28 Day Faster Diagnosis Standard
08/03/2017
Overview
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Introduction and background
Aims and objectives
Timeline for rollout
Areas highlighted by testing so far
Questions
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Introduction
• Recommendation from independent Cancer Taskforce:
95% of patients should receive a definitive diagnosis or ruling out
of cancer within 28 days of a referral
• ‘Early priority’ and a Secretary of State commitment
• Aims:
– Speed up access to diagnosis for those with cancer
– Ensure that patients who aren’t diagnosed do not wait and worry
– Fit with new NICE referral guidance lowering the threshold of
suspicion for ‘cancer’ referral
• Some big ambitions:
– ‘All patients’ whatever their suspicion
– Include primary care requested diagnostics
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Opportunities
• Big opportunities:
– Centre the pathway on the patient
– Focus on better communication
– Speedier and more efficient diagnosis, encouraging links
between primary and secondary care
– Greater flexibility than the current 2WW
• Potential barriers
– Data not currently collected and difficult to define end point
consistently
– New national CWT system required to capture and report data
– Capacity in diagnostics and administration
– Potentially large changes in practice
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Approach
• Five test sites: Leeds, East Lancs, Kingston, Bournemouth, Ipswich
• Two main objectives:
– Robustly test and develop rules (16/17)
– Explore impact on services of delivery of the FDS (17/18)
• Work collaboratively across test sites to develop approach
– Shared learning
– Build new standard from the ground up
– Develop and streamline good practice – set standard on that
basis
• Alliances key in moving towards national rollout
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Timeline
2016/17
Q1
Test site
bid process
Q2
2017/18
Q3
Q4
Q1
Q2
2018/19
Q3
Q4
Q1
Q2
Q3
Q4
Test site selection
(07/16)
Data set,
exclusions and
rules agreed
Phase 1 – data
development
Phase 2 – exploration of impact
on services
Faster
Diagnosis
Standard
ISN, Framework for
national rollout agreed
with alliances
Procurement
process – new CWT
system
Project
setup
NHS Digital
named supplier
Ongoing alliance support,
working towards full compliance
by 2020.
Development and testing
of new CWT system
Development
phase start
Test site
close and
evaluation
Ongoing data collection for 28
Day FDS
Implementation
of new system
Further development
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Develop and agree rules
• Agreed core dataset with test sites
• Set of clear rules, as well as exclusions and scenarios being
developed e.g. patient death, dealing with misdiagnosis, how
to apply DNA rules
• Now iterating with test sites – test and learn
• Still looking at primary care requested tests and how we might
be able to include them
• Aim to keep as clear and simple as possible – will keep core
principles of existing cancer waiting times standards
– ‘Complete pathway’ standard
– No adjustments or pauses
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Rollout data
• New CWT system critical – collect additional data items that
will also implement the new breach policy nationally
• Expect to have a phased collection – new items in shadow
form initially (time tbc, 6 months?)
• Once data quality consolidated, begin working towards
meeting new standard
• Early data collection will inform rollout schedule
• Significant change, priorities are:
– Minimise burden
– Integrate to existing systems and processes
– BUT make sure that the new data reflects the strategic
priorities and importance of this new standard
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Rollout performance
• Final ‘performance standard’ will be informed by results from
test sites
– Taskforce suggested 95% but will keep under review
• Expect regions, alliances and other local networks to have a
key role
– Links with ACE, transformation funding, diagnostic
capacity fund
– 28 Day standard doesn’t exist in isolation
• Will be strongly informed by test site evaluation and feedback,
but keen to engage more widely than that
• Test sites as ‘early adopters’ in each region
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Milestones so far
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Test sites began collecting data c.October 2016
Consolidating data collection and definitions 16/17
Reviewing pathways and planning for changes in 17/18
Data set now going through SCCI approvals process – keep
changes to minimum
• Discovery phase for new CWT system complete –
development phase beginning
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Reflections from test sites
• Relatively early in the process, however, some key reflections
• Diagnostic capacity is already clearly a challenge, in particular
pathology and radiology
• Primary care must have a large role and be engaged
• It is going to take some time for this data collection to get off
the ground – will need to have good support in place
• BUT
– Overall, performance is not as far away from the taskforce
ambition as you might think
– Buy-in from clinicians and managers so far has been
strong
– Patients have been well engaged in the project
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28 Day Faster Diagnosis
Standard – key considerations
• Tightly define cohort of patients
• How to deal with direct access referrals
• How to define and link ‘whole pathway’ related to one set of
symptoms
– Key objective to reduce patients ‘bouncing around’ the system
• How to adjust for incorrect diagnoses and revising performance over
time
• Avoiding perverse incentives
• Ensuring there is capacity in the system to allow providers to
succeed
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Summary
• Focus on the strategic goals – patient centred, faster,
more flexible
• Carefully testing the approach and developing it ‘from
the front line’
• Dependent on data collection
• Inter-connected with wide range of other diagnostic
initiatives which will be the focus for performance
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