THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Board Paper - Cover Sheet
Meeting28.9.2016 / Trust Board / Agenda Item
A5(viii)
Report Title / National Cancer Patient Survey 2015/16
Lead Director
Report Author / Helen Lamont Director of Nursing
Alison East Lead Cancer Nurse/Nurse Consultant,
Chris Eddy Deputy Director of Nursing and Patient Services
Classification / NHS Unclassified / NHS Protect / NHS Confidential
Purpose (Tick one only) / Approval / Discussion / For Information
Links to Strategic Objectives / NUTH Quality Strategy 2015-18 - key priority patient experience
· The Trust regularly seeks the opinions of its patients and receives feedback from a number of National Patient Experience Surveys.
Links to CQC Domains/
Fundamental Standard(s) / Links with fundamental standards concerned with patient centred care, dignity and respect, consent and safety 9, 10, 11, 12, 17
Identified Risk? (If yes, risk reference) / No
Resource Implications / Lack of substantive funding for the Macmillan one to one service.
Review of the Macmillan Cancer Information service delivery and the managers role and responsibilities.
Legal implications and equality and diversity assessment / Compliance with National Guidance and risk of reputational damage, potential harm to patients by non-compliance.
Benefit to patients and the public / Excellent performance in delivery high quality cancer services and care, highlighting areas of good practice and areas for improvement.
Report History
Next steps / To maintain excellent performance results and to show improvement in those areas of scored below the expected range.
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
NATIONAL CANCER PATIENT EXPERIENCE SURVEY 2015/16
EXECUTIVE SUMMARY
This paper outlines the current position of the Newcastle upon Tyne Hospitals NHS Foundation Trust with regard to the findings reported within the National Cancer Patient Experience Survey, it identifies the aspects of care patients are satisfied with, or where they perceive that their care could be improved and provides a baseline for services to work from.
The results suggest that most patients accessing the Trust cancer services have a positive view of the overall care and support they have received, scoring positively outside expected range for 20 questions; this performance, is above that of the other Trusts in the proposed Cancer Alliance region and on a par with one, and above others in the Trusts recognised peer group. However with scores below the expected range for 2 questions relating to patient support there are challenges to be addressed to minimise risks to the delivery of the national cancer strategy.
To address the questions that scored below the expected range, which specifically relate to financial information and support, the survey results have been distributed to all site specific CNSs and Multi-Disciplinary Teams for action plans. This will be supported by a number of work streams and projects to support maintaining and improving performance in the experience of cancer patients’ experience. There are however some risks identified and with limited resources will remain a challenge.
RECOMMENDATION
The Board is asked to (i) receive the paper and to acknowledge the positive aspects of the Survey (ii) To support proposed actions to facilitate an improvement in the support, care and management of cancer patients within the Trust. (iii) Note the risks to the service as a consequence of lack of substantive funding and growing workload.
Mrs Helen Lamont
Nursing and Patient Services Director
Alison East
Macmillan Lead Cancer Nurse / Nurse Consultant Cancer Services
Chris Eddy
Deputy Director of Nursing and Patient Services
14th September 2016
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
NATIONAL CANCER PATIENT EXPERIENCE SURVEY 2015/16
1. INTRODUCTION / BACKGROUND
The National Cancer Patient Experience Survey (NCPES) 2015 commissioned by NHS England and undertaken by Quality Health is the fifth iteration of the survey first commenced in 2010. This tool aims to provide an insight into the care experienced by cancer patients across England and allows Trusts and Clinical Commissioning Groups to understand their individual performance and identify areas for local improvement. It has been designed to monitor national progress on cancer care, as well as providing information to inform commissioners, and other stakeholders, that drive local quality processes to deliver the national cancer strategy.
The sample for the survey included all adult (aged 16 and over) NHS patients, with a confirmed primary diagnosis of cancer, discharged from a NHS Trust after an inpatient episode or day case attendance for cancer related treatment in the months of April, May and June 2015. A total of 71,186 patients (65%) responded to thisthe largest survey of cancer patients anywhere in the world; it included 1,308 patients in the care of the Newcastle Upon Tyne Hospital Trust (NUTH), which represents a 70% response of the 1,989 identified for the sample.
This is the first year that the results are being published as official statistics after the methodology and fieldwork periods underwent significant change. The length of the questionnaire was reduced, with response options changed to provide consistency throughout. Questions were replaced to improve comparability with those in other surveys (e.g. the Care Quality Commission national patient surveys), and ensure capture of experiences across the whole patient journey to provide the Trust with a new baseline of information for future comparison. The changes to the survey mean no comparisons with previous surveys or Trust league tables are available to be presented in this report.
2. CURRENT POSITION SUMMARY
This following information ( i- vii) will be included in the new national Cancer Dashboard, which brings together key cancer data, it is intended to help local clinical leaders, commissioners and providers within the proposed Cancer Alliances, to identify priority areas for improvement, linking patient experience alongside other key measured outcomes.
i) The experience of cancer patients in England is generally very positive, on nearly half of the questions in the survey; over 80% of respondents gave positive responses. Asked to rate their care on a scale of zero (very poor) to 10 (very good), respondents gave an average rating of 8.7, NUTH has been rated above the national average at 8.9.
ii) Nationally 78% of respondents said that they were definitely involved as much as they wanted to be in decisions about their care and treatment, compared to the higher NUTH rating of 81%.
iii) 90% of respondents were given the name of a Clinical Nurse Specialist (CNS) to support them through their treatment and this is equal to the local NUTH rating, although variation exists within Trust site specific tumour groups; for example only 85% of upper GI patients reported being given the name of a CNS compared to 97% of breast cancer patients. However 91% of respondents said that, when they had had important questions to ask their CNS, they received answers they could understand, which is above the expected range above the national average score of 88%
iv) Nationally when asked how easy or difficult it had been to contact their CNS 87% of respondents said that it had been ‘quite easy’ or ‘very easy’. Although NUTH scored above the national average at 90%, there is marked disparity within the site specific tumour groups, for example only 77% of Brain and Central Nervous System patients found it easy to contact their CNS compared to 98% of lung cancer patients.
v) Within the NUTH sample 89% of respondents said that, overall, they were always treated with dignity and respect while they were in hospital; this is higher than the national average of 87%.
vi) 94% of national respondents said that hospital staff told them who to contact if they were worried about their condition or treatment after they left hospital, with NUTH respondents rating 95%
vii) Locally 62% of respondents felt GPs and nurses at their general practice did everything they could to support them during cancer treatment, this compares to 63% of national respondents. There are two other home support questions which outline positive performance, 63% of patients compared to the national average of 54% responded that they definitely were given enough support from health or social services during treatment, and 55% locally compared to 45% nationally received enough support post treatment.
viii) There were a total of 59 questions, 20 of which NUTH scored positively outside expected range of care or experience for patients, this performance, is above that of the other Trusts in the proposed Cancer Alliance region and on a par with one. However NUTH scored below the expected range for 2 questions relating to support for people with cancer, both questions are related to financial support.
ix) Two questions that scored below the expected range related to information and support, specifically only 48% of patients received financial support information, all other Health Trusts in the region scored within the national average of 55% for this question apart from North Tees and Hartlepool who scored 65%, they provide this advice through established community and hospital based Cancer Information Services.
x) The second area of performance below the expected range revealed that only 72% of respondents were informed they could get free prescriptions compared to 80% nationally; again the Trust is an outlier regionally for this result. This has been shared with cancer MDTs and their nurse specialists to ensure patient written information informs them of that entitlement.
3. WORKING TO MAINTAIN AND IMPROVE PERFORMANCE
The Cancer Nursing Workforce
A consistent link to good cancer patient experience is access to a clinical nurse specialist (CNS) allocated to their care, it is encouraging that the survey suggests the number of cancer patients assigned a CNS continues to rise, however within this Trust around one in 10 people with cancer do not receive the expert care and support that a specialist cancer nurse can provide. To address this, the survey results have been distributed to all site specific CNSs who have been asked to look at individual service results and put into action plans for improvement as part of their Multi-Disciplinary Team annual work programmes.
There is difference in how easily people find it to contact their CNS across the organisation, and although the number of CNS roles have increased, it is difficult for them to keep pace with the growth in numbers of people diagnosed with cancer each year, as well as those living with and beyond cancer estimated at two million and set to rise to four million by 2030. The future workforce need to be flexible in supporting the drive to implement seven day services, for example extending the Acute Oncology Nursing service provision, as well as creating innovative ways of working such as the Macmillan One to One Team who support patients to manage their own care. This may require skill mix review to enable nurses and other specialists to focus on more complex needs.
It is already recognised that in England there is a variation in potential workload and the age profile of the cancer CNS workforce, and this is reflected locally with the ratio of CNS to patients significantly different within site specific teams, some of which have single handed practitioners, a large proportion of these highly skilled nurses are approaching retirement in the next five to ten years. To address this we must continue to talent spot to build the cancer care teams of the future, the previous cancer clinical nurse specialist group membership has been extended to include more senior nurses and clinical educators with the aim of using the forum for sharing, developing and expanding best practice, skills and knowledge.
Work streams and projects
There are a number of work streams and projects that support maintaining and improving performance in the cancer patient experience within the Trust.
i) Information and Support
With the changes to the welfare system there is an increasing demand for access to expert financial support as well as a growing concern for people affected by cancer. The NCPES has highlighted that within the Trust more needs to be done to help our patients overcome the obstacles that prevent them from receiving the financial support that is available. The Macmillan Cancer Information service based in the Northern Centre for Cancer Care (NCCC), has a crucial role to influence the financial impact of cancer. It is planned for them to proactively increase service user footfall, as well as signposting patients to regional financial and welfare rights advisers, the local Department of Work and Pensions local visiting team have agreed to provide training to centre staff to help them identify patients who would benefit from referral for review by their team.
The specialist cancer nursing workforce such as CNS and those who work in specialist cancer service teams will review their written patient information to ensure it includes information about eligibility for free prescriptions and signposts them to the Cancer Information Centre, facilitating patients to manage any unexpected financial consequences of a cancer diagnosis.
ii) Enhanced Supportive Care
Enhanced Supportive Care is a new initiative aimed at addressing more fully the needs of patients with a palliative cancer diagnosis who are on active anti-cancer treatment in the context of a cancer centre. The aim is to improve these patients’ outcomes by providing early access to supportive care assessment, within NCCC, by the Palliative Care Team in order to improve their experience and their ability to tolerate anti-cancer treatment.
iii) The Macmillan One to One Team
This is a community based nursing team that provide a service that offers a holistic model of care to patients ‘Living with and Beyond Cancer’, aligned to the National Cancer Survivor Initiative (2010) and The Strategy for Cancer (DH 2011) recommendations to improve the experience, effectiveness and quality of care for patients.
The team aim to improve the experience of patients across the whole cancer pathway, including after treatment. The local NUTH team are one of sixteen pilot sites operational since April 2013, Macmillan funded until March 2017. This quality nursing service are not substantively funded, previously submitted business cases for substantive funding recognised the clinical benefit for cancer patients; however with the changing landscape of NHS services no tariff could be applied to support the service, the ongoing work of the team will be to try and attract a tariff for the recovery package interventions they utilise, this is likely since the Secretary of State for Health has made commitment to everyone surviving cancer in England being entitled to a recovery package by 2020, with a quality of life metric being developed by 2017.