WinnerLeicestershire, Northamptonshire and Rutland Cancer Network

Service provision for the two cancer centres in Leicester, Northamptonshire and Rutland (LNR) was improved and standardised using Clinical Information Analysis (CIA) data.

In the autumn of 2006, the CIA Programme presented data to the Network Oncology Group which showed the different treatment approaches being given in radiotherapy and chemotherapy for the same tumour group across LNR. The analyses showed the same data for other cancer centres within the Thames Valley area for benchmarking.

The network pharmacist costed all chemotherapy regimens and started discussions with commissioners and the oncology network site specific group lead on moving towards standardising chemotherapy protocols across LNR.

A clinical governance meeting was held to discuss current clinical practice and to attempt to agree LNR-wide protocols. Invitations were sent to all clinical and medical oncologists within LNR and the cancer managers from each trust.
At the meeting, the CIA team presented data demonstrating the analyses of radiotherapy and chemotherapy regimens by cancer site, provider, PCT and showing variations between providers and trends.

Parallel sessions were run covering the main tumour sites – breast, lung, colorectal, urological (prostate and bladder), head and neck and upper GI.
As a result of the meeting, agreement on protocols of care for radiotherapy and chemotherapy were made for five of the six tumour sites. It was agreed that further discussion time was needed for lung cancer, which has since been achieved.

The pre-work undertaken by the network pharmacist, which showed the inconsistencies in care from a cost perspective, ensured that commissioners were engaged and prepared to support the decisions made by clinicians.
The information provided on the day empowered the clinicians to make informed decisions on patient care.

The judges said: 'This project offers an excellent demonstration of the importance in any service improvement process of information that is both robust and trusted by users.'

Leicester, Northamptonshire and Rutland (LNR) Cancer Network Oncology Group Clinical Governance Meeting, contact elspeth.macdonald@lcrpct.nhs.uk

Highly CommendedNottingham City PCT

A health equity audit of the New Leaf smoking cessation service was performed to enable the PCT to target the service.
Nottingham’s life expectancy is significantly lower than national levels, and reducing its high levels of smoking (34 per cent compared to 27 per cent nationally) was vital to narrowing this health inequality.
A health equity audit was performed using Mosaic Public Sector, a geo-demographic tool, combined with mapping.

Mosaic Public Sector identifies natural groupings that exist in the population. Each postcode is assigned to one of 11 distinct lifestyle groups. The analysis showed that four of the groups, which make up more than 60 per cent of Nottingham’s population, have high levels of smoking. And the people in Nottingham’s largest group are 25 per cent more likely to smoke than average.

Postcodes of clients accessing the service were matched to a Mosaic group. A high percentage of people using the service were from the high need groups, suggesting appropriate targeting. But there were some geographic areas where uptake was low, given the groups living there.

The information was fed back to the New Leaf team. Changes to the service in these low uptake areas were made, including advisors working more proactively with GP practices, changing some clinic times and venues and setting up new sessions.

Monitoring at six monthly intervals shows that targeting has improved.
The judges said: 'This projects demonstrates that a more sophisticated approach to "needs analysis" and service uptake can expose underserved populations at a very local level.'

A health equity audit of the New Leaf smoking cessation service using Mosaic and Geographic Information Systems, contact jeanelle.degruchy@nottinghamcity-pct.nhs.uk

Highly CommendedSandwell PCT

Patients at high risk of cardiovascular disease (CVD) were identified using an information technology algorithm.

The National Service Framework for Coronary Heart Disease states that patients who do not have CVD but are at high risk should be identified and offered preventative treatment.
A three stage method was developed to identify patients at high risk of CVD. Firstly, CVD risk factor data was extracted from GP electronic medical records for all patients in the relevant age groups, excluding patients already known to the practice.
Secondly, ten-year CVD risk was calculated using age, gender, smoking status, blood pressure, cholesterol levels and diabetes data. Default values were based on national averages where data was missing. This allowed assigning a probable CVD risk to all patients. Patients with the highest risk were invited for an assessment first, followed by those with the next highest probable risk respectively.
Finally, eligible patients were offered appropriate treatment.
Using this modelling, we predicted that a third of the practice population were aged 35 to 74 years old and not being treated for CVD diagnosis. Further analysis within this group showed that 17.7 per cent of patients would be eligible for preventive treatment.
The judges said: 'This is an excellent example of how commissioners and primary care providers can use the vast repository of patient level data held in digital form by GPs to identify with greater precision patients not currently in touch with services who may be at risk of developing a serious illness.'

Sandwell CVD Risk Project, contact jenny.chen@sandwell-pct.nhs.uk

Bedford Hospital NHS Trust

A capacity planning tool was implemented which uses forecasting and real time data to match staff and physical resources to workload.

Retrospective data was failing to accurately forecast demand because it did not take into account changes within the organisation on an hourly and daily basis. Plans were often inappropriate by the time they were due to be implemented as the data supporting them had become irrelevant.

CapPlan gives daily and weekly projections on activity which allow the trust to resource according to need. Longer term projections are 97 per cent accurate.

The trust is saving between£6,000 and£12,000 per week.

CapPlan, contact lisa.hunt@bedfordshire.nhs.uk

Community Nursing Service (South Downs Health NHST)

A formula was devised to determine staffing levels required for the community nursing service.

Anecdotal evidence showed that there were inequities between district nursing teams and their workloads, but the trust was not aware of any national formula that could be used to ensure that staff were equitably distributed.
A formula was designed, based on average rates of productivity and elderly patient populations on GPs' lists across the whole service.

As a result of this exercise, the trust changed the number of district nursing teams, the size of each team, the skill-mix, and the number of staff in each team.

Achieving equitable distribution of district nursing staff across Brighton & Hove, contact andrea.jones@southdowns.nhs.uk