Improving experience for people with cancer in Croydon

Presentation on the finding of the national cancer patient survey 2012-13

Claudia Tomlinson

Jackie Green

Tuck Kay Loke

How cancer services are organised at CHS

Type Treatment Cancer Centre

Breast Surgery Chemotherapy & Radiotherapy at RMH

Colorectal Surgery Chemotherapy & Radiotherapy at RMH

Dermatology Surgery Complex surgery requiring plastic at ST Georges

Gynaecology Diagnostic & Low risk endometrial surgery Chemotherapy, radiotherapy and surgery at RMH

Haematology Level II service Level III and Level IV at RMH

Lung Diagnostics and Palliative Care and follow up for radiotherapy

Chemotherapy at RMH and surgery at St Georges.

Paediatrics POSCU Levl1 GOS and RMH

Urology Surgery and Bladder chemotherapy Radiotherapy at RMH/Complex surgery at St Georges.

Upper GI Diagnostics Surgery at RMH

.

• CHS is part of the London Cancer Alliance

• Partnership with LCA, Macmillan Cancer Relief etc.

• Cancer and Core Functions Directorate (CCF)

• CAB, Macmillan Information Centre, Counselling & complimentary services

Background and context

National Cancer Patient Experience Survey 2012/13 CHS

•Annual survey undertaken by Quality Health

•All patients 16 + who had received treatment for cancer during September – November 2012 are eligible

•National number of patients included 116,525. Average national response rate was 64% .

•CHS number of patients included 66 with a 68% (44 patients) response rate

•Trusts are ranked in top 20% and lower 20% in all questions and the intermediate group 60%

Survey methodology

  2010/11 2011/12 2012/13

Sample month 01 Jan – 31 March 2010

01 Sept – 30 November 2011

01 Sept – 30 November 2012

Sample size (eligible patients)

199 81 66

Responses 103 50 44

Response rate 58% 66% 68%

Changes since the survey began:

Sampling month

Sample size

Reducing number of responses

Response rate stable over two years

Top 5 Tumour group respondents

Tumour Group 2010/11 2011/12 2012/13

Breast 18 19 20

Colorectal/Lower GI 20 12 11

Haematological 19 10 6

Urological 22   5

Lung 6    

Survey methodology - respondents

• Low numbers of eligible patients identified on PAS

• Possible sampling issues due to difficulty in identifying cancer patients

• Information services rely on clinical service to identify cancer patients by diagnosis

Survey methodology sampling issues for CHS

2010 / 11 CHS in bottom 10 in the countryx 35 fell in bottom 20% and 4 x in top 20%

2011/ 12 CHS no longer in the bottom 10 X 21 fell in bottom 20% and 19 in top %

2012/13 CHS in bottom 10 in the countryx 38 fell in bottom 20% and 4 x in top 20%

Last 3 years results

1 of the 9 London Trusts in the bottom 10

Questions rated in top 20% (‘green’ rated)

No Question Score

11 Patient told could bring a friend 81%

13 Patient completely understood what was wrong 81%

19 Patient told how treatment side effects could affect them in the future 

62%

63 GP given enough information about patient's condition/treatment

100%

Questions improved since last survey

No.

Table 2: Summary of thirteen indicators showing improvement in 2012/13

CHS 2012/13 Score (%)

Highest Trust’s score 2012/13

6 Staff explanation purpose of tests 76% 93%11 Patient told could bring a friend 81% 89%13 Patient completely understood what was wrong 81% 85%

16 Patient's views taken into account/treatment 69% 84%20 Patients involved in decisions about care and treatment 76% 85%

28 Patient informed they could get free prescriptions 70% 88%44 Enough nurses on duty 37% 89%47 Staff asked patient name they preferred to be called by 31% 84%

48 Privacy when discussing treatment/condition 83% 96%

49 Privacy when examined/treated 92% 100%55 Family given information to help care at home 58% 77%

63 GP given enough information about patient's condition/treatment

100% 100%

64 Practice staff did everything they could to support patient 64% 82%

Questions significantly worsened since last survey

No

Table 3: Specific indicators significantly worsened in 2012/13

CHS Score 2011/12

CHS Score 2012/13

2

Patient thought seen as soon as possible

88% 68%

4Patient health the same/better while waiting

90% 73%

30

Discussing taking part in cancer research with patient

62% 31%

35

Staff explained how the operation had gone

87% 64%

67

Given the right amount of information about condition/treatment

96% 70%

70

Patient rating of care 'excellent/very good'

89% 64%

No Period Action Lead Deadline

1 S Disseminate survey results to all directorates and key forums in CHS

Clinical Lead for Cancer & Lead Cancer Nurse

December 2013

2 S Meet the CNS team postersCNS/Keyworker business cards

Lead Cancer Nurse December 2013

3 S Root Cause Analysis exercise to be conducted using the 5 Whys technique

Lead Cancer Nurse & General Manager

December 2013

4 S All patients with cancer have access to a CNS/ key worker and Holistic Needs Assessment - business case developed to facilitate

Lead Cancer Nurse December 2013

5 S Deliver a listening event with stakeholders

Clinical Lead for Cancer & Lead Cancer Nurse

January 2014

Key Actions

No Period Action Lead Deadline

6 M Providing financial advice Continuation of partnership working with Croydon CAB service funded for 1 more year. Requires sustainability plan and pick up funding from October 2014

General Manager and Lead Cancer Nurse

June 2014

7 M Responding to patient feedback (including real time)

Clinical Lead for Cancer & Lead Cancer Nurse

April 2014

8 L Work with Macmillan and the London Cancer Alliance pathway groups in improving the patient experience

Clinical Lead for Cancer Lead Cancer Nurse & Cancer Manager

September 2014

9 L Taking Patients views into account – implementing action from the listening event

Clinical Lead for Cancer Lead Cancer Nurse & Cancer Manager

September 2014

10 L To review expanding the cancer and palliative care nursing service

Lead Cancer Nurse September 2014

Key Actions

Summary

• Picture of findings of cancer patient experience for past three years presented, showing fluctuating performance

• Methodological issues discussed including identification and sampling of patients

• Although an overall worsening since last survey, there is evidence of good performance in many areas

• Improvement actions will focus on:

Listening to patients and stakeholders Sharing and learning from the results Promote a multidisciplinary response