Tumour Streams Eleanor Whitehead CCN Project Manager

Topics National tumour stream standards project status Regional/local implementation considerations Progress against lung standards Other regional tumour stream work – skin, bowel Gynae pathway – presentation from Dr. Cecile Bergzoll CCDHB Proposed activities 2013/2014

National standards of service provision Background Ensure that patients receive timely and good quality care Enable the development of efficient and sustainable best practice management of specific tumour types Promote a nationally co-ordinated and consistent approach to service provision for the tumour type Required to help mitigate the risk of patients receiving poor quality care including the provision of services which meet the timeliness measures assciated with the FCT indicators

National tumour stream standards project status Aligned cancer standards agreed 30 th May 2013 CCN - Haematology stream – lymphoma and myeloma MCN – Breast SCN - Gynaecological SCN - Bowel NCN - Head and Neck NCN - Upper Gastrointestinal NCN- Melanoma NCN – Sarcoma Submitted end June 2013 To be published November 2013 as provisional documents

National tumour stream standards – future development plans Ongoing role of the working groups - the Chairs Group recommended a two-tier process for consideration by the MoH – – A smaller tumour specific group to give mandate to chair. – A national pan-tumour group including all the Chairs Additional tumour stream standards to be developed – prostate , urology and CNS TBA

National Aligned Cancer Standards Agreed clusters Prevention and early detection – optional Timely access to services Referral and communication Investigation, diagnosis and staging Multidisciplinary care Care co-ordination Treatment Follow-up and surveillance Clinical performance, monitoring and research

Examples of national activity in specific clusters ClusterExisting / planned activity in Timely access to services  DHB quarterly reporting on FCT indicators  RCN regional FCT implementation plans aimed at improving data quality  MOH currently seeking feedback from DHBs re additional initiatives to improve reporting Communication and referral  DHB e-referral developments Investigations, staging and diagnosis  Suspected Cancer in Primary Guideline  CCNZ implementation of structured reporting from labs  DHBs reporting on colonoscopy, CT/MRI wait time indicators  PET-CT Indicators  Fast track clinics Multidisciplinary care  MOH MDM Guidelines  RCN MDM development plans

Examples of national activity in specific clusters ClusterExisting/planned activity Care co-ordination and supportive care  MOH Supportive Care Guidance and implementation plan  DHB implementation of Cancer Nurse Coordinator initiative  MOH establishment of National Patient Information Network Treatment  Medical Oncology Models of Care Plan  National Radiation Oncology Plan  Palliative Care – Resource and Capability Framework completed, finalise Specialist Palliative Care Service Specifications  Bone Marrow Transplant Services in New Zealand for Adults – service improvement plan Follow up and surveillance Clinical Performance Monitoring and Research  CCNZ improvements to the NZ Cancer Registry (Staging, structured lab reporting)  Regional data repositories  RCN MDM development plans – data capture and reporting  MOSAIQ / METRIQ Pilot (SCN)  National View of Cancer

Example of national activity specific to individual tumour streams Tumour StreamExisting / planned activity in Breast  Management of Early Breast Cancer Guideline (MOH, 2009)  Breast Cancer Registry  BSA Digital Mammography project  NCN Breast Cancer Follow-up Guideline Bowel  Management of Early Colorectal Cancer Guidelines (MOH, 2011)  National Bowel Screening Pilot  Endoscopy Quality Improvement Programme – implement Global Rating Scale in all DHBs,  Colonoscopy – direct access guidelines and wait time indicator  National Bowel Cancer Working Group Plan Myeloma  Bone Marrow Transplant Services in NZ for Adults – Service Improvement Plan Lymphoma  Bone Marrow Transplant Services in NZ for Adults – Service Improvement Plan

Example of national activity specific to individual tumour streams Tumour StreamExisting / planned activity in Head and Neck Melanoma Upper GI Sarcoma Gynae  Draft National Gynae-oncology Service Plan  Consultation re 2,3 or 4 hub model to be undertaken by Gynae Standards Group  Cervical screening - implementation of Parliamentary Review Committee Recommendations Lung  National Lung Cancer Working Group Plan Prostate  Prostate Quality Improvement Programme (Phase 1):  Developing and distributing prostate cancer information resources  Developing prostate cancer standards and draft guidelines

FCT reporting Top four tumour streams account for 64% of all FCT data - breast (20%), lower GI (17%), urological (14%), lung (13%)

FCT reporting – waiting times Haematological tumour stream consistently had the best waiting time compliance across all three indicators, while urological consistently had the least favourable. Graph indicator 1 (referral to first treatment)

FCT indicators Indicator 2

FCT indicators Indicator 3

Some FCT data by tumour stream Indicator 1 –best practice 62 days – results: overall 62%, haem 76%, breast 73%, skin 71% gynae 70% urology 40% Indicator 2 –best practice 14 days - results : overall 55% haem 77%, lung 73%, gynae 73%, urology 32% Indicator 3 –best practice 31days- results: overall 88% all above 75% except urological at 48%

CCN Region – current tumour stream based activities CNCs tumour specific focus – lung, gynae, sarcoma, bowel, skin, lymphoma Skin in primary care – WhaDHB skin lesion project, MDHB Map of Medicine Bowel – NEQIP, colonoscopy indicators Lung progress against lung standards Gynae pathway

Lung standards – national

Lung standards - regional Regional lung steering group – proposed that function sits with lung MDMs Data – enabling clinical audit EBUS – C&CDHB implementation currently Lung MDMs – TORs referral criteria Care coordination – CNCs with lung focus in C&CDHB, MDHB, HBDHB

Lung standard indicators Indicators and year Indicator 1 %Indicator 2 % Indicator 3 % Q3/ DHBs Q3/ Q3/ Capital and Coast Midcentral NA 96NA 9196 Hawke’s Bay 76NA5561NA6696 Wairarapa 3350NR6757NR Hutt Valley Whanganui Taranaki

Gynaecological Oncology Patient Pathway Cecile Bergzoll Gynaecological Oncologist Wellington

Regional/local implementation considerations Audit Previous regional mapping work done in lung, gynae and bowel can be used as baseline data Faster Cancer Treatment data will be utilised Audit can be performed either within a tumour stream as well as across the aligned standards RCNs developing agreed audit tools Need to work out an audit plan with the DHBs to ensure we obtain the greatest value for each DHB and for the region as a whole to inform their FCT work

Bowel proposed activities 3.3 Support implementation of the National Endoscopy Quality Improvement Programme (NEQIP) plan in each DHB (led by NEQIP team, Bay of Plenty DHB) Proposed Activities: All DHBs completing the roll out of the Global Rating Scale Ministry visits to DHBs to discuss implementation of direct access to colonoscopy criteria in Aug/Sep 2013 Develop and implement a subregional approach to colonoscopy referral and wait list – C&CDHB, HVDHB, WaiDHB (3D) Participate in nationally led endoscopy workforce developments as appropriate

Prostate proposed activities 2.7 Identify and establish plan to address regional priorities arising from the National Prostate Cancer Quality Improvement Plan Proposed Activities: Contribute to the national development and distribution of prostate cancer information resources by June Contribute to the development of national standards and draft guidelines by June Suggest that the following two activities identified in the RSP are delayed until next year when the standards are available: Regional Prostate Cancer Steering Group established by end September Regional Prostate Cancer Improvement Plan approved by DHBs by end December 2013.

Overall tumour steam proposed activities Begin implementing the National Tumour Standards of Service Provision – annual priorities identified and actions planned to address gaps Proposed Activities: CCN stakeholders to continue to participate on national tumour stream groups as able (Ministry currently identifying roles and support for these groups). Confirm regional clinical leadership processes – proposed that this sits with MDM groups via 6 monthly meetings. Work with other RCNs to develop a tool for auditing the tumour standards by December 13 and undertake an audit against a tumour standard by March 13. (standard yet to be decided)