Importance of operational grip on cancer recovery The journey from despair to hope to success .

1. Importance of operational grip on cancer recovery The journey from despair to hope to success.

2. Introduction • Where were we? • IST support • A few simple changes helped turn cancer performance around • Focused support on challenged areas • Culture change “We’re taking cancer seriously” • Going from failing 2ww and 62 day to passing 3 quarters in a row • Still got a way to go! RBH

3. Background • Failing performance • High numbers on the PTL • High number of interim managers • Turnover in cancer team • Dermatology issue • Clinical Admin Team (CAT) restructure + turnover • Acceptance RBH

4. IST involvement • Demand & Capacity Review on 1st OPA, Diagnostic and IP wait • Advice around PTL meeting • Attendees • Format • Expectations • Training • Support on content and delivery RBH

5. Turning point • Demand & Capacity work complete and capacity on line and gap quantified. • Expectation that 2ww performance should be sorted for Quarter 1 2016. • Reality – at the end of April we had 268 breaches = whole quarter tolerance gone by end of the first month. • Agreed an ambitious but realistic goal of passing 62 day by Quarter 3 2016 RBH

6. Process • Pathway divided into a logical approach: • 2WW • Diagnostics • 62 Day • Quarterly trajectories by IST reflected this approach • Trust CCG and NHSI approved the trajectories RBH

7. Relationship management • Cancer Action Group • Weekly meeting, very quick • Chief Operating Officer, Planned Care Leaders, Cancer Pathways Manager, Access Manager, Service Managers as required • Discuss performance and predicted performance, decide short term action and support long term action • CCG transparency • Monthly executive led meetings including performance leads – less reactive reporting and a more transparent approach • Led by Chief Operating Officer • Open and challenging forum • Quarterly trajectories agreed with the NHSI / NHSE RBH

8. Gaining operational grip- 2WW • Daily Cancer Ops Meeting • Very quick • Snapshot of breaches and referrals • Attended by all specialties ranging from Booking Officer to Service Manager • Senior Chair • Visual management, high impact • Very quick to set up • Iterative! • Engaged and empowered teams who can own the pathway RBH

9. RBH

10. Gaining grip- 2WW • Open conversations with patients about choice to reduce cancellations Your GP has referred you very urgently to exclude a potentially serious issue such as cancer. We strongly advise you to accept this appointment. • 88 2ww choice breaches in April ’16 – 89.5% • 39 2ww total breaches in June ’16 – 97.2% • Lowest performing month since was Sept ’16 – 69 choice breaches, 95.1% • 1 complaint • “Aim for 7 days to achieve 14” RBH

11. Gaining grip - Radiology • Getting priority clear for diagnostics • Amended PAS order priority • Changed from “2ww” to “2ww suspected cancer” • Reduced inappropriate use of the 2ww priority and capacity • Allowed services to prioritise the 2ww booking process • Much clearer demand for true 62 day patients • Push to get diagnostics through in 7 days RBH

12. Gaining grip – Endoscopy • Endoscopy weekly meeting • Attended by clinicians, nurses and management • Additional management support • High clinical engagement • Problems broken down into manageable chunks • Structured and well supported • Most problems were solved by the service teams • Prioritised and visible demand managed by an empowered team RBH

13. Gaining Grip - 62 Day • Focus of tracking changed • Decrease in number of active patients on PTL – Jan 2016 saw over 2000 patients compared to now, between 1200-1400 patients. • Infoflex updated to fit our tracking needs • PTL meetings re-launched and given top priority • Every patient discussed • Come with completed actions • Up-to-date • Business as usual RBH

14. Gaining Grip - 62 Day RBH

15. Gaining Grip – Long Waiters • 104 day patients • Reviewed daily and actively managed • Rapid next steps • Escalation • Harm review • Start at day 90 • Clinical Harm Review board launched • Pathway reviewedby Lead Cancer Nurse • Chaired by Medical Director

16. Gaining Grip - 62 Day • Breach board in MDTC room • White board on the wall • Separated by month, patient initial, site and Hospital number • Any patient at risk of breaching in this month or next • Very visible to whole team • Predict performance RBH

17. Gaining Grip - 62 Day • IST review of training • Cancer training was introduced beyond the cancer team • All members of the clinical admin teams attended • Continue to be rolled out once a month • Training for the consultants is currently in the planning stages. RBH

18. Ethos at RBH • Accept no 2WW breach due to capacity • Only accept informed patient choice breaches • Understanding across all staff groups that the standards reflect: • High quality patient care • Improved outcomes • Trust priority for our patients • Achievement of the cancer standards is a good indicator that we are doing right by our patients RBH

19. Where we are now Current performance Q4: 2ww 96.6%, 62 day 85.7% Yearly performance 16/17: 2ww 95.4%, 62 day 85.02% Continuing to work through: • CT CIN (contrast-induced nephropathy) • Constant updates to our demand and capacity work • Quality of referrals • Vague symptom pathway • Tertiary referrals • Diagnosed by day 28 RBH

20. 2 Week Wait Performance RBH

21. 62 Day Performance RBH

22. Summary • Lots of small changes and a few larger projects • Logical approach broken down into manageable chunks • Focused support, particularly in diagnostics • Culture change regarding patient choice • Constant 2ww growth • Culture change at every level that we will push for continuous improvement. RBH

24. Laurie Scott Director of Operations Laurie.scott@royalberkshire.nhs.uk Chris Lowrie Directorate Manager Berkshire Cancer Centre Chris.lowrie@royalberkshire.nhs.uk Charlotte Wood Cancer Pathways Manager Charlotte.wood@royalberkshire.nhs.uk