The Acute Oncology Project Mrs Jenny Almond Project Lead for Acute Oncology

Background Recent reports from NCEPOD and NCAG recommend reform in the way acute oncology is structured and managed Acute Oncology Team at each Trust with an Emergency Department CCO is leading local design of acute oncology service in collaboration with MCCN

Project Management Structure An Acute Oncology Project Steering Group established with representation from MCCN Vision 2020 Steering Group Chair: Silas Nicholls Acute Oncology Project Steering Group Chair: Jenny Almond MCCN Clinical Advisory Group Chair: Ged Corcoran

Acute Oncology Issues High level bed occupancy in acute Trusts Acute oncology patients have complex medical needs and can be classified as: Known cancer patients with complications of chemotherapy Known cancer patients with complications of their disease Patients with Unknown Primary disease (~5% of all cancer pts)

NatCanSAT Data Analysis CCO & MCCN have jointly commissioned a detailed data analysis Led by Brian Cottier Understanding current and future ‘acute oncology’ workload Better understanding of emergency admissions                                N A  T  C  A  N  S  A  T The National Cancer Services Analysis Team

UKP Audit at St Helens & Knowsley Focus on early referral to oncologist Use of UKP pathway Reduced time to diagnosis Earlier planning and delivery of treatment Reduced LOS from 22 to 11 days Similar results seen at Sherwood Forest Hospitals NHS Trust

Aims of Acute Oncology Project Establish an Acute Oncology Team at each Trust with an ED (7 Trusts) This should lead to: Faster and better care of patients with complications of chemotherapy Faster and better care of patients with complications of cancer Appropriate investigation of UKP patients

Collaboration Acute oncology requires collaboration between: Oncology Palliative care Acute Medicine ED Haematology

Acute Oncology Clinical Model Monday – Friday, 9-5 service Consultant Oncologist to provide one clinical session per day at each Trust Clinical Nurse Specialist support to level of 1 FTE per Trust Secretarial support AOT Office

Acute Oncology Patient admitted via ED or AMU ‘Onco Alert’ to AOT Portfolio of protocols / pathways Oncologist / CNS review Diagnostic & Treatment Plan

Out of hours advice Initial contact with CCO’s triage service Triage being redesigned to meet the needs of acute oncology On-call oncologist available for telephone consultation

Acute Oncology -Peer review NCAG has recommended: Establishment of an acute oncology service with appropriate professional involvement Numbers of patients presenting with cancer as emergencies Interval between admission and oncological assessment Time to referral to appropriate specialist team Total length of stay for previously undiagnosed cancer patients

Local Implementation Plan Subject to agreement by commissioners the service will be rolled out in 3 phases: Two early implementer sites (2009/10) Three further Trusts (2010/11) Final two Trusts (2011/12)

Acute Oncology Progress Draft case in need produced for review Discussions are underway with RLBUHT and W&H NHS FT (EISs) Information will be cascaded at both Trusts by Cancer Lead Acute oncology meeting - April at RLH Plan to have an AOT at RLH in October 2009

Acute Oncology Progress cont… Re-design of triage service commenced (Kim Barrow / Mike Varey) CCO Medical Director planning medical staffing Develop CNS job descriptions / plans

Thank you for your attention Any questions? Further information: jenny.almond@ccotrust.nhs.uk