National Peer Review Report: Chemotherapy Services Report 2012/2013

Transcription

1 National Peer Review Programme National Peer Review Report: Chemotherapy Services Report 2012/2013

2 Clinical Chemotherapy Services MDT Overall Performance All 160 services reviewed against the 42 measures were on the internal validation cycle. 110 services were selected for a cancer peer review visit in 2012/2013. The table below shows the outcomes against the measures for the 160 services reviewed in 2011/2012: Compliance SA IV PR 100% % % % % % % % Median 81% Range % Interquartile Range 71-88% 100% Overall Compliance Ranges Clinical Chemo (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Clinical Chemo Clinical Chemo Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 2

3 Immediate Risks and Serious Concerns with IRs (SA) with IRs (IV/EV) with IRs (PR) Total with IRs Percentage of with IRs (SA) (IV/EV) (PR) Total No of Percentage of % % The main focus of these were: There is a national problem regarding the lack of chemotherapy teams who are still not set up with an E Prescribing system even though this is a mandatory requirement. The facilities for storage and preparation of chemotherapy are inadequate. There have been several issues regarding lack of an appropriate space to prepare chemotherapy drugs; cytoxic drugs are delivered in a transport bag without any lock which is kept in a freely accessible office and drugs are not kept in lockable refrigerators. It has been documented that there is a lack of clear labelling of the cupboards and fridges designated for the storage of chemotherapy drugs. Rooms that are designated for intrathecal chemotherapy do not have spillage kits or emergency call buttons. Refrigerated drugs are not being appropriately refrigerated and instead are being left in room temperature. This may affect the stability of the drugs. Lack of access to 24hr chemotherapy advice line, this means that patients experiencing complications/side effects of chemotherapy treatment only have access to the 111 and A&E services. One trust does have an out of hours 24 hour advice line, but the first point of call is a junior doctor. This is a concern regarding the level of knowledge and expertise. Haematology day unit not fit for purpose particularly in relation to the dignity and respect of the patients. There is a delay with regards to Chemotherapy being administered due to lack of beds. The use of an electronic prescribing system for two regimens have been developed in house and there has been no evidence to suggest it has been validated against the treatment protocols, no auditable record to identify who generated, checked or was responsible for any changes made to prescription and no hand written or electronic signature on the prescription. Robust processes are not in place for accessing the competencies of either pharmacist verifying prescription or medical staff prescribing chemotherapy. Lead clinician who is on the register as the named personnel who has been trained and certified to be competent to participate in ITC tasks has reported that they had not delivered ITC in the past year, this brings in to question how the competency can be achieved due to the time delays, it has also been reported that there is a lack of formalised medical training regarding prescribing chemotherapy. Logistics of getting the resuscitation trolley to a patient on either the oncology unit or haematology unit is impractical and could have a serious consequence for patient safety. Nursing and pharmacy staff are working over and above what is considered acceptable and of safe levels, there are reports of lack of core team members including medical oncologists, band 7 nurses and the different skill sets of nurses which is insufficient at of times of emergencies or when unexpected or insignificant events take place, workload of CNS s continues to be an issue nationwide. Other immediate risks and serious concerns related to: Incorrect versions of the neutropenic sepsis policy. Safe patient identification processes are not being adhered to. No clear robust mechanisms for managing and reviewing near misses and reporting errors to local meetings and network groups, this results in missed opportunities regarding shared learning and practices. 3

4 Measures with below 50% compliance: Measure Number and Short Title IV (14 teams) 11-3S The Chemotherapy Dataset 46% 11-3S Computer Generated Prescriptions 36% 11-3S Local Configuration of the Electronic Prescribing System 21% 11-3S Consideration of Suggested Variations to the Use of the Electronic Prescribing System 11-3S Validation of the Incorporation of Individual Regimens Onto the Electronic Prescribing System 29% 29% Measure Number and Short Title PR (110 teams) 11-3S Agreed List of Treatment Algorithms 42% 11-3S The Chemotherapy Dataset 44% 11-3S Chemotherapy Capacity and Scenario Planning 41% 11-3S Computer Generated Prescriptions 25% 11-3S Local Configuration of the Electronic Prescribing System 17% 11-3S Consideration of Suggested Variations to the Use of the Electronic Prescribing System 11-3S Validation of the Incorporation of Individual Regimens Onto the Electronic Prescribing System 29% 31% 4

5 Oncology Pharmacy Services Overall Performance Of the 155 services reviewed against the 7 measures 103 were on the self-assessment cycle, 10 were on the internal validation cycle and 42 were subject to a full peer review visit. 100% Overall Compliance Ranges Oncology Pharmacy (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oncology Pharmacy Oncology Pharmacy Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 2 services were selected for a cancer peer review visit in 2013/2014. The table below shows the outcomes against the measures for the 155 services reviewed in 2012/2013; Compliance SA IV PR 100% % % % % % % % Median 100% Range % Interquartile Range % 5

6 Immediate Risks and Serious Concerns with IRs (SA) with IRs (IV/EV) with IRs (PR) Total with IRs Percentage of with IRs (SA) (IV/EV) (PR) Total No of Percentage of % % The main focus of these were: Lack of inadequate labelling and bagging of vinka alkaloids does not differentiate these preparations from other intravenous infusions. Lead clinician who is on the register as the named personnel who has been trained and certified to be competent to participate in ITC tasks has reported that they had not delivered ITC in the past year, it has also been reported that there is a lack of formalised medical training regarding prescribing chemotherapy. The facilities for storage and preparation of chemotherapy are inadequate. There have been several issues regarding lack of an appropriate space to prepare chemotherapy drugs; cytoxic drugs are delivered in a transport bag without any lock which is kept in a freely accessible office and drugs are not kept in lockable refrigerators. It has been documented that there is a lack of clear labelling of the cupboards and fridges designated for the storage of chemotherapy drugs. Other immediate risks and serious concerns related to: Nursing and pharmacy staff are working over and above what is considered acceptable and of safe levels. There is a national problem regarding the lack of chemotherapy teams who are still not set up with an E Prescribing system even though this is a mandatory requirement. No out of hour s telephone advice. Measures with less than 50% compliance: None of the 7 measures for Oncology Pharmacy were under 50% compliance. 6

7 Chemotherapy Intrathecal Overall Performance Of the 157 services reviewed against the 22 measures 106 were on the self-assessment cycle, 9 were on the internal validation cycle and 42 were subject to a full peer review visit. 100% Overall Compliance Ranges Chemo Intrathecal (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Oncology Pharmacy Oncology Pharmacy Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 0 services were selected for a cancer peer review visit in 2013/2014. The table below shows the outcomes against the measures for the 157 services reviewed in 2012/2013; Compliance SA IV PR 100% % % % % % % % Median 100% Range 0-100% Interquartile Range % 7

8 Immediate Risks and Serious Concerns with IRs (SA) with IRs (IV/EV) with IRs (PR) Total with IRs Percentage of with IRs (SA) (IV/EV) (PR) Total No of Percentage of % % The main focus of these were: Rooms that are designated for intrathecal chemotherapy do not have spillage kits or emergency call buttons. Lead clinician who is on the register as the named personnel who has been trained and certified to be competent to participate in ITC tasks has reported that they had not delivered ITC in the past year, it has also been reported that there is a lack of formalised medical training regarding prescribing chemotherapy. Non chemotherapy drugs were being stored in the same fridge as chemotherapy drugs. There should be a separate lockable fridge for the storage of chemotherapy drugs to minimize the risks. Pharmacy preparation is inadequate and potentially causes a risk of mix up of drugs. The room where chemotherapy drugs are stored has no facility of locking, therefore it is easily accessible and causes a potential security risk. Other immediate risks and serious concerns related to: Non-qualified student pharmacist technicians are involved in ITC procedures. Lack of documentation provided to patients regarding ITC treatment. Measures with less than 50% compliance: No measures for Chemotherapy Intrathecal Services were below 50% compliance. Chemotherapy Network Group: Immediate Risks and Serious Concerns The main focus of these were: Lack of agreed network wide regimen protocols and associated algorithms and systematic deviation reporting Slow progress in implementation of E-prescribing Other serious concerns related to: The timeliness of access to drugs via the Cancer Drugs Fund Lack of 24 hour chemotherapy advice lines Chemotherapy Good practice: Continual development and expansion of chemotherapy units to better utilise space, reduce waiting times and provide improved surroundings for patients. On-going development of outreach services for the safe administration of appropriate chemotherapy closer to home. Development of telephone assessment clinics to avoid additional journeys. Establishment of pre-assessment sessions. Steady progress to implement full e-prescribing. Comprehensive information available for patients and carers. 8

9 NETWORK There are many examples of good practice at network level, these particularly focused on: Pro-active chemotherapy nurse and pharmacy sub-groups. Regular audit programme led by network nurse directors focusing on chemotherapy safety and capacity. Work to establish devolved models of chemotherapy ensuring patients have access to chemotherapy closer to home where appropriate. Development and use of websites for dissemination and implementation of network wide policies and protocols. Good progress on establishing network wide agreed treatment algorithms. 9

10 Appendix 1 OVERALL PERCENTAGE COMPLIANCE AGAINST THE MDT PEER REVIEW MEASURES Clinical Chemotherapy Services Measure Number and Short Title SA (35 teams) IV (14 team) PR (110 team) 11-3S Head of Service Responsibilities 100% 93% 94% 11-3S Lead Chemotherapy Nurse 100% 93% 91% 11-3S Named Wards 100% 100% 96% 11-3S Specified Room Policy 100% 100% 94% 11-3S Provision of Protocols and Equipment 100% 100% 90% 11-3S Temporary Storage and Preparation Area 100% 100% 67% 11-3S The Chemotherapy Multi-professional Team 97% 100% 77% 11-3S Multi-professional Team Meetings 100% 100% 90% 11-3S Representation on the Drugs and Therapeutic Committee 11-3S Representation on the Network Chemotherapy Group 97% 93% 89% 91% 100% 84% 11-3S Error Recording and Reporting 97% 86% 72% 11-3S Further Pre-Treatment Consultation 97% 86% 88% 11-3S Patient Identification Procedure 100% 100% 93% 11-3S Checks Prior to the Prescription of the First Cycle 97% 100% 82% 11-3S Checks Prior to Administration 100% 100% 88% 11-3S Training and Assessment Policy 100% 100% 69% 11-3S Assessors of Competence 100% 100% 57% 11-3S Named Areas of Competence 100% 93% 62% 11-3S Training Records 97% 93% 51% 11-3S Agreed List of Treatment Algorithms 63% 71% 42% 11-3S Policy for Preventing Regular Deviation from the NSSG Agreed Treatment Algorithms 11-3S Clinical Chemotherapy Service Treatment Protocols 91% 71% 61% 97% 79% 85% 11-3S Guidelines and Protocols 100% 100% 87% 11-3S Guidelines and Protocols for Systemic Therapy Acute Oncology Presentations 100% 100% 89% 11-3S Hospital Guidelines and Protocols 100% 100% 93% 11-3S hour Telephone Advice Service 97% 79% 85% 11-3S Information for Patients on Complications of Chemotherapy 100% 93% 95% 11-3S Regimen Specific Information on Complications 100% 100% 99% 11-3S Consent Form 100% 93% 95% 11-3S Patient Experience Exercise 97% 93% 84% 11-3S Treatment Plan Copy to GP 91% 93% 80% 10

11 11-3S Treatment Record Prior to Commencing a Course Oncology Pharmacy Services 100% 100% 88% 11-3S Treatment Record Prior to Commencing a Cycle 100% 100% 84% 11-3S Treatment Summary 83% 79% 58% 11-3S The Chemotherapy Dataset 76% 46% 44% 11-3S Workload Arrangement 97% 93% 75% 11-3S Chemotherapy Capacity and Scenario Planning 56% 50% 41% 11-3S Out of Hours Chemotherapy 97% 100% 90% 11-3S Computer Generated Prescriptions 91% 36% 25% 11-3S Local Configuration of the Electronic Prescribing System 11-3S Consideration of Suggested Variations to the Use of the Electronic Prescribing System 11-3S Validation of the Incorporation of Individual Regimens Onto the Electronic Prescribing System 63% 21% 17% 83% 29% 29% 86% 29% 31% Measure Number and Short Title SA (102 teams) IV (10 team) PR (42 team) 11-3S Lead Pharmacist 100% 90% 98% 11-3S Designated Pharmacist 98% 100% 95% 11-3S Designated Pharmacist Duties 100% 100% 93% 11-3S Responsibility for Aseptic Chemotherapy Preparation 100% 100% 95% 11-3S Aseptic Preparation Audit 97% 100% 95% 11-3S Vinca Alkaloid Policy 99% 100% 81% 11-3S Waiver to the National Guidance on Vinca Alkaloid Dilution in Syringes 100% 100% 86% 11-3S Multi-professional Team Meetings 100% 100% 90% 11-3S Representation on the Drugs and Therapeutic Committee 97% 93% 89% 11

12 Chemotherapy Intrathecal Measure Number and Short Title SA (105 teams) IV (10 team) PR (42 team) 11-3S Management and Organisation 99% 100% 95% 11-3S Single ITC Lead 100% 100% 100% 11-3S ITC Service Divisions 100% 88% 100% 11-3S Case Volume and Risk Assessments 100% 100% 94% 11-3S Local Protocol 100% 100% 94% 11-3S Distribution of the Local Protocol and Guidance 99% 100% 94% 11-3S Lead Trainer 99% 100% 89% 11-3S IT Register 100% 100% 97% 11-3S Registration Procedures 100% 100% 86% 11-3S Training Policy 100% 89% 94% 11-3S Named Competency Assessors 100% 100% 94% 11-3S Administration by ST1 or ST2 Medical Staff 100% 100% 100% 11-3S Storage in Pharmacy 100% 100% 94% 11-3S Issuing of ITC drugs 100% 100% 97% 11-3S Sequencing IV and IT Chemotherapy 100% 100% 100% 11-3S Labeling of ITC drugs 100% 100% 100% 11-3S ITC Prescription Chart 100% 100% 100% 11-3S Collection of ITC drugs 100% 100% 97% 11-3S Storage Outside Pharmacy 100% 100% 100% 11-3S Designated ITC Room 100% 100% 100% 11-3S ITC Checking Procedure 100% 100% 100% 11-3S ITC Administration within Normal Working Hours 100% 100% 100% 12

13 Appendix 2 CHEMOTHERAPY: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Clinical Chemotherapy Services Team Network % Stage IR SC MDT - Addenbrookes AngCN - Anglia MDT - Doncaster & Bassetlaw NTCN - North Trent MDT - Guy's & St Thomas' SELCN - South East London 100 PR SC* MDT - Norfolk & Norwich AngCN - Anglia MDT - RSCH SWSHCN - Surrey, West Sussex & Hampshire MDT - Milton Keynes General TVCN - Thames Valley 98 SA MDT - Oxford University TVCN - Thames Valley 98 SA MDT - Poole DCN - Dorset 98 SA MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset 98 SA MDT - South Tees NECN - North of England 98 SA MDT - St George's SWLCN - South West London 98 SA MDT - University Hospital North Staffordshire NHS Trust GMCN - Greater Midlands 98 PR MDT - WPH NTCN - North Trent 98 SA MDT - Burton Hospital EMCN - East Midlands 95 SA MDT - Clatterbridge Centre MCCN - Merseyside & 95 SA MDT - East MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria 95 SA 95 SA MDT - Great Western Hospitals TVCN - Thames Valley 95 SA MDT - Newcastle NECN - North of England 95 IV MDT - Northampton General Hospital NHS Trust EMCN - East Midlands 95 SA MDT - Royal Free Hampstead NHS Trust 95 SA MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 95 PR MDT - UHB ASWCN - Avon, Somerset & Wiltshire 95 SA MDT - University Hospitals Southampton NHS Foundation Trust CSCCN - Central South Coast 95 SA MDT - West Middlesex NWLCN - North West London 95 PR SC MDT - Whittington Hospital 95 SA MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast 93 SA MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley 93 IV SC MDT - Eastbourne SCN - Sussex 93 SA 13

14 MDT - Harrogate YCN - Yorkshire 93 PR MDT - Hastings SCN - Sussex 93 SA MDT - Lancashire Teaching Hospitals LSCCN - Lancashire & South Cumbria 93 SA MDT - St Helens & Knowsley MCCN - Merseyside & 93 IV MDT - Taunton MDT - Barnet And Chase Farm Hospitals ASWCN - Avon, Somerset & Wiltshire 93 SA 90 SA MDT - Chelsea & Westminster NWLCN - North West London 90 SA MDT - George Eliot ArCN - Arden 90 PR MDT - Rotherham NTCN - North Trent 90 SA MDT - University Hospital Coventry and Warwickshire NHS Trust ArCN - Arden 90 PR MDT - Bedford AngCN - Anglia 88 PR IR MDT - Calderdale & Huddersfield YCN - Yorkshire 88 PR SC MDT - Hinchingbrooke AngCN - Anglia 88 PR SC MDT - Kettering EMCN - East Midlands 88 IV SC MDT - Leicester Royal Infirmary EMCN - East Midlands 88 SA MDT - Peterborough AngCN - Anglia 88 PR SC MDT - Royal Cornwall PCN - Peninsula 88 PR MDT - Royal Hampshire County Hospital CSCCN - Central South Coast 88 SA MDT - South Devon PCN - Peninsula 88 IV MDT - Sunderland NECN - North of England 88 IV MDT - Gloucestershire Hospitals NHS Foundation Trust 3CCN - 3 Counties 86 PR MDT - Homerton NELCN - North East London 86 SA MDT - Ipswich AngCN - Anglia 86 IV MDT - North Tees And Hartlepool NECN - North of England 86 IV MDT - PRUH SELCN - South East London 86 PR IR* SC* MDT - QEW SELCN - South East London 86 PR IR* SC* MDT - QMS SELCN - South East London 86 PR IR* SC* MDT - The Royal Wolverhampton Hospitals Trust GMCN - Greater Midlands 86 IV MDT - Worthing & Southlands SCN - Sussex 86 PR SC* MDT - Northumbria Hospitals NHS Foundation Trust NECN - North of England 85 IV MDT - RHH NTCN - North Trent 85 SA MDT - RMH Sutton SWLCN - South West London 85 PR IR* SC* MDT - Royal Marsden - Chelsea SWLCN - South West London 85 PR IR* SC MDT - S Warwickshire General ArCN - Arden 85 SA SC MDT - Broomfield (Chelmsford) ECN - Essex 83 PR MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham 83 PR SC MDT - Heatherwood & Wexham TVCN - Thames Valley 83 PR SC 14

15 MDT - King George NELCN - North East London 83 PR SC* MDT - Kings Lynn AngCN - Anglia 83 PR SC MDT - Leeds Teaching YCN - Yorkshire 83 PR IR MDT - Queen's NELCN - North East London 83 PR SC* MDT - Royal Berkshire TVCN - Thames Valley 83 PR IR MDT - RWST CSCCN - Central South Coast 83 PR SC* MDT - Sherwood Forest Hospitals EMCN - East Midlands 83 SA MDT - Airedale YCN - Yorkshire 81 PR SC* MDT - Barts & London NELCN - North East London 81 PR SC* MDT - BSUH SCN - Sussex 81 PR MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 81 PR IR SC MDT - Epsom & St Helier SWLCN - South West London 81 PR SC MDT - Hull And East Yorkshire Hospitals NEYHCA - North East Yorkshire and Humber Clinical Alliance 81 PR SC MDT - Luton & Dunstable MVCN - Mount Vernon 81 PR IR SC MDT - University College London Hospitals 81 PR IR MDT - West Suffolk AngCN - Anglia 81 PR SC MDT - Yeovil ASWCN - Avon, Somerset & Wiltshire 81 PR MDT - Hereford Hospital 3CCN - 3 Counties 80 PR MDT - Kings College SELCN - South East London 79 PR IR* SC MDT - Mid Yorks YCN - Yorkshire 79 PR SC* MDT - Plymouth PCN - Peninsula 79 PR SC MDT - Salford 79 IV SC MDT - South Tyneside NECN - North of England 79 IV MDT - University Hospitals Birmingham Foundation Trust PBCN - Pan-Birmingham 79 PR SC* MDT - Watford General Hospital MVCN - Mount Vernon 79 PR SC MDT - Weston ASWCN - Avon, Somerset & Wiltshire 79 PR MDT - Royal Liverpool & Broadgreen MCCN - Merseyside & 78 PR IR* SC MDT - Christie Hospital 76 PR SC MDT - Croydon SWLCN - South West London 76 PR IR SC MDT - Dartford & Gravesham KMCN - Kent & Medway 76 PR SC MDT - Dorset County Hospitals DCN - Dorset 76 PR SC* MDT - Lewisham SELCN - South East London 76 PR SC* MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands 76 PR SC MDT - North Middlesex University Hospital 76 PR IR SC 15

16 MDT - Northern Lincolnshire And Goole Hospital NEYHCA - North East Yorkshire and Humber Clinical Alliance 76 IV SC MDT - Royal Devon & Exeter PCN - Peninsula 76 PR SC MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 76 IV MDT - Southend ECN - Essex 76 PR IR MDT - Southport & Ormskirk MCCN - Merseyside & 76 PR SC MDT - Blackpool Teaching Hospitals Trust LSCCN - Lancashire & South Cumbria 74 PR IR SC MDT - County Durham & Darlington Foundation Trust NECN - North of England 74 PR SC MDT - IoW CSCCN - Central South Coast 74 PR IR MDT - Kent & Canterbury KMCN - Kent & Medway 74 PR SC MDT - Newham Healthcare NELCN - North East London 74 PR SC MDT - RUH ASWCN - Avon, Somerset & Wiltshire 74 PR IR MDT - Walsall Healthcare PBCN - Pan-Birmingham 74 PR SC MDT - York YCN - Yorkshire 74 PR SC* MDT - Kingston SWLCN - South West London 73 PR SC MDT - Warrington & Halton MCCN - Merseyside & 73 PR SC MDT - Whipps Cross NELCN - North East London 73 PR SC MDT - Bolton MDT - Frimley Park MDT - Morecambe Bay Hospitals MDT - Pennine Acute MDT - Surrey & Sussex SWSHCN - Surrey, West Sussex & Hampshire LSCCN - Lancashire & South Cumbria SWSHCN - Surrey, West Sussex & Hampshire 71 PR IR SC 71 PR 71 PR IR 71 PR SC 71 PR SC MDT - Barnsley NTCN - North Trent 69 PR MDT - James Paget AngCN - Anglia 69 PR IR MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham 69 PR SC MDT - Wirral MCCN - Merseyside & 69 PR IR* SC MDT - Stockport MDT - Mid 68 PR SC* 67 PR SC MDT - Northwick Park Hospital NWLCN - North West London 67 PR SC MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands 67 PR SC MDT - The Princess Alexandra Hospital MDT - University Hospital of South Manchester NHS Foundation Trust MDT - Wrightington, Wigan And Leigh 67 PR IR SC 67 PR SC 67 PR IR SC 16

17 MDT - Bradford YCN - Yorkshire 64 PR IR* SC MDT - Chesterfield NTCN - North Trent 64 PR MDT - Derby Hospital EMCN - East Midlands 64 PR IR* MDT - Ealing Hospital NWLCN - North West London 64 PR SC MDT - Portsmouth CSCCN - Central South Coast 64 PR SC MDT - Central Manchester & Manchester Childrens 62 PR SC MDT - Countess of Chester MCCN - Merseyside & 62 PR SC MDT - North Devon PCN - Peninsula 62 PR SC MDT - St Peters SWSHCN - Surrey, West Sussex & Hampshire 62 PR SC MDT - Aintree MCCN - Merseyside & 60 PR SC MDT - Basildon & Thurrock ECN - Essex 60 PR IR SC MDT - Hillingdon NWLCN - North West London 60 PR SC MDT - Maidstone Hospital KMCN - Kent & Medway 60 PR SC MDT - North Cumbria NECN - North of England 60 PR IR SC MDT - Gateshead NECN - North of England 59 PR SC MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 57 PR SC MDT - Redditch 3CCN - 3 Counties 57 PR IR SC MDT - Scarborough And North East Yorkshire Health Care NEYHCA - North East Yorkshire and Humber Clinical Alliance 57 PR SC MDT - Kidderminster Hospital 3CCN - 3 Counties 55 PR IR SC MDT - Lincoln County Hospital EMCN - East Midlands 55 PR IR SC MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands 55 PR IR SC* MDT - Pilgrim Hospital Boston EMCN - East Midlands 55 PR IR SC MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties 55 PR IR SC MDT - Charing Cross NWLCN - North West London 52 PR SC MDT - Lister MVCN - Mount Vernon 52 PR IR* SC MDT - North Bristol MDT - Trafford ASWCN - Avon, Somerset & Wiltshire 52 PR SC 51 PR IR SC * = Resolved 17

18 Oncology Pharmacy Team Network % Stage IR SC MDT - Addenbrookes AngCN - Anglia MDT - Aintree MCCN - Merseyside & MDT - Airedale YCN - Yorkshire MDT - Barnsley NTCN - North Trent 100 PR MDT - Barts & London NELCN - North East London MDT - Basildon & Thurrock ECN - Essex 100 PR MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast MDT - Bedford AngCN - Anglia MDT - Blackpool Teaching Hospitals Trust MDT - Bolton LSCCN - Lancashire & South Cumbria MDT - Broomfield (Chelmsford) ECN - Essex 100 PR MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley MDT - Burton Hospital EMCN - East Midlands MDT - Calderdale & Huddersfield YCN - Yorkshire MDT - Charing Cross NWLCN - North West London MDT - Chelsea & Westminster NWLCN - North West London MDT - Christie Hospital MDT - Clatterbridge Centre MCCN - Merseyside & MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 100 PR MDT - Countess of Chester MCCN - Merseyside & MDT - County Durham & Darlington Foundation Trust NECN - North of England MDT - Croydon SWLCN - South West London MDT - Doncaster & Bassetlaw NTCN - North Trent MDT - Dorset County Hospitals DCN - Dorset 100 PR SC MDT - Ealing Hospital NWLCN - North West London IR SC MDT - East MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria MDT - Eastbourne SCN - Sussex MDT - Epsom & St Helier SWLCN - South West London MDT - Frimley Park SWSHCN - Surrey, West Sussex & Hampshire 100 PR MDT - Gateshead NECN - North of England MDT - George Eliot ArCN - Arden 18

19 MDT - Gloucestershire Hospitals NHS Foundation Trust 3CCN - 3 Counties 100 PR MDT - Great Western Hospitals TVCN - Thames Valley MDT - Guy's & St Thomas' SELCN - South East London MDT - Harrogate YCN - Yorkshire MDT - Hastings SCN - Sussex MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham MDT - Heatherwood & Wexham TVCN - Thames Valley 100 PR MDT - Hereford Hospital 3CCN - 3 Counties MDT - Hillingdon NWLCN - North West London MDT - Hinchingbrooke AngCN - Anglia SC MDT - Homerton NELCN - North East London MDT - Hull And East Yorkshire Hospitals NEYHCA - North East Yorkshire and Humber Clinical Alliance MDT - Ipswich AngCN - Anglia 100 IV MDT - James Paget AngCN - Anglia MDT - Kettering EMCN - East Midlands 100 IV SC MDT - King George NELCN - North East London MDT - Kings College SELCN - South East London MDT - Kings Lynn AngCN - Anglia MDT - Kingston SWLCN - South West London MDT - Lancashire Teaching Hospitals LSCCN - Lancashire & South Cumbria MDT - Leeds Teaching YCN - Yorkshire MDT - Leicester Royal Infirmary EMCN - East Midlands SC MDT - Lewisham SELCN - South East London MDT - Lincoln County Hospital EMCN - East Midlands 100 PR MDT - Lister MVCN - Mount Vernon MDT - Luton & Dunstable MVCN - Mount Vernon MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 100 PR SC MDT - Mid Yorks YCN - Yorkshire MDT - Milton Keynes General TVCN - Thames Valley MDT - Newcastle NECN - North of England MDT - Newham Healthcare NELCN - North East London MDT - Norfolk & Norwich AngCN - Anglia MDT - North Cumbria NECN - North of England 100 IV MDT - North Devon PCN - Peninsula 100 PR MDT - North Middlesex University Hospital SC MDT - North Tees And Hartlepool NECN - North of England MDT - Northampton General Hospital NHS Trust EMCN - East Midlands 19

20 MDT - Northern Lincolnshire And Goole Hospital NEYHCA - North East Yorkshire and Humber Clinical Alliance 100 IV SC MDT - Northumbria Hospitals NHS Foundation Trust NECN - North of England MDT - Northwick Park Hospital NWLCN - North West London MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands MDT - Oxford University TVCN - Thames Valley MDT - Pennine Acute MDT - Peterborough AngCN - Anglia MDT - Plymouth PCN - Peninsula 100 PR MDT - Poole DCN - Dorset MDT - Portsmouth CSCCN - Central South Coast 100 PR MDT - PRUH SELCN - South East London 100 PR IR* SC* MDT - QEW SELCN - South East London 100 PR IR* SC* MDT - Queen's NELCN - North East London MDT - RMH Sutton SWLCN - South West London SC MDT - Rotherham NTCN - North Trent MDT - Royal Berkshire TVCN - Thames Valley 100 PR MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset MDT - Royal Cornwall PCN - Peninsula 100 PR MDT - Royal Devon & Exeter PCN - Peninsula 100 PR MDT - Royal Free Hampstead NHS Trust MDT - Royal Hampshire County Hospital CSCCN - Central South Coast MDT - Royal Liverpool & Broadgreen MCCN - Merseyside & MDT - Royal Marsden - Chelsea SWLCN - South West London SC MDT - RSCH SWSHCN - Surrey, West Sussex & Hampshire MDT - RUH ASWCN - Avon, Somerset & Wiltshire 100 PR MDT - S Warwickshire General ArCN - Arden MDT - Salford 100 IV SC MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 100 PR SC MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham SC MDT - Scarborough And North East Yorkshire Health Care NEYHCA - North East Yorkshire and Humber Clinical Alliance 100 PR MDT - Sheffield NTCN - North Trent MDT - Sherwood Forest Hospitals EMCN - East Midlands MDT - South Devon PCN - Peninsula 100 IV MDT - South Tees NECN - North of England MDT - South Tyneside NECN - North of England 100 IV SC 20

21 MDT - Southend ECN - Essex 100 PR MDT - Southport & Ormskirk MCCN - Merseyside & MDT - St George's SWLCN - South West London MDT - St Helens & Knowsley MCCN - Merseyside & MDT - St Peters MDT - Stockport SWSHCN - Surrey, West Sussex & Hampshire 100 PR SC MDT - Sunderland NECN - North of England MDT - Surrey & Sussex SWSHCN - Surrey, West Sussex & Hampshire 100 PR SC MDT - Taunton ASWCN - Avon, Somerset & Wiltshire MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands MDT - The Princess Alexandra Hospital 100 IV MDT - The Royal Wolverhampton Hospitals Trust GMCN - Greater Midlands 100 IV MDT - Trafford MDT - University College London Hospitals MDT - University Hospital Coventry and Warwickshire NHS Trust MDT - University Hospital North Staffordshire NHS Trust ArCN - Arden 100 PR GMCN - Greater Midlands 100 PR MDT - University Hospital of South Manchester NHS Foundation Trust MDT - University Hospitals Birmingham Foundation Trust MDT - University Hospitals Southampton NHS Foundation Trust PBCN - Pan-Birmingham CSCCN - Central South Coast MDT - Walsall Healthcare PBCN - Pan-Birmingham MDT - Warrington & Halton MCCN - Merseyside & MDT - Watford General Hospital MVCN - Mount Vernon SC MDT - West Suffolk AngCN - Anglia 100 PR MDT - Weston ASWCN - Avon, Somerset & Wiltshire 100 PR MDT - Whipps Cross NELCN - North East London MDT - Whittington Hospital MDT - Wirral MCCN - Merseyside & MDT - Wrightington, Wigan And Leigh MDT - Yeovil ASWCN - Avon, Somerset & Wiltshire 100 PR MDT - York YCN - Yorkshire MDT - Maidstone Hospital KMCN - Kent & Medway 86 PR SC MDT - Redditch 3CCN - 3 Counties 86 SA MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties 86 SA 21

22 MDT - Barnet And Chase Farm Hospitals 83 SA MDT - Bradford YCN - Yorkshire 83 PR MDT - BSUH SCN - Sussex 83 PR MDT - Dartford & Gravesham KMCN - Kent & Medway 83 PR SC MDT - Derby Hospital EMCN - East Midlands 83 SA MDT - IoW CSCCN - Central South Coast 83 PR MDT - Mid 83 PR MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands 83 SA MDT - Morecambe Bay Hospitals LSCCN - Lancashire & South Cumbria 83 PR MDT - RWST CSCCN - Central South Coast 83 PR MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 83 IV MDT - UHB ASWCN - Avon, Somerset & Wiltshire 83 SA MDT - Worthing & Southlands SCN - Sussex 83 PR SC MDT - Central Manchester & Manchester Childrens 71 PR IR MDT - Chesterfield NTCN - North Trent 67 PR MDT - Kent & Canterbury KMCN - Kent & Medway 50 PR MDT - North Bristol ASWCN - Avon, Somerset & Wiltshire 50 PR MDT - West Middlesex NWLCN - North West London SA * = Resolved 22

23 Intrathecal Services Team Network % Stage IR SC MDT - Addenbrookes AngCN - Anglia MDT - Aintree MCCN - Merseyside & 100 IV MDT - Airedale YCN - Yorkshire MDT - Alder Hey Children's NHS Foundation Trust MCCN - Merseyside & MDT - Barnet And Chase Farm Hospitals MDT - Barnsley NTCN - North Trent MDT - Barts & London NELCN - North East London MDT - Basildon & Thurrock ECN - Essex 100 PR MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast MDT - Bedford AngCN - Anglia MDT - Blackpool Teaching Hospitals Trust LSCCN - Lancashire & South Cumbria MDT - Bolton MDT - Bradford YCN - Yorkshire 100 PR MDT - Broomfield (Chelmsford) ECN - Essex 100 PR MDT - BSUH SCN - Sussex 100 PR MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley MDT - Burton Hospital EMCN - East Midlands MDT - Calderdale & Huddersfield YCN - Yorkshire MDT - Central Manchester & Manchester Childrens MDT - Charing Cross NWLCN - North West London MDT - Chelsea & Westminster NWLCN - North West London MDT - Chesterfield NTCN - North Trent MDT - Clatterbridge Centre MCCN - Merseyside & MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 100 PR MDT - Countess of Chester MCCN - Merseyside & MDT - County Durham & Darlington Foundation Trust NECN - North of England MDT - Derby Hospital EMCN - East Midlands MDT - Doncaster & Bassetlaw NTCN - North Trent MDT - East MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria 100 IV MDT - Eastbourne SCN - Sussex MDT - Epsom & St Helier SWLCN - South West London 23

24 MDT - Frimley Park SWSHCN - Surrey, West Sussex & Hampshire 100 PR MDT - Gateshead NECN - North of England MDT - George Eliot ArCN - Arden MDT - Gloucestershire Hospitals NHS Foundation Trust 3CCN - 3 Counties 100 PR MDT - Great Western Hospitals TVCN - Thames Valley MDT - Guy's & St Thomas' SELCN - South East London MDT - Harrogate YCN - Yorkshire MDT - Hastings SCN - Sussex MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham MDT - Heatherwood & Wexham TVCN - Thames Valley 100 PR MDT - Hereford Hospital 3CCN - 3 Counties MDT - Hillingdon NWLCN - North West London MDT - Hinchingbrooke AngCN - Anglia MDT - Homerton NELCN - North East London MDT - Hull And East Yorkshire Hospitals NEYHCA - North East Yorkshire and Humber Clinical Alliance MDT - IoW CSCCN - Central South Coast 100 PR MDT - Ipswich AngCN - Anglia 100 IV MDT - James Paget AngCN - Anglia MDT - Kettering EMCN - East Midlands 100 IV MDT - King George NELCN - North East London MDT - Kings College SELCN - South East London MDT - Kings Lynn AngCN - Anglia MDT - Kingston SWLCN - South West London MDT - Lancashire Teaching Hospitals LSCCN - Lancashire & South Cumbria MDT - Leeds Teaching YCN - Yorkshire SC MDT - Leicester Royal Infirmary EMCN - East Midlands MDT - Lister MVCN - Mount Vernon MDT - Liverpool Heart & Chest MCCN - Merseyside & MDT - Liverpool Women's MCCN - Merseyside & MDT - Luton & Dunstable MVCN - Mount Vernon MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 100 PR MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands MDT - Mid Yorks YCN - Yorkshire MDT - Milton Keynes General TVCN - Thames Valley MDT - Morecambe Bay Hospitals LSCCN - Lancashire & South Cumbria MDT - Newcastle NECN - North of England MDT - Newham Healthcare NELCN - North East London MDT - Norfolk & Norwich AngCN - Anglia 24

25 MDT - North Cumbria NECN - North of England 100 PR MDT - North Devon PCN - Peninsula 100 PR MDT - North Middlesex University Hospital 100 IV MDT - North Tees And Hartlepool NECN - North of England MDT - Northampton General Hospital NHS Trust EMCN - East Midlands MDT - Northern Lincolnshire And Goole Hospital NEYHCA - North East Yorkshire and Humber Clinical Alliance MDT - Northumbria Hospitals NHS Foundation Trust NECN - North of England MDT - Northwick Park Hospital NWLCN - North West London MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands MDT - Oxford University TVCN - Thames Valley MDT - Pennine Acute 100 PR SC MDT - Peterborough AngCN - Anglia MDT - Plymouth PCN - Peninsula 100 PR MDT - Poole DCN - Dorset MDT - Portsmouth CSCCN - Central South Coast 100 PR MDT - Queen's NELCN - North East London MDT - RMH Sutton SWLCN - South West London SC MDT - Rotherham NTCN - North Trent MDT - Royal Berkshire TVCN - Thames Valley 100 PR MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset MDT - Royal Cornwall PCN - Peninsula 100 PR MDT - Royal Devon & Exeter PCN - Peninsula 100 PR MDT - Royal Free Hampstead NHS Trust MDT - Royal Hampshire County Hospital CSCCN - Central South Coast MDT - Royal Liverpool & Broadgreen MCCN - Merseyside & 100 PR MDT - Royal Marsden - Chelsea SWLCN - South West London SC MDT - RSCH SWSHCN - Surrey, West Sussex & Hampshire MDT - S Warwickshire General ArCN - Arden MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 100 PR SC MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham MDT - Scarborough And North East Yorkshire Health Care NEYHCA - North East Yorkshire and Humber Clinical Alliance MDT - Sheffield NTCN - North Trent MDT - Sheffield Children NTCN - North Trent MDT - Sherwood Forest Hospitals EMCN - East Midlands MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 100 IV 25

26 MDT - South Devon PCN - Peninsula MDT - South Tees NECN - North of England MDT - South Tyneside NECN - North of England SC MDT - Southport & Ormskirk MCCN - Merseyside & MDT - St George's SWLCN - South West London MDT - St Helens & Knowsley MCCN - Merseyside & MDT - St Peters MDT - Stockport SWSHCN - Surrey, West Sussex & Hampshire 100 PR SC MDT - Sunderland NECN - North of England MDT - Surrey & Sussex MDT - Tameside & Glossop Acute SWSHCN - Surrey, West Sussex & Hampshire 100 PR SC MDT - Taunton ASWCN - Avon, Somerset & Wiltshire MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands MDT - The Royal Wolverhampton Hospitals Trust GMCN - Greater Midlands 100 IV MDT - Trafford MDT - UHB ASWCN - Avon, Somerset & Wiltshire MDT - University Hospital Coventry and Warwickshire NHS Trust MDT - University Hospital North Staffordshire NHS Trust ArCN - Arden 100 PR GMCN - Greater Midlands 100 PR MDT - University Hospital of South Manchester NHS Foundation Trust MDT - University Hospitals Birmingham Foundation Trust MDT - University Hospitals Southampton NHS Foundation Trust PBCN - Pan-Birmingham CSCCN - Central South Coast MDT - Walsall Healthcare PBCN - Pan-Birmingham MDT - Walton MCCN - Merseyside & MDT - Warrington & Halton MCCN - Merseyside & MDT - Watford General Hospital MVCN - Mount Vernon 100 PR MDT - West Suffolk AngCN - Anglia 100 PR MDT - Whipps Cross NELCN - North East London MDT - Whittington Hospital MDT - Wirral MCCN - Merseyside & MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties MDT - Worthing & Southlands SCN - Sussex 100 PR MDT - Wrightington, Wigan And Leigh MDT - Yeovil ASWCN - Avon, Somerset & Wiltshire 100 PR 26

27 MDT - Birmingham Children's Hospital NHS Foundation Trust PBCN - Pan-Birmingham 95 SA MDT - Christie Hospital 95 PR MDT - Croydon SWLCN - South West London 95 PR IR SC MDT - Dorset County Hospitals DCN - Dorset 95 PR IR* MDT - Lincoln County Hospital EMCN - East Midlands 95 PR IR MDT - Maidstone Hospital KMCN - Kent & Medway 95 PR SC MDT - RUH ASWCN - Avon, Somerset & Wiltshire 95 PR MDT - RWST CSCCN - Central South Coast 95 PR MDT - Salford 95 IV SC MDT - Southend ECN - Essex 95 PR MDT - The Princess Alexandra Hospital MDT - University College London Hospitals 95 IV 95 PR MDT - York YCN - Yorkshire 95 SA MDT - Lewisham SELCN - South East London 86 PR SC* MDT - PRUH SELCN - South East London 86 PR IR* SC* MDT - QEW SELCN - South East London 86 PR IR* SC* MDT - West Middlesex NWLCN - North West London 86 PR SC MDT - Ealing Hospital NWLCN - North West London 76 PR SC MDT - Mid 0 SA * = Resolved 27

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