RE: Operational Standards for the Cancer Waiting Times Commitments

Transcription

1 30 July 2009 T: Strategic Health Authrity Chief Executives Primary Care Trust Chief Executives NHS Trust Chief Executives CC: Care Quality Cmmissin Mnitr NHS Imprvement Natinal Cancer Actin Team Strategic Health Authrity GFOCW Leads Prfessr Sir Bruce Kegh NHS Medical Directr Rm 504 Richmnd Huse 79 Whitehall Lndn SW1A 2NS Tel: Gateway Reference: Dear Clleague RE: Operatinal Standards fr the Cancer Waiting Times Cmmitments As yu knw, the Gvernment s Cancer Refrm Strategy, which was published in December 2007, utlined a significant prgramme t imprve cancer services, further with the aim being t make the services prvided by the NHS amngst the best in the wrld by One f the specific aims f the Cancer Refrm Strategy was t ensure that mre patients benefited frm the success f the existing cancer waiting times standards by extending these cmmitments. Alngside the intrductin f the new cmmitments frm the Cancer Refrm Strategy, a decisin was taken t align the mnitring f cancer waiting times with the existing 18 weeks data cllectin, the new cmmitments and the changes t the reprting methdlgy are explained in Annex A and B Operatinal standards were previusly set fr the existing cmmitments frm the NHS Cancer Plan. Hwever, the change f reprting methdlgy means that the peratinal standards used previusly fr the assessment f the 31-day and 62-day cmmitments (98% and 95% respectively) are n lnger suitable fr use within the NHS. The Department made a cmmitment t prduce revised peratinal standards t take accunt f these develpments. The new peratinal standards will, as previusly, take int cnsideratin that fr any given perid there will be a number f patients wh are nt available fr treatment within a waiting time standard because: they elect t delay their treatment (patient chice), are unfit fr their treatment r it wuld be clinically inapprpriate t treat them within the standard time. I wuld therefre like t advise yu f the new peratinal standards that will be applied t the existing cmmitments and thse intrduced by the Cancer Refrm Strategy:

2 Cmmitment (As specified in published Natinal Statistics data - where applicable) 62-Day (Urgent GP Referral T Treatment) Wait Fr First Treatment: All Cancers 62-Day Wait Fr First Treatment Frm Cnsultant Screening Service Referral: All Cancers 31-Day (Diagnsis T Treatment) Wait Fr First Treatment: All Cancers 31-Day Wait Fr Secnd Or Subsequent Treatment: Anti Cancer Drug Treatments Operatinal Standard 85% 90% 96% 98% 31-Day Wait Fr Secnd Or Subsequent Treatment: Surgery 94% 31-Day Wait Fr Secnd Or Subsequent Treatment: Raditherapy Treatments 94% All Cancer Tw Week Wait 93% Tw Week Wait fr Symptmatic Breast Patients (Cancer Nt initially Suspected) 93% Details f the methdlgy used t calculate these standards can be fund in Annex C. An peratinal standard fr the cmmitment f a maximum wait f 62 days fr first treatment fr thse patients wh are upgraded with a suspicin f cancer by the cnsultant respnsible fr their care has nt been prvided. This is because nt enugh patients have benefited frm the implementatin f this service yet t prvide enugh data fr a rbust calculatin f an peratinal standard. This wrk will be undertaken as sn as this is pssible. The Department f Health will use these peratinal standards as part f the assessment f deliverables with the NHS Operating Framewrk, and in ur wrk t supprt the implementatin f the Cancer Refrm Strategy within the NHS. We wuld als recmmend that these peratinal standards be used lcally within the NHS t infrm the develpment f services and the mnitring f Service Level Agreements. These peratinal standards will be shared with the Care Quality Cmmissin t infrm the develpment f indicatrs and scring systems within the assessments they carry ut. As future service develpments are implemented it may be necessary t revise these peratinal standards. Yurs sincerely Prfessr Sir Bruce Kegh NHS Medical Directr [email protected]

3 ANNEX A Cancer waiting times cmmitments intrduced by the NHS Cancer Plan and the Cancer Refrm Strategy. NHS Cancer Plan Cmmitments: The NHS Cancer Plan, published in September 2000 gave the fllwing cmmitments in relatin t access t cancer services: a maximum wait f tw weeks t see a specialist after being urgently referred with suspected cancer by a GP; a maximum wait f ne mnth frm diagnsis t first treatment fr all cancers; and a maximum wait f tw mnths frm an urgent GP referral fr suspected cancer t first treatment. Cancer Refrm Strategy Cmmitments: In rder t ensure that mre peple benefit frm better access t cancer services the Cancer Refrm Strategy, published in December 2007, gave extended cancer waiting times cmmitments. These new cmmitments are: a maximum wait f tw weeks fr thse patients referred urgently with breast symptms, where cancer is nt initially suspected (t be implemented frm December 2009); a maximum wait f 31 days fr a secnd r subsequent treatment, where the treatment is surgery (implemented frm 31 December 2008); a maximum wait f 31 days fr a secnd r subsequent treatment, where the treatment is an anti-cancer drug regimen (implemented frm 31 December 2008); a maximum wait f 31 days fr a secnd r subsequent treatment, where the treatment is raditherapy (t be implemented frm December 2010); a maximum wait f 62 days fr first treatment fr thse patients referred frm an NHS cancer screening service (implemented frm 31 December 2008); and a maximum wait f 62 days fr first treatment fr thse patients wh are upgraded nt a fast track pathway with a suspicin f cancer by the cnsultant respnsible fr their care (implemented frm 31 December 2008).

4 Annex B Methd fr Calculating Elapsed Time in a Cancer Waiting Times Perid It was recgnised that supprting the implementatin f the extended waiting times cmmitments within the Cancer Refrm Strategy meant that data wuld have t be cllected fr a much larger vlume f patients and episdes. In rder t minimise this burden upn NHS prviders it was decided t take the pprtunity affrded by this develpment t align with the existing 18 weeks data cllectin. Under this simplified prcess, cancer treatment prviders n lnger have t cllect infrmatin abut suspensins arising frm patients unfitness fr treatment r frm their taking time t think abut and discuss their varius treatment ptins. This updated data cllectin prcess therefre: makes the calculatin f waiting times mre meaningful fr patients by aligning it mre fully with their actual experience; vertime reduces the burden n the NHS f cllecting data, particularly f data that is nt used fr clinical purpses; streamlines the data cllectin prcess fr treatment prviders; brings cancer waiting times data int the mainstream f NHS perfrmance data prcesses; supprts patient chice and clinical autnmy (nt every patient wants t be treated within the standard time, and nt every patient can be); and helps deliver a service that better meets patients expectatins.

5 Annex C Overview f the methdlgy Used fr Calculating the Operatinal Standards These peratinal standards were calculated using statistics cllected in quarter three 2008/09 which gave accurate infrmatin detailing levels f patient chice r medical suspensins and current mnitring statistics (including perfrmance levels and admissin rates by tumur type and mdality). Where insufficient numbers f patient recrds relatin t secnd r subsequent treatment existed activity statistics frm 2008/09 relating t first treatment activity have been used as a prxy. Advice n the levels f cmplex individual cases where the cmmitments shuld nt be met fr clinical reasns was als factred int the mdelling. The apprpriateness f these peratinal standards was cnsidered by the Ging Further On Cancer Waits Advisry Grup, which includes representatives frm stakehlder rganisatins and the clinical cmmunity.