1. The Good, The Bad and The Patient Choice! Colorectal Patient Pathways Across the Network Presented by: Teresa Coombes Cancer, Oncology, Haematology and Palliative Care Business Unit Manager

2. Its Not Going Away! National slide in Cancer Waits Performance Focus on pathways – remove the “muppetry” and identify the real issues All SSG’s having discussion

3. National Position Sliding…….

5. Local Performance Variable…… TrustDec’14Jan’15Feb’15 UHB84.6% (81.8%)80.0% (77.8%)75.0% (36.4%) Weston88.1% (90.0%)75.4% (100.0%)90.2% (100.0%) Yeovil81.7% (100.0%)87.95% (80.00%)89.25% (100.0%) Taunton83.2% (57.1%)79.4% (52.6%)79.1% (50%) RUH NBT Trust 62day Performance (GP Sus Refs) (Colorectal Specific performance)

6. The Good: Weston First seen day 7 Completed diagnostic tests and MDT discussion by day 32 Surgery undertaken on day 43 Yeovil First seen day 14 Completed diagnostic tests and MDT discussion by day 41 Surgery undertaken on day 50

7. The Bad Challenging! UHB First seen day 7 Completed diagnostic tests and MDT discussion by day 62 Surgery undertaken on day 79 Trust Breach Review The delays for both multi-disciplinary team meeting and outpatients caused this pathway to exceed 62 days. Weston First seen day 13 Completed diagnostic tests and MDT discussion by day 72 Surgery undertaken on day 110 Trust Breach Review 48 day admin delay in booking the colonoscopy, (mismatch of access policies)

8. The Bad Challenging! RUH General outpatient and inpatient capacity, just due to the increasing number of referrals. Endoscopy capacity, particularly when our endoscopy unit is used as an inpatient ward when we're in black(!), but also just the general increase in demand. Waits for radiology appointments, particularly CT colonograms, and also the delay for radiology reports. The radiology delays are the main issue for us. MPH Our single biggest challenge at Taunton for meeting the 62 day pathway is access to endoscopy. Our waits for colonoscopies are particularly long. Also our histopathology staffing shortages can cause delays to reporting the endoscopies which further delays things. Some delays to first appointments caused by the need to triage cases and the reluctance of some patients to attend for invasive tests

9. The Bad Challenging! YDH First seen day 5 Completed diagnostic tests and MDT discussion by day 55 Surgery undertaken on day 82 Trust Breach Review Treatment plan initially dated in target further imaging requested outside of MDT, previously agreed treatment plan then followed. Glos

10. The Patient Choice: Across all MDT’s Frequent deferral of first appointment (higher if direct to test?) During diagnostic phase (CT / MRI / Endoscopy) Deferral of RT if delivered as outpatient Nothing we can do about this! Deferral of surgery - adjustable

11. Problem Solving! Sharing of best practice and “whose done what” Endoscopy capacity solutions? Expansion of CNS roles? Answers on a Postcard Please…………..