North Trent Cancer Network NSSG Constitution For Head ... and Neck... · The meeting is quorate when 50% of the constituent core members are represented at ... the Primary Care Referral

North Trent Cancer Network

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NSSG Constitution For Head & Neck Cancer NSSG 14/05/11

Agreements / Cover Sheet The NTCN Network Site Specific Terms of Reference (Appendix one) were revised and agreed at the Network Board on in February 2009. Agreement for these terms of reference was sought from Chair Network Board, SHA Chief Executive, Trust Chief Executives, NSSG Chairs, Specialist Commissioner and Lead Cancer Clinician prior to sign off. This NSSG Constitution was agreed by Mr Austen Smith, Consultant Maxillofacial Surgeon, Sheffield Teaching Hospitals, Chair of the Head & Neck NSSG, on 14/05/10 Mr David Chadwick Consultant Surgeon Chair of Thyroid subgroup on 14th May 2010 and 25th June 2010 This NSSG Constitution was agreed by Annette Laban, Chief Executive,NHS Doncaster, Chair of the Network Board on 14/05/10

This NSSG Constitution was agreed by the NSSG members, on 14/05/10

NSSG Constitution Review Date: 1st April 2012


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11-1A-201i Terms of Reference (see appendix 1) Membership of Group The Head & Neck NSSG consists of the following agreed members

11 - 1A-201i/ 11 - 1C-104i MEMBERSHIP OF HEAD & NECK NSSG GROUP and THYROID SUB-GROUP CORE MEMBERS CHAIR

Mr Austen Smith Cons Oral Maxillofacial Surgeon

Sheffield / Barnsley

DEPUTY CHAIR

Mr Mark Watson Cons ENT Surgeon Doncaster & Bassetlaw LOCALITY LEADS & DEPUTIES

Mr Alan Paterson Cons Maxillofacial Surgeon Rotherham Mr Stuart Richards(Dep)

Cons ENT surgeon Rotherham

Mr Mark Watson Cons ENT Surgeon Doncaster & Bassetlaw Janet Ryles (Dep) ENT CNS Doncaster & Bassetlaw Mr Martin Wickham Cons ENT Surgeon Barnsley Mr Michael Nussbaumer (Dep) Cons ENT Surgeon Barnsley Mr Peter Doyle Cons Maxillofacial Surgeon Chesterfield Mr Mohammed Haneefa (Dep) Cons ENT Surgeon Chesterfield Mr Thomas Westin MDT lead Cons ENT

Surgeon Sheffield

Dr Kash Purohit (Dep) Consultant Oncologist Sheffield EXTENDED CORE MEMBERS Mr David Chadwick Cons Surgeon (Thyroid Chair) Chesterfield Mr Stuart Richards Consultant ENT Surgeon Rotherham Mr Andy Parker Cons ENT Surgeon Sheffield Mr Robert Orr Cons Maxillofacial Chesterfield Dr Martin Robinson Snr Lecturer Oncology Sheffield Dr Bernie Foran Cons Oncologist Sheffield Dr Jonathan Wadsley Cons Oncologist Sheffield Mr Aidan Fitzgerald Cons Plastic Surgeon Sheffield Mr Shahed Quraishi Consultant Otolaryngologist Doncaster Keith Hunter Cons Oral Pathologist Sheffield Mr Raj Patel Cons Restorative Dentistry Sheffield Sam Sharpe Speech & Language Therapist Doncaster & Bassetlaw Abi Miller Speech & Language Therapist Chesterfield Jane Thornton Speech & Language Therapist Sheffield Vicky Gallivan Dietitian Sheffield


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NURSE MEMBERS Janet Ryles H&N Clinical Nurse Practitioner Doncaster & Bassetlaw Tracy White Macmillan CNS H&N Sheffield Louise Marley Macmillan CNS H&N Sheffield Mary Green Head and Neck clinical nurse

practitioner Chesterfield

Sharon Stoddart Head and Neck clinical nurse practitioner

Chesterfield

Judith Lunn Macmillan CNS H&N Rotherham Lisa Smith ENT CNS Barnsley USER MEMBERS Mr Dennis Atkin Mr Malcolm Babb Mr Ray Mountain

ROLES ASSIGNED TO CORE MEMBERS NSSG member responsible for recruitment to Clinical trials Bernadette Foran Consultant Oncologist Sheffield

NSSG SERVICE IMPROVEMENT LEAD

Janet Ryles H&N Clinical Nurse Practitioner Doncaster & Bassetlaw

MEMBER RESPONSIBLE FOR USER ISSUES AND INFORMATION

Tracy White Macmillan CNS H&N Sheffield

NON-CORE MEMBERS

MANAGEMENT SUPPORT

Management support will be provided as required by either the Network Lead Nurse, or the Service Improvement Lead.

ADMINISTRATIVE SUPPORT

Administrative support will be provided by the Network Groups’ Support Officer.

MEMBERSHIP OF THE WIDER GROUP

All ENT/OMFs surgeons, consultant radiologists, pathologists, specialist nurses with an interest in head and neck cancers are welcome to attend meetings. THYROID SUB-GROUP (11-1C-104i )

Mr David Chadwick (Chair)

Consultant Surgeon Chesterfield

Mr Amit Allahabadia Consultant Endocrinologist Sheffield

Mathew Bull Consultant Radiologist Sheffield Cathy Clout Consultant Radiologist Sheffield Judy Darwent Clinical Nurse Specialist Sheffield Maxine Eades Clinical Nurse Specialist Sheffield Anne French Clinical Nurse Specialist Sheffield Mr Barney J Harrison Consultant Surgeon Sheffield Mr Shahed Quraishi Consultant Otolaryngologist Doncaster


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Mr Stuart Richards Consultant ENT Surgeon Rotherham Dr Tim Stephenson Consultant Histopathologist Sheffield Mr Saba Balasubramanian

Consultant Surgeon Sheffield

Dr Jonathan Wadsley Consultant Clinical Oncologist Sheffield Mr Mark Watson Consultant ENT Surgeon Doncaster Mr Martin Wickham Consultant Surgeon Barnsley

The meeting is quorate when 50% of the constituent core members are represented at the meeting, but the chair can declare a larger meeting non-quorate if key members are not present. The mechanism for obtaining user advice if there is no user representative at the meeting is via feedback from the network representative to the network User facilitator and Partnership Group. Role / Function of the Group

The NSSG is recognised as;

• The board’s primary source of clinical opinion on issues relating to Head & Neck cancer for the network

• The group with corporate responsibility, delegated by the board, for co-ordination and consistency across the network for cancer policy, practice guidelines, audit, research and service improvement

• Consulting with the relevant ‘cross cutting’ network groups on issues involving chemotherapy, cancer imaging, histopathology and laboratory investigation and specialist palliative care; and with the head of service on issues involving radiotherapy.

• The chair facilitates the identification and agreement of the service priorities for the NSSG and recommends priorities to the network board.


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11-1C-101i

PROGRAMME OF DATES FOR 2010 NORTH TRENT HEAD & NECK CANCER NSSG MEETINGS

The following programme of dates for 2010/ 2011 meetings agreed by the NSSG.

DATE TIME VENUE

Friday 10th September 2010

2-4.00 p.m. Redmires Room Don Valley House Sheffield

Friday 10th December 2010

2-4.00 p.m Redmires Room Don Valley House Sheffield

Friday 11th February 2011 2-4.00 p.m Redmires Room Don Valley House Sheffield

Friday 13th May 2011 2-4.00 p.m Howden Room Don Valley House Sheffield

Friday 9th September 2011

2-4.00 p.m Redmires Room Don Valley House Sheffield

Friday 9th December 2011 2-4.00 p.m Redmires Room Don Valley House Sheffield

Thyroid subgroup meeting dates Date Time Venue Friday 4th December 2010 2-4.00p.m Don ValleyHouse

Sheffield

Friday 25th June 2010 (inc Business meeting)

2-4.00p.m Don Valley House Sheffield

Friday 14th January 2011 (inc Business meeting)

2-4.00p.m Don Valley House Sheffield


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Network Configuration

Scope of Service (11-1A-202i,)

The oversight of Head & Neck cancer for North Trent is via a single network group which deal with UAT cancer and has the structure, functions and terms of reference as in measure 11-1A- 201i plus a separate single sub group of the NSSG for the network which deals with Thyroid cancer 11-1C-104i.

(ii) 11-1A-203i The named hospitals, designated as in (i), for the network, distributed such that the PCTs agree that their populations have sufficient access.

• There are designated hospitals for the diagnostic and assessment service.

• The hospitals fulfil the following criteria:- o They have specialised facilities for investigation of head and neck patients. o They have contracted direct patient care sessions with at least two

designated clinicians for head and neck diagnosis and assessment o They are the only hospitals for which there are contact points specified in

the Primary Care Referral guidelines for head and neck cancer. MDT Designated Hospital

for Diagnosis & Assessment

Undertaking curative surgical Procedures

Designated Head & Neck Ward

Bassetlaw District General Hospital;

N/A N/A

Barnsley Hospitals NHS Foundation Trust

N/A N/A

Chesterfield Royal NHS Foundation Trust

Yes Barnes Ward

Doncaster Royal Infirmary

Yes (laser surgery only )

S12

Rotherham Hospitals NHS Foundation Trust

N/A N/A

NTCN Head & Neck MDT (from 1

st

December 2007)

Royal Hallamshire Hospital. Sheffield/Charles Clifford Dental Hospital

Yes Head & Neck Centre I Floor RHH.


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• There is agreement on those hospitals where the curative surgical treatment for head and neck cancer takes place

• They have a designated head and neck ward

• There is one named MDT based at Sheffield Teaching Hospitals NHS Foundation Trust which carries out all their surgical procedures for Head and Neck cancer

MDT Host

Organisation Designated Hospital for Diagnosis & Treatment

Referring PCT Catchment Population (resident)…

Bassetlaw District General Hospital;

NHS Bassetlaw 107,261 NTCN Specialist UAT MDT


NHS Barnsley 233,261

Chesterfield Royal NHS Foundation Trust

NHS Derbyshire County (excl.High Peak & Dales)

361,832

NTCN Specialist Skull base MDT


NHS Doncaster 293,316


NHS Rotherham

244,053

NTCN Specialist Thyroid MDT

Royal Hallamshire Hospital Sheffield

Royal Hallamshire Hospital. Sheffield/Charles Clifford Dental Hospital

NHS Sheffield 538,270

1,777,993


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11-1A-204i Designated hospitals for referrals with neck lumps The network board, in consultation with the NSSG(s) for head and neck cancer and the NSSG for haematological malignancy, should agree with the PCTs in the network the distribution of neck lump clinics as specified in measure 1A-204i. They should fulfill the following criteria: - • They should be the clinics named for referral of patients with neck lumps in the

primary care referral guidelines. • They should be hosted by a designated hospital. • They should be distributed such that the PCTs agree that their populations have

sufficient access. • It should be agreed for each clinic whether it will have clinicians designated for thyroid

cancer and assess patients with thyroid lumps.

Designated Hospital

Referring PCT

Resident Population

Type of Clinic

Frequency of Clinic

Designated Thyroid Clinician

Bassetlaw District General

NHS Bassetlaw

107,261 Head & Neck Screening clinic

Twice weekly Mr MG Watson Mr Quraishi


NHS Barnsley

233,261 Neck Lump Fortnightly Mr Wickham

Chesterfield Royal Hospital NHS Foundation Trust

NHS Derbyshire County (Excl High Peak & Dales )

361,832

Neck Lump

Weekly Mr D Chadwick

Head & Neck Screening clinic



NHS Doncaster

293,316

Thyroid Lump (includes Bassetlaw patients)

Twice monthly Mr S Quraishi


NHS Rotherham

244,053 Neck Lump (including thyroid lumps)

Twice weekly Mr S Richards

Charles Clifford Dental Hospital, Sheffield

??Called Weekly Dr Allahabadia

Royal Hallamshire Hospital. Sheffield

NHS Sheffield

538,270

ENT based Neck Lump clinic

Twice weekly Mr B Harrison


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11-1A -205i The distribution of specialist thyroid clinics as specified in measure. The network board in consultation with the NSSG responsible for thyroid cancer agrees with the PCTs in the network that there will be a mixture of thyroid clinics and neck lump clinics which assess thyroid lumps. They should fulfil the following criteria: - These clinics are: • Named in the primary care referral guidelines, for referral of patients with thyroid lumps • They are hosted by a designated hospital. • They are distributed such that, their populations have sufficient access to thyroid

cancer diagnosis and assessment. Designated Hospital

Referring PCT

Resident Population

Type of Clinic

Frequency of Clinic

Designated Thyroid Clinician

Bassetlaw District General

NHS Bassetlaw

107,261 Head & Neck Screening clinic



NHS Barnsley

233,261 Neck Lump Fortnightly Mr Wickham

Chesterfield Royal Hospital NHS Foundation Trust

NHS Derbyshire County (Excl High Peak & Dales )

361,832

Neck Lump

Weekly Mr D Chadwick

Head & Neck Screening clinic



NHS Doncaster

293,316

Thyroid Lump (includes Bassetlaw patients)

Twice monthly Mr S Quraishi


NHS Rotherham

244,053 Neck Lump (including thyroid lumps)

Twice weekly Mr S Richards

Charles Clifford Dental Hospital, Sheffield

Dr Allahabadia

Thyroid Clinic Weekly

?????? Royal Hallamshire Hospital. Sheffield

NHS Sheffield

538,270

Thyroid Clinic Twice weekly Mr B Harrison

• All the units have established standardised referral processes in place for all urgent head and neck cancer referrals.


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• All the clinic have access to facilities for urgent ultrasound and fine needle aspiration

11-1C-109i

The agreed policy with regard to named surgeons performing lymph node

resections on Thyroid Cancer patients is that:-

i) Any surgeon should be a core member of UAT MDT or Thyroid MDT.

ii) This does not apply to the simple excision of lymph nodes for diagnosis purposes.

iii) Patients are not referred from other networks for this procedure.

The named surgeons within North Trent Cancer Network to undertake these procedures

are:-

Mr B.J. Harrison

Mr S. Balasubramanian

11-1A-206i Referral guidelines for primary care practitioners regarding patients with head and neck symptoms are included in the clinical and management guidelines

(see Appendix 10) Distribution process of referral guidelines The NSSG have agreed that the referral guidelines for primary care will be distributed to the following in the network

• Primary care medical practices ( via PCT )

• Primary dental practices (via PCT)

• Designated consultant clinicians

• Non-designated head and neck consultant clinicians o ENT surgeons o Endocrine surgeons o OMFS surgeons o Oral medicine specialists o Endocrinologists o Restorative dentistry consultants


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11-1A-207i Referral proforma for routine referrals The referral proforma for UAT routine referrals is included in the Referral and Management guidelines for head and neck cancers within North Trent (Appendix 9)

• It is used for patients with UAT symptoms which are outside the “ the urgent suspicion of cancer’ definition and who have no neck lumps

• It allows for the referrer to categorize a patient by presenting features, so that the hospital can direct the referral to the relevant speciality (eg. ENT OMFS)

• The network-wide format is made locally specific by identifying a single referral point for each designated hospital to which proformas can be sent for direction to individual specialists.

11-1A-208i Internal referral guidelines for non designated hospital clinicians Internal referral guidelines for non designated hospital clinicians for the onward referral of patients presenting with features suspicious of head and neck cancer are included in the Referral and Management guidelines for head and neck cancer in North Trent ( Appendix 9) There is no network proforma, it is agreed that each locality will use their own clinical referral guidelines and schemas in the guidelines Distribution process of internal referral guidelines The internal referral guidelines are distributed to the following in the network

• Designated consultant clinicians

• Non-designated head and neck consultant clinicians o ENT surgeons o Endocrine surgeons o OMFS surgeons o Oral medicine specialists

• Endocrinologists

11-1A-209i Designated hospitals for referrals with thyroid lumps (see 10-1A-204i and 11- 1A-205i) 11-1A- 210i The named hospitals and ward with the named MDTs associated with each hospital (see10-1A-203i) 11-1A-211i Network MDT configuration There is a single Upper Aero-digestive Tract team (UAT MDT) embracing all units, with a nominal surgical “centre” comprising STH and Chesterfield Hospital for all simple cancer surgery. Thyroid Cancer and Skull base MDTs at Sheffield have evolved well, with consolidated links to the MDT and some shared membership


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11-1A-212i Named MDTs dealing with thyroid cancer configuration

11-1A-213i Distribution of local support teams The network board, in consultation with the NSSG, agrees the locality groups, and the distribution of local support teams in the network, for patients with head and neck cancer. The distribution fulfills the following: - • One or more teams should be established by each designated hospital for head and

neck cancer in the network. • Each team should cover a named geographical area.

• The whole network should be covered by means of such areas 11-1A – 214i The role of the local support team Local Support Teams - see extract below from rehabilitation guidelines

All five areas of Trent Region I.e.; Barnsley, Doncaster, Rotherham, Sheffield and Chesterfield must have a local support team, consisting of core members of the MDT. Each local support team should include speech and language therapists, dietitians, clinical nurse specialists and restorative dentists. All must specialise in head and neck cancer rehabilitation

Name of locality

Type of team Host Organisation Referring PCT Catchment Population

Barnsley Local support

Barnsley Hospital NHS Foundation Trust

NHS Barnsley 233,261

Chesterfield Local support

Chesterfield Hospital NHS Foundation Trust

NHS Derbyshire County (excludes High Peak & Dales)

361,832

Doncaster & Bassetlaw

Local support

Doncaster & Bassetlaw NHS Foundation Trust

NHS Doncaster NHS Bassetlaw

293,316 107,261

Rotherham Local support

The Rotherham NHS Foundation Trust

NHS Rotherham 244,053

Sheffield MDT

Local support Specialist MDT

Sheffield Teaching Hospital Foundation Trust

NHS Sheffield 538,270


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Extended members of the team may include; anaplastologist, clinical psychologist/counsellor, dental hygienist, occupational therapist and physiotherapist

There should be robust communication and referral pathways between the cancer

centre and the local support services to ensure that patients’ rehabilitation needs are met throughout the patient journey and in a seamless manner.

All patients should have their rehabilitation needs monitored and assessed

throughout their pathway by core members of the head and neck cancer team and/ or extended team members as appropriate using an assessment protocol agreed across the cancer network.

Every patient who is to be considered for head and neck surgical or oncological treatment should have;

• A full consultation with a clinical nurse specialist

• Pulmonary and respiratory functioning testing, including full tracheostomy care

• If speech or swallowing may be affected then full assessment by a speech and language therapist

• Nutritional status should be assessed and any supplementary and/ or enteral feeding requirements identified prior to any treatment.

• Dental assessment and restorative needs identified.

• Prosthetic assessment.

• Psychological evaluation using a recognised screening tool.

• Identification of Social support requirements

• Assessment of physical needs and Activities of daily Living.

• Referral to Smoking Cessation / Alcohol addiction support services if required.

• Assessment for referral onto specialist services including palliative care, pain management, and lymph oedema etc.

All patients should also be given access to the following information

• Local patient visitor and peer support groups e.g.; cancer support or laryngectomy groups, buddy system

• Cancer information support centre offering psychological, social and spiritual/cultural support, and other complimentary therapies.

• Information specific to the site of the disease and treatment options

• Contact information for relevant core members and extended team members, and information on their roles in treatment.

• Guidance/outline of the likely nature, timing and duration of the treatment(s) of choice and the short/long term effects of treatment.


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During any modality of treatment, patients need to have access to consultants, specialist nurses and therapists wherever that treatment is being delivered. Assessment of all the above areas must be ongoing and must include tracheostomy and speech prosthesis management.

11-1A 215i Guidelines for referral of patients with UAT These will be reviewed in December 2012 to assure current clinical practice 11-1A- 216i Guidelines for referral of patients with Thyroid Cancer These are included in the Head & Neck management guidelines were reviewed in December 2009 Data Collection 11-1C-110i Minimum dataset The agreed minimum dataset and policy regarding collection of the individual components is attached (Appendix 2 ) 11-1C-111i Data collection Each Trust has mechanisms in place to capture data items to facilitate monitoring against the Going Further for Cancer Waits targets. The NSSG have signed up to support collection of this data. The registry dataset is collected in part by the trusts and there is an action plan to have all data items collated by 2011 when electronic upload is mandated. 11- 1C- 112i The NSSG works closely with Service Improvement team within the network (Please see Work programme document for 3year development plan) and details Service development is a standard item on the NSSG agenda and is regularly reviewed. The main development has been the strengthening of the Central MDT and ensuring effective working practices within it IOG

Head and Neck cancer Improving Outcome Guidance

In April 2007, a network Implementation Group was set up to oversee and support the implementation of the head and neck cancer improving outcomes guidance including the necessary service changes.. As part of this work a number of governing principles were agreed with clinicians and managers in order to take the work forward a) Equal priority is given to enhancing and sustaining local services, and centralising radical

surgery.


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b) There will be two or more designated head and neck surgeons in each cancer unit that provide diagnostic services for symptoms. This will ensure there is a strong focus on and commitment to robust local diagnostic, assessment and follow-up services. This will also facilitate continuity of patient care.

c) There will be stronger links between the local services and the centre. Designated

clinicians will refer patients who have cancer to the MDT d) Formal links will be established between designated clinicians and the MDT. Working Assumptions

(a) There would be a single specialist MDT meeting in the centre held weekly. (b) All the designated unit head and neck clinicians would be able to participate in the centre

MDT to discuss all cases. (c) Diagnostic neck lump clinics should be established in all DGHs (d) Specialised teams would be formalised for thyroid cancer.

Salivary gland, skull based tumours and rare cancers of the head and neck would be dealt with by subgroups of the parent Upper Aerodigestive Tract and Head and Neck MDT. For skull based tumours, interested clinicians would be represented at both MDTs

(e) Local support teams would be established established to provide rehabilitation and support

within the locality. These teams would work closely with primary care and link to the specialist MDT

(f) Where appropriate ,the visiting oncologist would initiate / review non-surgical treatments. (g) A working algorithm would be developed to define a threshold for minor work above which

a centre referral would be appropriate. Subsequent work determined the unit of surgery within the centre based on complexity, workload and geography etc.

(h) Patients requiring treatment which was restricted to the centre would initially be reviewed centrally until it was felt appropriate to refer them back to the DGH with agreed limitations

(i) The surgeons would retain an involvement in the direction of their patients’ management Workforce Issues In order that Sheffield Teaching Hospital and the Chesterfield Royal Hospital were compliant with the Improving Outcomes Guidance and therefore able to develop as head and neck cancer surgery sites it was essential that a range of additional staff were recruited including:

• Additional administrative support to the MDT

• Clinical oncology session

• Rehabilitation staff

• Nursing staff


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This involved:-

STH Posts

1.0 wte Dietician

1.0 wte Speech Therapist

1.0 wte CNS

CRH Posts

0.5 wte Dietician

1.0 wte Speech Therapist

0.2 wte Physiotherapist

At Chesterfield:

• An OMFS surgical team was in place and there were already two cancer surgeons employed within the trust

• A ENT surgical team was in place and an additional cancer surgeon was needed to complete the team

To ensure that the service was developed according to the NICE guidance additional external advice was sought from the Professor of Otorhinolaryngology at Nottingham University particularly in relation to the on call arrangements Following discussions between STHFT and CRHFT a pragmatic solution was agreed. The key features of the new arrangements are as follows

a) The STH ENT surgeons proposed that each of them in turn would work a full day at CRHT, 2 sessions per week

b) Each surgeon would be available for a theatre session in the morning and clinic in the

afternoon. c) The preference was for each of them to be available on a Wednesday and work on a two–

weekly rotation d) Each of the STH surgeons could provide telephone support to the on call Chesterfield

consultant surgeon and attend for any immediate post-operative medical emergencies occurring on the first post-op night

e) It was agreed that there should be a training post based at CRHFT to work closely with the

STHFT surgeons and co-ordinate the management of the patients at CRHT on behalf of the STH surgeons

f) There would be regular reviews of the arrangements throughout the year including an

audit of the first 6 months data

g) The start date of the new arrangements was determined by the recruitment of an appropriate Trainee who started in the summer 2009

h) The start date was delayed due to sickness (consultant surgeon) but became fully

operational in November 2009


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There will be a formal review of the arrangements in June/July 2010 Kim Fell Cathy Edwards Network Director Director North Trent Cancer Network Yorkshire & the Humber SCG

Clinical and Referral Guidelines 11-1A-207i 11-1A-208i 11-1A-209i 11-1A-210i 11-1A-211i 11-1A-215i 11-1A-216i 11-1C-103i 11-1C-105i 11-1C-106i 11-1C-107i 11-1C-108i 11-1C-109i (Central MDT Operational Policy has been removed from the Referral and management guidelines for up date and will be appended prior to the Peer Review visit) Include responsibility for agreeing network clinical and referral guidelines and that they are up to date and reflect current practice. These are included in Appendix 1 document on CQUINs The Thyroid guidelines were reviewed in 2009 and PEG guidelines were also incorporated into the document. The list of personnel identified was updated in 2010 The guidelines are for full review in December 2012


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Appendix 1 – NTCN Network Site Specific Terms of Reference

NAME OF GROUP: Network Site Specific Group (NSSG) Cross Cutting Group (CCG)

ACCOUNTABLE TO:

The North Trent Cancer Network Board The NSSG/CCG Chair is a member of the Network Clinical Strategy Group and as such is responsible for ensuring risks associated with the delivery of services across the relevant pathway are fed into the network planning process.

PURPOSE: The NSSG/CCG has responsibility, delegated by the Board, for ensuring the co-ordination of the cancer pathway and the consistency of care for the relevant client group within the cancer network. This includes:

• Service planning

• Service Improvement / Redesign

• Service Quality Monitoring and evaluation including clinical performance and outcomes

• Workforce Development

• Research and Development The Network tumour-site specific groups should have the active engagement of all MDT leads from the relevant constituent organisations in the network. NSSGs should ensure that all agreed operational changes are discussed with local managers to ensure that changes are integrated into constituent organisational structures and processes. Discussions to explore other changes to existing patient pathways may be initiated by commissioners including Primary Care. NSSG provides advice in respect of all significant service changes (e.g. IOG) particularly if there are financial consequences, and will make recommendations to the Cancer Board. The NSSG has a key role in:

1 Peer review measures 1A -202 and -203 refer

NORTH TRENT CANCER NETWORK (NTCN)

NETWORK SITE SPECIFIC / CROSS CUTTING GROUP(s) COMMON TERMS OF REFERENCE 1

February 2009


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Developing plans to implement Improving Outcomes Guidance Monitoring the implementation of the agreed Improving Outcomes guidance action plans. Raising concerns and areas of risk to the Board via the agreed governance arrangements.

COMPOSITION OF NSSG:

• Chair of the NSSG

• The MDT lead clinician from each MDT in the network

• Nominated Oncologist

• Pathologist

• Specialist Surgeons / Physicians

• At least one nurse core member of a MDT

• A service improvement staff representative

• Two user representatives* All the above are core members common to every NSSG . The following members are optional: As many other members of those MDTs e.g. Physiotherapy, Speech and Language therapy as appropriate

• A representative of palliative care

• A Primary Care Cancer Lead

• A manager representative (from a PCT, provider or NORCOM HQ)

• As a minimum, involve users in their service planning and review * For any one NSSG, the network partnership group can agree an alternative mechanism for obtaining user advice.

Each NSSG will list all its members.

COMPOSITION OF CCG:

The composition of each cross cutting group includes a representative from each locality of each specific cross cutting group, and where appropriate wider membership will reflect National Guidance. All groups will review membership annually, and record attendance as per National Guidance.

CHAIR: The NSSG/CCG will select its own chair and deputy. Tenure in each role should be reviewed after 3 years. The Chair should have an annual appraisal.

CHAIR’S EXTRA-MEETINGS ROLE

The Chair will: -

• Ensure engagement of constituent members.

• Attend development programmes organised for the Lead Clinicians

• Facilitate the identification and agreement of the service priorities for the NSSG/CCG

• Recommend priorities via the Network Strategy group to the Network Board.

• Ensure an annual report of the NSSG’s work is written

• Have an annual (review) meeting with the Network Lead Clinician and the outcomes agreed by the Network Chair.

• Be an ambassador for service improvement locally and the


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NSSG/CCG, regionally and nationally. INDIVIDUAL ROLES:

Each core member should attend 50% or more of the NSSG/CCG meetings. It is assumed that their employers will protect the time commitment entailed. One of the NHS-employed NSSG members will be named as having specific responsibility for users' issues. One of the NHS-employed NSSG members will be named as having specific responsibility on information for patients and carers. One of the NHS-employed NSSG members will be named as having specific responsibility on service improvement* ie being a champion for it. None of the above three roles are mutually exclusive. Members should ensure that all decisions become integrated into constituent organisational structures and processes * but not the member of service improvement staff.

DECISION MAKING PROCESS:

All attendees at the NSSG meeting will have a vote. Recommendations to the Board will normally be achieved through consensus; however, when a vote is required it is essential that the split of votes is recorded to aid the understanding of the Board in the decision making process

QUORUM: The meeting is quorate when 50% of the constituent core members are represented at the meeting, but the chair can declare a larger meeting non-quorate if key members are not present.

RESPONSIBILITIES:

NB this (long) list of responsibilities assumes the regular input of provider managers and network officers. Service Planning is in line with: 1 National guidelines and advising commissioners and provider

trusts of the implications of that guidance for the whole network. 2 Identifying any risks within the service and developing a network-

wide service delivery plan to deliver the NHS Cancer Plan. 3 Responding to Improving Outcomes Guidance recommendations

and advising commissioners on appropriate patient pathway (or model options) developments within North Trent, which will deliver patient care within those recommendations. Developing efficient working models aligned to good practice guidance and national policy drivers.

4 Agreeing common standards including referral pathways, revised

in light of national policy or guidance, patient care pathways (from primary care, both into and out of tertiary services). This includes updating and revising referral guidelines as appropriate. In time a service specification will be generated.


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5 Agree on priorities for data collection, produce audit data and participate in open review including the user experience and service user evaluation

6 Monitor progress on meeting national cancer measures, trial entry

and ensure action plans agreed at Peer Review are implemented. 7 Reviewing approved clinical trials, and other research, once a year.

Agreeing a single list of clinical trials and studies into which the network’s MDTs should give priority for patient entry.

8 Develop clear cancer workforce recommendations that foster new

ways of working so that services are robust in the face of recruitment difficulties and emergent technologies.

9 Foster strong working relationships to develop network-wide

resolution to workforce issues 10 Liaising and consulting with the relevant "cross cutting" network

groups to identify issues that have wider implications and consequent knock on effects. This includes chemotherapy; imaging; histopathology (and other laboratory investigations); specialist palliative care, with the Head of Service for radiotherapy, Children and Young People and Primary Care.

FREQUENCY OF MEETINGS:

At least once every 6 months to a maximum of 4 times per year. Additional meetings may be necessary for short term task and finish projects e.g Peer Review preparation, IOG implementation

SERVICED BY: Cancer Network Office (2 days per meeting, but 9 days pa max) 2

COMMUNICATIONS:

Outward – NSSG/CCG lead to give feedback to the Lead Clinicians Forum and present findings, with recommendations, to the Network Strategy Group

- MDT leads to share items of news with fellow MDT members and with local managers

- NSSG (lead) to write an annual report - NSSG to write an annual work programme for Board endorsement

News can be placed on the network’s website

http://www.northtrentcancernetwork.nhs.uk Agreed guidelines will be downloadable from there.

MINUTES CIRCULATED TO:

NSSG members Network Lead Clinician Cross-Cutting Groups Leads Primary Care Cancer Leads

REVIEW DATE: January 2010


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Appendix 2 11-1C- 110i Minimum dataset

Head & Neck / Thyroid Data Collection Matrix

Data Item Dataset

Surname Registry

Forename Registry

Sex Registry

Date of Birth Registry

Marital Status Registry

Place of Birth Registry

Ethnic Origin Registry

NHS Number Registry

Address Registry

Date of Diagnosis Registry

Morphology Registry

Site Registry

Laterality Registry

Basis of Diagnosis Registry

Sex at Diagnosis Registry

Diagnosing Hospital Registry

Hospital Number Registry

Clinician Registry

Clinician Specialty Registry

Surgery Treatment Indicator Registry

Radiotherapy Treatment Indicator Registry

Chemotherapy Treatment Indicator Registry

Hormonal Treatment Indicator Registry

Other Treatment Indicator Registry

Organisation Code Waiting Times

Source Of Referral For Cancer Waiting Times

Delay Reason Referral To First Seen (Cancer And Breast Symptoms)

Waiting Times

Delay Reason Comment (First Seen) Waiting Times

Urgent Cancer Or Symptomatic Breast Referral Type Waiting Times

Cancer Or Symptomatic Breast Referral Patient Status Waiting Times

Waiting Time Adjustment (First Seen) Waiting Times


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Waiting Time Adjustment Reason (First Seen) Waiting Times

Source Of Referral For Out-Patients Waiting Times

Primary Diagnosis (ICD) Waiting Times

Multidisciplinary Discussion Indicator Waiting Times

Multidisciplinary Team Discussion Date (Cancer) Waiting Times

Recurrence Indicator Waiting Times

Decision To Treat Date (Surgery) Waiting Times

Start Date (Surgery Hospital Provider Spell) Waiting Times

Primary Diagnosis (Icd) Waiting Times

Decision To Treat Date (Anti-Cancer Drug Regimen) Waiting Times

Start Date (Anti-Cancer Drug Regimen) Waiting Times

Decision To Treat Date (Teletherapy Treatment Course) Waiting Times

Start Date (Teletherapy Treatment Course) Waiting Times

Decision To Treat Date (Brachytherapy Treatment Course) Waiting Times

Start Date (Brachytherapy Treatment Course) Waiting Times

Decision To Treat Date (Specialist Palliative Treatment Course) Waiting Times

Waiting Time Adjustment (Treatment) Waiting Times

Waiting Time Adjustment Reason (Treatment) Waiting Times

Delay Reason Referral To Treatment (Cancer) Waiting Times

Delay Reason Decision To Treatment (Cancer) Waiting Times

Delay Reason Comment (Referral To Treatment) Waiting Times

Delay Reason Comment (Decision To Treatment) Waiting Times

Decision To Treat Date (Active Monitoring) Waiting Times

Start Date (Active Monitoring) Waiting Times

Patient Pathway Identifier Waiting Times

Organisation Code (Patient Pathway Issuer) Waiting Times

Priority Type Waiting Times

Cancer Referral To Treatment Period Start Date Waiting Times

Consultant Upgrade Date Waiting Times


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Organisation Code (Provider Consultant Upgrade) Waiting Times

Metastatic Site Waiting Times

Cancer Treatment Event Type Waiting Times

Cancer Treatment Period Start Date Waiting Times

Treatment Start Date (Cancer) Waiting Times

Cancer Treatment Modality Waiting Times

Cancer Care Setting (Treatment) Waiting Times

Clinical Trial Indicator Waiting Times

Organisation Code (Provider Treatment Start Date (Cancer)) Waiting Times

Radiotherapy Priority Waiting Times

Radiotherapy Intent Waiting Times

Delay Reason (Consultant Upgrade) Waiting Times

Delay Reason Comment (Consultant Upgrade) Waiting Times

Organisation Code (Provider Decision To Treat) Waiting Times

Decision To Refer Date (Cancer Or Breast Symptoms) Waiting Times

NHS number DAHNO

Hospital identifier (Submitting organisation) DAHNO

Hospital identifier DAHNO

Patient case record number DAHNO Surname DAHNO Forename DAHNO

Patient post code DAHNO Patient sex DAHNO

Date of birth DAHNO GP Practice Code DAHNO Patient case record number DAHNO

Date of Diagnosis DAHNO Source of Referral DAHNO

Referral priority DAHNO Referral for cancer decision date DAHNO

Date referral request received DAHNO Date first seen DAHNO Date symptoms first noted DAHNO

MDT discussion indicator DAHNO MDT discussion date DAHNO

Care Plan agreed date DAHNO Cancer Care Plan intent DAHNO Planned cancer treatment type 1 DAHNO

Planned cancer treatment type 2 DAHNO Planned cancer treatment type 3 DAHNO


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Planned cancer treatment type 4 DAHNO

Comorbidity index DAHNO

Performance status at present DAHNO Primary care communication sent date DAHNO

Dental assessment date DAHNO Speech and Language assessment date DAHNO

Clinical trial patient status DAHNO

Recurrence Indicator DAHNO

Primary diagnosis (primary site) DAHNO

Pre-Treatment Tumour Site T category DAHNO Pre-Treatment Staging certainty T category DAHNO

Pre-Treatment Tumour site N category DAHNO Pre-Treatment Staging certainty N category DAHNO Pre-Treatment Tumour site M category DAHNO

Pre-Treatment Staging certainty M category DAHNO Pre-Treatment Overall Stage pre-treatment DAHNO

Pre-Treatment Staging certainty TNM category DAHNO Professionals present at breaking of bad news DAHNO

Date patient advised of cancer diagnosis DAHNO Clinical intervention date (cancer imaging) DAHNO Cancer imaging modality DAHNO

Anatomical examination site DAHNO Image request date DAHNO

Date of image report DAHNO Diagnostic Procedure Date DAHNO Diagnostic Procedure DAHNO

Cancer treatment intent DAHNO Pathology specimen type DAHNO

Date of Pathology Report DAHNO (Investigation Result Date) DAHNO

Histology DAHNO Exision margin DAHNO Specimen nature DAHNO

Primary diagnosis (primary site) DAHNO Tumour laterality DAHNO

Basis of diagnosis DAHNO Histology DAHNO Final Integrated Tumour site T category DAHNO

Final Integrated Staging certainty T category DAHNO Final Integrated Tumour site N category DAHNO

Final Integrated Staging certainty N category DAHNO Final Integrated Tumour site M category DAHNO

Final Integrated Staging certainty M category DAHNO Final Integrated Overall Stage pre-treatment DAHNO Final Integrated Staging certainty TNM category DAHNO

Date Pathology Report DAHNO Care Plan agreed date DAHNO

Cancer treatment intent DAHNO Date of decision to treat DAHNO [Date of decision to operate] DAHNO

Procedure Date DAHNO Primary procedure code (Main Surgical Procedure) DAHNO


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Secondary procedure code (s) (Other procedure DAHNO


Secondary procedure code (s) (Other procedure DAHNO Secondary procedure code (s) (Other procedure DAHNO


Discharge destination DAHNO

Primary Site Tumour DAHNO TNM stage category (pathological) DAHNO Tumour site T category (pathological) pT DAHNO

Tumour site N category (pathological) pN DAHNO Tumour site M category DAHNO

(pathological) pM DAHNO Date of Pathology Report DAHNO Histology DAHNO

Excision margin DAHNO Date teletherapy decision DAHNO

Cancer treatment intent DAHNO Teletherapy treatment to DAHNO

Radiotherapy treatment site DAHNO

Teletherapy start date DAHNO Date brachytherapy decision DAHNO

Cancer treatment intent DAHNO Brachytherapy treatment to DAHNO

Radiotherapy Treatment Site DAHNO

Brachytherapy start date DAHNO Date Chemotherapy decision to treat DAHNO

Chemotherapy drug type DAHNO Chemotherapy drug treatment intent DAHNO

Chemotherapy start date DAHNO Clinical status assessment date DAHNO

Primary tumour status DAHNO Nodal status DAHNO Metastatic status DAHNO

Morbidity code chemotherapy DAHNO Morbidity code radiotherapy DAHNO

Morbidity code combination DAHNO

Date of death DAHNO Contact date DAHNO

[Date of contact] DAHNO Speech & swallowing assessment date DAHNO

Normalcy of Diet [Post Treatment] DAHNO SVR contact professional involvement DAHNO

[Who actioned contact] DAHNO SVR contact purpose (Type of contact) DAHNO Patient follow-up status DAHNO

[Follow-up status] DAHNO SVR communication post operative method DAHNO

[Proposed method of post-operative communication] DAHNO SVR communication primary method DAHNO [primary method of communication at contact] DAHNO

SVR communication other method DAHNO [Other methods of communication] DAHNO


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Post operative voicing DAHNO

[Post-operative voicing] DAHNO

SVR permanent valve removal reason (reason for permanent removal) DAHNO

Patient estimated normal weight (Kg) DAHNO Person observation (weight) (Kg) DAHNO

Date weight measured DAHNO Person observation (height) (M) DAHNO Date height measured DAHNO

Contact date dietician post treatment DAHNO Contact date (dietitian initial) DAHNO

Date nutritional support instigated DAHNO Nutritional Support Type DAHNO Date nutritional support remains in place DAHNO

Date nutritional support withdrawn DAHNO Procedure date [Date nutritional procedure] DAHNO

Procedure (OPCS) [Nutritional Procedure Type] DAHNO Date palliative decision DAHNO

Palliative care start date DAHNO Source of referral for cancer to ClinNS DAHNO [Source of referral to ClinNS DAHNO

Cancer referral decision date to ClinNS DAHNO [Date of decision to refer to ClinNS] DAHNO

Reason for referral to ClinNS DAHNO Contact date (ClinNS initial) [Dte of first assessment with ClinNS] DAHNO Date patient advised of cancer diagnosis DAHNO

Professionals present at breaking of bad news DAHNO Date of ClinNS intervention DAHNO

Type of ClinNS intervention DAHNO Date of discharge from ClinNS DAHNO

Documents

North Trent Cancer Network NSSG Constitution For Head ... and Neck... · The meeting is quorate when 50% of the constituent core members are represented at ... the Primary Care Referral