3rd NICaN Haematology Regional Group MeetingNICaN

3rd NICaN Haematology Regional Group Meeting

Wednesday 31st January 2007

Seminar Room, Cancer Centre – Belfast City Hospital

2.00 – 4.00 pm

Record of Attendees

Ms Anne Marie Carey, BCH / Dr Anthony McCarthy, RGHT
Ms Sylvia Cole, AAH / Ms Sandra McDowell, BCH
Mr Gerard Crooks, BCH / Ms Lorraine McKenna, BCH
Ms Deborah Culbert, BCH / Dr Feargal McNicholl, AAH
Dr Gerard Daly, NICaN / Ms Lisa McWilliams, NICaN
Dr Dermott Davison, NICaN / Ms Margaret Michael, UH
Ms Eilish Dorrian, BCH / Professor Curly Morris, BCH
Mr Ray Elder, UCHT / Dr Yong Lee Ong, UCHT
Ms Ann Evans, UCHT / Ms Jacqui Quinn, BCH
Dr Frank Jones, BLL / Ms Maurice Regan, BCH
Dr Anne Kyle, UH / Ms Laura Shields, BCH
Dr Tom Lynch, BCH / Dr Lakshmi Venkatraman, RGHT
Ms Clare Marshall, BCH / Ms Claire Walsh, BCH
Ms Claire Mason, BCH / Mr Philip Windrum, Antrim

Apologies received: Ms Katherine Boyd, Dr Maloud El-Agnaf, Dr Russell Houston, Mr David Robinson and Dr Aine Shiels

Welcome and Introductions

Professor Curly Morris welcomed attendees to the 3rd NICaN Haematology Regional Group meeting before introducing a number of new faces to the regional group.

HG_0607_A18Matters arising from Minutes of 2nd Meeting

There were no amendments requested from the minutes of the second meeting and these were subsequently signed off.

Reference was made to a draft Data Definition document which had been emailed out with the agenda for today’s meeting and will be touched upon under item A23.

Professor Morris then recapped on the discussions at the last meeting with regards to the Healthcare Reform Programme and made reference to a Service Delivery Unit presentation which outlined the quality access standards for cancer services. It was reported there had been a number of relevant developments since the last meeting namely the announcement of the thresholds for the draft Priority for Action Targets and also the exploration of Service Frameworks.

Draft PFA Targets

It was outlined that the draft PFA targets for 2007-2008 are as follows for cancer services:

  • 98% of patients diagnosed with cancer (decision to treat) should begin their treatment within a maximum of 31 days;
  • 75% of patients urgently referred with a suspected cancer should begin their first definitive treatment within a maximum of 62 days. Where the performance of a tumour group currently exceeds this standard, performance should be sustained or improved against current levels.

The significance of PFA targets was outlined by stating that money follows PFA targets and PFA targets will be on Chief Executive’s radars. It was highlighted that with regards to the Haematology Service high standards are already being received and therefore it would hope to exceed the 75% threshold.

Dr Gerard Daly was then asked to make reference to the Service Frameworks which the Department of Health are looking to produce to inform future PFA targets. It was outlined that at a recent meeting with the Chief Medical Officer the NICaN Team were asked through the tumour specific regional groups to facilitate the development of Service Frameworks for cancer. With regards to the Service Frameworks the following were highlighted:

  • The Frameworks will include public health aspects of health promotion and disease prevention and will follow an individual’s journey through assessment, diagnosis, treatment and care from children from childhood to

adulthood, to include end of life;

  • Service frameworks will become part of the commissioning and performance management guide for the HSSA and RQIA in the public reporting of HPSS care;
  • The standards of cancer services should be devised in truly multidisciplinary form building on existing strategies and policies, and then introduced into the HPSS, the key audience being the public, with major stakeholders being the Department emphasising a ministerial commitment to raising these standards of outcome and care.

Dr Daly stated that Frameworks need to be in place by April 2008 in order for the HSSA to commission services against them. The Chief Medical Officer made clear the clinicians must be involved in describing the service and it is entirely appropriate for a Regional Group, like this one today, to focus on the creation and development of Service Frameworks.

Professor Morris asked about the way forward for the development of these Frameworks and it was reported there is currently no template available although this has been investigated by the NICaN Team and that elements within existing workplan will naturally take forward this for example the baseline assessment, care pathway development, GP referral and effective MDMs.

HG_0607_A19Baseline Assessment

The deadline for submissions for the baseline assessment was the 24th January 2007. Submissions have been received from Altnagelvin, Antrim and BCH. The data being captured was reiterated including facilities, staffing numbers, management structures, workload and new haematology malignancies by diagnosis. It was acknowledged that the data on the workload is difficult to capture in some places but people where encouraged to submit as much information as possible.

Outstanding submissions from the Ulster, Craigavon and from the Children’s Service are to be followed up with a full breakdown of data then being forwarded to members as part of quality assurance exercise.

Work Areas: Pathway Development

HG_0607_A20Development of Quality and Timely Care Pathways for Haematological Malignancies

Nominees to join Dr Anne Kyle (who agreed to lead this working group at the October meeting) were identified as follows:

  • Dr Frank Jones
  • Dr Tom Lynch / Dr Aine Shiels
  • Ms Janet Morrison

Further nominations are to be secured from Craigavon, Ulster and the Primary Care Regional Group.

It is proposed that initial work for care pathway development be conducted offline and Ms Lisa McWilliams agreed to forward nominees emails directly to Dr Kyle, to facilitate this process. It was highlighted that in the English system the Cancer Services Collaborative are only now looking at non solid tumour care pathways and contact details of the team leading the work for haematology will be forwarded to Dr Anne Kyle as there maybe opportunities for collaborative working.

HG_0607_A21GP Referral

Copies of the NICE and IOG referral guidance for suspected haematological malignancies had been tabled at the meeting and after some discussion with regards to this guidance it was agreed that a working group consisting of members of this group and the Primary Care Group consider referral guidance. This group will make recommendations back to the larger group and will consider the process required to secure regional implementation across all care sectors. Working group members were identified as:

  • Dr Dermott Davison
  • Dr Frank Jones
  • Dr Anthony McCarthy
  • Dr Feargal McNicholl
  • Dr Yong Lee Ong
  • Ms Jackie Quinn
  • Dr Mary Quinn (Primary Care nominee for this Group) ; and
  • a Southern Board nominee will be sought.

Initial work will be conducted offline and Ms McWilliams agreed to forward nominee email details to Doctors Quinn and Davison.

Dr Davison asked for information with regards to the significance of paraprotein banding to be incorporated into the work of this sub group, as this was an area requiring clarification for Primary Care colleagues.

HG_0607_A22Multidisciplinary Teams

A subgroup paper produced by Dr Lakshmi Venkatraman on MDM standards had been tabled at the last meeting and had led to a tool being devised which had been forwarded to each of the units to allow them to formally assess their current MDM practice against standards within the Manual of Cancer Services. Submissions had been received from Altnagelvin, Antrim and BCH. Outstanding

submissions are to be forwarded to the NICaN office by 9th February 2007 at which point a composite paper will then be compiled.

The existing working group led by Dr Lakshmi Venkatraman were asked to then consider which of the standards needs to be targeted, whether all haematological malignancies appeared to currently be discussed in MDMs and to identify areas for consideration by the larger group - for discussion at the next meeting.

Diagnostic Working Group

To inform the work of the care pathway group Professor Curly Morris agreed to pull a sub group together to consider the diagnostic elements of the care pathway to include cytogenetics, microbiology etc.

HG_0607_A23Cancer Access Standards

As referenced at the start of the meeting a draft Data Definitions document had been circulated with the agenda of the meeting which outlined the 52 data collection points identified by the Service Delivery Unit, for the introduction of cancer access standards. It was reported that the Northern Ireland Cancer Registry have been asked to help access this data and that Dr Lisa Ranaghan was currently working with a number of regional MDMs/regional groups to adapt MDT databases to capture this data. Professor Morris invited Dr Ranaghan to comment on the process and paper and it was stated that the Service Delivery Unit have earmarked £250,000 for patient tracker roles across the region. It was acknowledged that this was not enough but should be a start to help in the collection of data.

It was also highlighted that Ms Janet Morrison was investigating how patients currently get into the system at Belfast City Hospital as one of the difficult points can be the capturing of referrals first into the system. Dr Ranaghan also stated that the work is currently underway to transform the MDM databases into web based systems and it looks at this early stage to be of a cost of about £12,000 per tumour group and that this would need to go out to tender.

Dr Gerard Daly indicated that within the Cancer Data Definitions Document it would be desirable for some of the optional collection points to become mandatory to allow an emphasis to be put back on to the quality of service provided.

HG_0607_A24Emerging Issues

Regional Drugs and Therapeutics Committee

Dr Anne Kyle as one of the haematology representatives on the Regional Drugs & Therapeutics Committee provided a brief update on the last meeting stating that the committee are currently creating groups to examine how to work together and at the last meeting it was agreed that the paediatric oncology/haematology service needs to be included within the Committee.

UKMF Bortezomib Appeal

Professor Morris made reference to the Bortezomib Appeal, a copy of which had been forwarded to members at the end of last year, and stated that he was attending a meeting next Thursday as NICE have allowed the appeal on several grounds. Further information will be forwarded in due course.

Congratulations to Professor Morris

Dr Gerard Daly offered his congratulations on behalf of the NICaN Team and indeed members of the Regional Group on Professor Morris’s “Personal Chair“.

Date and Venue of Next Meeting

The next meeting will take place from 9.30 to 11.00am on Thursday 8th May 2007 in Antrim. Ms McWilliams is to liaise with Dr Kyle re. potential venues in Antrim for this meeting.

Professor Morris then closed the meeting and thanked all for their participation.

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