• East Kent Hospitals University FT flagged as outlier on two measures for lung cancer
  • Trust outlier in last year’s national audit also
  • Organisation has redesigned service and increased specialist nurse numbers

A teaching hospital has redesigned part of its cancer service after being flagged as an outlier in two national clinical audits.

The National Lung Cancer Audit revealed East Kent Hospitals University Foundation Trust was not complying with best practice guidelines on lung cancer treatment for two consecutive years.

The data set is collected nationally and, since a rule change in 2017, has to be shared with the Care Quality Commission so providers can be held to account for it.

Information released to HSJ under the Freedom of Information Act about these alerts shows that, on the most recent National Lung Cancer Audit,  East Kent was an outlier on two measures: The number of small-cell lung cancer patients receiving chemotherapy; and the number of fit patients with advanced non-small cell lung cancer patients receiving systemic anticancer treatment (which can include chemotherapy).

The NLCA report, written by the Royal College of Physicians, said patients with advanced and incurable NSCLC could benefit from SACT, delivered to improve quality of life and to extend survival.

The report said 65 per cent of eligible patients should receive this. However, from trust to trust, it varied between 36 and 96 per cent, with 12 organisations identified as negative outliers.

An East Kent spokesman said: “We were advised that we had an outlying statistic within a subset of the lung cancer audit some time ago and have since taken a number of actions to redress the issue.

“These include recruiting more specialist lung cancer nurses to support patients to make informed decisions about their ongoing treatment and care, working to reduce diagnostic waits by streamlining radiology reporting and flagging potential cancer specimens to the lab.

“We have also introduced a new organisational structure with a specific, clinically-led cancer care group to ensure we continue to focus on this.”

The NLCA charted an improvement in the number of patients nationally being seen by a lung cancer nurse specialist over recent years, with 58 per cent now having a lung cancer nurse present at the time of diagnosis.

Treatment for lung cancer was covered in a recent Getting It Right First Time report on thoracic surgery.

It noted an “unacceptable” variation in the number of NSCLC patients having a lung resection procedure from centre to centre in England. Two other trusts identified as outliers to the CQC by the NLCA said they had data problems rather than clinical problems.

Western Sussex Hospitals FT was flagged as an outlier on SACT.

A spokesman said: “Following [the] outlier alert from the NLCA we undertook a detailed internal audit. This showed our performance was in line with national norms but also identified issues with our validation processes which misinformed our response to the NCLA. We are now strengthening our data validation for the NCLA.”

Nottingham University Hospitals Trust was an outlier for its one-year survival rate. A spokesman said: “Our initial analysis indicates that the trust’s outlier position for mortality is associated with data errors, rather than concerns about clinical care, a view that is shared following independent expert review.

“In response to the audit results, we have strengthened our oversight of our data input processes and reported the actions we are taking to relevant regulatory bodies, including the CQC, who are satisfied with the actions we have taken.”

Portsmouth Hospitals Trust was also identified as an outlier two years in a row by the NLCA.

In June,HSJ reported the trust had reorganised its lung cancer service and bought a new CT scanner in response to the problems.

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