A Good Practice Guide - NHS England

1 Page 0 of 68 DELIVERING CANCER WAITING TIMES A Good Practice Guide Page 1 of 68 TABLE OF CONTENTS Introduction _____ 5 Overview _____ 5 How the Guide works and its intended audience _____ 5 Key to the Guide _____ 6 Understanding principles and rules _____ 7 Individual patient rights under the NHS Constitution _____ 7 NHS assessment of performance the provider standards _____ 7 nhs foundation Trusts _____ 8 National guidance _____ 8 Rules and definitions _____ 8 1. Managing capacity and demand _____ 9 Overview _____ 9 Guiding principles _____ 9 Dos and don ts _____ 10 Information requirements _____ 12 Role of demand and capacity in supporting cancer care delivery _____ 14 Getting help _____ 14 2. Governance reporting and performance management _____ 17 Overview _____ 17 Cancer leadership structures _____ 17 Communicating cancer across the organisation _____ 19 Attributing accountability and responsibility for cancer waiting times within the organisation _____ 19 Staff code of conduct _____ 20 Processes to build trust around cancer data quality _____ 20 Conflicts of interest _____ 21 Board assurance _____ 21 Board training _____ 21 Reports to the board _____ 21 Training _____ 22 Page 2 of 68 3.

2 Core functions _____ 23 Patient tracking _____ 23 Pathways _____ 23 Staff roles _____ 24 MDT coordinator _____ 25 Two week wait office _____ 25 Specialty manager/support service manager ( endoscopy, imaging) _____ 26 Cancer manager _____ 26 4. Reporting _____ 27 Tracking list _____ 27 MDT meeting _____ 27 Cancer PTL_____ 28 Tracking systems _____ 28 Breach analysis and reporting _____ 30 Data quality checks _____ 32 5. Processes and meetings _____ 32 trust PTL meeting _____ 32 Pre-PTL meeting/specialty meeting _____ 33 Access policy _____ 34 6. Operational delivery _____ 35 Pathways capable of delivering shorter waits _____ 35 Managing patients along their cancer pathway _____ 35 Pre-referral _____ 35 Right to obtain treatment within the maximum waiting time _____ 36 Centralised administrative teams _____ 36 Referral receipt _____ 36 Scheduling appointments _____ 37 Straight to test (STT) pathways _____ 37 One stop clinics _____ 38 Booking appointments _____ 38 Clinic templates_____ 39 Page 3 of 68 Overbooking _____ 39 Did not attends (DNAs) _____ 39 Pathway adjustment for DNAs to first attendance _____ 40 Pathway adjustment for admitted pathway _____ 40 Cancellations (by patient) _____ 41 Subsequent cancellations (by patient) _____ 42 Cancellations (by hospital) _____ 42 Transfer of patients between provider organisations _____ 42 7.

3 Diagnostics _____ 45 Useful resources: _____ 45 Paper referrals_____ 45 Advantages of electronic referrals _____ 45 Registration of referrals _____ 46 Pre-registration checks - the minimum dataset _____ 46 Vetting of referrals _____ 46 Electronic vetting of referrals _____ 47 Scanning protocols _____ 47 Booking of appointment _____ 47 Confirming appointments _____ 48 Patient preparation _____ 48 Scanner utilisation and scheduling _____ 48 Reporting _____ 49 Reporting performance monitoring _____ 49 Management of DNAs _____ 50 Unexpected findings _____ 50 8. Scheduling, pausing, booking, theatres _____ 51 9. Acknowledgements _____ 59 10. Revisions process _____ 60 11. Contact information _____ 60 APPENDIX 1: Website addresses _____ 62 Page 4 of 68 NHS improving quality challenges and improvements in diagnostic aervices across aeven _____ 63 NHS Managers Code of Conduct 2002 _____ 63 Royal College of Radiologists Standards and Recommendations for the Reporting and Interpreting of Imaging Investigations by Non Radiologists Medically Qualified Practitioners and Teleradiologists: _____ 63 APPENDIX 2 _____ 64 Cancer care access policy development guidelines.

4 _____ 64 Sign off _____ 64 Choose & book (C&B) _____ 64 Access standards _____ 64 Definitions _____ 65 Referral pathways _____ 65 Cancer referrals _____ 66 Patient information _____ 66 DNAs and cancellations _____ 66 Training and role clarity _____ 66 Reporting suites _____ 67 Page 5 of 68 INTRODUCTION Ove r vi ew Achievement of the national cancer waiting times (CWT) standards is considered by patients and the public to be an indicator of the quality of cancer diagnosis, treatment and care NHS organisations deliver. Delivering timely cancer pathways is crucial for the following reasons: Despite improving survival rates, cancer is the fourth leading cause of death in the UK; Patients continue to present late to their GP with their symptoms, resulting in delayed referral; There is variation in 2 week wait (2WW) referrals across the country suggesting that GPs are not always identifying suspicious symptoms; Once a patient has been referred, they want to be told It s not cancer as soon as possible or have their treatment planned in a timely manner; Where the diagnosis is cancer, a speedy diagnostic pathway is critical for 62 day compliance.

5 Despite consistent achievement of the cancer standards at a national level, it is recognised that many organisations either struggle to maintain compliant performance on a consistent basis or achieve below-standard performance. NIGEL COOMBER DIRECTOR, ELECTIVE CARE INTENSIVE SUPPORT TEAM APRIL 2014 H o w t h e gu i d e wo r ks a n d i t s inte n d e d audience The Guide is designed to walk you through the essential elements of a pathway for suspected cancer; from pre-referral advice and outpatients, all the way through diagnostics to patient admissions. The Guide also covers a number of key areas which support the operational delivery of a good pathway for elective cancer, including demand and capacity planning, cancer access policies, governance (performance management and reporting). The Guide is a collection of the advice and expertise from the NHS IMAS Elective Care Intensive Support Team (IST), which has been built up over the years through supporting various NHS organisations across the country delivering high quality pathways for patients and sustaining low waiting times for treatment.

6 Delivering Cancer Waiting Times A Good Practice Guide is an accompanying Guide to the NHS IMAS IST Elective Care Guide . The intended audience for this document is primarily NHS staff who are involved in any aspect of pathway management for suspected cancer and who want to understand how best to manage or deliver these pathways. This will include staff within acute trusts, nhs foundation Trusts, Area Teams (ATs) and Clinical Commissioning Groups (CCGs). Page 6 of 68 KEY TO THE Guide INDICATES WEBSITE LINK PROVIDING RESOURCE NAME AND LINK INDICATES GOOD Practice SUGGESTIONS INDICATES PITFALLS AND CAUTIONS EMAIL CONTACT DETAILS Page 7 of 68 Un d e rsta n d i n g pr i n c i p l e s a n d rules The NHS has set maximum waiting time standards for access to healthcare. In England , waiting time standards for cancer care come under two headings: the individual patient right (as per the NHS Constitution); the standards by which, individual providers and commissioners are held accountable by the Department of Health for delivering (as per the NHS Operating and NHS Performance Frameworks) In d i vi d u a l pat i e nt r i ght s u n d e r t h e NH S C o n st i t u t i o n For English patients (from an individual patient perspective) the current maximum waiting times for cancer care are set out in the NHS Constitution and the handbook to the NHS Constitution.

7 This can be found at: NHS CONSTITUTION HANDBOOK TO THE NHS CONSTITUTION 2013 The NHS Constitution sets out the following rights for patients with suspected cancer: to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible; to be seen by a cancer specialist within a maximum of two weeks from GP referral for urgent referrals where cancer is suspected. The handbook also lists the specific circumstances where the right will cease to apply and those services which are not covered by the right. NH S asses s me nt o f pe r fo r ma n c e t h e pro vi d e r sta n d a rd s In addition to the individual patient rights as set out in the NHS Constitution (and its supporting handbook) there is a set of waiting time performance measures for which the NHS is held to account for delivering by NHS England .

8 There are a number of government pledges on waiting times, including: a maximum one month (31-day) wait from the date a decision to treat (DTT) is made to the first definitive treatment for all cancers; a maximum 31-day wait for subsequent treatment where the treatment is surgery; a maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy; Page 8 of 68 a maximum 31-day wait for subsequent treatment where the treatment is an anti-cancer drug regimen; a maximum two month (62-day) wait from urgent referral for suspected cancer to the first definitive treatment for all cancers; a maximum 62-day wait from referral from an NHS cancer screening service to the first definitive treatment for cancer; a maximum 62-day wait for the first definitive treatment following a consultant s decision to upgrade the priority of the patient (all cancers); a maximum two-week wait to see a specialist for all patients referred with suspected cancer symptoms a maximum two-week wait to see a specialist for all patients referred for investigation of breast symptoms, even if cancer is not initially suspected.

9 These measures are set out in the current NHS England document: Everyone Counts: Planning for Patients 2013/14. EVERYONE COUNTS: PLANNING FOR PATIENTS 2013/14 NH S Fo u n d at i o n Tr u st s nhs foundation Trusts are held accountable through Monitor via the nhs foundation trust (NHSFT) Compliance Framework. nhs foundation trust COMPLIANCE FRAMEWORK Nat i o n a l guidance Rules and definitions In order to ensure that reported performance is consistent and comparable across providers, the measurement and reporting of waiting times is subject to a set of rules and definitions. For cancer services the guidance on cancer waiting times can be found at: GOING FURTHER ON CANCER WAITS STANDARDS It is important that there is a consistent approach to the interpretation and implementation of national guidance across NHS organisations. In some circumstances it is for the NHS locally to decide how these guidelines are applied to individual patients, pathways and specialties.

10 It is Page 9 of 68 important that decisions should be based on clinical judgment and in consultation with other NHS staff, commissioners and, of course, patients. The guidance is designed to ensure that reported waiting times are a true reflection of patients experiences. 1. MANAGING CAPACITY AND DEMAND Ove r vi ew This section of the cancer Guide will explore good Practice principles in relation to modelling demand and capacity for cancer services. The following areas will be explored: the various outputs that services should look to gain from demand and capacity modelling; good Practice approach and things to avoid when undertaking the modelling; mechanisms to build confidence and assurance around waiting times performance sustainability Gu i d i n g pr i n c i p l e s The successful delivery of any maximum waiting time standard ( two week waits) is predicated on the following factors: patient pathways are capable of delivering a short wait, and clearly describe what should happen, in what order and when; a balanced position between demand and capacity; a maximum number of patients waiting that is consistent with the level of demand and key pathway milestones , maximum time from referral for suspected cancer to the first outpatient appointment; patients are treated in order by clinical priority.