HEAD AND NECK NETWORK SITE SPECIFIC GROUP And THYROID SUBGROUP CONSTITUTION Including Network Configuration and Operational Framework

Transcription

1 HEAD AND NECK NETWORK SITE SPECIFIC GROUP And THYROID SUBGROUP CONSTITUTION Including Network Configuration and Operational Framework Agreed by: Mr Iain McVicar Consultant Maxillofacial Surgeon, Nottingham University Hospitals EMCN Head and Neck NSSG Chairperson & Mr D Ratliff, Consultant Surgeon, Northampton General Hospital Thyroid Subgroup Chairperson 9 th July 2010 Agreed by: Mr T Rideout Chief Executive, NHS Leicester City Chairperson, EMCN Board 10 th August 2010 Agreed by: Mr Prem Singh, CE NHS Derby City As the designated representative of the PCTs in the Network for Measures 10-1A-202i, 10-1A-203i, 10-1A-204i, 10-1A-205i, 10-1A-206i 10 th August 2010 (Minutes of EMCN Board 10 th August 2010) Agreed by: The Trust Lead Clinicians of the MDTs 10 th August 2010 (Minutes of NSSG of 10 th August 2010) For 10-1C-110i, 10-1C111i Agreed by: EMCN Head and Neck NSSG & Thyroid Subgroup 9 th July 2010 Status: Final Publication Date: July 2010 Expiry Date: July 2012 EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 1/111

2 Contents Page 1.0 Introduction and Background The East Midlands Cancer Network Scope of the East Midlands Cancer Network Head and Neck and Thyroid Service 3.1 Primary Care Referral 3.2 Network Configuration of Teams and Diagnostic Services Head and Neck Thyroid 3.3 Distribution of Neck Lump Clinics 3.4 Distribution of Specialist Thyroid Clinics 3.5 Referral Guidelines for Primary Care Practitioners 3.6 Named Hospitals, Wards and Associated MDTs 3.7 Network MDT Configuration Facilities of Host Trusts 3.8 Designated Hospitals Receiving Referrals - Thyroid Lumps Local Support Teams Guidelines for Referral of Patients with UAT Membership - Head and Neck - Thyroid Terms of Reference User Engagement Commissioning Influence MDS and Data Collection Service Developments Clinical and Referral Guidelines Research and Trials Format of NSSG Meetings Agreements 35 Appendix A: Terms of Reference of EMCN Head and Neck NSSG and Thyroid Subgroup Appendix B: Job Specification: EMCN Head and Neck NSSG Chair and Thyroid Subgroup Chair Appendix C: Policy for Collection of Minimum Dataset 41 Appendix D: EM Head and Neck and Thyroid Cancer Clinical Guidelines 42 EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 2/111

3 Page Reference Number for Peer Review Measures Head & Neck NSSG Page Reference Measure Thyroid Subgroup Page Reference A-201i 29 (Membership) A-201i 31 (ToR) A-202i 5 7/8 10-1A-203i 7/ A-204i A-205i 11 7/11/34/ A-206i 7/11/34/46 11/ A-207i 11/49 11/34/50/ A-208i / A-209i / a-210i 34/ A-211i 9/ A-212i A-213i A-214i A-215i A-216i A-217i C-101i 29 34/ C-103i C-104i 25/29 35/ C-105i C-106i 35/104 34/ C-107i C-108i 34/ C-109i 34/ C-110i C-111i C-114i 105 EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 3/111

4 NHS East Midlands * NATCANSAT has not yet produced an East Midlands Cancer Network (EMCN) Map. The EMCN is not fully co-terminous with NHS East Midlands as it does not cover north Lincolnshire or Bassetlaw. However the map does serve to illustrate the size and complexity of EMCN OXFORD Oxford Radcliffe Hospital EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 4/111

5 1.0 Introduction and Background (Demonstrating Compliance with Measure 10-1A-201i and 10-1A-202i) The purpose of this document is to provide the East Midlands Cancer Network Board and East Midlands Stakeholder Organisations (Service users and their families or carers, Acute Trusts, Primary Care Trusts, Voluntary Sector Organisations, Users and Clinicians) with an overview of how the East Midlands Head and Neck and Thyroid Cancer Network is structured in order to provide Improving Outcomes Guidance (IOG) compliant services. The associated documents Work Plan and Annual Report - demonstrate how the Head and Neck Cancer NSSG and its Thyroid Cancer Subgroup support the delivery of clinically safe, evidence based, clinically effective, IOG compliant cancer services for patients with head and neck and thyroid cancer, which are responsive to user identified issues and recommendations. The chairs of the three local Head and Neck groups and representation for the thyroid subgroup met on 20 th November 2009 to agree how to develop an East Midlands Cancer Network Head and Neck NSSG. It was agreed that there should be a single group for the network which deals with Upper Aerodigestive Tract (UAT) cancer with a Thyroid Subgroup. Following on from this meeting the inaugural meeting of the East Midlands Head and Neck Cancer NSSG was held on 12 th March The Network Management Board agree the format for the oversight of head and neck cancer for the whole group which is set out below for ease of reference:- Format 2 as presented in the Manual for Cancer Services (Measure 10-1A-202i) A single group for the network which deals with UAT cancer having the structure, functions and terms of reference specified in Measure 10-1A-201i plus a separate single subgroup of the NSSG which deals with thyroid cancer. Please see section 6 for further details on the membership of the EMCN Head and Neck NSSG and Thyroid Subgroup. SEPARATE UAT NSSG AND THYROID SUBGROUP: Each group is reviewed separately and independently The following measures from the Manual for Cancer Services apply and will be reflected in the three documents: Measures 10-1c-101, 10-1C-102, 10-1C-109 to Applied once to each group 10-1C-114 Measures 10-1C-103, 10-1C-115, 10-1C116 Applied once to each group Measures 10-1C-104, 10-1C-105, 10-1C-107 Applied once to UAT group Measures 10-1C-106, 10-1C-108 Applied once to thyroid group 2.0 The East Midlands Cancer Network The East Midlands Cancer Network (EMCN) embraces a core population of approximately 4.2 million people. It was formed by the merger of the three previous East Midlands Cancer Networks Derby- Burton, Mid-Trent and Leicestershire, Northamptonshire & Rutland and went operational on 1 st October It is not fully co-terminous with NHS East Midlands. There are close cross boundary working relationships with the adjacent cancer networks North Trent, Pan EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 5/111

6 Birmingham, Mersey and Cheshire, Thames Valley and Anglia Cancer Networks, reflecting traditional patient pathways which are part of coherent integrated care pathways. The East Midlands Cancer Network is divided into discrete localities as follows: PCTs Total locality pop Trusts Hospitals Kettering Locality Northants Teaching PCT Northampton Locality Northants Teaching PCT LLR Locality Leicester City PCT Leicester County & Rutland PCT Burton Locality South Staffs PCT Derby Locality Derbyshire County PCT NHS Derby City PCT Nottinghamshire Locality Nottingham City PCT Nottinghamshire County PCT Lincs Locality Lincolnshire County PCT 284, ,294 1,017, , ,330 1,070, ,402 Kettering General Hospital NHS FT Kettering General Northampton General Hospital Northampton General University Hospitals of Leicester UHL Burton Hosp FT Queens Hospital Derby Hospitals NHS Foundation Trust Burton Hospitals NHS Foundation Trust Royal Derby Hospital Nottingham University Hospitals NHS Trust Sherwood Forest Hospitals Foundation NHS Trust City Hospital Queens Medical Centre Newark Hospital Kings Mill Hospital United Lincolnshire Hospitals NHS Trust Lincoln County Hospital Grantham Hospital Pilgrim Hospital 3.0 Scope of the East Midlands Cancer Network Head and Neck Cancer Service The three original East Midlands Cancer Networks Derby-Burton, LNR and Mid Trent, submitted IOG Action Plans to cover the implementation of the NICE Improving Outcomes Guidance for Head and Neck Cancer including Thyroid Cancer. All three sets of relevant networks teams, NSSGs and Boards were Peer Reviewed successfully against the associated measures in the first diet of review. It was agreed with Mr Stephens Parsons that following the reconfiguration of the three networks into the East Midlands Cancer Network the IOG Action Plans would not need to be reworked. This means that there are five specialist teams reflecting the original planning. This seems entirely logical given the geography of the network and the previous agreements. The East Midlands PCT Chief Executives reaffirmed their ongoing support for the IOG Plans as they stood. This support is documented in the minutes of the EMCN Board ( appended as additional evidence). The East Midlands Head and Neck and Thyroid Cancer Network provide all key services related to head and neck and thyroid cancer. In particular there is good local access to specialised surgery and PET CT. The East Midlands Head and Neck and Thyroid Cancer Services are described below and are compliant with the IA Measures for Head and Neck Cancer. EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 6/111

7 3.1 Primary Care Referral Policy (Demonstrating Compliance with Measure 10-1A-203i, 10-1A-205i and 10-1A-206i) The Chair of the East Midlands Cancer Network Board and the PCT Chief Executives of the reconfigured PCTs reviewed the original referral policy for head and neck and thyroid patients referred as urgent, suspicious of cancer at the EMCN Board on 10 th August 2010 They, on behalf of the East Midlands Health Community endorsed the policy unchanged as outlined below: The policy is that such patients should be referred on the agreed form to the 2WW Office (or similar) at: Kettering General Hospital for Northamptonshire PCT (Heartlands) Clinical Lead for Head and Neck Mr A Tewary. Mr Tewary is a core member of the Head & Neck SMDT. Clinical Lead for Thyroid Mr S Al-Hamali. Mr Al Hamali co-chair of the Northamptonshire Thyroid SMDT. Northampton General Hospital for Northamptonshire PCT (Daventry & South Northants and Northampton) Clinical Lead for Head and Neck Mr W Smith. This is a local and specialist MDT Clinical Leads for Thyroid Mr D Ratliff co-chair of the Northamptonshire Thyroid MDT University Hospitals of Leicester for Leicester City PCT and Leicestershire County & Rutland PCT Clinical Lead for Head and Neck - Mr J Hayter. This is a Local/Specialist MDT Clinical Lead for Thyroid - Dr I Peat. This is a Local/Specialist MDT United Lincoln Hospitals for Lincolnshire PCT Clinical Lead for Head and Neck - Mr Alasdair McKechnie. This is a local and specialist MDT working jointly with NUH through a VTC linked single MDT Clinical Lead for Thyroid Mr A McRae. This is a local/ specialist MDT working jointly by VTC with NUH. Sherwood Forest NHS FT for Nottinghamshire County PCT All patients are discussed at the Nottingham MDT. Clinical Lead for Thyroid Mr Nigam attends NUH MDT Nottingham University Hospitals for Nottingham City PCT Clinical Lead for Head and Neck Ms Lorna Sneddon This is a local and specialist MDT Clinical Lead for Thyroid Mr Chas Ubhi. This is a local and specialist MDT Derby Royal Hospital for NHS Derby City and Derbyshire County PCT Clinical Lead for Head and Neck Mr Keith Jones. This is a local and specialist MDT Clinical Lead for Thyroid Mr Jerry Sharp. This is a local and specialist MDT Burton Hospitals for South Staffs PCT Clinical Lead for Head and Neck and Thyroid - Mr A Thompson. This is a local MDT There is a single point of contact agreed as follows: Trust Named Contact Telephone/ Kettering General Hospital 2ww Office Northampton General 2ww Office Hospital UHL Cancer Office EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 7/111

8 Derby Hospitals Via Choose & Book or Direct Fax Colorectal Clinic Burton Patient Access Centre Direct Fax Kings Mill Choose and Book NUH Helen Andrews United Lincoln Julie Miller Extn 2660 The Primary Care Referral Proforma for each Trust have been scrutinised and confirmed as fulfilling the requirements of the network policy. 3.2 Network Configuration of Teams & Diagnostic Services (Demonstrating Compliance with Measure 10-1A-203i, 10-1A-205i) Each of the original networks was compliant with the number of specialist MDTs within the network. Given the complex geography and distance of the East Midlands that was one of the reasons why no reconfiguration was proposed after the merger. This was agreed with Mr S Parsons, Director, NCAT. As part of the Action Plan to implement the Improving Outcomes Guidance for Head and Neck Cancer the designated hospitals for Diagnosis and Assessment of patients fulfilling the criteria of urgent suspicious of head and neck and thyroid cancer and the associated clinicians are outlined in the following tables. All have the relevant contractual time. Head and Neck PCT Lincolnshire 701,402 Nottinghamshire 678,301 Nottingham City 288,754 Trust United Lincolnshire Hospitals NHS Trust Sherwood Forest Hospitals NHS Foundation Trust Nottingham University Hospitals NHS Trust Hospitals providing diagnostic services for Head and Neck cancer Lincoln County Hospital King s Mill Hospital Queens Medical Centre City Hospital MDTs And Lead Clinician Lincoln County Mr A McKecnhie Pilgrim Hospital, Boston Mr A McRae All patients referred to Nottingham MDT Queens Medical Centre Ms L Sneddon Refers to Specialist MDTs Lincoln County Hospital VTC with Nottingham Mr A McKechnie Queens Medical Centre Ms L Sneddon Queens Medical Centre Ms L Sneddon RT and chemo Provide both radio and chemotherapy In Lincoln RT Chemotherapy In Nottingham With some outreach chemo at SFHFT Provides both radio and chemotherapy Derby City 237,905 Derby Hospitals NHS Royal Derby Hospital Royal Derby Hospital Royal Derby Hospital Provides both radio and chemotherapy EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 8/111

9 PCT Derbyshire County 284,000 (40%) Trust Foundation Trust Hospitals providing diagnostic services for Head and Neck cancer MDTs And Lead Clinician Mr K Jones Refers to Specialist MDTs Mr K Jones RT and chemo South Staffs 333,417 Leicester City 292,660 Leicester County and Rutland Burton Hospitals NHS Foundation Trust University Hospitals of Leicester Queens Hospital, Burton Leicester Royal Infirmary Queens Hospital, Burton Mr A Thompson Leicester Royal Infirmary Mr J Hayter Royal Derby Hospital Mr K Jones LRI Royal Derby Hospital for RT Royal Derby and Burton for chemo UHL Radiotherapy Chemotherapy 679,447 Northamptonshire 678,300 Kettering General Hospital FT Northampton General Hospital KGH NGH Local MDT Mr W Smith Local MDT Mr W Smith Northampton General Hospital NGH Radiotherapy Chemotherapy Brachytherapy Some outreach chemo at KGH Thyroid PCT Lincolnshire 701,402 Trust United Lincolnshire Hospitals NHS Trust Hospitals providing diagnostic services for Thyroid cancer Lincoln County Grantham Hospital MDTs And Lead Clinician Local MDT Mr A McRae Refers to Specialist MDTs Lincoln County Hospital VTC with Nottingham RT and chemo Provide both radio and chemotherapy In Lincoln Nottinghamshire County 678,301 Nottingham City 288,754 Sherwood Forest Hospitals NHS Foundation Trust Nottingham University Hospitals NHS Trust Pilgrim Hospital City Hospital, Nottingham City Hospital Queens Medical Centre Local MDT Mr J Chelladurai Mr Nigam from Kings Mill Hospital attends NUH MDT City Hospital, Nottingham Mr C Ubhi City Hospital, Nottingham VTC with Lincoln RT Chemotherapy In Nottingham With some outreach chemo at SFHFT Provides both radio and chemotherapy EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 9/111

10 PCT Derby City Derbyshire County 500,330 South Staffs 333,417 Leicester City 292,660 Leicester County & Rutland 679,447 Northamptonshire 678,300 Trust Derby Hospitals NHS Foundation Trust Burton Hospitals NHS Foundation Trust University Hospitals of Leicester Kettering General Hospital FT Northampton General Hospital Hospitals providing diagnostic services for Thyroid cancer Royal Derby Hospital Queens Hospital, Burton UHL KGH NGH MDTs And Lead Clinician Royal Derby Hospital Mr J Sharp Queens Hospital, Burton Mr A Thompson Leicester Royal Infirmary Dr I Peat Dr S Al- Hamali Mr D Ratliff Refers to Specialist MDTs Royal Derby Hospital Royal Derby Hospital LRI Joint Northamptonshire MDT Co-chaired by Mr Al Hamali & Mr Ratliff RT and chemo Provides both radio and chemotherapy Royal Derby Hospital for RT Royal Derby and Burton for chemo UHL Radiotherapy Chemotherapy NGH Radiotherapy Chemotherapy Some outreach chemo at KGH 3.3 Distribution of Neck Lump Clinics (Demonstrating Compliance with Measures 10-1A-204i & 10-1A-211i) The designated neck lump clinics outlined below are recognised as providing sufficient access for the respective PCT populations. These clinics are specified in the Primary Care Referral Guidelines which include designated clinicians and contact points see Clinical Guidelines. They have been agreed with the EMCN Haematology NSSG (Minutes in portfolio) Neck Lump Clinic Designated Hospital Thyroid Included Kettering General Hospital Neck Kettering General Hospital Yes Lump Clinic Northampton General Hospital Northampton General Hospital Yes Neck Lump Clinic University Hospitals of Leicester University Hospitals of Leicester Yes Neck Lump Clinic United Lincolnshire Hospitals Lincoln County Hospital Yes Neck Lump Clinic Nottingham University Hospitals Queens Medical Centre Yes Neck Lump Clinic Royal Derby Hospital Neck Lump Royal Derby Hospital Yes Clinic Burton Hospitals Neck Lump Clinic Queens Hospital, Burton Yes EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 10/111

11 3.4 The Distribution of Specialist Thyroid Clinics (Demonstrating Compliance with Measure 10-1A-205i) The designated specialist thyroid clinics outlined below are recognised as providing sufficient access for the respective PCT populations. These clinics are specified in the Primary Care Referral Guidelines which include designated clinicians and contact points see Clinical Guidelines. PCT Designated Hospital Specialist Thyroid Clinic Nottinghamshire City Hospital Nottingham Yes Nottingham City Northamptonshire Northampton General Hospital Yes Leicester City Leicester County & Rutland Derby City Derbyshire County South Staffs LRI Royal Derby Hospital Yes Yes 3.5 Referral Guidelines for Primary Care Practitioners (Demonstrating Compliance with Measure 10-1A-206i, 10-1A-207i and 10-1A-208i) (Measure 10-1A-206i) The referral guidelines for primary care practitioners regarding patients with head and neck symptoms are included in the Guidelines for the Investigation and Treatment of Head and Neck and Thyroid Cancer Appendix D. (Measure 10-1A-207i) The referral guidelines for primary care have been distributed to primary care medical practices, primary dental practices, designated consultant clinicians, non-designated head and neck consultant clinicians (ENT surgeons, endocrine surgeons, OMFS surgeons, oral medicine specialists, endocrinologists, restorative dentistry consultants). These were distributed by PCT Cascade,post and the Trust internal distribution systems. (Measure 10-1A-208i) The referral proformas have been agreed by the NSSG and localised (by identifying a single referral point for each designated hospital to which proformas can be sent for direction to individual specialists) for each designated hospital across the EMCN. The referral proforma is used for patients with UAT symptoms which are outside the 'urgent suspicion of cancer' definition, and who have no neck lumps and allow for the referrer to categorise a patient by presenting features, so that the hospital can direct the referral to the relevant specialty (e.g. ENT, OMFS). The proforma have been cross referenced to the EMCN Guidelines to ensure that they are compliant with the agreed policies. 3.6 The Named Hospitals and Wards with the Named MDTs Associated with each Hospital (Demonstrating Compliance with Measure 10-1A-212i) The named hospitals and wards where the curative surgical treatment for head and neck cancer will take place are set out in the table below. The hospitals each fulfil the following criteria: They are the designated hospital for the diagnostic and assessment service (cross reference to Measure 10-1A-206i) They are the hospital where one or more named MDTs carry out all their curative surgical procedures for head and neck cancer. EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 11/111

12 They have a designated head and neck ward (as specified in Measure 10-1D-108i) Designated Hospital Designated Ward Associated MDT Queens Medical Centre Ward C24 Nottinghamshire MDT (VTC with ULH) Lincoln County Hospital Waddington Ward Lincolnshire MDT (VTC with NUH) Northampton General Hospital Collingtree Ward Northamptonshire MDT (KGH, NGH, MKGH) University Hospitals of Kinmouth Ward (LRI) Leicestershire MDT Leicester Royal Derby Hospital Ward 16 Royal Derby Hospitals FT SMDT (Derby & Burton) 3.7 Network MDT Configuration (Demonstrating compliance with Measure 10-1A-213i) The East Midlands Cancer Network Board has agreed, in consultation with the NSSG and the lead clinicians of each trust in the Network, the list of named MDTs and their locations in the network as set out in the table below. This list with the case mix types and their locations is the network MDT configuration for head and neck cancer. The team members and designated clinicians who provide the diagnostic and assessment service to the local catchment of the MDT are listed under each MDT in the following table. Head and NECK MDT VTC between Nottingham and Lincoln (Two teams one in Lincoln (LCH) and one in Nottingham (QMC)) Surgeons - Nottingham Ms L Sneddon, Consultant Head and Neck Surgeon Mr P Hollows, Consultant Maxillofacial Surgeon Mr I H McVicar, Consultant Maxillofacial Surgeon Mr N Beasley, Consultant ENT Surgeon Mr J A McGlashan, Consultant Head and Neck Surgeon Surgeons Lincolnshire Mr A McKechnie, Consultant Head and Neck Surgeon Mr M Clark, Consultant Maxillofacial Surgeon Mr A McRae, Consultant ENT Surgeon Mr J Chelladurai, Consultant ENT Surgeon Oncologists - Nottingham Dr J A Christian, Consultant Clinical Oncologist Dr M Griffin, Consultant Clinical Oncologist Oncologists Lincoln Dr J Baumohl, Consultant Clinical Oncologist Dr T Sheehan, Consultant Clinical Oncologist COMPOSITION UAT MDT With Salivary gland tumours With UAT cancer invading the skull base Skull Base MDT at QMC once a month with neurosurgeons, other ENT surgeons, opthalmologists, maxillofacial surgeons, neuro-radiologists etc. EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 12/111

13 Head and NECK MDT COMPOSITION Radiologists - Nottingham Dr R K Lenthall, Consultant Radiologist, NUH Radiologists Lincoln Dr I Rothwell Histopathologist - Nottingham Mr R O Allibone, Consultant Histopathologist Histopathologist Lincoln Dr M Reed Clinical Nurse Specialist - Nottingham Ms J Graves Clinical Nurse Specialist Lincoln Ms A Mason Speech and Language Therapist - Nottingham Ms S Slade Ms F Robinson Speech and Language Therapy Lincoln Ms S Taylor Dietitian - Nottingham Ms M Donaldson Dietitian Lincoln Ms S Whitworth Neurosurgical member Skull based tumours are discussed at both Head and Neck and Neurosciences MDT meetings. Both MDTs meet once a month in the Skull Base MDT. Neurosurgical members are Mr Iain Robertson and Mr Graham Dow who are extended members of the Head and Neck MDT. Northamptonshire Head and Neck MDT (Based at NGH) VTC with Kettering General Hospital Surgeons Mr W Smith, Consultant Head and Neck Surgeon Mr S Al-Hamali, Consultant ENT Surgeon Mr V Bahal, Consultant Head and Neck Surgeon Mr C Harrop, Consultant Maxillofacial Surgeon Mr A Tewary, Consultant ENT Surgeon Mr P Ameerally, Consultant Maxillofacial Surgeon Oncologists Dr G Andrade, Consultant Clinical Oncologist Head and Neck and malignant salivary gland Base of skull is referred on to the Oxford MDT EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 13/111

14 Head and NECK MDT Dr C Elwell, Consultant Clinical Oncologist Dr R Matthew, Consultant Clinical Oncologist COMPOSITION Radiologists Dr A Bisset, Consultant Radiologist Dr C Clark, Consultant Radiologist Dr V Sukumar, Consultant Radiologist Histopathologists Dr N Gorgees, Consultant Histopathologist Dr J Nottingham, Consultant Histopathologist Dr D Walter, Consultant Histopathologist Dr S Milkins, Consultant Histopathologist Clinical Nurse Specialists Ms P Gibbings Ms A Hicks Speech and Language Therapists Ms E Coker Ms K Jackson-Waite Dietitian Mrs K Owen Leicestershire Head and Neck MDT (Based at UHL) Head and Neck With Salivary gland tumours Base of skull is referred on to the Nottingham MDT Surgeons Mr T Alun-Jones, Consultant ENT Surgeon Mr P Conboy, Consultant ENT Surgeon Mr J Hayter, Consultant Head and Neck Surgeon Mr A Moir, Consultant ENT Surgeon Mr C Avery, Consultant ENT Surgeon Oncologists Dr I Peat, Consultant Clinical Oncologist Dr S Vasanthan, Consultant Clinical Oncologist Dr T Sridhar, Consultant Oncologist Dr D Peel, Consultant Oncologist Radiologists Dr B Morgan, Consultant Radiologist Dr R Vaidhyanath, Consultant Radiologist Histopathologists Dr P Shaw, Consultant Pathologist Dr C Kendall, Consultant Histopathologist Clinical Nurse Specialists Ms R White EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 14/111

15 Head and NECK MDT COMPOSITION Speech and Language Therapists Ms S Harris Dietitian Miss C Hanlon Royal Derby Hospitals Head and Neck MDT VTC with Queens Hospital, Burton Surgeons Mr K Jones, Consultant Maxillofacial Surgeon Mr S Mortimore, Consultant ENT Surgeon UAT MDT With Salivary gland tumours Base of skull was originally referred to Liverpool in the process of repatriation to NUH. Oncologists Dr M Kumar, Consultant Clinical Oncologist Radiologists Dr N Cozens, Consultant Radiologist Dr S Elliott, Consultant Radiologist Mr Kulkarni, Consultant Radiologist Histopathologists Dr I Robinson, Consultant Histopathologist Clinical Nurse Specialists Ms K Jukes Ms J Petrie Ms V Shepherd Speech and Language Therapists Ms A Cartwright Dietitian Ms S Moorley Ms L Munro Thyroid cancer (endocrine) only MDT VTC between Nottingham and Lincoln (Two teams one in Lincoln (LCH) and one in Nottingham (CHN)) COMPOSITION Thyroid only Surgeons - Nottingham Mr C Ubhi, Consultant ENT Surgeon Surgeons - Lincoln Mr A McRae, Consultant ENT Surgeon Mr J Chelladurai, Consultant ENT Surgeon EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 15/111

16 Head and NECK MDT COMPOSITION Oncologists - Nottingham Dr S Morgan, Consultant Clinical Oncologist Oncologist Lincoln Dr T Sheehan, Consultant Clinical Oncologist Histopathologists - Nottingham Dr Z Chaudhary Histopathologists Lincoln Dr M Reed Clinical Nurse Specialists - Nottingham Ms L Sellors Clinical Nurse Specialists - Lincoln Ms A Mason Northamptonshire Thyroid MDT VTC with Kettering Surgeons Mr D Ratcliff, Consultant Surgeon Mr S Al-Hamali, Consultant Surgeon Thyroid only Oncologists Dr R Matthew, Consultant Clinical Oncologist Radiologists Dr A Bisset, Consultant Radiologist Dr D Walter, Consultant Radiologist Histopathologists Dr N Gorgees, Consultant Histopathologist Dr J Nottingham, Consultant Histopathologist Clinical Nurse Specialists Ms P Gibbings Speech and Language Therapists Ms E Coker Dietitian Ms K Owen Leicestershire Thyroid MDT (UHL) Surgeons Mr T Alun-Jones, Consultant ENT Surgeon Mr P Conboy, Consultant ENT Surgeon Mr A Moir, Consultant ENT Surgeon Thyroid only EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 16/111

17 Head and NECK MDT COMPOSITION Oncologists Dr I Peat, Consultant Oncologist Dr R Matthew, Consultant Oncologist Radiologists Dr A Bisset, Consultant Radiologist Dr D Walter, Consultant Radiologist Histopathologists Dr C Kendall, Consultant Histopathologist Clinical Nurse Specialists Ms P Gibbings Kettering Diabetic & Endocrine CNS Speech and Language Therapists Ms E Coker Dietitian Ms K Owen Royal Derby Hospitals Thyroid MDT VTC with Queens Hospital, Burton Surgeons Mr J Sharp, Consultant ENT Surgeon Mr A Thompson, Consultant ENT Surgeon Thyroid only Oncologists Mr M Kumar, Consultant Oncologist Dr R Vijayan, Consultant Oncologist Radiologists Dr N Cozens, Consultant Radiologist Dr S Elliott, Consultant Radiologist Dr Kulkarni, Consultant Radiologist Histopathologists Dr D Green, Consultant Histopathologist Dr I Robinson, Consultant Histopathologist Clinical Nurse Specialists Mrs K Jukes, Clinical Nurse Specialist Ms J Petrie, Clinical Nurse Specialist Ms V Shepherd, Clinical Nurse Specialist Speech and Language Therapists Mrs K Young, Speech and Language Therapist Dietitian EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 17/111

18 Head and NECK MDT Mrs S Moorley, Dietitian COMPOSITION The facilities of the host trusts are as follows:- Host Trust Nottingham University Hospitals United Lincolnshire Hospitals Kettering General Hospital (as part of the linked Thyroid MDT) Facilities on site Thyroid Surgery Complex Specialist Head and Neck Surgery Craniofacial Surgery Chemotherapy Radiotherapy Imaging Radiology/Interventional Radiology Pathology Endoscopy Dietetics SALT ITU/HDU Designated Head and Neck Beds Prosthetics Nuclear Medicine Restorative Dentistry Videofluoroscopy PET-CT Local Support Group Thyroid Surgery Head and Neck Surgery Chemotherapy Radiotherapy Imaging Radiology Pathology Endoscopy Dietetics SALT ITU/HDU Designated Head and Neck Beds Prosthetics Nuclear Medicine Videofluoroscopy Local Support Group Thyroid surgery Imaging Pathology Palliative and Supportive Care Patient Information Outreach Chemotherapy SALT Dietetics Endoscopy Videofluoroscopy VOCAL Support Group (Local Support Group) EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 18/111

19 Host Trust Northampton General Hospital (as part of the linked Thyroid MDT) University Hospitals of Leicester Royal Derby Hospital FT Burton Hospitals NHS Trust Facilities on site Thyroid Surgery Complex Specialist Head and Neck Surgery Chemotherapy Radiotherapy Imaging Pathology Endoscopy Dietetics SALT FACE FAX Support Group ITU/HDU Designated Head and Neck Beds Prosthetics Nuclear Medicine Hygienist Restorative Dentistry Videofluoroscopy Thyroid Surgery Complex specialist Head and Neck Surgery Chemotherapy Radiotherapy Radiology (including interventional) Nuclear Medicine Restorative Dentistry Pathology Endoscopy Dietetics SALT ITU/HDU Designated Head and Neck Beds Videofluoroscopy Prosthetics PET-CT for LNR Specialist Head and Neck Surgery Thyroid Surgery Imaging Pathology Palliative and Supportive Care Patient Information Chemotherapy Radiotherapy ITU/HDU Prosthetics Nuclear Medicine SALT Dietetics Endoscopy Videofluoroscopy Support Groups Access to tracheostomy clinic Nurse led endoscopy Nurse led thyroid follow up Thyroid Surgery EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 19/111

20 Host Trust Facilities on site Imaging Chemotherapy Dietetics SALT Videofluoroscopy Nuclear Medicine Patient Information Palliative and Supportive Care Pathology 3.8 The Designated Hospitals Receiving Referrals of Patients with Thyroid Lumps (Demonstrating Compliance with Measure 10-1A-214i, cross reference to 10-1A-211i) In agreement with the Network Management Board, PCT leads and NSSG the following are the named PCTs which will refer patients with lumps clinically of thyroid origin to the named, designated hospitals. The configuration and associated populations are as originally submitted and accepted by NCAT and peer reviewed as compliant in the second diet of review. Referring PCT Nottingham City PCT Nottinghamshire County Teaching PCT Population Receiving Hospital for Lumps of Thyroid Origin 1,070,000 City Hospital QMC Lincolnshire PCT 701,402 Lincoln County Hospital Northamptonshire 284,087 Kettering General Teaching PCT Hospital (Heartlands) Northamptonshire Teaching PCT (Daventry, South Northants and Northampton area) 309,087 Northampton General Hospital Milton Keynes PCT 220,000 Milton Keynes General Hospital Leicestershire County and 1,017,900 University Hospitals of Rutland PCT Leicester Leicester City PCT Derby City 285,000 Derbyshire County 284,000 40% of population referred South Staffordshire 37% of population referred Leicestershire County 10% of population referred 220,150 66,000 Royal Derby Hospitals NHS FT Burton Hospitals NHS Trust 4.0 The Role of Local Support Teams in the Network (Demonstrating compliance with Measures 10-1A-215i, 10-1A-216i) MDT discussing patient Nottingham/Lincoln VTC MDT Northamptonshire Thyroid MDT Leicestershire Thyroid MDT Royal Derby Hospitals NHS FT Measure 10-1A-215i Distribution of Local Support Team: The distribution of the Local Support Teams remains as agreed with the original chairs of the Locality Groups at the time of the first diet of review. Named Local Support Team Designated Hospitals Area(s) Covered by Local Support Team EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 20/111

21 Derbyshire Local Support Team Leicestershire Local Support Team Lincolnshire Local Support Team Northamptonshire Local Support Team Nottinghamshire Local Support Team Derby Hospitals NHS Foundation Trust Burton Hospitals NHS Foundation Trust University Hospitals of Leicester NHS Trust United Lincolnshire Hospitals NHS Trust Kettering General Hospital NHS Trust Northampton General Hospital NHS Trust Nottingham University Hospitals NHS Trust Sherwood Forest Hospitals NHS Foundation Trust Derby Derbyshire Burton Leicester Leicestershire Rutland Lincoln Lincolnshire Kettering Northampton Northamptonshire Nottingham County Nottingham City Measure 10-1A-216i Role of Local Support Team Introduction It is clearly recognised that both patients treated curatively for Head and Neck Cancer as well as those treated symptomatically require considerable ongoing support both during and after any immediate treatment phase. To this end the service has established Local Support Teams to ensure that access to appropriate ongoing support is available as and when needed by each individual and their family or carers. Patients can have considerable co-morbidity. The surgical and non-surgical oncology treatments both of OMFS Cancer and ENT Cancers within the UAT can be physically demanding and alter radically the individual s appearance and speech with all the concomitant potential for psychological morbidity as well as physical disability. To maximise the support provision as close as possible to the individual there is a small core team that co-ordinate the relevant input from the appropriate local community services and hospital services. Purpose of the Local Support Team for Head and Neck Cancer Patients To manage the aftercare and rehabilitation of head and neck cancer patients within the relevant locality To work closely with the relevant specialist MDT To work closely with other teams who may have contact with Head and Neck patients on their cancer journey To have agreed shared-care policies with the referring MDT to ensure that there is clarity of responsibility for the provision of relevant care at each stage on the pathway To co-ordinate the provision from relevant local services for each individual EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 21/111

22 Service that require to be available through the Local Support Team The Local Support Team will ensure access to the following services for the individual as required:- Dietetics: advice on nutrition including modified consistency diet, special diets and supplements, monitoring of weight, feeding tube and associated stoma care management SALT: communication and dysphagia management Community Nursing: dressings, training of staff, valve care, monitoring of weight Palliative and Supportive Care Macmillan CNS, Hospital and Community Palliative Care Teams Welfare Rights: Disability rights if unable to return to work Support Groups: FACE FAX, Laryngectomy Association Information: Local information, Cancer Information, National Patient Information (Prescriptions) Community dentistry Prosthetics Physiotherapy; shoulder issues following radical surgery Occupational Therapy To ensure that the individuals and their family or carers receive timely and appropriate support. Whilst it is not envisaged that all disciplines will meet regularly on a formally basis it is envisaged that there will be clear channels for communication. Protocols agreed with the MDTs Valve care Nutritional Assessment Dental access Patient packs Please see below a summary of the protocol for referring patients back to members of the MDT from the local support team: EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 22/111

23 Patients are advised to contact these key persons should problems arise in between regular reviews once discharged from hospital or completion of treatment PROBLEM SUPPORT TEAM MEMBERS MDT MEMBERS Swallow District Nurse GP Speech & Language Therapist Hospital Clinician Dietitian Stoma / Valve District Nurse GP Speech & Language Therapist Hospital Clinician Nurse Practitioner Wound District Nurse GP Speech & Language Therapist Hospital Clinician Symptom Management District Nurse GP Speech & Language Therapist Hospital Clinician Alteration to the capacity for independence Relevant Short / Long / Term Team / GP Hospital Clinician EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 23/111

24 Co-ordinated Lead It is envisaged that in each team the lynchpin for co-ordination will be the CNS. However, if this is not possible then this role could, in certain circumstances be fulfilled by the SALT or dietitian. 5.0 The Guidelines for Referral of Patients with UAT (Demonstrating compliance with Measure 10-1A-217i and 10-1A-218i) The following are the guidelines for the referral of patients with UAT cancer from designated hospitals in the Network to the MDTs for UAT cancer. UAT, salivary glands, skull based tumours Patients fulfilling the following criteria should be referred: Newly diagnosed UAT cancer including malignant salivary tumour and skull based tumours They must meet the imaging criteria for suspected UAT, malignancy salivery tumour or skull based tumour. Imaging (CR or MRI) if this is a diagnostic test. Clinical symptoms suggestive of recurrence in patients with a previous history of UAT cancer, malignant tumour of the salivary glands or skull based tumour Palliative issues All relevant clinical information is required: Previous relevant surgery Case notes with history All diagnostic test results Where a reoccurrence of a cancer is suspected they will be discussed without confirmed histology. Table 1 - Referral to MDT for UAT and malignant salivary gland tumours Designated Hospital MDT for discussion MDT Co-ordinator Queens Medical Centre Single MDT VTC with Lincoln Nicola Hodgkinson Ext Lincoln County Hospital Single MDT VTC with Nottingham Wendy Smith ext 2659 Kettering General Hospital Northampton General Northamptonshire Head and Neck MDT Donna Jacobs Hospital Milton Keynes General Hospital (based at NGH) University Hospitals of Leicestershire Head and Lyn Connell Leicester Royal Derby Hospital Queens Hospital Burton Neck MDT Royal Derby Hospital Table 2 Referral to MDT for Base of Skull lesions Tehmoor Najib Designated Hospital MDT for discussion MDT co-ordinator Queens Medical Centre Single MDT VTC with Lincoln Nicola Hodgkinson Ext Lincoln County Hospital Single MDT VTC with Wendy Smith EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 24/111

25 Northampton General Hospital (including Kettering General Hospital patients) University Hospitals of Leicester Royal Derby Hospital (including Queens Hospital, Burton patients Nottingham ext 2659 Oxford MDT Donna Jacobs Via the Northamptonshire Head and Neck MDT Nottingham MDT Via the Leicestershire Head and Neck MDT Nottingham MDT Via the Derby Head and Neck MDT Nicola Hodgkinson Ext Gemma Tooby Ext Thyroid Patients fulfilling the following criteria should be referred: Newly diagnosed Thyroid cancer They must meet the imaging criteria for suspected thyroid cancer Imaging (CT or MRI) if this is a diagnostic test. Clinical symptoms suggestive of recurrence in patients with a previous history of thyroid cancer Palliative issues All relevant clinical information is required:- Previous relevant surgery Case notes with history All diagnostic tests results Where a reoccurrence of a cancer is suspected they will be discussed without confirmed histology. Table 3 Referral to MDT for Thyroid Tumours Designated Hospital MDT for discussion MDT co-ordinator Nottingham City Hospital Single MDT VTC with Lincoln Jackie Cowley Lincoln County Hospital Single MDT VTC with Ext Nottingham Kettering General Hospital Northamptonshire Thyroid MDT Bronwen Thomason Northampton General Hospital Northamptonshire Thyroid MDT University Hospitals of Leicester Leicestershire Thyroid MDT (based at LRI) Lynn Connell Royal Derby Hospitals Queens Hospital, Burton Royal Derby Hospital Tehmoor Najib The Northamptonshire MDT also takes ALL the Thyroid Cancer Patients from Milton Keynes General Hospital. These patients are cared for by Mr P Gurr who has a joint NGH/MKGH appointment. 6.0 East Midlands Cancer Network Head and Neck Cancer NSSG and Thyroid Subgroup Membership: (Demonstrating compliance with Measure 10-1A-201i and Measure 10-1C-101i, 10-1C-104i) EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 25/111

26 The NSSG Leads, at the Planning Meeting on 20 th November 2010, reviewed the membership requirements. It was agreed that the core membership would be as described within the Manual of Cancer Services, namely: MDT Lead from each Network MDT At least one nurse member of an MDT in the network A Service Improvement representative and NSSG lead Three User representatives, if possible or an agreed mechanism for securing user input NHS member responsible for users issues and patient/carer information (CNS) Member of the NSSG responsible for trials recruitment Named administrative/secretarial support (as documented) In the spirit of inclusion all members of the three previous NSSGs are members of the East Midlands Head and Neck Cancer NSSG or Thyroid subgroup.. The core membership of the East Midlands Head and Neck NSSG is compliant with the requirements of the guidance. It is multidisciplinary and has representation from each acute trust providing Local/Specialist services, links to Primary Care and to Users and Carers. Core members are marked**. However in recognition of the demands on clinical time it has been proposed that specialist groups marked* function as virtual subgroups and that at least one member will be present at the NSSG. Measure 10-1A-101i: The designated administrative support for the East Midlands Head and Neck Cancer NSSG and the associated Thyroid Subgroup is as follows: Mrs Beverley Dyson, Team Administrator EMCN Ms Janet Duffin, Service Development Manager, East Midlands Cancer Network Dr Elspeth Macdonald, Director, East Midlands Cancer Network These colleagues will work with the chair to organise the support for the meetings including venues, papers, minutes and other requirements identified by the NSSG Chair. East Midlands Cancer Network Head and Neck and Cancer NSSG Local Head and Neck MDT Name Base Kettering Local MDT Milton Keynes Local MDT link Burton Local MDT Mr A Tewary** Consultant ENT Surgeon, KGH Mr P Gurr** Consultant ENT Surgeon, NGH/MKGH Mr A Thompson** Consultant ENT Surgeon, QHB Specialist Head and Neck MDT Nottingham SMDT Ms L Sneddon** Consultant Head and Neck Surgeon QMC Derbyshire SMDT Mr K Jones** Consultant Maxillofacial Surgeon, RDH Leicestershire Mr J Hayter** Consultant Maxillofacial Surgeon, LRI SMDT Northampton SMDT Mr W Smith** Consultant Head and Neck Surgeon, NGH Lincolnshire SMDT Mr A Consultant Head and Neck Surgeon, LCH McKechnie** Thyroid MDTs Name Base Derbyshire SMDT Northamptonshire local & SMDT Consultant ENT Surgeon, RDH Consultant Surgeon, NGH NUH local & SMDT Mr J Sharp** Mr D Ratliff** & Mr Al Hamali** Mr C Ubhi** Consultant Surgeon KGH Consultant ENT Surgeon, CHN EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 26/111

27 East Midlands Cancer Network Head and Neck and Cancer NSSG Local Head and Neck MDT Name Base With Lincoln MDT Mr A McRae** Consultant ENT Surgeon, LCH Name Base NSSG Chairs Mr I McVicar** Mr W Smith** Mr J Sharp** Consultant Maxillofacial Surgeon, QMC EMCN NSSG Chair Consultant Head and Neck Surgeon, NGH Consultant ENT Surgeon, RDH Surgical Representation Medical Representation Imaging Representation* Pathology Representation* Oncology Representation* Dr V Bahal Mr N Beasley Mr M Clark Mr P Conboy Mr C Harrop Mr A Hawrani Mr P Hollows Mr K Lingam Professor N London Mr J McGlashan Mr A Moir Mr S Mortimore Mr A Perks Dr T Howlett Dr M Levy Dr A Bisset Dr C Clark Dr N Cozens Dr S Elliott Dr K Kulkarni Dr R Lenthall Dr B Morgan Dr I Rothwell Dr V Sukumar Dr Vaidhyanath Dr D Walter Dr R Allibone Dr N Gorgees Dr J Falconer- Smith Dr C Kendall Dr T Khan Dr J Nottingham Dr M Reed Dr I Robinson Dr G Andrade Dr S Muhkerjee Dr J Christian Dr C Elwell Dr M Griffin Dr R Matthew Dr S Morgan Dr I Peat Dr T Sheehan Dr S Vasanthan Consultant Thyroid Surgeon, KGH Consultant ENT Surgeon, QMC Consultant Head and Neck Surgeon, ULH Consultant ENT Surgeon, LRI Consultant Maxillofacial Surgeon, KGH&NGH Consultant ENT Surgeon, QHB Consultant Maxillofacial Surgeon, QMC Consultant Surgeon, RDH Consultant Surgeon, LRI Consultant Head and Neck Surgeon, QMC Consultant ENT Surgeon, LRI Consultant ENT Surgeon, RDH Consultant Plastic Surgeon, CHN Consultant Physician and Endocrinologist, LRI Consultant Endocrinologist, LRI Consultant Radiologist, NGH Consultant Radiologist, KGH Consultant Radiologist, RDH Consultant Radiologist, RDH Consultant Radiologist, Queens Hospital Burton Consultant Radiologist, CHN Consultant Radiologist, LRI Consultant Radiologist, LCH Consultant Radiologist, NGH Consultant Radiologist, LRI Consultant Radiologist, KGH Consultant Histopathologist, QMC Consultant Histopathologist, KGH Consultant Chemical Pathologist, UHL Consultant Histopathologist, DRI Consultant Histopathologist, NGH Consultant Histopathologist, NGH Consultant Head and Neck Pathologist, LCH Consultant Pathologist, RDH Consultant Clinical Oncologist, NGH Consultant Oncologist, NGH Research Lead for NSSG Consultant Clinical Oncologist, CHN Consultant Clinical Oncologist, NGH Consultant Clinical Oncologist, CHN Consultant Clinical Oncologist, NGH Consultant Clinical Oncologist, CHN Consultant Oncologist, LRI Consultant Clinical Oncologist, LCH Consultant Clinical Oncologist, LRI Service Mrs Cameron** EMCN SIL EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 27/111

28 East Midlands Cancer Network Head and Neck and Cancer NSSG Local Head and Neck MDT Name Base Improvement Ms Walker EMCN Local Improvement Lead NCRN Ms J Berridge NCRN Mid Trent Representation* Ms S Hare NCRN Derby Burton Palliative Care Representation* Clinical Nurse Specialist Representation* Allied Health Professionals Speech and Language Therapists Dietetics Ms S Nicholson Dr G Finn Dr V Keeley Dr S Shah Ms F Dawson Ms L Elliott Ms P Gibbings Ms J Graves Ms A Hicks Ms K Jukes Ms J Petrie Ms V Shepherd Ms S Slade Ms S Stringer Mrs R White Ms A Mason Ms A Cartwright Ms E Coker Ms S Harris Ms K Jackson- Waite Ms F Millichap Ms F Robinson Ms K Young Ms Donaldson Miss C Hanlon Ms S Moorley Ms L Munro Mrs K Owen Ms V Harrison NCRN LNR Consultant in Palliative Medicine, John Eastwood Hospice Consultant in Palliative Care, RDH Consultant in Palliative Care, Cransley Hospice, Northants Clinical Nurse Specialist, LRI Clinical Nurse Specialist, LRI Clinical Nurse Specialist, NGH (User Issues) Clinical Nurse Specialist, KMH Clinical Nurse Specialist, NGH Clinical Nurse Specialist, RDH Clinical Nurse Specialist, Queens Hospital Burton Clinical Nurse Specialist, RDH Clinical Nurse Specialist, QMC Clinical Nurse Specialist, KMH Clinical Nurse Specialist, LRI Clinical Nurse Specialist, LCH Speech and Language Therapist, Queens Hospital, Burton Speech and Language Therapist, NGH Speech and Language Therapist, NGH Speech and Language Therapist, NGH Speech and Language Therapist, Milton Keynes Speech and Language Therapy Manager, QMC Speech and Language Therapist, RDH Clinical Specialist Dietitian, QMC Head and Neck Dietitian, LRI Dietitian, RDH Dietetics, Queens Hospital Burton Senior Dietitian, NGH Dental Public Consultant in Dental Public Health, Health Northamptonshire Heartlands PCT Community Sister C Nichol District Nurse Liaison, Queens Hospital Burton AHP Lead EMCN Ms R Hopkin EMCN Allied Health Professional Lead Medical Physics Mr S Evans Head of Physics, NGH Mr P Goldie Senior Physicist, NGH Dr J Marais Nuclear Medicine Physicist, NGH Mr D Monk Medical Physicist, LRI Biochemistry Dr Gidden Consultant Chemical Biochemist, NGH Patient Representative Mr T Thompson** Communicating Members Ms S Bashir Ms D Julal Ms V Mallows Mr T Alun- Jones Oncology Data Manager, QHB MDT Co-ordinator, RDH PCT Cancer Lead Consultant ENT Surgeon, Glenfield and LRI EMCN Peer Review Self Assessment/ head & Neck NSSG and Thyroid Subgroup Constitution em 28/111