Supported by Roche

Judges

  • Professor David Levy, medical adviser for cancer, Department of Health
  • Joanne Rule, chief executive, Cancerbackup
  • Paul Catchpole, healthcare management director, Roche

Winner Sussex Cancer Network

A tool was developed which enabled the network to calculate the amount of nurse and chair time required to deliver any treatment, and the impact of changing treatments. The judges called it a 'fabulous piece of work'

A capacity and demand study in outpatient chemotherapy units was conducted across the Sussex Cancer Network in 2005 to provide information for potential areas of service redesign and develop a predictive tool to aid planning of services. Demands on nursing time were assessed by breaking down chemotherapy administration into individual stages, including cannulation, patient assessment and drug administration.

In one month, chemotherapy nurses collected timings on how long each of these processes took. Information from 465 chemotherapy patient episodes was gathered and the data used to begin the development of a chemotherapy nurse demand calculator. This took 10 months to develop, and during this time further data was collected. In total 3,435 data sets were analysed and averages taken of the component parts, which were recombined to form the total demand of nursing time. Because nurses do other things between treating patients, such as talking to relatives and preparing for the next day, a percentage of time needed to be added to all regimes.

Staff shadowing conducted at each trust found that approximately two-thirds of nurses' time was spent in direct patient care and the remaining third was indirect supportive care. This percentage was added to the overall timings.

The tool can be used to calculate how much nurse and chair time is required to deliver any treatment, including new treatments that have never been timed before. It can also calculate the impact of new treatments or changes to current treatments, and safe working limits. A risk assessment tool has been developed for managers to monitor activity and trigger risk reporting, and the study has produced recommendations for improvements to service delivery.

The judges said it was innovative and a 'fabulous piece of work' that could be transferred to other parts of the NHS. From this project, the rest of the NHS could learn 'how to get better at planning', they said.

Development of a toolkit for measuring capacity and demand in chemotherapy outpatients and calculation of safe working limits, contact clare.pirie@bhcpct.nhs.uk

Highly commended Heart of England Foundation Trust

A straight-to-test system was implemented for patients referred with suspected colorectal cancer, as this step had created a bottleneck in the cancer pathway

The time from first referral to consultant was well within the 14-day standard, but problems arose after consultation and the decision to refer for investigation. Capacity issues in radiology were causing delays of up to four weeks making it difficult to achieve the 62-day target.

Average waits for Barium, CT and flexible sigmoidoscopy - the mainstays of investigations for colorectal cancer - ranged from 17-63 days, plus the two weeks in which to see patients and arrange the tests.

A meeting was convened including all relevant parties and the team set about tackling this issue. It was decided to implement straight to test.

Although this did not mean any increase in activity for radiology as the same patients would be tested, only earlier in their pathway, there were concerns about the criteria patients would need to meet in order to be placed straight on a waiting list. So, a specific criteria-driven referral form was prepared with the help of GPs.

Patients are now sent straight to test based on symptoms of suspected bowel cancer. If the patient does have cancer, the results are available for discussion on the first visit to see the colorectal specialist. The time from decision to treat to treatment has consistently remained below 31 days, even in instances of tertiary referral.

The judges said the project provided evidence that straight to test can work for bowel cancer patients. 'Simple concept "powerful impact,' they said.

Diagnosing colorectal cancer and changing the pathway - a bum decision or not?, contact cait.allen@heartofengland.nhs.uk

Finalist Knowsley PCT

Knowsley's integrated palliative care service was set up to improve the end-of-life experience for adult patients with cancer or other long-term conditions

The service encompasses health, social domiciliary and personal care and is for patients deemed to be in the last six months of life. It aims to support patients to die at home if this is their preferred place of death. The model has been developed in partnership with Knowsley PCT and Knowsley metropolitan borough council, which jointly manage the service.

The care team is nurse-led, supported by the new role of health and social care worker in palliative care.

In the first year, 2,148 emergency bed days were saved.

Knowsley integrated palliative care, contact ben.o'brien@knowsley.nhs.uk

Finalist Northampton General Hospital Trust

The urology team at Northampton General Hospital redesigned the entire pathway for patients referred with a suspected urological cancer

One-stop clinics were developed for all patients with suspected bladder, kidney and prostate cancers. Patients no longer have to wait for diagnostic tests but are referred 'straight to test' within 14 days of an urgent referral to the hospital. Patients diagnosed with cancer now start their treatment well within the target time of 62 days, and patients who were referred but do not subsequently have a cancer are reassured and discharged earlier. Other improvements that had made the pathway quicker for patients include agreed timescales and protocols, agreed staging protocols and nurse-led follow-up clinics.

One stop urology clinics - total pathway redesign, contact sally.watts@ngh.nhs.uk

Finalist Northern Cancer Network

Fresh ideas for a key worker scheme to ensure better cancer care came about through forming a patient and carer focus group at the Northern Cancer Network

Patients back the idea of a nominated worker who offers support and reassurance, helps to organise care, and facilitates general and out-of-hours contact. Participants at a small patients and carers' focus group hosted by network nurse director Ann Fox were asked to think about how a worker might be nominated and how he or she might ensure people did not fall through gaps in the service.

Issues raised included the need for a 24-hour central phone number, continuity between venues, contact with specialists and the introduction of a key worker card system. Key worker 'business' cards with contact and out-of-hours details have since been piloted.

Key worker card, contact carol.mayes@northtyneside-pct.nhs.uk