National Cancer Waits Project

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National Cancer Waits Project

• Nigel Coomber
• Performance Lead
• Intensive Support Team

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Cancer waits targets

• 62 day targetMaximum 2 month waits from an
  urgent GP referral to first treatment for all
  cancers by end 2005
• 31 day targetMaximum 1 month wait from decision
  to treat to first treatment for all cancers by
  end 2005

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The current situation 31 days
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The current situation 62 days
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By tumour site

• 31 day
• Breast 99
• Lower GI 93
• Upper GI 97
• Lung 97
• Skin 95
• Head neck 89
• Urology 87
• Gynae 92

• 62 day
• Breast 98
• Lower GI 57
• Upper GI 70
• Lung 67
• Skin 94
• Head neck 69
• Urology 69
• Gynae 76

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Key messages

• These targets really matter to patients and the
  public.
• They were set out in 2000 they are not new
  targets.
• They present an opportunity to improve patient
  experience.
• There is recognition that there may be genuine
  clinical reasons why the targets cant be reached
  in a few instances

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Measurement

• Used as part of Health Care Commission rating
  system.
• Q4 (Jan March 2006) data - patients referred
  urgently after 31 Oct 05, and patients with DTT
  after 30 Nov 05 will count.
• 98 threshold for 31 day target, and 95 for 62
  day.

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Clinical Exceptions

• A few patients will not be treated within 31/62
  days for good clinical reasons. Usually this will
  be because of diagnostic uncertainty.
• These patients are included in the cancer waiting
  times returns.
• This term does not cover instances where delays
  are the result of resource constraints, or
  unusual combinations of diagnostic tests.

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Adjustments

• Waiting times can be adjusted for patient reasons
  and medical reasons, for example
• Patient requests time to think before deciding on
  treatment options
• Patient declines an appointment, or defers an
  admission (eg for holiday)
• Patient unavailable due to another medical
  condition which needs to be resolved first)
• Detailed guidance is available

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Measurement 2

• The three way ping
• All Trusts involved in the referral and
  treatment of a patient will be affected if the
  target is breached
• The patients PCT
• The Trust to whom the patient was referred
• The treating Trust (if different from the above).

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NCWP Intensive Support Team

• Purpose to support Trusts in meeting the
  national targets.
• Who we are senior NHS managers and Directors
  seconded to DH
• Working with CSC, national clinical leads,
  Cancer Action Team.
• Working through SHAs.
• Working for.. about 65 Trusts at present.

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What works

• Cut out unnecessary steps (eg straight to test
  where appropriate).
• Pooling of patients and a maximum of two queues
  (but not just cancers in the urgent queue).
• Prospective monitoring (tracking patients).
• Timed pathways and clear escalation processes.

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What works 2

• Correct use of the cancer waiting times guidance
  patient suspensions, and stopping the clock.
• Engagement of all staff in the pathway.
• Clear processes for referral between Trusts
  what does too late mean?
• Equal priority with elective waits preferably
  the same management process.

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Contact details

• Nigel.coomber_at_dh.gsi.gov.uk
• 07879 898161