Published on: 1 March 2020

Sean DuffyHello, my name is Sean.

Every month in West Yorkshire and Harrogate, between 10,000 and 12,000 people are referred by their GP for investigation of cancer symptoms.  Between 600 and 700 will go on to be diagnosed and treated for cancer, and to experience the roller coaster of emotions that this inevitably introduces to their lives and their personal journey.

Two weeks ago, 150 patients, clinicians and leaders from across West Yorkshire and Harrogate came together  to celebrate and share good practice in enhancing patient experience and outcomes through improving cancer waiting times performance, with a particular focus on our most challenging tumour sites, prostate and lung.

Each of us was in the room because we are committed to delivering the best possible care and outcomes for all our patients. Cancer does not discriminate, and so it’s a given that many of the health professionals and managers there on the day had also experienced the personal impact of a cancer diagnosis and the importance of putting each individual person affected at the very forefront of our ambitions – wrapping services around our patients.

The event was a follow up to our launch last year of the WYH Cancer Improvement Collaborative, which heralded a new way of working together across our area, breaking down the artificial barriers that exist from the patient’s perspective between our organisations and approaching performance improvement as a system, rather than simply by individual provider Trust.

Julian_Hartley_with_patients_Sara_and_Richard_web.JPGIt was encouraging to hear from patients Richard Seddon and Sara Williamson – in conversation on stage with Cancer Alliance Board Co-Chair Julian Hartley – about some of the changes they are seeing from their perspective. Thought-provoking too as they reiterated their challenge to those not yet converted to the power of patient engagement in delivering improvements; their plea to develop a language that is common to all and to overcome the ever-present temptation to overcomplicate our information and our communications.

It was great to hear David Fitzgerald, National Cancer Programme Director and keynote speaker for the day, highlight West Yorkshire and Harrogate Cancer Alliance as an exemplar of good practice in terms of its integration with the wider WYH Health and Care Partnership, and its support for system-wide working to drive performance and improvement.

It was inspirational to hear from colleagues across our acute Trusts and local places as they outlined both the specific work they have been doing over recent months since the launch to support the collaborative, and also the daily efforts of our clinical teams and managers to improve our pathways.

System-wide analysis of the prostate and lung cancer pathways has been supported by the NHS Intensive Support Team, and each Trust has developed improvement plans which have been shared across the system.  These include the delivery of MRI scans before biopsy across all our Trusts, introducing more targeted biopsies and increased diagnosis of medium and high risk prostate cancer. Three out of six Trusts are planning to implement trans perineal biopsy, which gives more accurate diagnosis. In lung cancer, early access to CT scans and clinic triage in secondary care are among the successful developments.

A series of workshops, led by local clinicians and managers from local places, partner organisations and the Cancer Alliance Project Management Office team, facilitated shared learning across key elements of local improvement work.

Topics included prostate transperineal biopsy (Leeds Teaching Hospitals NHS Trust); pathway improvements in pathology (Mid Yorkshire Hospitals NHS Trust); personalised care in action (Cancer Support Yorkshire/Bradford Teaching Hospitals NHS Trust); workforce and new roles (Calderdale and Huddersfield NHS Foundation Trust). System-wide working towards pathology networks; radiology (CT and MRI) demand and capacity work, and new models of care, such as Rapid Diagnostic Centres, also featured on the agenda.

WYAAT Chief Executives with_David FitzgeraldAcross West Yorkshire and Harrogate, the Cancer Alliance is also using transformation funds to develop a network of dedicated improvement facilitators based in local places. Along with the Optimal Pathways team now hosted within Calderdale and Huddersfield NHS Foundation Trust and the three Macmillan-funded posts already supporting the system to offer personalised support post cancer diagnosis, they form a strong place-based improvement resource to drive and co-ordinate change at local level.

Despite this excellent progress, we have to acknowledge, that we are still some way short of achieving our ambitions and the desired impact on the number of patients treated within 62 days of an urgent referral – one of the national cancer waiting time standards which are viewed as a touchstone for the performance of the NHS.   From talking with our patients, we know that for many of them, this element of their cancer journey creates the greatest distress and psychological impact.

The Cancer Alliance Board provides system leadership for delivery of the overall strategic plan for cancer across WYH. In relation to operational performance, the Alliance works closely with WYAAT leadership and its constituent six local Trusts. Together, we have set out our strategy for how we will build on the firm foundations now in place and effect a significant change in performance, and therefore patient experience and access.

Next steps include:

  • Taking continued ownership as a system of the challenge to recover – across West Yorkshire and Harrogate, this means improving access for the 40 – 50 patients each month who are currently facing unacceptable waits beyond the performance standard
  • Over the next month, each Trust will work up its improvement plan for demonstrable and quantified service improvement. Where additional investment is required, this will be clearly identified and costed
  • Plans will focus in the first instance on the most challenged pathways – prostate, lung, lower and upper gastrointestinal cancers, but not at the expense of other pathways
  • Organisational teams will support each other to test the robustness of local plans to come up with the best system-wide solutions to addressing gaps in capacity.Based on this, we will develop a West Yorkshire and Harrogate plan for 2020/2021that identifies the support we require over and above that which can be achieved through Alliance transformation funding.

Colleagues in the Cancer Alliance Programme Management Office will work closely with senior leadership teams within our acute Trusts to agree the most cost effective strategy for delivering improved performance without adversely affecting current pathway performance, or impacting negatively on patient experience or outcomes.

The strategy will be shared with the Health and Care Partnership’s System Leadership Executive for discussion, support and agreement, particularly in relation to securing commissioning support or calls against wider ICS transformation funding where required.

Together, as a system, we can allow ourselves some collective pride in the way the system has come together in a committed, open and transparent way from Board level (with the commitment of all six WYAAT Chief Executives) across organisations through to the ‘shop floor’ – our NHS frontline.

Through a willingness to strengthen quality improvement methodologies and to be transparent about gaps and areas for improvement, our organisations have facilitated an appreciation of how best to use the resources available and an emerging understanding of how any additional funding available could be used to support further operational performance improvement. The quality and maturity of relationships across our WYH Integrated Care System has been key to what we have achieved so far – and stands us in good stead for the future.

Have a good weekend,
Sean

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