28 Day Faster Diagnosis Standard 08/03/2017

Overview Introduction and background Aims and objectives Timeline for rollout Areas highlighted by testing so far Questions

Introduction Recommendation from independent Cancer Taskforce: 95% of patients should receive a definitive diagnosis or ruling out of cancer within 28 days of a referral ‘Early priority’ and a Secretary of State commitment Aims: Speed up access to diagnosis for those with cancer Ensure that patients who aren’t diagnosed do not wait and worry Fit with new NICE referral guidance lowering the threshold of suspicion for ‘cancer’ referral Some big ambitions: ‘All patients’ whatever their suspicion Include primary care requested diagnostics

Opportunities Big opportunities: Centre the pathway on the patient Focus on better communication Speedier and more efficient diagnosis, encouraging links between primary and secondary care Greater flexibility than the current 2WW Potential barriers Data not currently collected and difficult to define end point consistently New national CWT system required to capture and report data Capacity in diagnostics and administration Potentially large changes in practice

Approach Five test sites: Leeds, East Lancs, Kingston, Bournemouth, Ipswich Two main objectives: Robustly test and develop rules (16/17) Explore impact on services of delivery of the FDS (17/18) Work collaboratively across test sites to develop approach Shared learning Build new standard from the ground up Develop and streamline good practice – set standard on that basis Alliances key in moving towards national rollout

Faster Diagnosis Standard Timeline 2016/17 2017/18 2018/19 Q1 Q2 Q3 Q4 Faster Diagnosis Standard Test site bid process Test site selection (07/16) Data set, exclusions and rules agreed Phase 1 – data development Test site close and evaluation Phase 2 – exploration of impact on services ISN, Framework for national rollout agreed with alliances Ongoing alliance support, working towards full compliance by 2020. Procurement process – new CWT system Project setup Development and testing of new CWT system Ongoing data collection for 28 Day FDS NHS Digital named supplier Development phase start Implementation of new system Further development

Develop and agree rules Agreed core dataset with test sites Set of clear rules, as well as exclusions and scenarios being developed e.g. patient death, dealing with misdiagnosis, how to apply DNA rules Now iterating with test sites – test and learn Still looking at primary care requested tests and how we might be able to include them Aim to keep as clear and simple as possible – will keep core principles of existing cancer waiting times standards ‘Complete pathway’ standard No adjustments or pauses

Rollout data New CWT system critical – collect additional data items that will also implement the new breach policy nationally Expect to have a phased collection – new items in shadow form initially (time tbc, 6 months?) Once data quality consolidated, begin working towards meeting new standard Early data collection will inform rollout schedule Significant change, priorities are: Minimise burden Integrate to existing systems and processes BUT make sure that the new data reflects the strategic priorities and importance of this new standard

Rollout performance Final ‘performance standard’ will be informed by results from test sites Taskforce suggested 95% but will keep under review Expect regions, alliances and other local networks to have a key role Links with ACE, transformation funding, diagnostic capacity fund 28 Day standard doesn’t exist in isolation Will be strongly informed by test site evaluation and feedback, but keen to engage more widely than that Test sites as ‘early adopters’ in each region

Milestones so far Test sites began collecting data c.October 2016 Consolidating data collection and definitions 16/17 Reviewing pathways and planning for changes in 17/18 Data set now going through SCCI approvals process – keep changes to minimum Discovery phase for new CWT system complete – development phase beginning

Reflections from test sites Relatively early in the process, however, some key reflections Diagnostic capacity is already clearly a challenge, in particular pathology and radiology Primary care must have a large role and be engaged It is going to take some time for this data collection to get off the ground – will need to have good support in place BUT Overall, performance is not as far away from the taskforce ambition as you might think Buy-in from clinicians and managers so far has been strong Patients have been well engaged in the project

28 Day Faster Diagnosis Standard – key considerations Tightly define cohort of patients How to deal with direct access referrals How to define and link ‘whole pathway’ related to one set of symptoms Key objective to reduce patients ‘bouncing around’ the system How to adjust for incorrect diagnoses and revising performance over time Avoiding perverse incentives Ensuring there is capacity in the system to allow providers to succeed

Summary Focus on the strategic goals – patient centred, faster, more flexible Carefully testing the approach and developing it ‘from the front line’ Dependent on data collection Inter-connected with wide range of other diagnostic initiatives which will be the focus for performance