolution of complex renal pathway. Mechanism
for service developments approved.
Weaknesses:
Residual issue re structure and organisation e.g. tail end of renal controversy
Data collection. MDS to be agreed as part of Peer review prep work. Somerset needs to be implemented
Documentation
Constitution: yes to be reviewed at clinical guidelines sub group in April 2011.
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Work plan + Strategic plan:
RNL + SM largely done, out for comment and approval.
Annual report in draft; to circulate in April for May sign off.
Peer review outcomes and concerns
Renal resolved
Documentation deficits being addressed
Pelvic surgery numbers at Southend now >60 resolved
Data and audit
Data collection Somerset in place not fully implemented good clinical support the issue is administrative
•
•
•
IOG
Commissioners
Service development
Audit Network wide and commissioning questions
Clinical ownership and engagement
Good
Self sufficiency + agenda ownership
Improving e.g. definitive lead clinicians for BTUH and MEHT was a little vague and ad hoc. Continued need
for management support from the centre limited self sufficiency is possible but likely to need some support.
Personal development needs and plans
Nil identified
Signed 25.3.2011
Mr T W Carr
Medical Director ECN
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