National Peer Review Report: Lung Cancer Services Report 2012/2013

National Peer Review Programme National Peer Review Report: Lung Cancer Services Report 2012/2013 www.nationalpeerreview.nhs.uk

National Peer Review Programme 2012-2013 Lung Overall Performance Of the 157 teams reviewed against the 28 measures, 155 teams were on the selfassessment cycle. 1 team was on the IV cycle and 1 team was subject to a full peer review visit. The table below shows the outcomes against the measures for 157 teams reviewed in 2012/2013; Teams Compliance SA IV PR 100% 14 0 0 90-99% 63 0 0 80-89% 67 0 1 70-79% 9 1 0 60-69% 2 0 0 50-59% 0 0 0 40-49% 0 0 0 0-39% 0 0 0 Median 89% Range 68-100% Interquartile Range 86-96% 100% Overall Compliance Ranges Lung MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Lung 11 12 Lung 12 13 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) 3 teams were selected for a cancer peer review visit in 2013/2014. 2

National Review Programme 2012-2013 Lung Immediate Risks and Serious Concerns No of Teams with IRs (SA) No of Teams with IRs (IV) No of Teams with IRs (PR) Total No of Teams with IRs Percentage of Teams with PRs No of Teams with SCs (SA) No of Teams with SCs (IV) No of Teams with SCs (PR) Total No of Teams SCs 4 0 0 4 3% 15 1 1 17 11% Immediate Risks and Serious Concerns The main focus of these were: Percentage of Teams with SCs CT scans being performed before bronchoscopy s, this goes against national guidelines. Teams breaching cancer waiting times and targets for diagnosis and treatment due to the lack of medical administrative support. Core membership and cover core team members including thoracic surgeon and clinical oncologist. CNS resource is stretched due to high workload and and inadequate cover for CNS. No Specialist palliative care representation at MDT. Lack of level 4 psychological support. Not all appropriate patients discussed at MDT. No interventional radiologist at MDT. Lack of local EBUS facilities and long waiting times for EBUS. No access to CT guided lung biopsy due to issues with staffing. Low oncology capacity resulting in low active treatment rates and delays in both chemotherapy and radiotherapy Other immediate risks and serious concerns related to: Access to bronchoscopy at one stop clinics. Chemotherapy day unit capacity issues. Need for second bronchoscopy list to prevent increasing delays in reporting. Good Practice There were many examples of good practice. These particularly focused on: Availability of EBUS. Access to EGFR testing. Involvement in early diagnosis initiatives. Comprehensive audit programmes. Streamlining of patient pathways. Participation in clinical research. Improved levels of attendance at national advanced communication skills training programme. Access to level 2 psychological support. Increased levels of staffing from all disciplines. Active patient support groups. Educational events including work with community practitioners. Clinical Lines of Enquiry (CLE) There were a number of issues highlighted through reporting of, and discussion on, the Clinical Lines of Enquiry for lung, both at Network and MDT level. For a list of the metrics please see appendix 3. 3

National Peer Review Programme 2012-2013 Lung At Network level these were: Difficulties with recording and validation of data into the national lung cancer audit Systematic issues with uploading data to LUCADA and problems with trusts overwriting each other s uploads. Low resection rates have led to more aggressive staging of some patients which in turn led to a doubling of resection rates. Other reasons for low resection rates have been patient wishes, additional co-morbidity, low performance status and poor lung function. Clinical lines of enquiry are a standing agenda item at NSSG meetings demonstrating clear mechanism for review. Some report low radiotherapy rates and using MALTHUS radiotherapy modelling tools this is found to be conform to predictions other than for ages 80 and above. Deaths within 30 days of treatment being reviewed in monthly chemotherapy mortality and morbidity meetings to understand high risk patients groups. Some below average percentages for small cell cancer patients receiving chemotherapy which when investigated is linked to age, performance status and patients presenting for treatment. At MDT level these were: Live MDT data collection ensuring clinical validation of data. Low resection rates have prompted more discussion as to reasons and this could be due to thoracic surgeon attendance at MDT. Some MDTs are routinely requesting second opinion if a patient is turned down for surgery. Systematic issues with uploading data to LUCADA and problems with trusts overwriting each other s uploads. Regular attendance of thoracic surgeon at MDT is seen to have improved resection rates. Mystery shopper audits taking place. Some poor performance highlighted by the CLEs is down to data entry problems. Poor trial recruitment due to lack of oncology presence at MDT and research nurse resource. Increase in the amount of small cell lung cancer patients receiving chemotherapy. Very extensive discussion of CLEs at self-assessment and internal validation level. Radiotherapy numbers for patients deemed unfit for surgery could increase with new techniques such as Stereotactic Body Radiation Therapy (SBRT). Successful implementation of EBUS services which have improved histological conversion rates. 4

National Peer Review Programme 2012-2013 Lung Measures with less below 50% compliance: Measure Number and Short Title 11-2C-115 - Attendance at National Advanced Communication Skills Training Programme SA (155 teams) 42% Measure Number and Short Title IV (1 team) 11-2C-103 - Support for Level 2 Practitioners 0% 11-2C-106 - MDT Agreed Cover Arrangements for Core Members 0% 11-2C-107 - Core Member (or Cover) Present for 2/3 of Meetings 0% 11-2C-115 - Attendance at National Advanced Communication Skills Training Programme 11-2C-116 - Extended Membership of MDT 0% 11-2C-118 - Patient Experience Exercise 0% 0% Measure Number and Short Title PR (1 team) 11-2C-106 - MDT Agreed Cover Arrangements for Core Members 0% 11-2C-110 - Policy for Communication of Diagnosis to GP 0% 11-2C-115 - Attendance at National Advanced Communication Skills Training Programme 11-2C-116 - Extended Membership of MDT 0% 11-2C-127 - Agreed List of Approved Trials 0% 11-2C-118 - Patient Experience Exercise 0% 0% 5

National Review Programme 2012-2013 Lung NETWORK 100% Lung NSSGs 2012-2013 90% 80% 70% 60% 50% 40% 30% 20% 10% SA 0% There were many examples of good practice at network level. These particularly focused on: Availability of EBUS. Access to EGFR testing. Involvement in national early diagnosis initiatives. Good collaboration between CNSs across geographical areas. Comprehensive audit programmes. User involvement in service developments. Increased access to PET-CT. Smoking cessation initiatives. 6

National Peer Review Programme 2012-2013 Lung Appendix 1 OVERALL PERCENTAGE COMPLIANCE AGAINST THE MDT PEER REVIEW MEASURES Lung Measure Number and Short Title SA (155 teams) IV (1 team) PR (1 team) 11-2C-101 - Lead Clinician and Core Team Membership 90% 100% 100% 11-2C-102 - Level 2 Practitioners for Psychological Support 74% 100% 100% 11-2C-103 - Support for Level 2 Practitioners 51% 0% 100% 11-2C-104 - Team Attendance at NSSG Meetings 95% 100% 100% 11-2C-105 - MDT Meeting 100% 100% 100% 11-2C-106 - MDT Agreed Cover Arrangements for Core Members 11-2C-107 - Core Member (or Cover) Present for 2/3 of Meetings 76% 0% 0% 64% 0% 100% 11-2C-108 - Annual Meeting to Discuss Operational Policy 97% 100% 100% 11-2C-109 - Policy for All New Patients to be Reviewed by MDT 99% 100% 100% 11-2C-110 - Policy for Communication of Diagnosis to GP 94% 100% 0% 11-2C-111 - Operational Policy for Named Key Worker 99% 100% 100% 11-2C-112 - Core Histopathology Member Taking Part in Histopathology EQA 11-2C-113 - Core Nurse Member Completed Specialist Study 11-2C-114 - Agreed Responsibilities for Core Nurse Members 11-2C-115 - Attendance at National Advanced Communication Skills Training Programme 98% 100% 100% 92% 100% 100% 99% 100% 100% 42% 0% 0% 11-2C-116 - Extended Membership of MDT 89% 0% 0% 11-2C-117 - Patient Permanent Consultation Record 92% 100% 100% 11-2C-118 - Patient Experience Exercise 92% 0% 100% 11-2C-119 - Provision of Written Patient Information 100% 100% 100% 11-2C-120 - Agree and Record Individual Patient Treatment Plans 100% 100% 100% 11-2C-121 - MDT Agreement to Network Clinical Guidelines 100% 100% 100% 11-2C-122 - MDT Agreement to Network Referral Guidelines 100% 100% 100% 11-2C-123 - MDT Agreement to Network Imaging Guidelines 99% 100% 100% 11-2C-124 - MDT Agreement to Network Pathology Guidelines 11-2C-125 - MDT Agreement to Network Collection of Minimum Dataset 99% 100% 100% 99% 100% 100% 11-2C-126 - Network Audit 97% 100% 100% 11-2C-127 - Agreed List of Approved Trials 92% 100% 0% 11-2C-128 - Joint Treatment Planning for TYAs 89% 100% 100% 7

National Review Programme 2012-2013 Lung Appendix 2 LUNG TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - BSUH SCN - Sussex 100 SA SC MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley 100 SA MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 100 SA MDT - George Eliot ArCN - Arden 100 SA MDT - Heatherwood & Wexham TVCN - Thames Valley 100 SA MDT - Kettering EMCN - East Midlands 100 SA MDT - Lister MVCN - Mount Vernon 100 SA MDT - Oxford University TVCN - Thames Valley 100 SA MDT - Portsmouth CSCCN - Central South Coast 100 SA MDT - Sherwood Forest Hospitals EMCN - East Midlands 100 SA MDT - Southport & Ormskirk MCCN - Merseyside & 100 SA MDT - University Hospitals Birmingham Foundation Trust PBCN - Pan-Birmingham 100 SA MDT - Walsall Healthcare PBCN - Pan-Birmingham 100 SA MDT - Watford General Hospital MVCN - Mount Vernon 100 SA MDT - Barnsley NTCN - North Trent 96 SA MDT - Basildon & Thurrock ECN - Essex 96 SA MDT - Bradford YCN - Yorkshire 96 SA MDT - Charing Cross NWLCN - North West London 96 SA SC MDT - Chelsea & Westminster NWLCN - North West London 96 SA MDT - Croydon SWLCN - South West London 96 SA MDT - Dartford & Gravesham KMCN - Kent & Medway 96 SA MDT - Derby Hospital EMCN - East Midlands 96 SA MDT - East 96 SA MDT - Glenfield Hospital EMCN - East Midlands 96 SA MDT - Gloucester Royal 3CCN - 3 Counties 96 SA MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham 96 SA MDT - Hillingdon NWLCN - North West London 96 SA MDT - James Paget AngCN - Anglia 96 SA MDT - Lincoln County Hospital EMCN - East Midlands 96 SA MDT - Luton & Dunstable MVCN - Mount Vernon 96 SA MDT - Maidstone Hospital KMCN - Kent & Medway 96 SA MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 96 SA MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands 96 SA MDT - Mid Yorks YCN - Yorkshire 96 SA 8

National Peer Review Programme 2012-2013 Lung MDT - Milton Keynes General TVCN - Thames Valley 96 SA MDT - North Devon PCN - Peninsula 96 SA MDT - North Middlesex University Hospital NCLWECCN - North Central London and West Essex CCN 96 SA MDT - Northampton General Hospital NHS Trust EMCN - East Midlands 96 SA MDT - Northumbria (North Tyneside) NECN - North of England 96 SA MDT - Northwick Park Hospital NWLCN - North West London 96 SA MDT - Papworth AngCN - Anglia 96 SA MDT - Peterborough AngCN - Anglia 96 SA MDT - South Devon PCN - Peninsula 96 SA MDT - St Marys NWLCN - North West London 96 SA SC MDT - University Hospital Coventry and Warwickshire NHS Trust ArCN - Arden 96 SA MDT - West Suffolk AngCN - Anglia 96 SA MDT - Whittington Hospital NCLWECCN - North Central London and West Essex CCN 96 SA MDT - William Harvey KMCN - Kent & Medway 96 SA MDT - Aintree MCCN - Merseyside & 93 SA MDT - Barts & London NELCN - North East London 93 SA MDT - Blackpool Teaching Hospitals Trust LSCCN - Lancashire & South Cumbria 93 SA MDT - Broomfield (Chelmsford) ECN - Essex 93 SA MDT - Doncaster & Bassetlaw NTCN - North Trent 93 SA MDT - Ealing Hospital NWLCN - North West London 93 SA MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria 93 SA MDT - Hereford Hospital 3CCN - 3 Counties 93 SA MDT - Hull And East Yorkshire Hospitals NEYHCA - North East Yorkshire and Humber Clinical Alliance 93 SA MDT - Kent & Canterbury KMCN - Kent & Medway 93 SA MDT - Kingston SWLCN - South West London 93 SA MDT - North Cumbria NECN - North of England 93 SA MDT - Northumbria (Wansbeck) NECN - North of England 93 SA MDT - Pennine Acute 93 SA SC MDT - Poole DCN - Dorset 93 SA MDT - Rotherham NTCN - North Trent 93 SA MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset 93 SA MDT - Royal Hampshire County Hospital CSCCN - Central South Coast 93 SA MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 93 SA MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham 93 SA MDT - St George's SWLCN - South West London 93 SA MDT - St Helens & Knowsley MCCN - Merseyside & 93 SA 9

National Review Programme 2012-2013 Lung MDT - St Peters MDT - Surrey & Sussex SWSHCN - Surrey, West Sussex & Hampshire SWSHCN - Surrey, West Sussex & Hampshire 93 SA 93 SA MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands 93 SA MDT - The Princess Alexandra Hospital MDT - Trafford MDT - University College London Hospitals NCLWECCN - North Central London and West Essex CCN NCLWECCN - North Central London and West Essex CCN 93 SA IR SC 93 SA 93 SA MDT - University Hospital North Staffordshire NHS Trust GMCN - Greater Midlands 93 SA MDT - Barnet And Chase Farm Hospitals NCLWECCN - North Central London and West Essex CCN 89 SA MDT - Bedford AngCN - Anglia 89 SA MDT - Bolton 89 SA MDT - Chesterfield NTCN - North Trent 89 SA MDT - Dorset County Hospitals DCN - Dorset 89 SA MDT - DPofW MDT - Frimley Park NEYHCA - North East Yorkshire and Humber Clinical Alliance SWSHCN - Surrey, West Sussex & Hampshire 89 SA 89 SA MDT - Grantham Hospital EMCN - East Midlands 89 SA SC MDT - Great Western Hospitals TVCN - Thames Valley 89 SA MDT - Harrogate YCN - Yorkshire 89 SA MDT - Ipswich AngCN - Anglia 89 SA MDT - Kings College SELCN - South East London 89 SA MDT - Kings Lynn AngCN - Anglia 89 SA MDT - Lewisham SELCN - South East London 89 SA MDT - Liverpool Heart & Chest MCCN - Merseyside & 89 SA MDT - Pilgrim Hospital Boston EMCN - East Midlands 89 SA MDT - QEW SELCN - South East London 89 SA MDT - Royal Cornwall PCN - Peninsula 89 SA MDT - Royal Devon & Exeter PCN - Peninsula 89 SA MDT - RUH ASWCN - Avon, Somerset & Wiltshire 89 SA MDT - RWST CSCCN - Central South Coast 89 SA MDT - S Warwickshire General ArCN - Arden 89 SA MDT - SGH MDT - Tameside & Glossop Acute NEYHCA - North East Yorkshire and Humber Clinical Alliance 89 SA 89 SA MDT - The Royal Wolverhampton Hospitals Trust GMCN - Greater Midlands 89 SA MDT - Warrington & Halton MCCN - Merseyside & 89 SA 10

National Peer Review Programme 2012-2013 Lung MDT - Wirral MCCN - Merseyside & 89 SA MDT - York YCN - Yorkshire 89 SA MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast 86 SA MDT - Burton Hospital EMCN - East Midlands 86 SA MDT - Calderdale & Huddersfield YCN - Yorkshire 86 SA MDT - Central Manchester & Manchester Childrens 86 SA MDT - Epsom & St Helier SWLCN - South West London 86 SA MDT - IoW CSCCN - Central South Coast 86 SA MDT - King George NELCN - North East London 86 SA IR SC MDT - Newcastle NECN - North of England 86 SA MDT - PRUH SELCN - South East London 86 SA SC MDT - Royal Berkshire TVCN - Thames Valley 86 SA MDT - Royal Free Hampstead NHS Trust MDT - RSCH NCLWECCN - North Central London and West Essex CCN SWSHCN - Surrey, West Sussex & Hampshire 86 SA 86 SA MDT - Sheffield NTCN - North Trent 86 SA MDT - Stockport MDT - Taunton MDT - UHB ASWCN - Avon, Somerset & Wiltshire ASWCN - Avon, Somerset & Wiltshire 86 SA 86 SA 86 SA MDT - UHND NECN - North of England 86 SA MDT - Whipps Cross NELCN - North East London 86 SA MDT - South Tyneside NECN - North of England 85 SA MDT - Airedale YCN - Yorkshire 82 SA MDT - Cheltenham General 3CCN - 3 Counties 82 SA MDT - Countess of Chester MCCN - Merseyside & 82 SA MDT - Eastbourne SCN - Sussex 82 SA SC MDT - Lancashire Teaching Hospitals MDT - Morecambe Bay Hospitals LSCCN - Lancashire & South Cumbria LSCCN - Lancashire & South Cumbria 82 SA 82 SA SC MDT - Norfolk & Norwich AngCN - Anglia 82 SA SC MDT - North Tees And Hartlepool NECN - North of England 82 SA MDT - Royal Brompton Hospital NWLCN - North West London 82 SA MDT - Scarborough And North East Yorkshire Health Care NEYHCA - North East Yorkshire and Humber Clinical Alliance 82 SA MDT - South Tees NECN - North of England 82 SA MDT - Sunderland NECN - North of England 82 SA MDT - University Hospital of South Manchester NHS Foundation Trust 82 SA 11

National Review Programme 2012-2013 Lung MDT - University Hospitals Southampton NHS Foundation Trust CSCCN - Central South Coast 82 SA MDT - West Middlesex NWLCN - North West London 82 SA MDT - Weston ASWCN - Avon, Somerset & Wiltshire 82 SA MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties 82 SA IR SC MDT - Worthing & Southlands SCN - Sussex 82 PR SC* MDT - Yeovil MDT - North Bristol ASWCN - Avon, Somerset & Wiltshire ASWCN - Avon, Somerset & Wiltshire 82 SA SC 81 SA MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 81 SA MDT - Harefield Hospital NWLCN - North West London 79 SA MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands 79 SA MDT - Plymouth PCN - Peninsula 79 IV SC MDT - Gateshead NECN - North of England 78 SA MDT - Leeds Teaching YCN - Yorkshire 78 SA MDT - Queen's NELCN - North East London 75 SA IR SC MDT - North West Sector Lung MDT MDT - Mid 74 SA 71 SA MDT - Redditch 3CCN - 3 Counties 71 SA MDT - Wrightington, Wigan And Leigh 71 SA SC MDT - DMH/BAGH NECN - North of England 68 SA MDT - Guy's & St Thomas' SELCN - South East London 68 SA MDT - Wrightington, Wigan And Leigh 63 SA SC * = Resolved 12

National Peer Review Programme 2012-2013 Lung Appendix 3 LUNG CLINICAL LINES OF ENQUIRY BRIEFING SHEET AND DATA Metric DATA COLLECTION 1.The percentage of expected cases on whom data is collected Data HISTOLOGY CONFIRMATION 2. The % histological confirmation rate NLCA TREATMENT SURGERY CHEMOTHERAPY SCLC 3. The percentage having active treatment 4. The percentage undergoing surgical resection (all cases excluding Mesothelioma & confirmed Small Cell Lung Cancer) 5. The percentage of small cell cancer patients receiving chemotherapy National Lung Cancer Audit (NLCA) NLCA NLCA NLCA 13

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