Specialist Therapeutic Services. 2012/13 End of Year Review

Transcription

1 Specialist Therapeutic Services 2012/13 End of Year Review

2 Overview NHS Blood and Transplant (NHSBT) has a long history of providing life-saving and life-enhancing therapeutic apheresis services within the NHS. Specialist Therapeutic Services (STS) provides patients access to a portfolio of therapies using technology that exchanges, removes, or collects certain components within the blood. Treatments provided include; Plasma Exchange, Peripheral Blood Stem Cell Collection, Red Cell Exchange, Extracorporeal Photopheresis, Low Density Lipoprotein Removal, Lymphocyte Collection, Platelet Depletion and White Cell Depletion. For more information on the services we provide please refer to the procedure portfolio on the last page of this document. STS delivers its services from six units that are based within NHS Trusts and which operate an outpatient model for non-acute patient procedures. Delivering services from within an acute setting enables STS to offer a peripatetic outreach model for paediatrics and acutely unwell patients. Our units are located in the following Trusts: The Christie NHS Foundation Trust North Bristol NHS Trust Oxford University Hospitals NHS Trust Sheffield Teaching Hospitals NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Royal Liverpool and Broadgreen University Hospitals NHS Trust. Activity Review 2012/13 In 2012/13 STS provided approximately 4,500 patient treatments. Low Volume Procedures eg platelet and white cell depletion and red cell exchange 141 3% Plasma Exchange 1,768 40% Peripheral Blood Stem Cell Collection % Photopheresis 1,347 30% Low Density Lipoprotein Removal 222 5%

3 An update on STS key achievements and successes in 2012/13: Strategic Intent Approval of Strategic Plan In 2012 the first ever strategic plan for STS was approved by the NHSBT board. This important milestone acknowledged the increased demand within the NHS for consolidation of specialist services delivered by centres of excellence. As a national service provider, STS is uniquely positioned to supply these services to patients. The main strategic objective for STS is to become the NHS preferred provider of high quality, cost effective therapeutic apheresis services. Service Improvement Initiatives Patient Experience Survey Last year STS carried out a survey to establish how patients rated their experience of the service we provide. The survey was conducted across each of the six STS units during July and August. Extremely positive results were received from all locations achieving a top box score (percentage of nine and ten out of ten scores) of 95% for patients overall experience with the service. The quantitive data was accompanied by numerous positive comments from patients. The patient experience survey will be conducted on a bi-annual basis and a summary report from the 2012 survey is available on the STS hospitals webpages. Service User Satisfaction Survey In September 2012, STS carried out a survey to seek feedback from service users to measure their satisfaction with the service we provide. Report analysis shows a top box score for overall satisfaction of 58%. Responses were received from 37% of clinicians who referred to STS in 2011/12. There was opportunity to rate satisfaction (1-10) and provide more qualitative feedback in the form of comments. Areas demonstrating greatest satisfaction were the professionalism and attitude of STS staff, quality of service delivery from nursing staff and quality of clinical advice from medical teams. STS has developed a number of recommendations and an action plan as a result of the survey feedback. The service user s satisfaction survey summary will be conducted on a bi-annual basis and the report which includes all resulting recommendations is available on the STS hospitals webpages.

4 Relocation of STS Units Given the clinical nature of the service we provide, our units are ideally sited within a hospital. There has been considerable investment to optimise current unit space and unit locations across the country. An overview of unit relocations from last year and next year is provided below: Manchester: We officially opened our new Photopheresis unit at The Christie NHS Foundation Trust on Friday 2nd November Sheffield: The Sheffield unit is situated within Sheffield Teaching Hospitals NHS Foundation Trust. Following an increase in referrals within the region, the unit will relocate into a larger space (within Sheffield Teaching Hospitals NHS Foundation Trust) later in Liverpool: The Liverpool unit is situated within the Royal Liverpool and Broadgreen University Hospitals NHS Trust, however, is not directly linked to the hospital clinical areas. Plans are now being progressed to relocate the unit to a more appropriate clinical area within the Trust in the next six to nine months. Bristol: The Bristol unit is currently located within the NHSBT blood donor clinic at Southmead Hospital (part of North Bristol NHS Trust). The unit is being relocated into University Hospitals Bristol NHS Foundation Trust in early Machine Technology In order to improve services to patients, donors and service users, STS has undertaken a number of tenders to improve and replace the machine technology used within each of our units. During 2012 the Optia multi-purpose machine technology (manufactured by TerumoBCT) has been implemented into each STS unit (and the former Spectra machines de-commissioned). We have upgraded the technology used for Photopheresis to the Cellex provided by Therakos. Launch of New Photopheresis Service Bristol In September 2012 our Bristol unit launched a new Photopheresis service, provided collaboratively with University Hospitals Bristol NHS Foundation Trust. Providing a local service from the Bristol unit enables patients from the South West of England to have improved access to this specialised service. Prior to this, patients from this area were either required to travel to centres in London or Southampton for treatment. This service improvement initiative was supported by the South West Commissioning Group. Anthony Nolan Regional Collection Centre Sheffield In early 2012, the STS unit in Sheffield was awarded a contract by the Anthony Nolan UK charity, to provide a regional collection centre in the North of England. STS provides this Stem Cell collection and Bone Marrow harvesting service in collaboration with Sheffield Teaching Hospitals NHS Foundation Trust. Prior to this contract award, Stem Cell collection and Bone Marrow harvesting for Anthony Nolan donors was only undertaken in London.

5 Quality and Compliance One of the main strategic objectives for STS is to provide apheresis therapies that meet the highest standards of safety and regulatory compliance. STS is the only area of NHSBT where treatment is provided directly to NHS patients and therefore our first priority will always be their safety and the quality of their experience. STS has a longstanding exemplary performance in this area having never received a major or critical non compliance and no attributable Serious Untoward Incidents. In 2012, each STS unit was inspected by the Care Quality Commission and found to be fully compliant with all essential standards for quality and safety. Units are also regulated by the Human Tissue Authority and accredited by the Joint Accreditation Committee ISCT (Europe) & EBMT (JACIE). In addition to regulation via external inspection bodies, STS also undertakes a range of internal audits of practice. Over the last twelve months, these included: Audit of the use of National Forms Audit of Infection Control Practice Audit of Consent Practice Re-audit of Transfusion Knowledge & Practice in Apheresis Units. Stakeholder Communication Initiatives As part of our strategy to improve patient, donor and service user engagement, dedicated patient and hospital webpages have been developed: Patient Webpages In March 2013 STS launched new dedicated patient webpages. Patients, donors (and the public) can access a wealth of information on STS and are able to review and download useful information, eg patient information leaflets. The pages are hosted on our corporate website under the following link: Hospital Webpages Our hospital webpages provide detailed information which service users may find of interest eg: Procedure portfolio Referral forms Patient information leaflets Compliments and complaints procedure. The webpages are accessible on the NHSBT hospitals and science website, under the following link:

6 Looking ahead to 2013/14 STS has an ambitious agenda in 2013/14 to provide more life enhancing and life saving treatments to patients. In addition to provision of these services, STS has a number of key strategic objectives: Appointment of a Head of Specialist Therapeutic Services Continued expansion of Photopheresis services Completion of market analysis to inform future demand for apheresis therapies Review on-call service provision in response to the guidelines on the diagnosis and management of Thrombotic Thrombocytopenic Purpura and other Thrombotic Microangiopathies. We are delighted that for the second year running, there is no generic or inflationary uplift of prices for the services provided by STS. We are planning to undertake a comprehensive pricing review of our therapeutic services in the next financial year (proposed implementation 2014/15). The purpose of this exercise is to ensure that whilst recovering our costs, we provide the most cost effective therapeutic services for the NHS. The 2013/14 Service Level Agreements (for provision of STS services) were distributed to Chief Executives for signature at the end of March A copy of the clinical services section of the agreement will be sent separately to referring clinicians for reference.

7 Specialist Therapeutic Services Procedure Portfolio Therapeutic Plasma Exchange Removal of disease mediators or to substitute missing or defective constituents in the plasma for the treatment of a wide range of patients across a number of clinical specialities. The process removes the patient s plasma and replaces it with either fresh frozen plasma components or refined plasma products. Peripheral Blood Stem Cell Collection Used in bone marrow transplantation for the treatment of some blood cancers and solid tumours. Stem cells are collected from either patients, for use in their own treatment, or from donors. The procedure separates the blood and removes only the specific white blood layer which contains the stem cells then returns the remainder of the blood back to the patient or donor. Extracorporeal Photopheresis Integrated two-stage procedure involving the collection and removal of white cells, which are treated with a photo activated drug and exposed to ultraviolet light then returned to the patient. Used for the treatment of Cutaneous T cell Lymphoma and Chronic Graft versus Host Disease (a side effect in some bone marrow transplants). Low Density Lipid Removal Removal of low density lipid cholesterol molecules, using absorption technology, in patients with hereditary high levels of cholesterol who do not respond adequately to cholesterol lowering drugs and low fat diet. Lymphocyte Collection This collection process is very similar to the collection of stem cells. Lymphocytes (a type of white blood cell) are collected from donors who have previously donated stem cells to further support the patient in their treatment by helping to induce a beneficial graft vs. disease effect. Red Cell Exchange Performed in a procedure similar to plasma exchange in which red cells are removed and replaced. Red cell exchange is used for the treatment of red cell disorders or disease such as sickle cell disease or some cases of malaria. White Cell Depletion Performed on patients newly diagnosed with leukaemia who have excessively high levels of white cells in their blood in a procedure similar to stem cell collection. Red Cell Removal This procedure removes excess red cells circulating in the blood as a result of a disease called polycythemia. It is similar to a red cell exchange but without the replacement of red cells. Platelet Depletion A rare procedure for the removal of large volumes of platelets in patients with very high platelet counts caused by an underlying disease. It is similar to the platelet component collection procedure undertaken on volunteer donors.

8 NHS Blood and Transplant NHS Blood and Transplant (NHSBT) saves and improves lives by providing a safe and reliable supply of blood components, organs, stem cells, tissues and related services to the NHS, and other UK health services. We manage the UK-wide voluntary donation system for blood, tissues, organs and stem cells, and turn these donations into products that can be used safely to save lives or radically improve the quality of people s lives. We rely on thousands of members of the public who voluntarily donate their blood, organs, tissues and stem cells. Their generosity means each year we re able to supply around two million units of blood to hospitals in England and North Wales and 7,500 organ and tissue donations, which save or improve thousands more people s lives. For more information Visit nhsbt.nhs.uk enquiries@nhsbt.nhs.uk Call