Regional Colorectal Cancer Meeting
2.00pm, 4th December 2008
Ewart Room Holywell Hospital, Antrim
Minutes
Record of Attendance
Mr Victor Blease / Ms Annette MawhinneyMs Shelagh Fleming / Mr Roy Maxwell
Sr Daphne Garrett / Mr Kevin McCallion
Dr Robert Harte / Mrs Shelia McQuaid
Ms Geraldine Kerr / Dr. Ozo
Mr Kourosh Khosraviani / Dr Lisa Ranaghan
Mr Roger Lawther / Ms Danielle Sinclair
Mrs Sarah Liddle / Dr Paul Smyth
Mr Eamon Mackle / Dr Richard Wilson
Apologies
Dr Grant Caddy / Ms Arlene SpiersMs Sally Campalani / Ms Janis McCulla
Mr David Galloway / Ms Alana Bell
Dr Anna Gavin / Ms Karen Boyd
Mr Colm Harvey / Ms Wilma Boyd-Carson
Dr Simon Johnston / Mr Brian Cranley
Dr Kiran Kuar / Ms Elizabeth England
Ms Patricia Sheppard / Dr Maurice Loughrey
Ms Caroline Lynas / Dr Dermot Hughes
Mr Jack Lee / Ms Marguerite Greenhill
Dr Paul Lynch / Mr Brendan Harding
Mr David McCrory / Dr Peik Lim
Dr Myles Nelson / Ms Mary Jo Thompson
1.0 Welcome and introductions
1.1 Mr Maxwell welcomed everyone to the meeting, in particular new member Mr Victor Blease, Patient Representative and Mr Roger Lawther, Consultant Surgeon.
2.0 Matters arising
2.1 The Stoma Standard was discussed; it was agreed that a clear definition of an NHS stoma nurse is required.
2.2 Point 4.6 to be amended to clarify the point. (Sarah to amend)
2.3 Minutes agreed.
3.0 Colorectal CaPPS Database
3.1 Dr Lisa Ranaghan gave a brief presentation on the CaPPS database. Slides will be sent out with the minutes. To date clinical modules have been developed for Lung, Gynae (live) and Breast (goes live Monday). Colorectal is currently being developed.
3.2 The system can record clinical entry and facilitate reporting. It is envisaged that with minimal training a range of professionals can enter data along the pathway as required. Initial training in the use of CaPPS with surgeons showed that the system is very easy to use; it was accepted as such by those surgeons that attended.
3.3 The system is SNOMED linked and will be able to capture screening patients, useful for bowel cancer screening in 2009. It will gather data for all CSF standards. It is linked to PAS. It is hoped to develop an interface with pathology systems and NIPACS by the end of next year.
3.4 Mr Maxwell stated that he is enthusiastic about the implementation of this system, which has a lot of potential, particularly for the production of good outcome data.
3.5 Dr Ozo asked if it could capture data at MDT to facilitate requirements of Manual of Cancer Services Standards. It does record attendance at MDT.
3.6 Mr McCallion asked if it would be possible to build in the facility to record both the consultant and their representative (names and role). Dr Ranaghan added that this could be done as an enhancement. Mr McCallion stated that he thought the system was good. It is also requested that the system is compatible with the selected endoscopy reporting tool; it is envisaged that this would be supported by including an export tool.
3.7 It was agreed that the system looks very easy to use and could bring significant benefits to the service. Dr Ranaghan offered to visit Trusts to show them the screens when they are developed (this could be ready in around 3 weeks). In the meantime, if there are further changes they should be forwarded to Dr Ranaghan via Sarah Liddle.
4.0 MDT Peer Review
4.1 On behalf of Dr Dermot Hughes, Sarah Liddle provided a brief update on the process for MDT peer review as follows:
§ The Tender process did not result in identification of a peer review body;
§ It is hoped that colleagues in England would be able to take on the role;
§ A meeting is planned for 12th January to discuss with the Peer Review Lead in England;
§ This will support quality in bowel cancer screening for those people found to have cancer; and
§ More detail about timescales will be available following agreement of review body.
4.2 There was some discussion about the amount of detail required for this process, and the time taken to collate it. Mr McCallion advised colleagues that it will be time consuming and will require action sooner rather than later. MDT Chairs should take the lead on this.
4.3 Action: Mr Maxwell will formally approach liver, thoracic and plastic surgeons to make a single named nominee and deputy to perform the role of extended MDT members for all MDTs in the region.
5.0 Clinical Management Guidelines
5.1 Mr Maxwell let the group know about the planned development of CMG for colorectal cancer. He stated that there had been some debate about the purpose of the guidance. Mr Harte and Sarah Liddle outlined the discussion at the meeting. It was noted that it is not desirable to duplicate existing guidance.
5.2 Dr Wilson stated that the development of chemotherapy guidance had been useful for a number of reasons, including additional issues such as clinical trials and getting resource to support the service. It was stated that while there is variability in practice at present, this is not undesirable in all cases. It is vital that clinical judgement is supported by the development of guidelines. Follow-up is one area where the development of colorectal cancer guidelines could be developed.
5.3 Mr Maxwell asked the group to send any ideas on areas which would benefit from the development of guidelines to Sarah Liddle by email.
6 Patient Information Pathway
6.1 Ms Danielle Sinclair provided the group with an update on the development of the patient information pathway. Slides will be circulated with the minutes.
6.2 The variation in existing information was noted by the group; the idea is to gain a balance between written and electronic information. Recommending websites that provide high quality information will help patients find a reliable source of information that is relevant to their needs and easy to understand. The pathway will be ‘live’ and link through to appropriate information for each stage.
6.3 Mrs Sheila McQuaid asked that hard copy information is provided for patients who don’t have access to a computer. Ms Sinclair stated that this would be provided.
6.4 Mr Victor Blease stated that he thought this work was very worthwhile and that audit of the pathway on a regular basis is undertaken to ensure it remains an effective tool. He added that Patients and Carers should be involved in deciding the core materials.
6.5 Mr Kerr asked for assurance that there would be consistency in the implementation of the pathway across the region. Ms Sinclair stated that a named Information Lead will be identified in each Trust to ensure implementation takes place.
7 NICaN Website Launch
7.1 Danielle Sinclair provided a brief update on the new NICaN website. Slides will be circulated with the minutes.
8.0 Progress updates
8.1 Patient Pathway V7: The following changes were made to the pathway (Sarah Liddle to amend):
§ the removal of the shaded area ‘palliative care’ from all 3 pathways;
§ the addition of a box to indicate that the intent of treatment as palliative may be decided at any point in each of the 3 pathways;
§ the addition of ‘consideration of chemo/radiotherapy’ to the anal pathway; and
§ Amend the bottom box on the colon pathway to read ‘…consideration of palliative care / palliative chemotherapy’.
8.2 Cancer Services Framework: Sarah Liddle provided a brief update on behalf of Dr Dermot Hughes:
§ All 48 standards are agreed;
§ The DHSSPS/NICaN are currently looking at costs; and
§ Public consultation will follow in the 2009/10 financial year.
8.3 Core Membership: Mr Maxwell emphasised that the purpose of core membership is not to have a two tier group, but only in the highly undesirable and unlikely event that a vote was required and to ensure representation from across the region and different medical and nursing specialties. The group membership is not exclusive but open and all contributions are very welcome.
8.4 Following discussion, it was agreed that a medical oncologist be added to the core membership. Mr Wilson is happy to take on this role if it is felt to be acceptable.
8.5 Bowel Cancer Screening / MES Project: Mr Khosraviani provided a brief update on progress toward readiness for screening. A paper update was circulated before the meeting.
8.6 There was some discussion about the approval of colonoscopists. Mr Khosraviani broadly outlined the proposals for Northern Ireland.
9.0 Dates for future meetings
§ Tuesday 3rd March 2009, 2-4pm, Boardroom, Holywell Hospital
§ Thursday 21st May 2009, 2-4pm venue TBA
10.0 Any Other Business
11.1 Follow-up: Dr Harte suggested that his group become a forum for looking at standardising approaches to follow-up in the region. Mr Maxwell and others agreed to take this forward under the remit of MDT Peer Review and the information pathway.