National Peer Review Report: Colorectal Cancer Services Report 2012/2013

Transcription

1 National Peer Review Programme National Peer Review Report: Colorectal Cancer Services Report 2012/2013

2 Colorectal MDTs Overall Performance All of the 166 teams reviewed against the 43 measures. 163 teams were on IV cycle and 3 were subject to a peer review visit. The table below shows the outcomes against the measures for 166 teams reviewed in 2012/2013; Compliance IV PR 100% % % % % % % % 0 0 Median 90% Range % Interquartile Range 87-95% 100% Overall Compliance Ranges Colorectal MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colorectal Colorectal Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 65 teams were selected for a cancer peer review visit in 2013/

3 Immediate Risks and Serious Concerns Colorectal MDTs with IRs (SA) with IRs (IV/EV) with IRs (PR) Total with IRs Percentage of with IRs with SCs (SA) with SCs (IV/EV) with SCs (PR) Total No of with SCs Percentage of with SCs % % The main focus of these were: CNS capacity and the lack of cover, resulting patients not receiving the correct support from CNS, such as being available for breaking bad news. Core Radiologist has no time within job plan to review radiology before the MDT, this leads to patient cases being reviewed within an extremely time limited discussion without preparation. Colorectal surgeon participating in 2-3 elective surgeries. Lack of core team membership at MDT s, oncology in particular. No cover for MDT coordinator which results in MDT s not taking place whilst MDT coordinator is on annual leave. Consultant workload numbers do not meet the minimum standards from the IOG GP s not being informed within 24 hours of diagnosis Patients are being managed by non-colorectal specialists through the surgical emergency pathway and not transferred to the care on an appropriate specialist within 24 hours (in line with network guidance). Infloflex or similar MDT management systems not implemented. Delay in resection results, impacts on waiting times and adjuvant treatment for appropriate patients. Lack of psychological support for patients. One team has reported the lack of laparoscopic training for the surgeon within the MDT. 3

4 Stand Alone Liver Resection MDTs Overall Performance All of the 7 teams reviewed against the 25 measures. All 7 teams were on IV cycle. The table below shows the outcomes against the measures for 5 teams reviewed in 2012/2013; Compliance IV 100% % % % % % % % 0 Median 88% Range 76-96% Interquartile Range 80-90% 100% Overall Compliance Ranges Colorectal Liver Resection MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colorectal Liver Resection Colorectal Liver Resection Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 0 teams were selected for a cancer peer review visit in 2013/

5 Immediate Risks and Serious Concerns Colorectal MDTs with IRs (SA) with IRs (IV/EV) with IRs (PR) Total with IRs Percentage of with IRs with SCs (SA) with SCs (IV/EV) with SCs (PR) Total No of with SCs Percentage of with SCs % % The main of focus of these were: Lack of Network Referral guidelines for liver metastatectomies could lead to inequity of service across the Network. Workload of the MDT s especially with regards to CNS cover and support. Good Practice Colorectal and Liver resection standalone MDTs There were many examples of good practice. These particularly focused on: Increased survival rate. Live data entry for NBOCAP within MDT Meetings, clinical validation exercises introduced. Enhanced recovery programme for colorectal surgery. Laparoscopic surgery introduced. Full MDT attendance at the national LOREC study day. Increased numbers of patients considered for clinical trials. Measures with under 50% compliance: Colorectal MDTs Measure Number and Short Title IV (163 teams) 11-2D Support for Level 2 Practitioners 42% 11-2D Attendance at National Advanced Communication Skills Training Programme 30% Measure Number and Short Title PR (3 teams) 11-2D Support for Level 2 Practitioners 33% 11-2D Named Consultant Core Member(s) for Anal Cancer 0% 11-2D MDT Agreed Cover Arrangements for Core Members 33% 11-2D Attendance at National Advanced Communication Skills Training Programme 0% 11-2D Extended Membership of MDT 33% 11-2D Network Audit 33% 11-2D Agreed List of Approved Trials 33% 11-2D Joint Treatment Planning for TYAs 33% 5

6 Stand Alone Liver Resection MDTs Measure Number and Short Title IV (7 teams) 11-2D Oncology Agreement with Each Referring MDT 29% Clinical Lines of Enquiry (CLE) There were a number of issues highlighted through reporting of, and discussion on, the Clinical Lines of Enquiry for Colorectal, both at Network and MDT level. Colorectal Clinical Lines of Enquiry (CLE) Network Level Wide variation in robustness of data collection dependent on resources and management. An emphasis on the importance of real time capture at MDT & introduction of electronic systems such as Infoflex and Somerset Cancer registry. MDTs working closer with cancer services to ensure clinical validation and higher quality NBOCAP submissions. MDT Level Inaccurate coding. Issues with recording of TNM data at MDT. Good provision of laparoscopic surgery reported nationally. Progress in adopting Enhanced Recovery resulting In lower lengths of stay. High levels of 30 day post op mortality rates, with reasons being noted as late presentation and higher levels of patients presenting with late stage disease. 6

7 NETWORK 100% Colorectal NSSGs % 80% 70% 60% 50% 40% 30% 20% 10% SA 0% There are many examples of good practice at network level, these particularly focused on: Recruitment to clinical trial has improved with network wide clinical trials lists agreed. Enhanced recovery programme rolled out across whole network pathway. Laparoscopic surgical training gap analysis undertaken. Increased National bowel screening campaign awareness. 7

8 Appendix 1 OVERALL PERCENTAGE COMPLIANCE AGAINST THE MDT PEER REVIEW MEASURES Colorectal Measure Number and Short Title SA (0 teams) IV (163 teams) PR (3 teams) 11-2D Lead Clinician and Core Team Membership 96% 100% 11-2D Level 2 Practitioners for Psychological Support 66% 100% 11-2D Support for Level 2 Practitioners 42% 33% 11-2D Named Consultant Core Member(s) for Anal Cancer 95% 0% 11-2D Named MDT for Anal Cancer 98% 100% 11-2D Team Attendance at NSSG Meetings 91% 100% 11-2D MDT Meeting 99% 100% 11-2D MDT Agreed Cover Arrangements for Core Members 11-2D Core Members (or Cover) Present for 2/3 of Meetings 11-2D Annual Meeting to Discuss Operational Policy 11-2D Policy for All New Patients to be Reviewed by MDT 11-2D Policy for Communication of Diagnosis to GP 77% 33% 77% 67% 95% 100% 100% 100% 89% 100% 11-2D Operational Policy for Named Key Worker 99% 100% 11-2D Core Histopathology Member Taking Part in Histopathology EQA 11-2D MDT Agreement to Network Guidelines on Management of Surgical Emergencies 11-2D MDT Agreement to Network Onward Referral Policy 11-2D MDT Agreement to Network List of Personnel Judged Competent for Colorectal Stenting 11-2D Core Nurse Members Completed Specialist Study 11-2D Agreed Responsibilities for Core Nurse Members 11-2D Attendance at National Advanced Communication Skills Training Programme 97% 100% 98% 100% 99% 100% 97% 100% 90% 67% 100% 100% 30% 0% 11-2D Extended Membership of MDT 83% 33% 11-2D Patient Permanent Consultation Record 90% 67% 11-2D Patient Experience Exercise 91% 100% 11-2D Provision of Written Patient Information 98% 67% 11-2D Agree and Record Individual Patient Treatment Plans 100% 100% 8

9 11-2D MDT Agreement to Network Clinical Guidelines for Colorectal Cancer 11-2D MDT Agreement to Network Guidelines for the Clinical Management of Anal Cancer 11-2D MDT Agreement to Network Guidelines for the Clinical Management of Early Rectal Cancer 11-2D MDT Agreement to Network Guidelines on the Resection of Liver Metastases 11-2D MDT Agreement to Network Referral Guidelines between for Anal Cancer 11-2D MDT Agreement to Network Referral Guidelines between for Early Rectal Cancer 11-2D MDT Agreement to Network Referral Guidelines between for the Resection of Liver Metastases 11-2D MDT Agreement to Network Investigation Protocol for Colorectal Cancer 99% 100% 99% 100% 99% 100% 96% 100% 99% 100% 97% 100% 94% 100% 99% 100% 11-2D Agreed Collection of Minimum Dataset 96% 100% 11-2D Network Audit 82% 33% 11-2D Agreed List of Approved Trials 87% 33% 11-2D MDT to Discuss 60 or More New Cases per Year 11-2D or More Operative Procedures per Core Surgical Member 99% 100% 86% 67% 11-2D Clinical Oncologist Core Members 94% D Policy on the Choice of Laparoscopic Colorectal Cancer Surgery 11-2D Training in Laparoscopic Colorectal Cancer Surgery 11-2D Referral Guidelines for Laparoscopic Colorectal Cancer Surgery (Applicable to Colorectal MDTs Without Trained or Exempt Members) 98% 100% 95% 100% 97% 100% 11-2D Joint Treatment Planning for TYAs 89% 33% 9

10 Stand Alone Liver Resection Measure Number and Short Title SA (0 teams) IV (7 teams) 11-2D Lead Clinician and Core Team Membership 96% 11-2D Level 2 Practitioners for Psychological Support 66% 11-2D Support for Level 2 Practitioners 42% 11-2D Team Attendance at NSSG Meetings 95% 11-2D MDT Meeting 98% 11-2D MDT Agreed Cover Arrangements for Core Members 11-2D Core Members (or Cover) Present for 2/3 of Meetings 11-2D Annual Meeting to Discuss Operational Policy 11-2D Agreed Follow Up Policy with Referring MDTs 91% 99% 77% 77% 11-2D Named Hospital for Metastatectomies 95% 11-2D ITU 100% 11-2D Core Nurse Member Completed Specialist Study 11-2D Agreed Responsibilities for Core Nurse Members 89% 99% 11-2D Extended Membership of MDT 97% 11-2D Oncology Agreement with Each Referring MDT 98% 11-2D Patients Permanent Consultation Record 99% 11-2D Patient Experience Exercise 97% 11-2D Provision of Written Patient Information 90% 11-2D Agree and Record Individual Patient Treatment Plans 11-2D MDT Agreement to Network Guidelines for the Resection of Liver Metastases 11-2D MDT Agreement to Network Referral Guidelines for Consideration of Metastatectomy 100% 30% 83% 11-2D Agreed Collection of Minimum Dataset 90% 11-2D Network Audit 91% 11-2D Agreed List of Approved Trials 98% 11-2D Joint Treatment Planning for TYAs 100% PR (0 teams 10

11 Appendix 2 COLORECTAL TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Barnsley NTCN - North Trent 100 IV MDT - BSUH SCN - Sussex 100 IV MDT - Derby Hospital EMCN - East Midlands 100 IV MDT - Poole DCN - Dorset 100 IV MDT - Salford 100 IV IR MDT - South Devon PCN - Peninsula 100 IV MDT - Watford General Hospital MVCN - Mount Vernon 100 IV MDT - Croydon SWLCN - South West London 98 IV MDT - Doncaster & Bassetlaw NTCN - North Trent 98 IV MDT - Dorset County Hospitals DCN - Dorset 98 IV MDT - East Cheshire 98 IV MDT - Gloucester Royal 3CCN - 3 Counties 98 IV MDT - Hillingdon NWLCN - North West London 98 IV MDT - Lister MVCN - Mount Vernon 98 IV SC MDT - Luton & Dunstable MVCN - Mount Vernon 98 IV SC MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 98 IV MDT - Northampton General Hospital NHS Trust EMCN - East Midlands 98 IV MDT - PRUH SELCN - South East London 98 IV SC MDT - Royal Devon & Exeter PCN - Peninsula 98 IV MDT - Southport & Ormskirk MCCN - Merseyside & Cheshire 98 IV MDT - University Hospital North Staffordshire NHS Trust GMCN - Greater Midlands 98 IV MDT - University Hospital of South Manchester NHS Foundation Trust MDT - Wirral MCCN - Merseyside & Cheshire 98 IV 98 IV MDT - Dartford & Gravesham KMCN - Kent & Medway 95 IV MDT - Eastbourne SCN - Sussex 95 IV MDT - Epsom & St Helier SWLCN - South West London 95 IV SC MDT - Frimley Park SWSHCN - Surrey, West Sussex & Hampshire 95 IV MDT - George Eliot ArCN - Arden 95 IV MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham 95 IV 11

12 MDT - Kings College SELCN - South East London 95 IV MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands 95 IV MDT - Northumbria (Wansbeck) NECN - North of England 95 IV MDT - Peterborough AngCN - Anglia 95 IV MDT - QE2 MVCN - Mount Vernon 95 IV SC MDT - Royal Cornwall PCN - Peninsula 95 IV MDT - Royal Liverpool & Broadgreen MDT - RUH MCCN - Merseyside & Cheshire ASWCN - Avon, Somerset & Wiltshire 95 IV IR SC 95 IV MDT - RWST CSCCN - Central South Coast 95 IV MDT - Sherwood Forest Hospitals EMCN - East Midlands 95 IV MDT - St Helens & Knowsley MCCN - Merseyside & Cheshire 95 IV MDT - St Marys NWLCN - North West London 95 IV MDT - Surrey & Sussex MDT - Taunton SWSHCN - Surrey, West Sussex & Hampshire ASWCN - Avon, Somerset & Wiltshire 95 IV 95 IV MDT - The Royal Wolverhampton Hospitals Trust MDT - University Hospital Coventry and Warwickshire NHS Trust GMCN - Greater Midlands 95 IV ArCN - Arden 95 IV MDT - Walsall Healthcare PBCN - Pan-Birmingham 95 IV SC MDT - West Suffolk AngCN - Anglia 95 IV MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley 93 IV MDT - Chelsea & Westminster NWLCN - North West London 93 IV SC MDT - Countess of Chester MDT - DPofW MCCN - Merseyside & Cheshire NEYHCA - North East Yorkshire and Humber Clinical Alliance 93 IV SC 93 IV MDT - Hastings SCN - Sussex 93 IV MDT - Leicester Royal Infirmary EMCN - East Midlands 93 IV SC MDT - Lewisham SELCN - South East London 93 IV MDT - Milton Keynes General TVCN - Thames Valley 93 IV MDT - Newcastle NECN - North of England 93 IV MDT - North Devon PCN - Peninsula 93 IV MDT - Northumbria (North Tyneside) NECN - North of England 93 IV MDT - Northwick Park Hospital NWLCN - North West London 93 IV MDT - Queen's NELCN - North East London 93 IV MDT - Rotherham NTCN - North Trent 93 IV 12

13 MDT - Royal Berkshire TVCN - Thames Valley 93 IV MDT - South Tyneside NECN - North of England 93 IV MDT - University Hospitals Birmingham Foundation Trust MDT - University Hospitals Southampton NHS Foundation Trust PBCN - Pan-Birmingham 93 IV CSCCN - Central South Coast 93 IV MDT - Whipps Cross NELCN - North East London 93 IV MDT - Worthing & Southlands SCN - Sussex 93 IV SC MDT - Basildon & Thurrock ECN - Essex 92 IV MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast 92 IV MDT - Christie Hospital MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria 92 IV 92 IV MDT - IoW CSCCN - Central South Coast 92 IV MDT - Kingston SWLCN - South West London 92 IV MDT - North Cumbria NECN - North of England 92 IV SC MDT - Royal Hampshire County Hospital CSCCN - Central South Coast 92 IV MDT - Maidstone Hospital KMCN - Kent & Medway 91 IV MDT - Portsmouth CSCCN - Central South Coast 91 IV MDT - QEW SELCN - South East London 91 IV SC MDT - Sheffield NTCN - North Trent 91 IV MDT - South Tees NECN - North of England 91 IV SC MDT - Aintree MCCN - Merseyside & Cheshire 90 IV SC MDT - Bradford YCN - Yorkshire 90 IV SC MDT - Burton Hospital EMCN - East Midlands 90 IV MDT - Calderdale & Huddersfield YCN - Yorkshire 90 IV SC MDT - Central Manchester & Manchester Childrens 90 IV SC MDT - Cheltenham General 3CCN - 3 Counties 90 IV MDT - Chesterfield NTCN - North Trent 90 IV MDT - Gateshead NECN - North of England 90 IV MDT - Great Western Hospitals TVCN - Thames Valley 90 IV MDT - Hereford Hospital 3CCN - 3 Counties 90 IV MDT - Homerton NELCN - North East London 90 IV SC MDT - James Paget AngCN - Anglia 90 IV MDT - Kettering EMCN - East Midlands 90 IV SC MDT - Leicester General Hospital EMCN - East Midlands 90 IV MDT - Mid Yorks YCN - Yorkshire 90 IV 13

14 MDT - North Tees And Hartlepool NECN - North of England 90 IV MDT - Oxford University TVCN - Thames Valley 90 IV SC MDT - Queen Elizabeth, Queen Mother KMCN - Kent & Medway 90 IV MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 90 IV SC MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham 90 IV SC MDT - SGH MDT - Stockport NEYHCA - North East Yorkshire and Humber Clinical Alliance 90 IV SC 90 IV MDT - Sunderland NECN - North of England 90 IV MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands 90 IV MDT - UHB MDT - Warrington & Halton ASWCN - Avon, Somerset & Wiltshire MCCN - Merseyside & Cheshire 90 IV 90 IV MDT - West Middlesex NWLCN - North West London 90 IV MDT - Weston MDT - Yeovil MDT - Bolton MDT - Christie Anal MDT ASWCN - Avon, Somerset & Wiltshire ASWCN - Avon, Somerset & Wiltshire 90 IV 90 IV 89 IV SC 89 IV MDT - Addenbrookes AngCN - Anglia 88 IV MDT - Bedford AngCN - Anglia 88 IV SC MDT - Harrogate YCN - Yorkshire 88 IV IR* MDT - Norfolk & Norwich AngCN - Anglia 88 IV MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands 88 IV SC MDT - Pilgrim Hospital Boston EMCN - East Midlands 88 IV SC MDT - RMH Sutton SWLCN - South West London 88 IV MDT - Roch Oldham 88 IV MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 88 IV MDT - University College London Hospitals NCLWECCN - North Central London and West Essex CCN 88 IV SC MDT - William Harvey KMCN - Kent & Medway 88 IV MDT - Barts & London NELCN - North East London 87 IV MDT - DMH/BAGH NECN - North of England 87 IV MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset 87 IV MDT - S Warwickshire General ArCN - Arden 87 IV 14

15 MDT - Tameside & Glossop Acute MDT - Trafford MDT - Wrightington, Wigan And Leigh MDT - Lancashire Teaching Hospitals LSCCN - Lancashire & South Cumbria 87 IV SC 87 IV 87 IV SC 86 IV SC MDT - Leeds Teaching YCN - Yorkshire 86 IV SC MDT - Lincoln County Hospital EMCN - East Midlands 86 IV IR SC MDT - North Middlesex University Hospital NCLWECCN - North Central London and West Essex CCN 86 IV SC MDT - Plymouth PCN - Peninsula 86 IV SC MDT - RSCH SWSHCN - Surrey, West Sussex & Hampshire 86 IV MDT - Southend (Anal MDT) ECN - Essex 86 IV MDT - Airedale YCN - Yorkshire 85 IV MDT - Blackpool Teaching Hospitals Trust LSCCN - Lancashire & South Cumbria 85 IV IR SC MDT - Broomfield (Chelmsford) ECN - Essex 85 IV MDT - Ealing Hospital NWLCN - North West London 85 IV SC MDT - Hinchingbrooke AngCN - Anglia 85 PR MDT - Ipswich AngCN - Anglia 85 IV MDT - Mid Cheshire MDT - North/Bury 85 IV SC 85 IV SC MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties 85 IV SC MDT - Royal Liverpool Small Rectal Cancer MDT MCCN - Merseyside & Cheshire 84 IV MDT - Southend ECN - Essex 84 IV MDT - Heatherwood & Wexham TVCN - Thames Valley 83 PR SC MDT - Morecambe Bay Hospitals MDT - Barnet And Chase Farm Hospitals LSCCN - Lancashire & South Cumbria NCLWECCN - North Central London and West Essex CCN 83 IV SC 82 IV MDT - Kings Lynn AngCN - Anglia 82 IV MDT - Redditch 3CCN - 3 Counties 82 IV SC MDT - UHND NECN - North of England 82 IV SC MDT - Hull And East Yorkshire Hospitals MDT - The Princess Alexandra Hospital NEYHCA - North East Yorkshire and Humber Clinical Alliance NCLWECCN - North Central London and West Essex CCN 81 IV SC 81 IV IR 15

16 MDT - St Peters SWSHCN - Surrey, West Sussex & Hampshire 80 PR IR* SC MDT - Guy's & St Thomas' SELCN - South East London 79 IV SC MDT - Royal Free Hampstead NHS Trust MDT - Scarborough And North East Yorkshire Health Care MDT - Whittington Hospital NCLWECCN - North Central London and West Essex CCN NEYHCA - North East Yorkshire and Humber Clinical Alliance NCLWECCN - North Central London and West Essex CCN 79 IV SC 79 IV 79 IV MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 78 IV MDT - St George's SWLCN - South West London 78 IV MDT - Royal Free Hampstead NHS Trust (Anal MDT) NCLWECCN - North Central London and West Essex CCN 74 IV MDT - York YCN - Yorkshire 74 IV MDT - Newham Healthcare NELCN - North East London 71 IV SC MDT - North Bristol ASWCN - Avon, Somerset & Wiltshire 59 IV * = Resolved 16

17 STAND ALONE LIVER TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Aintree MCCN - Merseyside & Cheshire 96 IV MDT - Sheffield NTCN - North Trent 92 IV MDT - Basingstoke and North Hampshire Hospital MDT - Hammersmith CSCCN - Central South Coast NWLCN - North West London 88 IV 88 IV MDT - Norfolk & Norwich AngCN - Anglia 80 IV SC MDT - Oxford University TVCN - Thames Valley 80 IV SC MDT - Leeds Teaching YCN - Yorkshire 76 IV SC * = Resolved 17

18 Appendix 3: CLINICAL LINES OF ENQUIRY Briefing Paper for National Cancer Peer Review Following the release of the Breast and Colorectal Service Profiles, these Service Profiles are being used in the Breast and Colorectal Clinical Lines of Enquiry (CLEs) for as the entry point for meaningful dialogue. The Service Profiles identify key metrics that reflect the quality of local cancer services, in line with the ethos of the Clinical Lines of Enquiry. Many MDTs will be familiar with these profiles as there was a period of consultation with breast and colorectal MDT teams before they were released to the wider NHS. The profiles provide comparative information for benchmarking the tumour specific Multidisciplinary (MDTs) across England. Although much of the data within these profiles is already available within the NHS, it is the first time this range of indicators has been brought together in a profile format. The profiles help quantify the variation across the cancer specific MDTs for both the patient experience and the quality of patient care. The indicators included have been discussed with cancer commissioners and clinicians working in MDTs as being important elements for objective dialogue in terms of clinical practice and service delivery. The profile will highlight areas where an MDT is doing well and may also highlight other areas for improvement, although it is also important to consider recent progress against the indicators in the dialogue. The inclusion of benchmarking to identify whether a particular indicator is significantly at variance to the national mean is a helpful way to identify those aspects of service delivery which might be the focus of initial discussion. It is anticipated that many trusts will be significantly different to the mean on one or two indicators. In general for any trust, the more indicators that are significantly at variance, the greater the need for understanding why this should be the case. This explanation may be grounded in the population age and socio-economic status. It is also important to note that whether a higher value or a lower value than the mean is regarded as good is dependent on the individual indicator. Some indicators are relatively straightforward to interpret (e.g. cancer waiting times) whereas other indicators may need more discussion and local intelligence to understand the context and case mix of patients managed within the particular service. Documents for both the general guidance on the service profiles, and the data definitions, will be provided alongside the Service Profile to inform their interpretation and discussion. MDTs should discuss their profiles with reference to the areas where benchmarking shows there are areas for improvement. All the profiles and further background information can be found on the Cancer Commissioning Toolkit Additional Colorectal Metric Proportion of newly diagnosed colorectal cancers being radiologically staged with CT scanning (and, in the case of rectal cancer, with MR imaging of the pelvis) Both of these items are requested by NBOCAP but local audits may have also been performed. There is firm guidance from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and COG guidelines that both pre-operative CT imaging in all cases, and additionally MR imaging for cases of rectal cancer, are the radiological investigations of choice. Not only do they allow appropriate selection of patients for neo-adjuvant treatment but the results, coupled with the pathological examination of the resected specimen, allows the MDT to record an integrated clinico-pathological stage for each tumour. There will also be patients, identified as having advanced disease on CT imaging, who will be recommended palliative chemotherapy rather than initial surgical excision. The proportion of patients who are recorded as having had a CT scan, either by having a CT scan result reported or by having a date of CT scan reported was over 80 per cent in the 09/10 reporting period and was similar across cancer sites. In 79 per cent of trusts at least 80 per cent of patients are recorded as having had a CT scan. NICE guidelines recommend that 100 per cent of patients should have a CT scan. It is reported that over 80 per cent of rectal cancer patients undergoing major surgery had an MRI scan, although not all of these patients had a result recorded. In 65 per cent of trusts at least 80 per cent of rectal cancer patients undergoing major surgery had an MRI scan. NICE guidance is that patients with invasive rectal cancers for whom surgery is being considered should have magnetic resonance imaging (MRI) scans before treatment begins. 18

19 Where teams fall below the NICE guidance reviewers should enquire about what is being done to increase the proportion, as well as the impact on patients locally who are not gaining access to this radiological staging. In discussing the NBOCAP data it is important to note that poor uptake may be a reporting issue rather than a failure to perform CT and MR. The National Bowel Cancer Audit Report 2011 is available on the NHS Information Centre website 19

20 All rights reserved Crown Copyright 2013