Project Title

Ovarian Cancer Maintenance Therapy clinic

Organisations involved

MSD (UK) Ltd and The Christie NHS Foundation Trust

Summary

The project will be an eighteen-month pilot of a “one stop shop” dedicated Ovarian Cancer Maintenance Therapy (OCMT) Clinic at The Christie, with a proposed start date of February 2022.  The service would be nurse led, supported by a pharmacist and with clinical expertise provided by an oncology consultant. The proposed pilot will provide a dedicated ovarian cancer maintenance therapy clinic which will concentrate clinical expertise in this specific group.

Background

The Christie manages patients from across Greater Manchester, with a population of 2.8 million ⁽¹⁾, which is the largest cancer network in the UK. It also provides second opinions for patients nationally and additionally, there is a private patient service available through HCA Christie. The Christie treats ovarian cancer patients from across Greater Manchester and currently patients on ovarian cancer maintenance therapies are managed in the medic-led outpatient clinic together with patients on active chemotherapy regimens. The numbers of patients requiring this treatment are growing and there is a backlog of patients due to the Covid pandemic ^(1). The clinic will aim to manage these patients within a dedicated service, alleviating the backlog of patients.

Project Approach

The project aims to enable The Christie NHS Foundation Trust to successfully set up and implement a “one stop shop” dedicated ovarian cancer maintenance therapy clinic, and to share lessons with peers and the wider NHS. The service would be nurse led, supported by a pharmacist and with clinical expertise provided by the oncology consultant. There will be a mix of virtual and face to face appointments, and treatment to be offered at home where appropriate. Additionally, the clinic will aid COVID recovery plans, by alleviating the back-log of patients due to the additional nurse time provided within the 5 weekly sessions in the clinic.

Project Objectives

•  The clinic will aim to treat 90% of eligible patients with ovarian cancer by the end of the pilot
• The Christie will capture and collate the data, and results will be reviewed, with success measured via patient experience
• Help improve patient experience through patients having a designated time for their appointment
• Aid COVID recovery plans through the additional nurse time provided by the clinic to support patient awaiting treatment
• Funding to be secured to continue the clinic post pilot

Benefits

Patients:

• Dedicated service and point of contact to manage their treatment

• Addressing patient concerns will continuously improve and develop the service for subsequent patients
• Patient experience data may prove sufficiently compelling to lead to wider adoption of the service in other Trusts and reduce variation across the NHS
• Dedicated service may improve treatment options, compliance and experience for patients

NHS

• Patients managed within a nurse led OCMT clinic may result in consultants having more time available to deal with complex cases
• Continuously improve the service (e.g. highlighting areas of need or dissatisfaction)

• Provide other hospitals and services evidence to form business cases to adopt a similar service

• Dedicated clinic to providing additional nurse time will aid with reducing post COVID backlog

MSD

• Lead consultant may be willing to share experience of working with MSD to support future partnerships with the wider NHS
• Reputational benefit from partnering with The Christie
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of the ovarian cancer maintenance therapy clinic project is that MSD may see more appropriate use of their NICE approved medicines

Funding

From MSD (or budget to be covered by MSD):

• MSD £45,150 (based on Band 8 nurse (c£60k salary) 0.5 WTE. 5 sessions per week (3 patient facing, 1 MDT, 1 admin)
• To be phased in over 2 years:
  • 2022 £30,150
  • 2023 £15,000
• Project management- £6,000 (1 day per month)

From the NHS:

• NHS Pharmacist – £45,000 (salary c£60k)
• Consultant expertise – £6,980 (salary c£98k) (0.5 days per week)

Total MSD £51,150

Total NHS £51,980

Total project= £103,130

GB-NON-05464  |  November 2025

References:

• Dr Jurjees Hasan, Consultant in Medical Oncology, The Christie NHS FT

Project Title

Oxford TNBC Neo-adjuvant and Adjuvant Clinic Support

Organisations involved

Oxford University Hospitals NHS Foundation Trust (OUH) and MSD

Summary

The project’s goal was to redesign the treatment clinics for patients within the triple negative breast cancer (TNBC) service at the OUH. This enabled the service to better meet the growing patient volumes and demand on resources. To support this project, MSD provided funding of £24,000 which enabled the employment of a Pathway Coordinator. Further resources were pooled as MSD provided project management time, and the OUH provided Advanced Nurse Practitioner (ANP) project oversight for the service development initiative. The new Pathway Coordinator took on the administerial duties that the ANP team and Systemic Anti-Cancer Therapy (SACT) nurses would usually undertake. The duties included those which required a great deal of valuable specialist nursing time that otherwise could have been spent on patient treatment and care.

Employing a Pathway Coordinator enabled the ANP team to initiate and run clinics fully dedicated to the treatment and care of neo-adjuvant and adjuvant TNBC patients, as well as specialised SACT nurse clinic time for patients on oral SACT. Before we started the project, these patients were all seen in the same clinic where there can be a lack of focus and specific holistic care aimed towards those patients undergoing neo-adjuvant and adjuvant treatment. The project duration was 12 months, over which time we measured the capacity released in terms of CNS and ANP time freed up to focus on the running of new clinics to meet the growing patient demand.

Benefits Realised

This section describes how delivering this project has helped the TNBC service address the Trusts three quality domains: Patient Experience, Clinical Effectiveness and Patient Safety.

Patient Benefits – Neo-adjuvant and adjuvant SACT patients

• Dedicated clinic time now provides holistic and psychological support, addressing not only medical needs but also emotional and practical concerns. This includes managing side effects, adjusting prescriptions, and offering strategies to cope with treatment.
• Dedicated clinic time and greater focus may lead to fewer dose reductions and better management of side effects, which may help patients stay on treatment longer and improves their overall experience.
• Patients benefit from having a consistent point of contact who understands their treatment and can provide timely support.

Patient Benefits – Oral SACT patients

• Patients now experience improved care due to the increased availability of nurses for clinical duties.
• Service has moved from patients being given an 8-hour appointment window for telephone consultation, to patients now being given a 1 hour booking window, bringing the patient more convenient structure and timings.
• Patients now experience well-structured care and treatment planning, with better service coordinated and improved nurse organisation and engagement.
  • Improved coordination of patient clinic bookings and blood appointments mean that the service has moved from booking just one appointment into the future, to now booking appointments for the next 4 months. It has been observed that this approach brings more certainty to a SACT patient at a time when there is a great deal of uncertainty.

NHS Benefits

Time and Cost Savings

• For the 5 months January to May 2024, the Pathway Coordinator has saved:
  • 66 days (495 hours) of SACT nurse time.
  • This equates to a B6 SACT nurse time cost equivalent saving of £3,678.
  • When modelled out to 12 months, this would result in 158 days saved and a cost saving of £8,827.
  • In addition, we can calculate that:
    • £6.07 of nurse time equivalent is saved for every Band 3 Pathway Coordinator hour worked.
    • 7 hours of SACT nurse time is saved per day for every day worked by Pathway Coordinator (of 7.5 hours).

Service Quality Improvement

• As a result of nurse time saved and capacity released, dedicated treatment clinic time has been created to focus on neo-adjuvant / adjuvant patients, with separate clinics being run for oral SACT patients. Dedicated treatment clinic time for neo-adjuvant and adjuvant patients has enabled:
  • Patients now being seen at critical points in their treatment, such as after their first cycle of SACT, which is when they typically experience their first side effects. Timely management of side effects improves overall patient treatment experience.
  • Anecdotally, the management of side effects early and effectively has reduced the need for patients to use triage services or be admitted to the hospital. This has resulted in cost savings and optimised the use of healthcare resources.
• Moving from clinic times not being harmonised and subsequent inability to engage junior doctors and consultants around treatment decisions, to now having all clinics running concurrently, enabling:
  • Implementation of pre and post clinic meetings where senior clinical advice is sought in a timely manner.
  • Improved clinical effectiveness where safer, timely and better-informed decision making takes place.
  • Improved patient safety where treatment decisions are peer reviewed where needed, and made in a timely manner.
  • Improved patient experience where patients don’t have to wait to find out what changes are needed to their treatment.

An increase in the number of patients seen in clinic

• Patient numbers seen in treatment clinic from Jan 2024 to May 2024 were observed to increase by 48% in 4 months (112 patients in January to 166 in May).
  • This is due to SACT nurses now having a more clinically efficient service with better coordination of nurse resource and capacity that’s been released.

Clinical effectiveness

• We increased clinical compliance and effectiveness by ensuring that patients are put onto the correct nurses list relative to the stage they’re at in their treatment cycle.
• We reduced the amount of duplication and incorrect nurse attendances.

Nurse experience

• Anecdotally, job satisfaction and retention has improved as nurses are not having their clinical productivity reduced by admin duties.
• This is especially important given the OUH’s difficulties recruiting B6 SACT trained nurses, and the lengthy training requirements to upskill nurses to be SACT trained.

Recurrent funding for a substantive pathway coordinator role

• At the time of writing a Case of Need document (Business Case) has been written detailing the benefits of employing a Pathway Coordinator. This document has been used to secure continued ‘temporary’ funding while longer term, recurrent funding is still being secured. Despite current financial constraints within the NHS, the financial benefits, clinical efficiencies and improved patient experience from employing a pathway navigator have made it easier to justify the continued funding of the role in the near term. The benefits to the trust, the clinicians, the patient and the breast cancer service are clear and have been recognised by the senior OUH management team.

MSD Benefits

• Contributing towards the development of cancer services in the breast pathway, gaining experience of how to create service efficiencies, releasing capacity and improving patient experience.
• Collaborating on a project that will positively impact patients and has the potential to be scaled to other geographies as speaks to the NHSE cancer workforce agenda.
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.
• Enhanced reputation of MSD through partnership work.

Funding & Resources

This project was a shared funding commitment from OUH & MSD. The total project cost was £24,000.

Lessons learnt

The project highlighted the importance of administrative support in improving clinical efficiency and patient care. Future collaborations should consider the value of dedicated administrative roles to alleviate the burden on clinical staff. Additionally, the project demonstrated the need for clear communication and collaboration between different departments to achieve the desired outcome.

Publications

None

GB-NON-10387  |  January 2025

Project Title

University Hospitals of Birmingham (UHB) Breast Cancer Pathway Development Project (PDP)

Organisations involved

University Hospitals of Birmingham (UHB)

Summary

There is an opportunity in Birmingham to optimise the breast cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved breast cancer pathway achievement of the breast cancer 28 day Faster Diagnostic Standard and the 31- and 62-day Cancer Waiting Time Targets. The project intends to run for approximately 6 months, The data set used for baseline and impact evaluation will the UHB Breast Milestone Dashboard created for the project.

Benefits Realised

Due to significant and unanticipated capacity issues within the University Hospitals Birmingham system which needed to take priority the outcome summary for the UHB breast cancer pathway PDP has not been initiated and has been delayed.

Funding & Resources

This was a project with shared time commitment from University Hospitals of Birmingham (UHB) & MSD

Lessons learnt

Creation of a formal contingency plan should any of the key stakeholders and MSD project manager have time capacity issues, leave their post or their organisation during the implementation of the project.

Publications

No publications are planned.

GB-NON-09618 |  June 2024

Project Title

Belfast Health and Social Care Trust Oesophageal Pathway Development Project (PDP)

Organisations involved

MSD

Belfast Health and Social Care Trust

Summary

A national optimal oesophageal cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all oesophageal cancer patients receive optimal cancer care. There was an opportunity in Belfast Health and Social Care Trust to optimise the oesophageal cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved oesophageal cancer pathway and achievement of the oesophageal Cancer 31- and 62-day Cancer Waiting Time (CWT) targets. The project started in April 2022 and finished in June 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Belfast Health and Social Care Trust team, MSD provided project management support to assess the current state of the oesophageal cancer pathway and provide a gap analysis comparing the pathway with the National Cancer Pathway. MSD then supported the implementation, led by the NHS, of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the oesophageal cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome if patients are diagnosed earlier on in the pathway. Refer to NHS benefits below to see number of days potentially saved.

 NHS Benefits

•  Pathology Pathway was reduced by 4-6 weeks vs current turnaround times which will impact 759 patients per year. This was done by:
  • Belfast Health and Social Care Trust reviewing the outcomes of the PDP and procuring a new companion diagnostic testing equipment which will allow in house testing.
  • All patients will be reflexed tested.
• Pathology – The project highlighted the need for training which was then implemented across Belfast Health and Social Care Trust.
• Overall treatment rates were not measured as part of this Pathway Development Programme
• % of patients achieving CWT:
  • 31 day target improved from 89% June 2022 to 95% June 2023
  • 62 day target improved from 0% June 2022 to 31% June 2023

MSD Benefits

• Better understanding of oesophageal cancer patient needs
• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8.5/10 and 8.5/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively.
  • Average score of 8/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Improved pathology processes”
  • “Nothing specific to the part of the pathway I’m associated with but I can see other aspects are positively affected”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Very useful to have additional capacity and an outside voice to support project”
  • “MSD very positive about trying to improve cancer pathways and always approach things with a ‘solution’ orientated mindset”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from Belfast Health and Social Care Trust & MSD

Lessons learnt

• Oesophageal cancer and patient numbers during the project was defined as per the Northern Ireland Oesophago-Gastric Cancer Audit published 2021 measuring the quality of care for patients diagnosed 2018-2019.
• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the oesophageal cancer patient pathway, attainment of the Cancer Waiting Time targets remains challenging. The CWT performance for oesophageal cancer has improved against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-08707  |  February 2024

Project Title

Southern Health and Social Care Trust Pathway Development Project (PDP)

Organisations involved

MSD

Southern Health and Social Care Trust

Summary

A national optimal oesophageal cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all oesophageal cancer patients receive optimal cancer care. There was an opportunity in Southern Health and Social Care Trust to optimise the oesophageal cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved oesophageal cancer pathway and achievement of the oesophageal cancer 31 and 62 day Cancer Waiting Time (CWT) targets. The project started April 2022 and finished June 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Southern Health and Social Care Trust team, MSD provided project management support to assess the current state of the oesophageal cancer pathway and provide a gap analysis comparing the pathway with the National Cancer Pathway. MSD then supported the implementation, led by the NHS, of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the oesophageal cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome if patients are diagnosed earlier on in the pathway. Refer to NHS benefits below to see number of days potentially saved.

 NHS Benefits

• Pathology Pathway was reduced by 4-6 weeks vs current turnaround times which will impact 140 patients per year. This was done by:
  • Belfast Health and Social Care Trust reviewing the outcomes of the PDP and procuring a new companion diagnostic testing equipment which will allow in house testing.
  • All patients will be reflexed tested.
  • Southern Health and social care trust will send samples to Belfast Health and Social Care trust
• Endoscopy (including Oesphagogastro duodenoscopy – OGD’s) Did Not Attend (DNA’s) rates improved from 39 patients (5.80%) in June 2022 to 20 patients (2.19%) in June 2023. Attendance rates for endoscopy (including OGD’s) improved from 82.56% in June 2022 to 93.52% in June 2023 by contacting patients prior to the procedure with a reminder and explanation of the procedure.
• Triage – improved triage from 7 days on average to 5 days on average per patients by adapting internal processes.
• Direct to Test rates improved from 89% in June 2022 to 95% in June 2023 even with additional demand on the service by adapting internal processes impacting 140 patients
• Overall treatment rates were not measured as part of this Pathway Development Programme
• % of patients achieving CWT:
  • 31 day target= 100% June 2023 (maintained at same level as 2022)
  • 62 day target improved from 25% June 2022 to 50% June 2023

MSD Benefits

• Better understanding of oesophageal cancer patient needs
• Enhanced reputation of MSD through partnership work. Four NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8/10 and 6.5/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively.
  • Average score of 7.75/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Better communication and networking between key stakeholders”
  • “Better understanding of all roles that each team member does and how this affects the service as a whole”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Great team to work with, very engaging and encouraging. A sense that they were very much invested in patient benefit”
  • “The partnership working with MSD was conducive in linking with all stakeholders, identifying issues across the whole patient pathway and supporting the development of the RAG plan to work on areas to address the issues. The regular stakeholder meetings helped to review, update and further develop the work plan”
  • “Excellent interaction and constructive feedback”
•  This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from Southern Health and Social Care Trust & MSD

Lessons learnt

• Oesophageal cancer and patient numbers during the project was defined as per the Northern Ireland Oesophago-Gastric Cancer Audit published 2021 measuring the quality of care for patients diagnosed 2018-2019.
• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible.
• Regular touch points to ensure clarity of expectation and outcomes.
• Clear plan of action and review within stakeholder meetings.
• Despite the best efforts of the NHS and MSD to optimise the oesophageal cancer patient pathway, attainment of the Cancer Waiting Time targets remains challenging. The CWT performance for oesophageal cancer has remained steady against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-08711 | February 2024

Project Title

Northern Health and Social Care Trust Pathway Development Project (PDP)

Organisations involved

MSD

Northern Health and Social Care Trust

Summary

A national optimal oesophageal cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all oesophageal cancer patients receive optimal cancer care. There was an opportunity in Northern Health and Social Care Trust to optimise the oesophageal cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved oesophageal cancer pathway and achievement of the oesophageal cancer 31 and 62 day Cancer Waiting Time (CWT) targets. The project started in April 2022 and finished June 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Northern Health and Social Care Trust team, MSD provided project management support to assess the current state of the oesophageal cancer pathway and provide a gap analysis comparing the pathway with the National Cancer Pathway. MSD then supported the implementation, led by the NHS, of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the oesophageal cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome if patients are diagnosed earlier in the pathway. Refer to NHS benefits below to see number of days potentially saved.

NHS Benefits

• Pathology Pathway was reduced by 4-6 weeks vs current turnaround times which will impact 188 patients per year. This was done by:
• • Belfast Health and Social Care Trust reviewing the outcomes of the PDP and procuring a new companion diagnostic testing equipment which will allow in house testing.
  • All patients will be reflexed tested
  • Northern Health and social care trust will send samples to Belfast Health and Social Care Trust
• Endoscopy – Oesophago-gastro-duodenoscopy (OGD) direct to test levels were maintained at a 50% level even though additional demand on the service by adapting internal processes, impacting 188 patients per annum.
• OGD waiting times improved June 2022 vs June 2023 for suspect cancer, urgent and routine even with additional demand on the service by additional planning of the weekly lists.

Suspect Cancer      2.6 weeks June 2022 vs 2.3 weeks June 2023

Urgent                    32.9 weeks June 2022 vs 12.6 weeks June 2023

Routine                   87 weeks June 2022 vs 32.6 weeks June 2023

• Dietetics – Reducing the turnaround time of 84% patients receiving nutritional supplements from 3-5 days to 0-2 days by changing request from phone to email. This will impact 188 patients per annum
• Overall treatment rates were not measured as part of this Pathway Development Programme
• % of patients achieving CWT:
  • 31 day target= 100% June 2023 ( maintained at same level as 2022)
  • 62 day target improved from 0% June 2022 to 50% June 2023

MSD Benefits

• Better understanding of oesophageal cancer patient needs
• Enhanced reputation of MSD through partnership work. Nine NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 9.11/10 and 7.56/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively.
  • Average score of 8.44/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Improved Direct to test rates, OGD waits reduced. More understanding of pathway across all MDT. Dietetic delays reduced”
  • “It has allowed time to focus specifically on the service and bring the team together to review current ways of working”
  • “Improved process for engaging with GPs regarding supplements and improved early referral to the CNS”
  • “It has allowed time to focus specifically on the service and bring the team together to review current ways of working”
  • “Faster prescription of nutritional supplements for our UGI patients via GP Regional dietetic agreement on streamlining/developing literature for our patients- dysphagia score specific”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Positive experience and allowed the MDT to review individually their part in the patient pathway and how this feeds into the overall patient pathway and anyway that this can be improved”
  • “It was extremely useful to have oversight of pathway – not just locally but on a Regional level too”
  • “excellent working with MSD and potential areas for improvement identified”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from Northern Health and Social Care Trust & MSD

Lessons learnt

• Oesophageal cancer and patient numbers during the project was defined as per the Northern Ireland Oesophago-Gastric Cancer Audit published 2021 measuring the quality of care for patients diagnosed 2018-2019.
• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the oesophageal cancer patient pathway, attainment of the Cancer Waiting Time targets remains challenging. The CWT performance for oesophageal cancer has improved against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-08708 | February 2024

Project Title

Community Pharmacy/General Practitioner (CP/GP) Head and Neck Cancer Pathway Project

Organisations involved

NHS Tayside

MSD-UK

Summary

NHS Tayside, through the North Cancer Alliance, worked in collaboration with MSD to develop a communication pathway between community pharmacies in the Dundee city area and their local primary care practices for patients with suspected head and neck cancers (HNC).

The project evaluated the effectiveness of a communication pathway between community pharmacy and primary care to determine whether it help to facilitate earlier patient review.

Project Objectives

The project would aim to deliver –

• A communication pathway between community pharmacies and primary care services in the Dundee city area aimed at identifying HNC’s
• A written evaluation of the feasibility of engaging community pharmacies to identify potential cases of HNC’s and the effectiveness of the communication pathway
• A road map for other Health Boards and/or Scottish Government to emulate/scale the project

Project Outcomes

The project aimed to recruit 20 pharmacies and conduct approximately 1000 consultations for suspected head and neck cancer symptoms. However, 14 pharmacies were recruited, with 9 completing the project and several hundred consultations were carried out for suspected head and neck cancer symptoms. The reasons for incomplete participation included pharmacists leaving, maternity leave, failure to undergo training, and disengagement with the project. The reasons for an estimated number of consultations is that all pharmacies aimed to record the consultations however due to not all pharmacies taking part and the continued requirement to use locum pharmacists, who may or may not been aware of the project, only an estimation can be made. The project identified two patients for the communication pathway.

Benefits Realised

Benefits/ Impact to patients

• The project has demonstrated that community pharmacy teams can be trained to recognise symptoms of head and neck cancer amongst people presenting at the pharmacy meaning that more patients may be identified earlier in their disease and potentially benefit from earlier treatment.
• The project has helped to expand the services offered to patients by community pharmacies, especially those in deprived areas where accessing health provision such as GP appointments is often difficult thus helping address health inequalities.
• Patients may feel more confident in initially going to a community pharmacy to discuss their symptoms knowing that staff have been upskilled and there is a communication pathway in place with their GP practice.

Benefits to the NHS

• The project has supported action points 16, 17 and 18 of the Scottish Cancer Action Plan and shows that community pharmacies can support earlier diagnosis of cancer and help a sustainable earlier cancer diagnosis solution.
• The training provided to the pharmacists has allowed pharmacists to be more confident in identifying the potential symptoms of head and neck cancer and delve deeper into patients’ symptoms by asking more relevant questions meaning that patients maybe identified earlier in their disease meeting the Scottish Government’s policy of earlier identification of cancer.
• The pharmacists noted that the pathway fitted in well with their current practice and did not add much additional workload making its easy to incorporate into their service.
• The project has highlighted the additional services that a pharmacy can provide and this may lead to patients accessing pharmacies for advice rather than turning up at A&E if they cannot get to see a GP, which may help to reduce pressure on acute services.
• The project demonstrated that the work of pharmacy teams in this area is broadly welcomed by GP’s and oncologists which will help to increase communication between the different disciplines.
• The Centre for Sustainable Delivery’s Earlier Cancer Diagnosis Programme Board has been supportive of the project and have engaged with the Scottish Government’s Pharmacy Policy Team, to explore the route to national implementation.

Benefits to MSD

• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the project and the results are shown below:
• Average score of 9.3/10 was scored for being satisfied with MSD’s collaborative working project and 9/10 believed MSD contributed to their organisation’s cancer service pathway respectively.
• NHS stakeholders were asked prior to working with MSD on this collaborative working project, how likely were you to work with MSD or the pharmaceutical industry and the response was 4.3/10. Whereas after the project was completed, the score went to 9/10.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this project–
  • “MSD’s support enabled us to take forward a project that we would have been unable to deliver otherwise. The project has opened up a discussion about the possibility of a National Service in Scotland.”
  • “This was a feasibility project which has hopefully provided some groundwork and evidence for consideration of further roll out of the service.”
• When questioned on feedback of your experience of working in collaboration with MSD –
  • “MSD and its officers were helpful and supportive and contributed very positively to the experience of delivering the project. Mr MacDonald was/is a pleasure to work with.”
  • “My MSD contact was very supportive and, aside from financial support, helped to facilitate communication with relevant contacts, provide background data and assist in development of the project plan and obtaining of approvals.”
• This collaboration may have enabled more patients to access innovative treatments in line with SMC guidance which may or may not have included MSD medicines.

Funding & Resources

This project was a shared funding commitment from NHS Tayside & MSD. The total project cost was £36,222.

Publications

No publications planned at this time.

GB-NON-09808 |  August 2024

Project Title

Swansea Bay University Health Board Head and Neck Pathway Development Project (PDP)

Organisations involved

MSD-UK

Swansea Bay University Health Board

Summary

The aims of this project were to optimise the head and neck cancer pathway across Swansea Bay University Health Board (SBUHB) through service redesign with the head and neck cancer multidisciplinary team and focussing on the pathway from suspicion of recurrence through to subsequent treatment. MSD helped to project manage the implementation of this initiative through MSD’s Pathway Development Programme.  The project started in May 2022 and finished in March 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the SBUHB team, MSD provided project management support to assess the current state of the recurrent head and neck cancer pathway.  MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the recurrent head and neck cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome. Refer to NHS benefits below to see number of days potentially saved
• Patient experience was not measured as part of this project.

 NHS Benefits

• Referrals and tracking:
  • A ‘one-for-all’ request form given to MDT lead by pathology to standardise the request for PDL-1 testing
  • PDL-1 test request form being sent directly to the referrals team rather than coming through pathologist initially. This standardisation will help to improve efficiencies and potentially minimise patient delays
  • PDL-1 test requested at the point of MDT after imaging review rather than waiting until later in the pathway (potentially saving a week in the pathway)
  • PDL-1 test sent back to SBUHB via email and to Oncology at the same time as pathology to ensure treatment decisions could be made as quickly as possible. This can reduce the pathway by up to 2 days
• Pathology:
  • Blocks identified and marked at initial pathology diagnostics to show which block would be best for preparing of slides for PDL-1 testing. Prior to this the blocks were taken out of archive and viewed by the pathologist at a separate stage of the pathway to identify the blocks
• Due to the actions listed above the patient pathway has been shortened by approximately 3 weeks
• The proportion of patients that are experiencing this pathway shortening is increasing and is now realised in more than 50% of cases
• Overall treatment rates were not measured as part of this Pathway Development Programme
• Data is still being gathered to see the impact on the 62-day Cancer Waiting Times

MSD Benefits

• Better understanding of head and neck cancer patient needs
• Enhanced reputation of MSD through partnership work. Two NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8.5/10 and 8/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively
  • Average score of 8/10 in the likelihood of working with MSD and the pharmaceutical industry in the future (up from 5.5/10 prior to the PDP)
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Know where the delays are in the work flow”
  • “Highlighted awareness of importance of smooth PDL1 pathway and highlighted areas of immediate improvement (generic email to submit requests already active) and to request at earlier points in the pathway”
• When questioned on feedback of your experience of working in collaboration with MSD:
  • “MSD personnel were professional and provided helpful feedback”
  • “Professional, thorough, personable and practical”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Swansea University Health Board & MSD-UK

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Waiting times on the recurrent head and neck pathway remain challenging. There are significant workforce challenges across Swansea Bay University Health board

Publications

There are currently no plans to publish the outcomes of this project by the health board as per the date of this summary.

GB-NON-08642 |  December 2023

Project Title

Aneurin Bevan University Health Board Head and Neck Pathway Development Programme (PDP)

Organisations involved

Aneurin Bevan University Health Board

MSD-UK

Summary

The aims of this project were to optimise the head and neck cancer pathway across Aneurin Bevan University Health Board (ABUHB) through service redesign with the head and neck cancer multidisciplinary team and focussing on the pathway from suspicion of recurrence through to subsequent treatment. MSD helped to project manage the implementation of this initiative through MSD’s Pathway Development Programme.  The project started in February 2022 and finished in February 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the ABUHB team, MSD provided project management support to assess the current state of the recurrent head and neck cancer pathway.  MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the recurrent head and neck cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome. Refer to NHS benefits below to see number of days potentially saved
• Patient experience was not measured as part of this project.

NHS Benefits

• Referrals and tracking:
  • A ‘one-for-all’ request form given to MDT lead by pathology to standardise the request for PDL-1 testing
  • PDL-1 test request form being sent directly to the referrals team rather than coming through pathologist initially. This standardisation will help to improve efficiencies and potentially minimise patient delays
  • PDL-1 test requested at the point of MDT after imaging review potentially reducing the pathway by up to 7 days
  • PDL-1 test sent back to ABUHB via email and to Oncology at the same time as pathology to ensure treatment decisions could be made as quickly as possible. This can reduce the pathway by up to 2 days
• Pathology:
  • The health board is continuing to investigate the move to digital pathology to assist and alleviate issues with having multiple sites across pathology services. This project further highlighted the business case and initial work that had already been completed
  • Blocks identified and marked at initial pathology diagnostics to show which block would be best for preparing of slides for PDL-1 testing. Prior to this the blocks were taken out of archive and viewed by the pathologist at a separate stage of the pathway to identify the blocks. This will reduce the pathway by 2 days
  • Blocks now sent to an alternative reference centre for PDL-1 testing rather than ABUHB having to prepare slides. This has alleviated preparation capacity for ABUHB and the average turnaround time for PDL-1 tests being received has reduced from 40 days (Apr 2022) to 12.83 days (June 2023)
• Overall treatment rates were not measured as part of this Pathway Development Programme

MSD Benefits

• Better understanding of head and neck cancer patient needs
• Enhanced reputation of MSD through partnership work. Four NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8/10 and 7.5/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively
  • Average score of 9.67/10 in the likelihood of working with MSD and the pharmaceutical industry in the future (up from 3.67/10 prior to the PDP)
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Engagement of the pathology department has been the most helpful aspect. It’s too early to see whether changes have resulted in improvement yet”
  • “Our understanding of the workflow from surgeons to laboratory”
  • “I am not sure what has improved. we are struggling with all the cancer pathways so prioritising one in isolation has a negative impact on the others”
• When questioned on feedback of your experience of working in collaboration with MSD:
  • “I was impressed with the feedback MSD made summarising the changes that would benefit the service and MSD enabled good communication between Cellular Pathology admin staff, Clinicians and pathologists”
  • “I was very impressed with MSD”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Aneurin Bevan University Health Board & MSD-UK

 Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Waiting times on the recurrent head and neck pathway remain challenging. There are significant workforce challenges across Aneurin Bevan University Health board

Publications

There are currently no plans to publish the outcomes of this project by the health board as per the date of this summary.

GB-NON-07847 |  October 2023

Project Title

South Yorkshire and Bassetlaw Cancer Alliance Head & Neck Pathway Development Project (PDP)

Organisations involved

South Yorkshire and Bassetlaw Cancer Alliance: Sheffield Teaching NHS Foundation Trust, Barnsley Hospital NHS Foundation Trust, The Rotherham NHS Foundation Trust, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust and Chesterfield Royal Hospital NHS Foundation Trust & MSD-UK

Summary

A national head and neck cancer best practice timed pathway (BPTP) has been created with the intention of improving patient experience through promoting equality in cancer care and ensuring all head and neck cancer patients receive optimal cancer care. There was an opportunity in South Yorkshire to optimise the head and neck cancer pathways in line with the BPTP to improve the service quality, service efficiency, productivity and patient experience. Also, to improve cross-functional working relationships across all South Yorkshire and Bassetlaw Cancer Alliance Trusts including but not limited to ENT (ear, nose and throat) and OMFS (oral maxillofacial surgery) departments. The desired outcome of this project was an improved efficiency of the regional diagnostic head and neck cancer pathway aligned with the BPTP milestones, 28 day Faster Diagnostic Standard (FDS) and the 31- and 62-day Cancer Waiting Time (CWT) Targets. The primary objective was to implement the changes in the 5 foundation hospital trusts within the South Yorkshire Cancer Alliance region in partnership with Chesterfield. The project began on 1^st January 2022 and finished on the 31^st December 2022.

Benefits realised

Through implementation of MSD’s Pathway Development Programme with the South Yorkshire and Bassetlaw Cancer Alliance team, MSD provided project management support to assess the current state of the head and neck pathway and provided a gap analysis contrasting the pathway with the BPTP. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. Also, MSD facilitated the formulation of service improvement meetings within each of the 5 diagnostic hospitals. As a result of the project, the following benefits were realised:

Patient Benefits

• Quicker diagnosis and time to treatment of head and neck cancer has been reported through this project potentially leading to improved patient outcomes, See NHS benefits below:
• Patient experience was not measured

NHS Benefits

• Barnsley Hospital NHS Foundation Trust
  • Referral of patient to when first seen by oncologist reduced from 9 days to 5 days
• Rotherham NHS Foundation Trust CT
  • Reporting has reduced from 6 days to 4 days
• Sheffield Teaching Hospital NHS foundation Trust
  • ENT referral of patient to when first seen by oncologist reduced from 10 days to 6 days
  • ENT patients are now reviewed at MDT on day 35 vs day 40
  • OMFS patients are now reviewed at MDT on day 36 vs day 40
• Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust and Chesterfield Royal Hospital NHS Foundation Trust
  • No data was collected
• Achievement of CWT & FDS was analysed from the 62- and 28-day CWT target performance data concluded the following:
  • The 62-day CWT in January 2022 was 47.1% vs 52.9% in December 2022
  • The 28-day FDS  in January 2022 was 74% vs 77% in December 2022
  • Data was an amalgamation of all the trusts within the South Yorkshire and Bassetlaw Cancer Alliance
• Treatment rates were not measured as part of this project

MSD Benefits

• Better understanding of head and neck cancer patient needs
• Enhanced reputation of MSD through partnership work. Four NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8.75/10 were satisfied with MSD’s collaborative working project
  • Average score of 8/10 believed MSD supported their organisations development or improved cancer service
  • Average score of 3.25/10 to unlikely work with MSD and the pharmaceutical industry prior to the collaborative project which then changed to an average score of 8.25/10 in favour of collaboration following the project.
  • Average score of 8.5/10 would recommend working in collaboration with MSD to others
• Quotes from NHS Stakeholders taken from the survey when questioned ‘what has improved in your service/pathway following this collaborative working project’:
  • “Improvement in achievement of best practice timed pathway milestones, significant improvements in engagement with service improvement methodology and increased staff morale within the CDG leadership team”
  • “Improved understanding of the pathway and barriers, data collection to inform developments, collaborative working through working groups and progress towards meeting BPTP (best practice timed pathway) milestones”
  • “The involvement of MSD has resulted in vastly improved cohesion, consistency and efficiency across a number of aspects of the head and neck pathway in South Yorkshire & Bassetlaw”
• When prompted for ‘any feedback of your experience of working in collaboration with MSD’:
  • “Wasn’t aware of the MSD collaboration projects prior to this”
  • “Became a valued and welcome addition bringing expertise and previous experience”
  • “Friendly and supportive in identifying the challenges that are faced in our area of work”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources 

This was a project with shared time commitment from South Yorkshire and Bassetlaw Cancer Alliance, the participating Trusts & MSD.

Lessons learnt 

• Importance of having access to tumour pathway steps timings data, and the challenges in extracting pathway timing data from Hospital IT systems. Recommendation – get agreement on data extract (both how and what) in project scoping phase.
• Wider NHS workforce challenges impacted on project delivery. Recommendation – engage project sponsors to ensure project work is prioritised throughout the duration of the project.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-07849  |  August 2023

Project Title

Northern Cancer Alliance (NCA) Head & Neck Pathway Development Project (PDP)

Organisations involved

MSD-UK

Northern Cancer Alliance:

North Cumbria Integrated Care NHS Trust

Newcastle upon Tyne NHS Foundation Trust

County Durham and Darlington NHS Foundation Trust

South Tyneside and Sunderland NHS Foundation Trust

South Tees NHS Foundation Trust

Summary

A national Best Practice Timed Pathway for head and neck Cancer Diagnostics Pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all head and neck cancer patients receive optimal cancer care. There was an opportunity in the Northeast and North Cumbria to optimise the head and neck cancer pathways in line with the national timed head and neck cancer diagnostic pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved head and neck cancer pathway aligned with achievement of the head and neck cancer 28 day Faster Diagnostic Standard and the 31- and 62-day Cancer Waiting Time Targets. The project began on 1^st January 2022 and finished on 31^st December 2022

Benefits Realised

Due to changes in personnel and other unavoidable circumstances, data for the project is currently being gathered and analysed. The project benefits will be updated once data has been reviewed.

Funding & Resources

This was a project with shared time commitment from Northern Cancer Alliance & MSD

Lessons learnt

External challenges such as strike days within the NHS impacted on the delivery timescales of the project so the recommendation would be to factor in contingency time

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

Job Code: GB-NON-07754 |  Date of Preparation: July 2023

Project Title

Royal Liverpool University Hospital NHS Foundation Trust Histopathology Head & Neck Pathway Development Project (PDP)

Organisations involved

MSD UK and Royal Liverpool University Hospital NHS Foundation Trust

Summary

The objective of this project was to optimise the histopathology pathway in line with the head and neck national best practice timed pathway with an aim to improve the service quality, efficiency, productivity, and patient outcomes. This would contribute towards the achievement of the 31- and 62-day cancer wait time targets. MSD helped to project manage the implementation of this initiative through MSD’s Pathway Development Programme. The project began on 27th September 2022 and finished on 28th March 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with Royal Liverpool University Histopathology team and Clatterbridge/ Aintree surgical and oncology teams, MSD provided project management support to assess the turnaround times of their histopathology testing pathway from MDT test-request to result reporting.  A gap analysis was carried out and 3 areas of improvement were identified:

1. Standardise the test requesting process:
   • Switch test requests from multiple routes to one repository to increase efficiencies
   • All test requests to be sent to pathology by latest Friday to get results for the following Wednesday MDT
2. Standardise the process for locating and validating biopsies for testing:
   • Surgeon and oncologist to include site of original biopsy, block, and year on the MDT form for future reference
3. New way of working within the MDT:
   • MDT outcome form to include PD-L1 result section which is to be declared at every MDT
   • Biopsies gathered onsite would need to be reported within 7 days; 14 days for offsite

Patient Benefits:

Reduction in turnaround times will positively impact time to treatment decision for patients.

NHS Benefits:

Histopathology reports are now included on the MDT outcome form, which is visible to all MDT members, so all information is present at the MDT to discuss treatment options.

Report is also accessible on the ICE (integrated clinical environment system) which is available anytime to increase efficiency.

A reduction of 2 days in turnaround time and an increase in the number of cases being available for presentation at next MDT (Optimised pathway 77% v Routine Pathway 53%).

Achievement of 31- and 62-day treatment cancer wait time target was not measured.

Earlier referral, diagnosis and treatment of head and neck patients was not measured or used as a baseline as it was not relevant to histopathology.

Increase in treatment rates for head and neck was not measured or used as a baseline as it was not relevant to histopathology testing pathway.

Graph 1: From the 30 onsite cases the turnaround time and cases presented at MDT were compared between those following the routine pathway (17) and optimised pathway (13)

• New Average TAT is 9 days from 11 days
• More cases presented at next MDT (10 vs 9)

Total of 48 cases were evaluated, with 33 meeting reporting criteria and then 30 being managed onsite. These 30 cases were evaluated above.

MSD Benefits:

Better understanding of head and neck cancer patient and NHS needs.

Enhanced reputation of MSD through partnership work.

As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Quotes from NHS Stakeholders

“An enjoyable experience. The team provided excellent support, and this has improved our service” 

“The PDL1 pathway has been streamlined. The system is more efficient”

“MSD colleagues have been professional and enthusiastic in this collaboration”

“Useful to meet service users in order to gain an understanding of their & our requirements”

Funding & Resources

This was a project with shared time commitment from both the NHS & MSD.

Lessons learnt

Tight project management and clear communication plan to ensure all stakeholders are aware of the initiative and the time demand needed for the project.

MSD workshops to be tagged onto meetings where you have a high attendance of healthcare professionals and stakeholders to increase attendance.

Following implementation of test requests to go through one repository, focus will now be on continually improving the process. It is currently managed by one healthcare professional; provisions need to be put in place in case of absence.

Publications

At the time of writing this summary there were no plans from the NHS organisation to publish this data.

Job Code: GB-NON-07560 |  Date of preparation: June 2023

Project Title

Streamlining Urology MDT meetings across the Southwest Urology Network of Hospitals

Organisations involved

Peninsula Cancer Alliance and MSD

Summary

MSD intend to work in partnership with Peninsula Cancer Alliance (PCA) and the Southwest Urology network, to provide project management support to assess the performance of multi-disciplinary team meetings (MDTMs) across the region with a view to running improvement initiatives depending on the findings. By seeking endorsement and advocacy from the NHS Southwest Urology network, we will use MDT streamlining methods and principles to optimise these meetings and we will measure the impact of doing so.

Within the 12 months of planned project duration, our aims are to:

• Provide an analysis of the current functioning of each of the MDTMs across the region for Renal, Prostate and Bladder, including:
  • Number of patients reviewed at each meeting and average time to review each patient
  • At what frequency do meetings over-run
  • Does each Trust run one meeting for all 3 tumour types or are the meetings separate
  • Are Standards of Care used to standardise and expedite clinical decision making
  • Average attendance by role
  • Current challenges experienced in the running of the MDTMs
• Work with Urology leads and MDT coordinators from each Trust to define initiatives to streamline their MDTMs
• Assist with the implementation of these initiatives
• Measure and evaluate the impact of improvement and streamlining initiatives undertaken
• Demonstrate efficiency savings via improvement of meeting effectiveness

Background

Care by a MDT has long been the gold standard for patients with cancer, and a central part of the cancer pathway. However, much has changed in the cancer landscape over the last 20 years, as more sophisticated and personalised treatments are provided to a higher volume of patients, with increasingly complex cases¹. Studies have found that there is generally not enough time in MDTMs to discuss more complex patients, with around half of patients discussed for two minutes or less². An Independent Cancer Taskforce Report recommends that NHS England should encourage providers to focus specialist time in the MDTM on those cases which do not follow well-established clinical pathways³. This project serves to help address these recommendations.

Project Objectives

• Assessment of each MDTM across the region for Renal, Prostate and Bladder
• Analysis of current challenges and operating metrics of each MDTM
• Collaboration with each local team lead(s) to identify improvement initiatives
• Implementation of improvement initiatives to enable streamlining
• Evaluation of improvement initiatives and embedding of continuous improvement culture

Benefits

Benefits to the patient

• As a result of streamlined MDTMs, the patient may experience a faster cancer pathway
• Improved care processes and optimal treatment decisions made for each patient

Benefits to Peninsula Cancer Alliance

• Potential to introduce Standards of Care to streamline patient volume
• Capacity of Healthcare Professionals released through adoption of streamlining principles
• Help work towards meeting the quality actions stated in the Getting It Right First Time (GIRFT) Urology guidance

Benefits to MSD

• Enhanced reputation of MSD through partnership work
• A better understanding of the MDTM dynamics and NHS continuous improvement

Funding & Resources

This project is a shared contribution of time between Peninsula Cancer Alliance and MSD

1. Streamlining Multi-Disciplinary Team Meetings Guidance for Cancer Alliances
2. Cancer Research UK, “Meeting Patients’ Needs, improving the effectiveness of multidisciplinary team meetings”, January 2017
3. Independent Cancer Taskforce Report, “Achieving World-Class Cancer Outcomes, a Strategy for England 2015-2020”, July 2015.

GB-NON-08626 |  February 2024

Project Title

South Eastern Health and Social Care Trust Renal Cell Carcinoma Pathway Development Project (PDP)

Organisations involved

MSD

South Eastern Trust Health and Social Care Trust

Summary

There was an opportunity in South Eastern Health and Social Care Trust to optimise the RCC cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved RCC cancer pathway and achievement of the RCC 31 day and 62 day Cancer Waiting Time (CWT) targets. The project started in March 2023 and finished in February 2024.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the South Eastern Health and Social Care Trust team, MSD provided project management support to assess the current state of the RCC cancer pathway and provide a gap analysis of the pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the RCC cancer pathway which allowed patients to navigate through the pathway more efficiently.
• Refer to NHS benefits below to see number of days potentially saved.

NHS Benefits

• Average wait for Computer Tomography (CT), Pathology and Multi – Disciplinary Team (MDT) discussion of results was reduced to 2.5 weeks in 2023 impacting approximately 52 patients
• From September 2023 to March 2024 the following reductions in waiting times were achieved in the RCC adjuvant pathway impacting 16 patients who underwent kidney resection:
  • Pathology turn around time post nephrectomy from 6 weeks to 3-4 weeks
  • CT scan request post triage from 5 weeks to 1-2 weeks
  • Results appointment from surgery date from 6-8 weeks to 5 weeks
  • Time to MDT discussion post triage from 6 weeks to 1-2 weeks
• Time from nephrectomy to MDT referral to oncology improved from 17 weeks to 8 weeks within the renal cancer patient pathway.
• % of patients achieving CWT
  • 31–day target= improved from 92% in 2022 vs 96% in 2023
  • 62-day target= improved from 24% in 2022 vs 25% in 2023
• From the results of the project a regional commissioning paper has been submitted to the Department of Health for a stand-alone Regional Renal MDT to be developed
• Overall treatment rates were not measured as part of this Pathway Development Programme (outside the project scope)

MSD Benefits

• Better understanding of RCC patient needs
• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 9.5/10 achieved with regards to level of satisfaction of MSD’s collaborative working project.
  • Average score of 8.5/10 achieved regarding belief that MSD contributed to improvements in their organisation’s cancer service pathway.
  • Average score of 9.5/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Looking at reducing waiting times for patients such as being referred for CT scan prior to first appointment”
  • “Significant improvement in patient pathway resulting in timely referral for consideration of systemic anti-cancer therapy”
  • ”Heightened awareness of importance of meeting target timelines”
• When questioned on feedback of your experience of working in collaboration with MSD:
  • “Perception of working with a pharmaceutical company would have been sceptical prior to working on this project as felt pressured to use their drugs but there was no pushing of their drugs whatsoever. It was good to introduce an outside source to help get people talking and drill down into the issues. Sometimes the mountain seems too big but we were able to get a few small wins which boosts morale and helps patients in the long run”
  • “Extremely professional and patient focused throughout the project”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from South Eastern Health and Social Care Trust & MSD

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Important to have a clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the RCC patient pathway, attainment of the Cancer Waiting Time (CWT) targets remains challenging. The CWT performance 31-day and 62-day for RCC have improved against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-09804  |  November 2024

Project Title

Western Health and Social Care Trust Renal Cell Carcinoma Pathway Development Project (PDP)

Organisations involved

MSD

Western Health and Social Care Trust

Summary

There was an opportunity in Western Health and Social Care Trust to optimise the RCC cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved RCC cancer pathway and achievement of the RCC 31 day and 62 day Cancer Waiting Time (CWT) targets. The project started in February 2023 and finished in December 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Western Health and Social Care Trust team, MSD provided project management support to assess the current state of the RCC cancer pathway and provide a gap analysis contrasting the pathway with the national cancer pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

•  Optimisation of the RCC cancer pathway which allows patients to navigate through the pathway more efficiently.
• Refer to NHS benefits below to see number of days potentially saved.

NHS Benefits

• Time from presentation to Computed Tomography (CT) kidney triple phase scan improved from a median of 9 days 2022 to a median of 7.5 days 2023.
• Pathology post-surgery turnaround times maintained at a median of 16 days in both 2022 and 2023.
• New post-surgery RCC pathway implemented across the region allowing all eligible patients to be discussed at the regional specialist urology MDM (Multi-Disciplinary Meeting).
• This project supports the long-term aim of a regional renal service focused around a single regional renal MDT and a regional waiting list based on this.
• Theatre capacity – maintained at 84 sessions in 2022 and 85 sessions in 2023.
• % of patients achieving CWT:
  • 31–day = improved from 69% in 2022 vs 73% in 2023
  • 62-day = 80% in 2022 vs 61% in 2023
• Overall treatment rates were not measured as part of this Pathway Development Programme

MSD Benefits

• Better understanding of RCC patient needs
• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 8/10 and 7/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to improvements in their organisation’s cancer service pathway respectively.
  • Average score of 8/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Standardisation of renal cancer care throughout the region”
  • “The pathway already worked very well, however the project was good to bring the team together and highlight the need for regional MDM”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Worked well”
  • “Good collaborative working and well organised”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Western Health and Social Care Trust & MSD

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the RCC patient pathway, attainment of the Cancer Waiting Time (CWT) targets remains challenging. The CWT performance for RCC however has improved for 31-day target against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-09637  | September 2024

Project Title

Belfast Health and Social Care Trust Renal Cell Carcinoma Pathway Development Project (PDP)

Organisations involved

MSD

Belfast Health and Social Care Trust

Summary

There was an opportunity in Belfast Health and Social Care Trust to optimise the RCC pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved RCC pathway and achievement of the RCC 31-day and 62-day Cancer Waiting Time (CWT) targets. The project started in July 2022 and finished in December 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Belfast Health and Social Care Trust team, MSD provided project management support to assess the current state of the RCC pathway and provide a gap analysis contrasting the pathway with the national cancer pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the RCC cancer pathway which allows patients to navigate through the pathway more efficiently.
• Refer to NHS benefits below to see number of days potentially saved.

NHS Benefits

•  Time from Renal Surgery to Multi-Disciplinary Meeting (MDM) improved from 42 days in 2022 to 34 days in 2023.
• Development of a new regional adjuvant RCC pathway developed to meet the 12 week (84 days) patient criteria from nephrectomy to oncology treatment impacting 71 patients from October 2022 to December 2023. The following mean times were achieved:
  • Nephrectomy to MDM discussion was 35 days
  • Urology results post-surgery appointment 44 days
  • Oncology appointment 60 days
  • Nephrectomy to Computed Tomography (CT) scan 44 days
  • Nephrectomy to start of oncology treatment 82 days
• This project supports the long-term aim of a regional renal service focused around a single regional renal Multi-Disciplinary Team (MDT)
• Improvement in cancer Waiting Times
  • 31–day = improved from 40% in 2022 vs 51% in 2023
  • 62-day = 6% in 2022 vs 7% in 2023
• Overall treatment rates were not measured as part of this Pathway Development Programme

MSD Benefits

• Better understanding of RCC cancer patient needs
• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 9/10 and 8/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to improvements in their organisation’s cancer service pathway respectively.
  • Average score of 7/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Regional renal cancer multi-disciplinary team being planned. Supported by clinical staff and regional cancer network”
  • “Two of the 14 project measures have progressed through the renal optimisation project”
  • “Automated mechanism to flag eligible patients for adjuvant treatment and waiting times met”
  • “All other actions will remain on the trusts cancer improvement plan for regular review”
  • “Improved discussion regarding the issues and potential solutions”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Excellent, provided drive and support to a project that would not otherwise have happened”
  • “This project has allowed us to produce a plan for the improvements required across the renal pathway”
  • “Helpful to have outside input to drive things forward”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from Belfast Health and Social Care Trust & MSD

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the RCC patient pathway, attainment of the Cancer Waiting Time (CWT) targets remains challenging. The 31 day CWT performance for RCC has improved against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system. It is unlikely the actions taken as part of the project contributed to the increase in 31 day performance as the main actions implemented related to improving the pathway between first and subsequent treatment

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-09635 | September 2024

Project Title

Southern Health and Social Care Trust Renal Cell Carcinoma Pathway Development Project (PDP)

Organisations involved

MSD

Southern Health and Social Care Trust

Summary

A national optimal Renal Cell Carcinoma (RCC) cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all RCC patients receive optimal cancer care. There was an opportunity in Southern Health and Social Care Trust to optimise the RCC cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved RCC cancer pathway and achievement of the RCC 31 day and 62 day Cancer Waiting Time (CWT) targets. The project started in July 2022 and finished in December 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Southern Health and Social Care Trust team, MSD provided project management support to assess the current state of the RCC cancer pathway and provide a gap analysis of the pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the RCC cancer pathway which allows patients to navigate through the pathway more efficiently. This could potentially increase the chance of a successful outcome if patients are diagnosed earlier on in the pathway.
• Refer to NHS benefits below to see number of days potentially saved.

NHS Benefits

• All RCC patients in 2022/2023 now triaged within 0-3 days impacting 60 patients
• Time to surgery improved from 41 days in April 2023 to 21 days in December 2023 impacting 36 patients
• Time to post surgery Computed Tomography (CT) scan improved from 23 days in April 2023 to 13 days in December 2023
• Time to first surgical outpatients appointment post-surgery improved from 26 days in March 2023 to 19 days in December 2023
• This project supports the long-term aim to develop a regional renal service focused around a single regional renal MDT.
• Two nurses can now directly request CT Urograms following protocol training (the time aspect of this has not been measured)
• % of patients achieving CWT
  • 31–day target= improved from 82% 2022 vs 86% 2023
  • 62-day target= declined from 17% 2022 vs 0% 2023
• Overall treatment rates were not measured as part of this Pathway Development Programme (outside the project scope)

MSD Benefits

• Better understanding of RCC patient needs
• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 6.75/10 achieved with regards to level of satisfaction of MSD’s collaborative working project.
  • Average score of 5.25/10 achieved regarding belief that MSD contributed to improvements in their organisation’s cancer service pathway.
  • Average score of 5.75/10 would recommend working in collaboration with MSD to others.
• Quotes taken from NHS stakeholders when questioned, “what has improved in your service/pathway following this collaborative working project”:
  • “Streamlined pathway for patients post-surgery. More collaborative working across teams and increased emphasis on getting patients through the pathway”
  • “Multi-disciplinary work on addressing priority areas following the process mapping work. Engagement of staff from different areas / specialities to see feedback”
• Quotes taken from NHS stakeholders when questioned on “feedback of your experience of working in collaboration with MSD”:
  • “Good partnership working. Facilitation of meetings were very good and it was useful to have an independent person involved in this”
  • “Clear objectives, excellent communication, regular updates. Encouraged more multi team working. Professional”
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This was a project with shared time commitment from Southern Health and Social Care Trust & MSD

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Important to have a clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the RCC patient pathway, attainment of the Cancer Waiting Time (CWT) targets remains challenging especially the 62 day CWT due to system capacity pressures. The CWT performance 31-day for RCC has improved against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-09636 | July 2024

Project Title

Western Health and Social Care Trust Lung Cancer Pathway Development Programme (PDP)

Organisations involved

MSD

Western Health and Social Care Trust

Summary

There is an opportunity in Western Health and Social Care Trust to optimise the lung cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is potential improvement of the lung cancer patient pathway and of the 62-day* and 31-day** cancer waiting time (CWT) targets, currently set at a target of 95% for 62-day and 98% for 31- day cancer waiting times. The project intends to run for approximately 12 months.

Background

Current Problems & Needs:

• Pressure in the pathway to achieve the 62- and 31-day cancer waiting times, with over 50% of lung cancer patients in Northern Ireland waiting longer than the 62-day target (reference: NI Department for Health Cancer Waiting Times).
• Despite improvements in quality of care and patient outcomes over the last ten years, 44.4% of Northern Ireland lung cancer patients are diagnosed with advance stage IV disease (reference: Northern Ireland Cancer Registry).
• Delays in the pathway due to capacity issues delaying transit of patients through the pathway.
• Consultants, nurses and pharmacists are currently over capacity and demand on services is expected to increase further due to the introduction of lung cancer screening.

Project Objectives

The primary objective of this project is the optimisation of the lung cancer pathway across Western Health and Social Care Trust. Specifically contributing towards; –

• Potentially improving the 62-day and 31-day treatment target cancer waiting time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience through the lung cancer pathway in the Western Health and Social Care Trust
• Potentially quicker time to treatment through improved pathway efficiencies

NHS Benefits

Optimised lung cancer pathway across Western Health and Social Care trust hospital sites resulting in

• More efficient & quicker referral process through the lung cancer pathway from red flag referral to treatment
• Potential improvement of the 62-day and 31-day cancer waiting time targets
• Potential efficiencies leading to more patients being treated in a faster time

MSD Benefits

• Better understanding of the patient journey through the lung cancer pathway
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC reimbursed medicines

Funding & Resources

No funding is associated with this project. This project is a shared contribution of time between Western Health and Social Care Trust and MSD.

* 62-day CWT: 62-day target between the date hospital receives urgent referral for suspected cancer and start of treatment

** 31-day CWT: 31-day target between the date doctor agrees treatment plan and start of treatment

GB-NON-10354 | January 2025

Project Title

NHS Tayside Lung Cancer Pathway Development Project (PDP)

Organisations involved

MSD

NHS Tayside

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care.  There is an opportunity in NHS Tayside to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved  lung cancer pathway aligned with the national optimal pathway and achievement of the Cancer Waiting Time Targets. The project intends to run for approximately 9 months.

Project Objectives

The primary objective of this project is the optimisation of lung cancer pathways across NHS Tayside. Specifically contributing towards; –

• An optimised lung cancer pathway aligned to the national optimal lung cancer pathway
• Achievement of the Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the lung cancer pathway in NHS Tayside.
• Quicker diagnosis and treatment of lung cancer and hence improving the chance of successful treatment.

NHS Benefits

An optimised pathway in lung cancer across NHS Tayside hospital sites resulting in

• Achievement of the Cancer Waiting Time targets
• Earlier referral, diagnosis and treatment of lung cancer patients
• Increase in treatment rates for lung cancer
• Optimisation of service delivery

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09373 | May 2024

Project Title

Kent & Medway Cancer Alliance Pathway Development Project (PDP)

Organisations involved

MSD

Kent & Medway Cancer Alliance

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care.  There is an opportunity in Kent & Medway to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved lung cancer pathway aligned with the national optimal pathway  and achievement of the lung cancer  28 day Faster Diagnostic Standard and the 31 and 62 day Cancer Waiting Time Targets. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of lung cancer pathways across Kent & Medway. Specifically contributing towards; –

• An optimised lung cancer pathway aligned to the national optimal lung cancer pathway
• Achievement of the lung cancer 28 day Faster Diagnostic Standard, 31-day treatment target and 62 day referral to treatment Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the lung cancer pathway in Kent & Medway.
• Quicker diagnosis and treatment of lung cancer and hence improving the chance of successful treatment

NHS Benefits

An optimised pathway lung cancer across Kent & Medway hospital sites resulting in

• Achievement of the lung cancer 28 day Faster Diagnostic Standard, 31-day treatment target and 62 day referral to treatment Cancer Waiting Time targets
• Earlier referral, diagnosis and treatment of lung cancer patients
• Increase in treatment rates for lung cancer
• Optimisation of service delivery

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work

• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09627 | June 2024

Project Title

Newcastle NHS Foundation Trust Lung Cancer Pathway Development Project (PDP)

Organisations involved

MSD

Freeman Hospital

Royal Victoria Hospital

Summary

There is an opportunity in Newcastle to optimise the lung cancerpathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved lung cancer pathway aligned with the national optimal pathway and achievement of the lung cancer 28 day Faster Diagnostic Standard and 62-day Cancer Waiting Time Targets. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of lung cancer pathways across Newcastle. Specifically contributing towards; –

• An optimised lung cancer pathway aligned to the national optimal timed lung cancer pathway
• Achievement of the lung cancer 28 day Faster Diagnostic Standard and 62 day referral to treatment Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the lung cancer pathway in Newcastle.
• Quicker diagnosis and treatment of lung cancer and hence improving the chance of successful treatment

NHS Benefits

An optimised pathway lung cancer across Newcastle NHS Foundation Trust hospital sites resulting in

• Achievement of the lung cancer 28 day Faster Diagnostic Standard and 62-day referral to treatment Cancer Waiting Time targets
• Earlier referral, diagnosis, and treatment of lung cancer patients
• Increase in treatment rates for lung cancer.
• Optimisation of service delivery

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines.

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09322 |  April 2024

Project Title

St Bartholomew’s Hospital Equity of Access to Lung Cancer Treatment For Diverse Communities Pathway Development Programme (PDP)

Organisations involved

MSD

Barts NHS Trust- St Bartholomew’s Hospital

Summary

There is an opportunity in Barts NHS Trust to optimise the Lung Cancer Patient Pathway. The aim of the project is to map and understand the lung cancer patient pathway from delivering the diagnosis results to delivery of either standard treatment or inclusion into a clinical trial, with a specific focus on understanding the needs of patients from all communities. This will be achieved through pathway mapping workshops and one to one interviews with all healthcare professionals and other relevant decision makers who are responsible for the patient pathway. The second aim is to address some of the inefficiencies seen within the pathway to ensure equity of all for all treatment options, this will be achieved though GAP Analysis workshops and action planning through the implementation of the project. This project is part of a broader piece of work with St Bartholomew’s hospital to help support improvements in treatment access for diverse communities including uptake of clinical trials. This project will help to inform and direct the interventions needed. The project intends to run for approximately 12 months.

Background

Bart’s Health NHS Trust serves one of the largest, most diverse populations in the UK¹. Providing equitable cancer care including access to and inclusion in clinical trials to this diverse cultural and social demographic of patients is a priority for the trust and hospital. This project is part of a wider cross functional project where MSD are supporting St Bartholomew’s hospital to understand and redress this imbalance. The Lead Lung Cancer Clinician feels there is a lack of clarity on the existing lung cancer patient pathway, especially in relation to the different touch points- patient experiences, and the different approaches of clinicians. Consequently it was decided that pathway mapping exercises and workshops would be needed. This will then help to inform the wider and broader piece of work.

Project Objectives

The Primary Objective of this project is the optimisation of the lung cancer patient pathway, contributing towards an increase in the uptake of standard treatment of care and inclusion in clinical trials amongst patients from diverse communities. Key Measures will be to:

• Understand the current patient pathway.
• Understand the resources and existing support in place (for patients & clinicians) surrounding conversations that happen during these consultations.
• Use the data and workshop findings to understand the challenges and obstacles of the patient pathway from a diverse patient perspective and to support further service improvements to help increase access to cancer treatments (including clinical trials) in diverse communities.
• Identify ways to address the challenges and obstacles within the patient pathway to optimise this pathway.
• Outline and reduce some of the inconsistencies in the existing patient pathway.
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of project completion.

Benefits

Patient Benefits:

• Patients are better supported to make informed decisions on their standard treatment of care or clinical trial inclusion irrespective of demographic
• An increase in the proportionate representation of diverse populations across both uptake of standard treatment of care and inclusion in clinical trials

NHS Benefits:

• Increased understanding of the challenges and inefficiencies of the pathway and potential options to further support in optimising the pathway for diverse communities
• Increased uptake of standard treatment of care and inclusion in clinical trials amongst patients from diverse communities
• A clear pathway in relation to how HCPs and patients from diverse communities interact with the system in lung cancer

MSD Benefits:

• Enhanced reputation of MSD through partnership work
• Increased understanding of the lung cancer patient pathway and the impact when treating patients from diverse communities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines or inclusion into any active clinical trials

Funding & Resources

This project is a shared contribution of time between St Barts NHS and MSD.

References:

1. NHS Choices, WeBelong – Barts Health NHS Trust (www.bartshealth.nhs.uk/webelong/), last accessed 04/03/2024

GB-NON-09026 | March 2024

Project Title

Lung Cancer Healthbot – Greater Manchester Cancer Alliance Self-Referral to Chest X-Ray Symptom Awareness & Activation Project

Organisations involved

• Greater Manchester Cancer Alliance (GM Cancer)
• The Christie NHS Foundation Trust
• MSD UK Ltd

Summary

In 2022 Greater Manchester introduced a Self-Referral Chest X-Ray (SRCXR) service across some of its localities to enable patients who may have worrying respiratory symptoms to have direct access to a chest x-ray. The service has been running well and GM Cancer wishes to ensure more coverage and awareness of the service and thus increase uptake. A campaign in certain communities both out of home and social media could help bring more awareness and coupled with a sustainable method of activating patients to seek help, will aid more patients to attend the SRCXR service. This project will bring together a digital healthbot co-designed with GM Cancer Alliance and the Lung Pathway Board and developed by MSD with an awareness campaign to help more people become aware of potential symptoms of lung cancer and then take help-seeking action to attend the SRCXR service.  Attendance rates to the service, reach of and engagement with the awareness campaigns and healthbot will be measured to help understand the impact of the project on the service.

Background 

Since July 2022, members of the public registered at a GP in Bury, Heywood, Middleton & Rochdale (HMR) have been able to access a chest x-ray at their local hospital, without having to see a GP, or book an appointment in advance. The scheme not only intends to offer peace of mind for many, who may be experiencing concerns about their health, but to also expose the cases which may need extra attention quickly. Conditions like lung cancer have better outcomes when they are caught earlier^[1] , so the pilot intended to improve early diagnosis, and potentially improve outcomes for residents. The initiative is available at select hospitals across the area. GM Cancer acknowledge that the self-referral chest x-ray (SRCXR) service is an effective tool to reach a greater number of patients and thus impact earlier diagnosis rates, positively contributing to the NHS long term plan’s 75% target.

Project Objectives

The primary aim of the project is to provide residents of Bury and HMR localities with a digital tool that will signpost them to local services. The secondary aim of the project is to increase awareness and uptake of the SRCXR service via the co-developed Healthbot and measure its impact. The project will run over 9 months and then be evaluated.

Benefits

Potential Patient Benefits 

• Awareness of symptoms relating to lung cancer and awareness of services available
• Patients can validate symptom concerns

Potential NHS Benefits

• Wider awareness of SRCXR service
• Use of a sustainable method to improve patient activation to help seeking behaviour as opposed to telephone calls
• Support the utilisation of SRCXR service
• Potential for increase in disease diagnosis and treatment rates

Potential MSD Benefits

• Testing of the Healthbot in the UK
• Understand the wider use of the tool
• The intended benefits of raising awareness of lung cancer symptoms and encouraging a self-referral to chest x-ray may mean that more patients have access to treatment options in line with NICE/SMC guidance, which may or may not include MSD medicines

Funding

This project is a shared contribution between GM Cancer and MSD. The total project cost is £69,600

 GB-NON-08732 | January 2024

References

^[1] Cancer Research UK; Survival for Lung Cancer document; last accessed 18^th January 2024 Survival for lung cancer | Cancer Research UK

Project Title

South Yorkshire and Bassetlaw Cancer Alliance Lung Cancer Pathway Development Project (PDP)

Organisations involved

• MSD
• South Yorkshire and Bassetlaw Cancer Alliance
• Barnsley Hospital Foundation Trust
• Sheffield Teaching Hospital NHS Foundation Trust
• The Rotherham NHS Foundation Trust
• Doncaster and Bassetlaw Teaching Hospitals Foundation Trust
• Chesterfield Royal Hospital Foundation Trust

Summary

There is an opportunity in South Yorkshire Bassetlaw to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved lung cancer pathway aligned with the national optimal lung cancer pathway and achievement of the lung cancer 62-day Cancer Waiting Time Targets. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of lung cancer pathways across South Yorkshire and Bassetlaw Cancer Alliance. Specifically contributing towards; –

• An optimised lung cancer pathway aligned to the national optimal timed lung cancer pathway.
• Achievement of the lung cancer 62-day referral to treatment Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the lung cancer pathway in South Yorkshire and Bassetlaw.
• Quicker diagnosis and treatment of lung cancer and hence improving the chance of successful treatment.

NHS Benefits

An optimised pathway in lung cancer across South Yorkshire and Bassetlaw hospital sites resulting in

• Achievement of the lung cancer 62-day referral to treatment Cancer Waiting Time targets
• Earlier referral, diagnosis, and treatment of lung cancer patients
• Increase in treatment rates for lung cancer.
• Optimisation of service delivery

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work

• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines.

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD.

GB-NON-08838 | January 2024

Project Title

Northern Cancer Alliance lung cancer Getting It Right First Time (GIRFT) implementation Project

Organisations involved

Northern Cancer Alliance + MSD UK Ltd

Summary

This is a collaborative working project between MSD UK and The Northern Cancer Alliance (NCA). NCA is responsible for overseeing the implementation of 3 selected treatment recommendations from the national lung Getting It Right First Time (GIRFT) report. The Northern Cancer Alliance has also identified improvement of Systemic Anti-Cancer Treatment (SACT) rates, introducing a Stage 2 Multi-Disciplinary Team (MDT) meeting and Inter-Patient Transfer (IPT) rules as priorities.

This project intends to work with the NHS Foundation Hospital Trusts (FTs) in the Northern Cancer Alliance (North Cumbria NHS FT, Northumbria Healthcare NHS FT, Newcastle upon Tyne Hospital FT, Gateshead NHS FT, South Tyneside and Sunderland NHS FT, North Tees and Hartlepool NHS FT, Country Durham and Darlington NHS FT and South Tees NHS FT) to implement the 4 GIRFT recommendations and to implement a new Stage 2 MDT meeting for lung cancer and create and implement new Inter-Patient Transfer (IPT) rules across the region. The project aims to run for approximately 12 months.

Background

The Northern Cancer Alliance has some of the highest incidence of lung cancer in the UK, with lung cancer being the 2^nd most common cancer in the region. In the Northern Cancer Alliance, lung cancer accounts for 24.8% of cancer deaths¹.

Project Objectives

The Project intends to achieve the following:

• Implementation of 4 GIRFT recommendations (and achievement of the targets involved with each priority):
  • >85% radical treatment rate in all FTs for NCSLC stage I-II and PS 0-2
  • All FTs to ensure Multimodality treatment recording for Stage IIIA and radical treatment for fit patients
  • Radical treatment to start by day 49; Surgery, Thermoablation, Radiotherapy to start by day 16 after decision to treat (DTT)
  • All trusts should improve their treatment rates with SACT to achieve greater than 70% treatment for fit patients with advanced NSCLC

• Implementation of Stage 2 MDTs in all FTs across the region
• Agreement and implementation of region wide IPT rules for lung cancer

Benefits Realisation

Benefits/ Impact to patients

• More options for treatment for lung cancer patients
• More rapid access to treatment for lung cancer patients
• Better experience of the healthcare system

Benefits to the NHS partner

• Implementing GIRFT and implementing new ways of working with Stage 2 MDT and IPT ‘rules’
• Cancer Waiting Time performance improvement (28-day, 62 day & 31 day).

Benefits to MSD

• The intended benefits of implementing GIRFT recommendations across NCA, may mean that more patients have access to treatment options in line with NICE guidance, which may or may not include MSD medicines
• Better understanding of the challenges faced by the NHS in delivering high-quality patient services and care
• Reputational benefits of MSD collaborating with the NHS to support patient care

Resources

This project is a shared contribution of time between Northern Cancer Alliance and MSD UK

Ref 1: NHS Digital, Cancer registration statistic’s 2019 (published 2021) North East had the highest rate of cancer incidence for males and females – NDRS (digital.nhs.uk) last accessed 31^st May 2023

GB-NON-07314 |  Date of Prep May 2023 | Reapproved for extended use Apr 2025

Project Title

Manchester University NHS Foundation Trust Patient Experience App

Organisations Involved

Manchester University NHS Foundation Trust, MSD

Summary

Wythenshawe Hospital (Manchester University NHS Foundation Trust) have initiated a RAPID (rapid access to pulmonary intervention and diagnosis) pathway for all lung cancer patients. It aimed to reduce the time from GP referral to first treatment to 28 days, less than half the current NHS target. While the pathway had demonstrated advantages in time to diagnosis, further evidence was needed to understand the impact of such a fast-track diagnosis on the patient experience. The aim of the project was to work with Manchester University NHS Foundation Trust to develop a patient experience survey. The purpose of the survey was to build an evidence base of what the experience of the patient is within this accelerated pathway, and to facilitate continuous improvement to the pathway through real-time analysis.

Benefits Realised¹

The survey included a total of 322 participants, comprising of 283 patients and 39 family/carers. 50% of survey respondents were over 70 years old, 20% were from the most deprived areas, and 96% identified as ‘White’ ethnicity, prompting reflection on whether this reflects the served communities.

Over 200 positive comments were received, praising the care received at Wythenshawe, while approximately 40 negative comments highlighted issues such as waiting for CT results and negative experiences in the RAPID hub waiting area.

Safe-7: Seven questions were asked around safety across the following categories: speed, communication, accessibility, kindness, trust, listening and overall safety. All categories demonstrated improvements from the baseline score with final scores of 9 and above, out of 10. The overall safety category rated was 9.6 out of 10.

Benefits to patients:

• This project incorporated patient feedback to enhance the RAPID pathway, although due to insufficient data, some areas of improvement were not fully measured. The app provided insights into thoracic oncology services, assessing if high-quality care was being provided.
• The patients involved were grateful for the integration of Safe-7 into practice.
• There is a request to provide Safe-7 in the top 5 non-English languages in Greater Manchester and in an easy-read format to ensure equitable access.

Benefits to NHS:

• Capturing this patient experience data has enabled the Trust to demonstrate the pathway’s performance and deliver effectively.
• The report acknowledges the need for development and reconfiguration of clinic templates.
• The report encourages the continued integration of Safe-7 into daily practice and invites ideas for enhancements and opportunities for conference abstracts and staff publications.
• There are now plans of scaling up the project to expand beyond Manchester Foundation Trusts to other trusts across Greater Manchester and across other cancer sites.

Benefits to MSD:

Data generated on the patient pathway and experience prior to treatment decision could be used by MSD for:

• Policy and advocacy activities
• Development of patient support materials
• Advocacy for the RAPID pathway model
• Collaborating on this high-profile, innovative project has enhanced our reputation, leading to opportunities for further expansion across Greater Manchester Trusts.

This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This project was a shared funding commitment from Manchester University NHS Foundation Trust & MSD. The total project cost was £79,150.

Lessons learnt and possible project expansion:

Languages

The Safe-7 survey report shows that 96% of respondents are of ‘White’ ethnicity, indicating the need to make the survey more accessible and equitable. To achieve this, the survey will be made available in the following languages: Arabic, Bengali, Cantonese, Easy Read, Farsi, Gujarati, Polish, Punjabi, Romanian, and Urdu. The optimal implementation approach would involve linking the invitation to a specific language and providing a language-switching option on the survey platform to ensure inclusivity.

Selecting the Service Area within the Email Invitation

The current practice of asking participants to select the service area on the survey’s home page has been found to be error-prone and overly technical for laypersons. The proposed solution is to allow participants to select the service area within the email invitation, providing a more user-friendly experience and reducing potential errors in service area selection.

Completing the Survey without an Email Invitation

To increase the survey’s uptake, there is a proposal to enable patients to complete the survey directly, without needing an email invitation. This additional option aims to accommodate patients who prefer to complete the survey during clinic consultations. The new process would include the ability to select the service area and language and could be accessed directly via a phone or provided iPad, in addition to the traditional email invitation.

New Service Areas Expansion of the Safe-7 project to Manchester Royal Infirmary and North Manchester General Hospital will require adjustments to the email communication, replacing references to Wythenshawe Hospital with ‘Manchester University NHS Foundation Trust’.

Publications

The system now has >1500 responses, The Christie have commissioned an independent analysis of the outcomes which will be planned for formal publication.

References

1. MFT Safe7 Report October 2023

GB-NON-10332  |  October 2024

Project Title

Hywel Dda University Health Board lung Pathway Development Project (PDP)

Organisations involved

MSD

Hywel Dda University Health Board

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care. There is an opportunity in Hywel Dda University Health Board (HDUHB) to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved lung cancer pathway aligned with the national optimal pathway and achievement of the lung cancer 62 day Cancer Waiting Time Targets. The project intended to start on 1st April 2022 and was extended to finish on 31st December 2023.

Benefits Realised

Due to significant and unanticipated capacity issues within the HDUHB system which needed to take priority, it has not been possible to complete the outcome summary for the HDUHB lung cancer pathway PDP.

Funding & Resources

This was a project with shared time commitment from HDUHB & MSD

Lessons Learnt

Creation of a formal contingency plan should any of the key stakeholders and MSD project manager have time capacity issues or their organisation suffers significant disruption which affects stakeholder capacity during the implementation of the project.

Publications

No publications are planned.

GB-NON-09771 | July 2024

Project Title

EPIC: Early Prehabilitation in Lung Cancer

Organisations involved

NHS Lothian, Edinburgh Cancer Center, South East Scotland Cancer Network (SCAN) & MSD

Summary

The Edinburgh Cancer Centre, NHS Lothian and SCAN worked with MSD to understand the feasibility of utilising prehabilitation techniques in patients with advanced metastatic lung cancer with the overall aim of reducing symptom burden, improving patient fitness and increasing treatment rates for lung cancer.

Lung cancer is the most common cancer in Scotland with more than 5,500 registrations in 2019¹ and it accounted for over 25%² of all cancer deaths. Around 50% of patients are identified at stage 4¹ meaning that access to treatment can be limited and this is compounded by the fact that many patients have comorbidities and are frail which adds to the symptom burden³.

Prehabilitation is the practice of enhancing a patient’s functional and psychological capacity before treatment commences. Ideally, prehabilitation interventions start at diagnosis, helping people to prepare for the next treatment stage in their journey of care.

The project was based at St John’s Hospital, Livingston and aimed to include all patients with locally advanced and advanced lung cancer (visible metastases or mediastinal nodes on diagnostic CT scan). It was run over 30 months including during the covid pandemic which impacted the expected patient numbers.

The principal objectives of the project were to –

• maximise patient fitness as they are investigated and start treatment for lung cancer
• Reduce symptom burden
• Improve nutrition and stop weight loss
• Increase treatment rates for lung cancer

Benefits Realised

Patients

•  Patients may be more likely to access treatment and the project may improve their overall survival versus a matched cohort
• Patients are less likely to attend A&E, be admitted to hospital and if admitted spend less time in hospital versus a matched cohort
• Patients nutritional needs are better understood and their weight is managed more effectively
• Adaptations made to the prehabilitation program between phase 1 and phase 2 of the project improved patient uptake by managing patient symptoms before accessing physiotherapy and nutritional input
• 93% of patients who participated in the project said that they “would recommend others to attend” the prehabilitation clinic

NHS Benefits

• Implementing a prehabilitation service within the existing lung cancer pathway signals improved outcomes for advanced lung cancer patients and contributes to meeting NHS Lothian’s objectives
• Patients enrolled in the prehabilitation program experience reduced A&E admissions (20.4 adm’s vs. 28.3 adm’s), inpatient hospital admissions (51.9 adm’s vs. 67.9 adm’s), and shorter hospital stays (2.5 days vs. 8 days) compared to a matched cohort, helping to alleviate capacity pressures and freeing up vital resources to support other patients
• Scaling the prehabilitation service across NHS Scotland has the potential to unlock over 10,000 bed days per year, presenting a substantial opportunity to enhance capacity and resource allocation
• The EPIC project closely aligns with the goals and action points of the Scottish Government’s Cancer Strategy and Action Plan, particularly its focus on lung cancer and the urgent need for comprehensive action and resource allocation to address the complex challenges associated with this disease, making prehabilitation initiatives a valuable support approach

MSD Benefits

• Enhanced reputation of MSD through partnership work. NHS stakeholders completed a survey following the project and the results are shown below:
• Average score of 8.5/10 was scored for being satisfied with MSD’s collaborative working project and 7.8/10 believed MSD contributed to their organisation’s cancer service pathway respectively.
• Average score of 7.5/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this project–
  • “Engagement between health care professionals, charitable services and patient community. Valuable in building evidence base on prehabilitation and how it can be integrated into existing pathways.”
• When questioned on feedback of your experience of working in collaboration with MSD –
  • “Been valuable to be involved. Allocating time to such project development can be difficult given competing demands. I think this project has enhanced cross-team working and opportunities to share good practice.”
  • “It has been helpful to have MSD drive some of the project forward – this takes some pressure off clinicians”
• Increased understanding of the lung cancer pathway, the challenges to current service provision and potential solutions to support patients.
• This collaboration may have enabled more patients to access innovative treatments in line with SMC guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from NHS Lothian & MSD

Publications

1. Early prehabilitation in suspected locally advanced and metastatic lung cancer (https://spcare.bmj.com/content/13/e3/e908)
2. Early prehabilitation reduces admissions and time in hospital in patients with newly diagnosed lung cancer (https://spcare.bmj.com/content/early/2024/04/17/spcare-2024-004869)

References

1. Cancer incidence in Scotland – Cancer incidence and prevalence in Scotland to December 2019 – Cancer incidence in Scotland – Publications – Public Health Scotland (https://publichealthscotland.scot/publications/cancer-incidence-in-scotland/cancer-incidence-in-scotland-cancer-incidence-and-prevalence-in-scotland-to-december-2019/)
2. Scottish – ScotPHO (https://www.scotpho.org.uk/health-conditions/cancer-lung/data/scottish/
3. The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis – PubMed (nih.gov)

GB-NON-09668 |  June 2024

Project Title

University Hospitals Dorset NHS Lung Pathway Development Project (PDP)

Organisations involved

University Hospitals Dorset NHS FT (UHD)
MSD-UK

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care. There was an opportunity in and across Dorset to optimise the lung cancer pathway in line with the national optimal lung cancer pathway (NOLCP) to improve the quality, efficiency, productivity, and patient experience of the service. The project began on 1st June 2021 and finished on 30th January 2023.

Project Objectives

The primary objective of this project was the optimisation of lung cancer service pathway at University Hospital Dorset – Poole. Specifically contributing towards; –

• An optimised or improved lung cancer pathway aligned to the national optimal timed lung cancer pathway.
• Achievement of the lung cancer 2 week wait (2WW), 28 day Faster Diagnostic Standard, 31-day treatment target and 62-day referral to treatment Cancer Waiting Time (CWT) target.

Benefits Realised

Patient Benefits

• Per Getting IT Right First Time (GIRFT) recommendation, a pathway navigator is now embedded in the Oncology Clinical Nurse Specialist (CNS) team to support patients by navigating them through all or parts of the cancer pathway from a referral with suspected cancer to a confirmed cancer diagnosis and so enabling the trust to help sustain meeting the 28-day Faster Diagnosis Standard (GIRFT LUCN2d – All lung cancer teams should have an administrative navigator post integrated into their specialist nursing team)
• Faster diagnosis of lung cancer was improved, and treatment of each patient’s lung cancer has been sustained above national targets (reference Benefits to NHS University Hospital Dorset below)

NHS Benefits

• Pathway navigator embedded in oncology CNS team to improve efficiencies and support 28 days FDS.
• CNS led Outpatient Triage Clinic to free up Respiratory Consultant Time (+ 1-day Full Time Equivalent (FTE)/month)
• Full time lung pathologist recruited to support 5 day-service (consistent with GIRFT recommendation LUC7e)
• Full benefits to be reviewed and analysed as improvement work is still ongoing.

An initial analysis taken from UHD CWT data Jan 2023 to June 2023 (vs Jan 2021 to June 2021) reported the following changes vs the lung cancer pathway targets (Increase/decrease vs Performance Standard):

• 28-day Faster Diagnostic Standard performance improved to 92.1% (+1.3%. Target 75%),
• 2WW performance improved to 99.0% (+1.4% improvement. Target 93%)
• The 31-day wait was 97.96% (-0.65%. Target 96%)
• The 62-day referral to treatment CWT was 50% (+0.98%. Target 85%) – upon discussions with sponsors at the Trust, it is thought the increase was limited due to the extended impact of the pandemic and recent industrial action.

MSD Benefits

• Increased understanding of the lung cancer pathway, the challenges to current service provision and solutions to enable improvement towards the NOLCP target of diagnosis to treatment in 49 days.
• A better understanding of customer and patient needs in lung cancer.
• Enhanced reputation of and legitimacy for partnership work with MSD
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from University Hospital Dorset – Poole NHS FT & MSD.

Lessons learnt

The importance of:

• Developing a strong sponsor (management, clinical and administrative) engagement plan to aid the Corporate Cancer Manager with the frequent communication required to maintain the momentum and commitment to prioritise pathway improvement activity.
• Senior stakeholder’s activation to sustain support with a clear vision and appetite that is necessary to effect change in clinical services.
• Aligning on a communication plan for disseminating the incremental successes of service change during the project to maintain support to make service development permanent and sustainable.
• Creating of a formal contingency plan should any key stakeholders leave their post or the organisation during the implementation of the project.
• Identification of a trust ‘Project Manager’ resource to support implementation of the action plans from the end of the project through the immediate 6-month period to evaluation.
• NHS governance audit trail – when improvement projects are signed off at senior level, they are added to a project register so that they can be prioritised when resource is limited and there are other operational pressures.

Publications

No publications have been planned.

GB-NON-07838 | October 2023

Project Title

Manchester Royal Infirmary (MRI) Pathway Development Project (PDP) Outcome Summary

Organisations involved

MSD-UK

Manchester Royal Infirmary

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care. There is an opportunity in Greater Manchester to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved lung cancer pathway aligned with the national optimal pathway and achievement of the lung cancer 28 day Faster Diagnostic Standard and the 31- and 62-day Cancer Waiting Time (CWT) Targets. The project began in October 2022 and finished in March 2023.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with Manchester Royal Infirmary Hospitals team, MSD provided project management support to assess the current state of the lung cancer pathway and provided a gap analysis contrasting the pathway with the National Optimal Lung Cancer Pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Quicker diagnosis and time to treatment of lung cancer has been reported through this project potentially leading to improved patient outcomes. Please refer to days saved in NHS benefits below
• Direct upgrades of CXR to CT scan if suspicion of lung cancer
• Electronic alert system from radiologist to lung cancer team via HIVE (new integrated patient electronic record keeping system)
• Introduction of a new lung cancer team member, a Pathway Navigator, which aims to support the streamlined lung cancer investigations and patient appointments throughout the pathway

The following initiatives were identified and implemented to support with optimising the lung pathway at MRI

NHS Benefits

• After the workshops we identified some issues with regards to patient flow and communications amongst teams, utilising the HIVE system. Upon identification, the team went onto work with IT and make some necessary adjustments with regards to departmental communication such as triage lists, patient tracking lists and in basket referrals for suspicious lung cancers
• The unit have now successfully achieved the HOT reporting of CT scans, to ensure that they only receive reporting of scans with suspicious lesions- reducing 3-5 days on pathway
• A successful business case to increase lung CNS team from 2 to 4
• Trust secured a navigator and used the workshops to plan implementation of the role to maximise rapid integration to support patients through the lung pathway
• CT guided biopsy slots for MRI patients has been made accessible for GM – CAD (Greater Manchester Cancer Diagnostic System). Which means accessible and unutilised local slots within the Manchester region were facilitated for Manchester patients and benefitted MRI
• Development of timely discussion at MDT with initial provisional histopathology report by pathologist and final histopathology report before initiation of cancer treatment
• Implementation of local MDT toolkit validated by greater Manchester Cancer Alliance

An initial analysis taken from MRI CWT data 2022- 2023 reported an improvement of the lung cancer pathway targets:

• Data is currently being audited for cancer waiting times and may be included at a later stage

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Manchester Royal Infirmary & MSD.

Lessons learnt

An agreed strong engagement plan with the respiratory department, with commitment from all departmental members to fully engage and drive this pathway work forward within the NHS contributed significantly to the success of this project.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-08222 | October 2023

Project Title

Glasgow Royal Infirmary lung prehabilitation Pathway Development Programme (PDP)

Organisations involved

Respiratory Medicine Department Glasgow Royal Infirmary (GRI)

MSD-UK

Summary

The aim of this project was to map the lung cancer treatment and prehabilitation service pathways, identify service inefficiencies and facilitate service improvement. The purpose of which was the improvement of pathway service quality, efficiency, and productivity. At an early stage, and because of the parallel development of a national optimal lung cancer pathway, the lead requested we support a similar piece of work to gain insights for all lung cancer MDTs across Scotland. Because of this request, we entered into a separate piece of pathway work in collaboration with the UK Lung Cancer Coalition (UKLCC) which aims to improving health guidance in relation to lung cancer. This resulted in the narrowing of the focus of this project to only the prehabilitation pathway at the GRI. This project began June 2022 and finished November 2022.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme (PDP) with the Glasgow Royal Infirmary team, MSD provided project management support to assess the current state of the lung prehabilitation cancer pathway and provide a gap analysis of the available patient support services on the ability to provide robust prehabilitation to their patients. As a result of the project, the following benefits were realised:

Patient Benefits:

• Improved referral pathway to general prehabilitation patient support services in Glasgow. Before this project, there was no pathway set up for healthcare professionals to refer to prehabilitation services and services available were not widely known across GRI
• Access to prehabilitation support aims to maintain fitness levels, nutrition, and mental wellbeing. This is yet to be measured by GRI

NHS benefits:

• Creation of a 1-year physiotherapy led lung cancer prehabilitation service improvement project based at the Beatson cancer centre that will benefit patients from GRI, Gartnavel General Hospital, and the New Victoria Hospital. This service hasn’t started yet, therefore no data available at time of the outcome summary publication
• Improved Healthcare Professional understanding of limited scope of currently available general prehabilitation patient support services in Glasgow. This is to be measured by GRI at a later date
• Impact on treatment rates for lung cancer was not measured or used as a baseline as the project scope changed

 MSD Benefits:

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work. Four NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 9/10 and 6.75/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively
  • Average score of 9.5/10 would recommend working in collaboration with MSD to others
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Better understanding of deficiencies and needs, particularly regarding prehab”
  • “Highlighted already existing resources we were not using or not using fully and from a starting point of having a vague idea what we wanted to improve, we learned a great deal and can now see a clear path to achieving desired improvement and how that should look”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Very supportive and enthusiastic”
  • “This has been an eye opener in many ways – several projects originated and gained momentum once we started to collaborate – from general service prehab design to specific trial at Beatson, to a Scotland wide gap analysis for the National Lung Cancer Pathway, and hopefully further collaboration to implement findings in a local pilot but with view to regional improvements. It was difficult to find time sometimes but well worth it”
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their SMC approved medicines

Funding & Resources

This was a project with shared time commitment from Glasgow Royal Infirmary lung cancer team & MSD

Lessons learnt

Committed project manager and communication plan is essential to ensure all relevant parties are kept informed

Strong clinical leadership with a clear vision for change is necessary to effect change

A longer time period is required to make and measure significant service improvements

Publications

There are currently no plans to publish the outcomes of this project by the hospital as per the date of this summary

GB-NON-07558  |  October 2023

Project Title

Belfast Health and Social Care Trust Pathway Development Project (PDP)

Organisations involved

Belfast Health and Social Care Trust & MSD UK

Summary

The aims of this project were to optimise the lung cancer pathway across the Belfast Health and Social Care Trust through service redesign with the lung cancer multidisciplinary team and focussing on the pathway from red flag referral through to first definitive treatment. Specifically, contributing towards achievement of the lung 31-day treatment target and 62-day referral to treatment Cancer Waiting Time targets (CWT). MSD helped to project manage the implementation of this initiative through MSD’s Pathway Development Programme.  The project started in March 2022 and finished December 2022

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Belfast Health and Social Care Trust team, MSD provided project management support to assess the current state of the lung cancer pathway and provide a gap analysis contrasting the pathway with the National Optimal Lung Cancer Pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Optimisation of the lung cancer pathway which allows patients to navigate through the pathway more efficiently potentially increasing the chance of a successful outcome if patients are diagnosed earlier on in the pathway. Refer to NHS benefits below to see number of days potentially saved.

 NHS Benefits

•  Pathology – Implementation of Next Generation Sequencing (NGS) to create a suite of reflex molecular testing to avoid the need to send samples to reference centres reducing sample turnaround time by a minimum of 4 weeks. This will benefit all lung cancer patients diagnosed in Northern Ireland (approx. 1355/ annum). NGS currently achieving a 91% turnaround within 10-14 days.
• Fast track histopathology pathway to expedite patient samples within 24 hours of the multi-disciplinary meeting (MDM), reducing deferrals and optimising the pathway by 8 days and benefitting approx. 190 patients per year.
• New transfer pathway between histopathology and molecular pathology optimising the pathway by 3 days per sample.
• Interventional radiology – optimised pathway reducing the time to fine needle biopsy from 8 weeks to 4 weeks benefiting approx. 120 patients per year who will have a reduction of 4 weeks to have their fine needle biopsy.
• Establishment of a Computerised Tomography (CT) rapid access pilot which is assessing the impact of fast-tracking definite lung cancer patients (confirmed by Chest X-Ray) to a CT scan within 5 days vs current 14 days.
• Cost per case -new guidance for consultants to start patients’ treatment without delay and allow Cost per Case documentation to be completed in parallel. The new guidance is anticipated to reduce the time to initiation of treatment by approximately 1-2 weeks.
• Additional MDM tracker recruited to provide cover and additional capacity to track patients through the lung cancer pathway to expedite patients faster and monitor potential areas of delays.
• Overall treatment rates were not measured as part of this Pathway Development Programme

MSD Benefits

• Better understanding of lung cancer patient needs
• Enhanced reputation of MSD through partnership work. Six NHS stakeholders completed a survey following the PDP and the results are shown below:
  • Average score of 9.5/10 and 8.5/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively.
  • Average score of 8.33/10 would recommend working in collaboration with MSD to others.
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “Expedited CT pathway, expedited pathology sample delivery and inception of Next Generation Sequencing”
  • “Improving care for our patients”
  • “Improved communication across specialities”
• When questioned on feedback of your experience of working in collaboration with MSD
  • “Great team to work with, very engaging and encouraging. A sense that they were very much invested in patient benefit”
  • “MSD gave us additional project management capacity and an external voice which was really helpful”
  • “Excellent experience – without their focus we would have had difficulty achieving what we have”
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE approved medicines

Funding & Resources

This was a project with shared time commitment from both the NHS & MSD

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• Despite the best efforts of the NHS and MSD to optimise the lung cancer patient pathway, attainment of the Cancer Waiting Time (CWT) targets remains challenging. The CWT performance for lung cancer has remained steady against a backdrop of decreasing performance for other tumour types suggestive of even greater challenges within the system.
  • 31–day CWT compared Jan-Mar 2021 vs Jan-Mar 2023: 87% vs 84%
  • 62-day CWT compared Jan-Mar 2021 vs Jan-Mar 2023: 50% vs 50%

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-07574 | Date of Preparation: July 2023

Project Title

Peninsula Cancer Alliance Lung Cancer Pathway Development Project (PDP)

Organisations involved

Peninsula Cancer Alliance; Royal Devon & Exeter Hospital; University Hospital Plymouth; North Devon Hospital; Royal Cornwall Hospital and Torbay & South Devon Hospital

MSD-UK

Summary

A national optimal lung cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care. There was an opportunity in Devon and Cornwall to optimise the lung cancer pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project was an improved lung cancer pathway aligned with the national optimal pathway and achievement of the lung cancer 28 day Faster Diagnostic Standard (FDS) and the 62-day Cancer Waiting Time Target. The project began on 3rd January 2022 and finished on 30th November 2022

Each provider Trust completed the 28-day lung FDS pathway audit indicating the number of pathway days that a representative group of patients took to reach each pathway milestone, as defined by the NHSE 28-day best practice timed pathway. The audit results were analysed and feedback meetings were held with each provider Trust to discuss challenges and potential pathway solutions to improving attainment of the 28-day FDS cancer wait time target. As a result, each of the provider Trusts implemented different improvement initiatives and the results were measured by comparing the number of 28-day breaches (NHSE data) for the period June to September, versus the baseline period of January to April 22

Benefits Realised

• Patient Benefits

  • As a result of the audit and improvement work, patients benefited from a faster diagnostic pathway with fewer pathway times breaching the standard overall, please see NHS benefits

• NHS Benefits

  • Royal Cornwall Hospital introduced a new pathway to triage CT scans on the same day that they were performed and prior to the outpatient appointment
    • Lung patient breaches of the 28-day FDS reduced from 18% down to 10%*
  • University Hospital Plymouth increased their workforce to support improvements in the pathway through employing a Cancer Improvement Facilitator, a Lung CNS and a trainee Advanced Nurse Practitioner
    • Lung patient breaches of the 28-day FDS reduced from 17% down to 9%*
  • Torbay & South Devon Hospital focussed improvement work on developing the Radiology service to prioritise urgent referrals from primary care
    • The lung patient breaches of the 28-day FDS reduced from 19% down to 18%*
  • We did not measure the direct impact on treatment rates in this project

*Data obtained from NHSE Cancer Waiting time data. Time periods compared the 4 months June-Sept 2022 against a baseline of Jan-Apr 2022

• MSD Benefits

  • Better understanding of lung cancer patient needs
  • Enhanced reputation of MSD through partnership work. NHS stakeholder commented their experience of working in collaboration with MSD was “very professional, had good subject knowledge and a great support for the Alliance and the wider organisations”
  • As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This was a project with shared time commitment from both the NHS & MSD

Lessons learnt

Effectively engaging a wider group of relevant stakeholders is essential to drive maximum involvement and benefit from improvement work

Publications

At the time of writing this summary there were no plans to publish this data

GB-NON-07092 |  June 2023

Project Title

University Hospitals of Birmingham (UHB) Lung Cancer Pathway Development Project (PDP)

Organisations involved

University Hospitals Birmingham Foundation Trust (UHB), West Birmingham & Sandwell Foundation Trust, Walsall Foundation Trust, Birmingham & Solihull Integrated Care System (BSOL ICS), Birmingham Health Partners (BHP), Black Country & West Birmingham Strategic Transformational Partnership (BC & WB STP) & West Midlands Cancer Alliance

Summary

A national optimal lung pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all lung cancer patients receive optimal cancer care. There was an opportunity in Birmingham and the referring trusts of the West Midlands to optimise the lung cancer pathway in line with the national optimal lung cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project was an improved lung cancer pathway aligned with the national optimal lung cancer pathway and achievement of the lung cancer 28 day Faster Diagnostic Standard, the 31, 62- and 104-day Cancer Waiting Time Targets. The project began on 1st January 2022 and finished on 23rd May 2022. The data set used for baseline and impact evaluation was the Milestone Dashboard created by UHB for the project (data collected from September 2022 – Feb 2023).

Project Objectives

The primary objective of this project was the optimisation of lung cancer pathways across Birmingham and referring centres across the West Midlands. Specifically contributing towards; –

• An optimised lung cancer pathway aligned to the national optimal lung cancer pathway
• Achievement of the lung cancer 28 day Faster Diagnostic Standard, 31-day treatment target, 62-day referral to treatment and 104-day Cancer Waiting Time targets

Benefits Realised

Benefits to the Patient

• Delivering Targeted Lung Health Checks (TLHC) screening with trust led screening reviews & protocols
• By the introduction of a new pan-trust prehabilitation & smoking cessation service, it is understood that quicker diagnosis and treatment of lung cancer has been achieved, hence improving the chance of successful treatment. Data is still being collected on this
• By implementing changes, it is understood that there would be an improved patient experience, across the lung cancer pathway in Birmingham and referring centres across the Midlands

NHS Benefits

An optimised pathway in lung cancer across UHB hospital sites resulting in

• Achievement of the 28 day Faster Diagnostic Standard across 3 of 4 sites, 31-day treatment target all sites, 62-day referral to treatment all sites in Cancer Waiting Time targets. Time constraints, industrial action & staff absences meant that the 104 data was unable to be fully verified, so not included at this time, it is planned to be included in a case study
• Through the introduction of new services such as prehabilitation and smoking cessation and by creating dedicated outpatient appointments and capacity for lung resections, it is believed this will enable earlier referral, diagnosis and treatment of lung cancer patients. Data is currently being collected on the impact of this
• Created engagement & collaboration across previously siloed departments
• Optimisation of service delivery is ongoing post the project close
• The rigour & vigour of qualitative & quantitative data enabled efficient & effective change
• Live changes to working practices from the workshops saw the immediate change and benefits. This has led to:
  a. a new triage process immediately reducing CWTs by 7 days in 3 sites
  b. CNS capacity saving by 1.5 FTE
  c. Training on internal data systems for administrative staff, as well as CNS Somerset optimisation training reduced CWTs between departments.

MSD Benefits

• Better understanding of lung cancer patient needs
• Anecdotal enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE approved medicines

Funding & Resources

This was a project with shared time commitment between University Hospitals of Birmingham and MSD. Implementation of improvements resourced solely by UHB.

Lessons learnt:

• Early engagement & inclusion of all players across the pathway, delivered clear insight & understanding of both the issues, as well as the possible solutions.
• Solutions were consciously developed to not put pressure on other parts of the pathway
• Created engagement & collaborative working across previously silos departments
• The exceeded expected uptake of the TLHC increased demand on capacity more than expected
• Not all opportunities were realised and to have done so may have improved the CWTs & pathway improvement further

Publications

No planned publications

GB-NON-07496 | May 2023

Project Title

Gloucestershire AHP Prehabilitation Service (GAPS) for Lung Cancer Patients

Organisations involved

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) and MSD

Summary

We supported Gloucestershire Hospitals NHS Foundation Trust to set up and run a lung cancer prehabilitation service pilot over a 6-month period. We set out to determine the extent to which prehabilitation support for lung cancer patients can either maintain or improve their fitness levels and suitability for systemic anti-cancer therapy (SACT). Secondarily, we intended to measure the effect of prehabilitation on supporting a patient’s physical function and mental resilience. Patients were referred by a lung physician or lung cancer clinical nurse specialist at the diagnostic clinic stage as soon as a lung cancer is highly suspected. They were then assessed for the level of prehabilitation support that would best suit their individual needs and circumstance. We intended to use the evaluation to inform a business case that will seek to ensure recurrent funding and sustainability of this service. MSD provided funding, project management and evaluation support for this initiative. The project began on the 2^nd May 2022 and finished on the 30^th November 2022.

Benefits Realised

Benefits to the Patient

• As a result of engaging with GHNHSFT ‘s prehabilitation service, 80% of patients either maintained (41 patients or 68%), or improved (7 patients or 12%) their fitness from the time they were referred, through to the time that their treatment started:
  • Of the 25 patients measured as PS1 on referral, 16 (64%) maintained their PS1 and 3 (12%) had improved to PS0 by the time of decision to treat
  • Of the 27 patients measured as PS2 on referral, although 21 (78%) patients maintained their PS2, 5 (19%) had improved to PS1 by the time of decision to treat
• Patient experience and outcomes of receiving the service were measured:
  • 90% of patients stated they were satisfied with the information and advice provided (59% ‘very satisfied’ and 31% ‘satisfied’). This number increased to 97% among those who attended face to face prehabilitation
  • 79% of patients reported prehabilitation as improving their overall health and wellbeing either ‘a great deal’ (39%), or ‘a fair amount’ (40%). This number increased to 85% among those attending face to face
  • Of the patients that were able to use the psychological skills training, 82% stated that it helped reduce their worry/anxiety either ‘a great deal’ 31% or a fair amount 51%
• Patient’s lifestyle factors were seen to improve as a result of receiving prehabilitation support
  • 69% of patients reported that prehabilitation has helped them increased their physical activity
  • 57 % reported that prehabilitation has supported a positive change in their diet and nutrition
  • 61% of patients stated that prehabilitation supported their emotional well-being during a traumatic time in their lives

Benefits to GHNHSFT

• The development of a prehabilitation service in Gloucestershire dedicated to the needs of lung cancer patients
• Redesign and expansion of the lung cancer patient pathway to incorporate prehabilitation services
• Achievement of recommendations to provide prehabilitation within NHSE Diagnostic Standards of Care for suspected lung cancer
• A service evaluation has been produced highlighting the benefits of a prehabilitation service for lung cancer patients, which can serve as supporting business justification for longer term funding of the service
• The data available through the service evaluation is not sufficient enough to conclude that introducing prehabilitation results in an improvement of treatment rates

Benefits to MSD

• Enhanced reputation of MSD through partnership work
• A better understanding of how prehabilitation services support the needs of lung cancer patients
• An opportunity for MSD to support a service evaluation to help establish the benefits of prehabilitation for lung cancer patients
• An opportunity to engage as a partner with NHS Gloucestershire rather than just being seen as a supplier of medicines to the healthcare system
• Involvement in a potentially scalable service that could be shared with other cancer centres across the UK

Funding & Resources

This project was a shared funding commitment from GHNHSFT and MSD. The total project cost was £28,119

Lessons learnt:

• This project benefitted from having a data lead who can dedicate time to supporting the project through capturing service level data and synthesising the data to produce relevant insights.
• Outlier events such as global pandemics can’t be predicted, but where there is solid justification for setting up a new service, the strength of the case to do so will outlast external challenging forces
• Our forecast of patient numbers referred to the service over the 6-month pilot were affected by several factors (150 forecasted, 76 actual). These were, relying on an average number of patients flowing through the service, not factoring in patients declining the service, clinicians not referring patients who are PS3 and above to the service (due to the likely rapid deterioration and subsequent palliation), as well as perhaps more broadly communicating the service prior to it starting.
• Aligning all constituent elements of a prehabilitation service can be challenging and subject to change. For example, the local smoking cessation service initially agreed to attend prehabilitation sessions, but sadly did not engage when it was up and running.

Publications

Gloucestershire Hospitals NHS Foundation Trust intend to publish the results in a Professional Journal

GB-NON-07465  | May 2023

Project Title

Nottingham University Hospital NHS Trust Lung Cancer Pathway Development Project (PDP)

Organisations involved

Nottingham University Hospital (NUH) NHS Trust and MSD-UK 

Summary

The objective of this project was to improve Nottingham University Hospitals lung cancer service efficiency, service quality, productivity, and patient experience.  The desired outcome was an improved lung cancer pathway aligned with the national optimal lung cancer pathway and achievement of the lung cancer 28 day Faster Diagnostic Standard, the 31-day treatment target and 62-day referral to treatment Cancer Waiting Time (CWT) Targets.  The project began on 25th July 2022 and finished on 30th November 2022. 

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with the Nottingham University Hospitals team, MSD provided project management support to assess the current state of the lung cancer pathway and provide a gap analysis contrasting the pathway with the National Optimal Lung Cancer Pathway. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised: 

Patient Benefits

• Quicker diagnosis and time to treatment of lung cancer has been reported, as demonstrated below, through this project potentially leading to improved patient outcomes 
• All patients now have access to the Nottingham Education Materials for smoking cessation, diet, activity/exercise, and psychological support which was not previously available. It is envisaged this will support an improved patient experience 

NHS Benefits

An initial analysis taken from NUH CWT data Jul 2022-Feb 2023 reported an improvement of the lung cancer pathway targets (Percentage absolute change): 

• 28-day Faster Diagnostic Standard improvement of 6.9%
• 2WW improvement of 4.7% (with the 2WW percentage at 100% in Feb 2023)
• 31-day treatment target improvement of 1.5%  
• The 62-day referral CWT target is an ongoing measurement as only data to Feb 2023 was available at the time of the outcome summary publication. NUH are continuing to monitor the impact of the project and CWT data 

MSD Benefits

• Better understanding of lung cancer patient needs 
• Enhanced reputation of MSD through partnership work. NHS stakeholder commented their experience of working in collaboration with MSD was very insightful and helpful to have an objective review   

Funding & Resources

This was a project with shared time commitment from Nottingham University Hospital NHS Trust & MSD

Lessons learnt

Development of a strong engagement plan with the pathway manager and regular communication is needed to maintain the project momentum and drive the pathway work within the NHS. 

Strong leadership with a clear vision and appetite for change is necessary to effect a change in clinical services. 

A communication plan for disseminating the success of the service is essential to gain support to make service development changes sustainable and permanent. 

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary

GB-NON-07433 |  May 2023

Project Title

Surrey & Sussex Cancer Alliance Urgent Suspected Lung, Breast & Gynae Cancer Pathology Pathway Development Programme (PDP)

Organisations involved

SURREY & SUSSEX CANCER ALLIANCE and MERCK SHARP & DOHME (UK) LIMITED

Summary

The Purpose of this Project is to optimise the Urgent Suspected Cancer (USC) Pathology Pathways in Lung, Breast & Gynaecology from biopsy taken in theatre to final report being written up and made available by the trusts that are served by the Berkshire & Surrey Pathology Service (BSPS) within Surrey & Sussex Cancer Alliance (SSCA). This will aim to improve pathway service quality, efficiency, and productivity. The desired outcome is to see an improvement and less variation in turnaround times for histopathology in Lung, Breast and Gynaecology across the 4 trusts which in turn could positively impact the 28 days Faster Diagnostic Standard and 31-day treatment target Cancer Waiting Time targets.

This would be delivered collaboratively by both partners via the co-development and engagement in pathway mapping workshops and gap analysis workshops to identify barriers and blocks. Based on the findings from the gap analysis, both partners would subsequently work towards implementing plans of the identified areas of improvement and commit to measuring the outcomes of the project and disseminating these outcomes within 6 months of the project completion. The project intends to run for approximately 12 months.

Background

• Surrey & Sussex Cancer Alliance are looking to identify current bottlenecks in workflow and determine possible efficiencies in process which if improved could positively impact the 28 days Faster Diagnostic Standard and 31-day treatment target Cancer Waiting Time targets.
• Surrey & Sussex Cancer Alliance aim to improve the Lung, Breast & Gynaecology pathology pathway which could lead to improvement of the pathology target of 90% of diagnostic cases reported within 10 days which can significantly impact patients’ diagnosis and experience.
• There is unwarranted variance in the delivery of histopathology USC reports across the trusts served by the same laboratories (Surrey & Berkshire), being able to understand the current variance in service seen across each trust will allow efficiencies in process to be identified.

Project Objectives

The objectives of this collaboration are as follows:

• Reduce variation and optimise the Urgent Suspected Cancer (USC) Pathology Pathways in Lung, Breast & Gynaecology from biopsy taken in theatre to final report being written up and made available by the trusts that are served by Berkshire & Surrey Pathology Service (BSPS). BSPS provide two hub laboratories at Royal Surrey Foundation Trust which serves Royal Surrey Foundation Trust (RSFT), Ashford and St. Peter’s Hospital (ASPH), East Surrey Hospital (SASH) and Frimley Park Hospital (FPH) sites and the other is in Berkshire at the Harborne Building which serves Wexham Park Hospital (WPH) within SSCA
• Understand the current pathway in all 4 hospital trusts (5 sites) and within both hub laboratories to create a standardised pathway across SSCA.
• Utilise data and workshops findings to understand the variation, best practice, challenges, and inefficiencies within the pathways.
• Identify ways to address the challenges and inefficiencies found in the pathways to optimise pathway and reduce variation to provide an equitable service across the trusts and tumour pathways.

Benefits

Benefits to patients

• An improved patient experience of the Urgent Suspected Lung, Breast & Gynaecology Cancer Pathology pathways in Surrey
• Quicker diagnosis and treatment of Lung, Breast and Gynaecology Cancer through optimisation of the histopathology turnaround times and hence improving the chance of successful treatment.

Benefits to the NHS partner

• Achievement of the Lung, Breast & Gynaecology 28 day faster diagnostic standard and 31-day treatment target Cancer Waiting Times targets by reducing pathology turnaround times.
• Earlier diagnosis and treatment of Lung, Breast & Gynaecology Cancer patients
• Increase in treatment rates for Lung, Breast & Gynaecology Cancer.
• Optimisation of service delivery.

Benefits to MSD

• Better understanding of Lung, Breast & Gynaecology patient needs.
• Enhanced reputation of MSD through partnership work.
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway. may be that MSD see more appropriate usage of their NICE/SMC approved medicines.

Funding & Resources

This project is a shared contribution of time between Surrey and Sussex Cancer Alliance and MSD.

GB-NON-10725 |  February 2025

Project Title:

Re-design of a Specialist Immuno Oncology (SIO) Service supporting Systemic Anti-Cancer Treatment (SACT) delivery across Sussex

Organisations Involved

University Hospitals Sussex NHS Foundation Trust

East Sussex Healthcare NHS Trust

MSD UK

Summary

The project will support the development and delivery of a SIO Service providing different levels of support to patients and clinical teams across all six sites in East & West Sussex.

MSD (UK) were approached by a medical oncologist at UHSussex Brighton to provide project management support for the re-design of the existing acute oncology provision to develop a re-designed SIO Service. This is following a successful bid to Surrey & Sussex Cancer Alliance to fund the new/expanded specialist team for 24 months.

The new service will fill a gap in current provision by enabling equitable access for patients receiving immune checkpoint inhibitors (ICIs) immunotherapy to a highly skilled specialist team providing high quality Chemotherapy & Immunotherapy Supportive Care. The service will educate, provide advice & guidance to clinical teams around Sussex to identify toxicity early, helping to ensure treatment is effective and patients are well informed no matter where they are cared for.

The SIO team will predominately support patients experiencing side effects from immunotherapy cancer treatment but also implement management pathways which will include advice and guidance for other novel agents where a pathway can be optimised by the involvement of the service. The SIO team will additionally provide support and cross cover for their local trust SACT colleagues via a single ‘centralised’ team utilising digital processes and standard protocols.

The project will deliver the following as outcomes:

• Implementation and delivery of national management protocols, assessing /quantifying the movement of patients through the service (local pathways) and the development of new regional pathways
• Stratification of patient needs and provision of care and the interaction/transfer of care between these groups across the region, either under the SIO / Acute Oncology (AO) / Tumour Site Reference Group (TsRG) teams (including oncologists, site specific cancer nurse specialists, physician associates and specialist pharmacist)
• Develop equitable outpatient and ambulatory management, allowing admission avoidance in certain cases and expediting discharge for those for whom admission is necessary.
• Optimisation of management, triage and admission for patient with severe/ refractory adverse effects including the delivery of biological therapies.
• Appropriate utilisation, education & support of same day emergency care (SDEC) pathways.
• Development and delivery of patient facing resources to improve knowledge and patient experience to promote patient self-identification move towards self-management

MSD’s commitment will be for the agreed 24-month period. An evaluation will be completed at 30 months.  The goal is to evaluate the impact on patient care, bed days and experience of the service. To achieve sustainability, 75% of the way through the 2-year program a joint case for investment will be developed and submitted UHSussex Exec +/- External Commissioners for substantive/permanent service funding beyond the initial transformation funding committed by SSCA (2024/2025).

Background

University Hospitals Sussex (UHSussex) NHS Foundation trust provides acute and specialist services for 6 hospitals across East and West Sussex including an oncology service in East Sussex Healthcare trusts serving a population of approx. 2.4 million people.

Delivery of SACT is recognised as a challenge at both regional and national levels. This is due to several issues including geographical disparity of pretreatment assessments, increased burden of assessment throughout treatment, sheer chair capacity, and the recognition, management, and support of patients during an acute problem with their cancer pathway.

Increasingly it is being recognised that there is a mortality burden associated with these newer therapeutics and avoidance of this may be optimised in the early recognition, appropriate management, and effective monitoring of patients.

Due to the burden of work on the Sussex cancer workforce including the increasing longevity of cancer care in palliative patient pathways, the delivery of direct patient care and education to the wider medical teams can be more effectively delivered by a specialised team supported by Standard Operating Procedures (SOPs) and decision matrices than the current piecemeal delivery by individual teams has resulted in inconsistencies of care and limited experiential learning up to this point.

Many cancer centres already provide nurse led clinic support at a tumour level or to manage the broader effects of immunotherapy e.g., Velindre Cancer Centre, Cardiff.

This project will aim to drive consistency of support across different cancers for patients treated with ICIs in all Trust led services across Sussex. The service will be important because it allows more patients to stay well whilst going through their cancer treatment and supports those who do get side effects so they are often less severe, with fewer negative impacts on the patient than there could be otherwise and to remain where possible on active therapy. Spotting the signs of these side effects early also means patients are less likely to be admitted to hospital.

Project Objectives

The objectives of this collaboration are as follows:

1. Establishment of a dedicated service to run for 24 months within the scope of the project, followed by an evaluation 6 months after the project has completed. Within the scope of the project, a business case for ongoing trust support will be developed to sustain the service after the initial project period.
2. Provide a specialist sub-acute management pathway to manage treatment continuance, wean treatment in a timely manner and co-ordinate team input where needed.
3. Education and training for the TsRG teams to ensure robust, standardised care and continuity of medication management.
4. Multi-speciality co-ordination and cross-speciality working to promote effective management of complex cases arising from improved depth of exposure and knowledge, underpinned by detailed patient record keeping.

Benefits

Benefits/ Impact to Patients

• Patients will receive consistent, standardised education on checkpoint inhibitors (CPIs) & how to manage the side effects during treatment irrespective of cancer type alongside their other tumour-related education.
• Patient will have a dedicated service and confidence that their immune treatment side effects are identified & managed appropriately in a timely manner
• Patients potentially stay on their treatment for longer/re-start their treatment following side effects
• Prevents unnecessary attendance / admission

Benefits to the NHS Partner

• Patients managed by the Specialist Immuno-Oncology (SIO) Service may result in released clinical capacity (oncology consultants/department CNS and Emergency Department (ED)/Acute medicine) that can be reallocated to the running of their clinics / other activity.
• Reduction in acute / unplanned admissions and related bed days
• Project management resource to support the development/re-design of the new SIO Service supporting SACT delivery across Sussex
• Sustained improvement of care, reduction of acute burden both in terms of attendance/admission and adverse outcomes/mortality

Benefits to MSD

• Enhanced reputation for MSD through partnership work
• A better understanding of the challenges experienced along the treatment pathway to ensure informed conversations internally and with external stakeholders
• As a pharmaceutical manufacturer of oncology medicines, and indirect result of the CPI is that MSD may see more appropriate use of their NICE approved medicines.

Funding & Resources

This project is a shared contribution of time between University Hospitals Sussex NHS Foundation Trust and MSD UK.

GB-NON-10761 | December 2024

Project Title

Surrey & Sussex Cancer Alliance SACT Day Unit Demand & Capacity Project

Organisations involved

Surrey & Sussex Cancer Alliance,

Ashford and St. Peter’s Hospitals NHS Foundation Trust,

University Hospitals Sussex NHS Foundation Trust,

East Sussex Healthcare NHS Trust,

Frimley Health NHS Foundation Trust,

Queen Victoria Hospital NHS Foundation Trust,

Royal Surrey NHS Foundation Trust,

Surrey and Sussex Healthcare NHS Trust (SASH)

MSD

Summary

This project is to be conducted in partnership with Surrey & Sussex Cancer Alliance, and will impact the following Trusts: Ashford and St. Peter’s Hospitals NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust, East Sussex Healthcare NHS Trust , Frimley Health NHS Foundation Trust, Queen Victoria Hospital NHS Foundation Trust, Royal Surrey NHS Foundation Trust.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Surrey & Sussex Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Surrey & Sussex Cancer Alliance. The project is expected to run over a 12 month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Surrey & Sussex Cancer Alliance.
• Optimised treatment timings and utilisation of services within SACT day units across Surrey & Sussex Cancer Alliance.
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• Surrey & Sussex Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Surrey & Sussex Cancer Alliance and MSD.

GB-NON-10771 |  December 2024

Project Title

East of England Cancer Alliance (EOECA) SACT (Systemic Anti-Cancer Therapy) demand and capacity project

Organisations involved

East of England Cancer Alliance (EOECA)

Norwich and Norfolk University Hospitals NHS Foundation Trust

James Paget University Hospitals NHS Foundation Trust

Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

North West Anglia NHS Foundation Trust

Cambridge University Hospitals NHS Foundation Trust

West Suffolk NHS Foundation Trust

East Suffolk and North Essex NHS Foundation Trust

Milton Keynes University Hospital NHS Trust

Bedfordshire Hospitals NHS Foundation Trust

East and North Hertfordshire NHS Trust

West Hertfordshire Teaching Hospitals NHS Trust

Princess Alexandra Hospital NHS Trust

Mid and South Essex NHS Foundation Trust

Summary

This project is to be conducted in partnership with East of England Cancer Alliance (EOECA) and will impact the following Trusts: As listed above.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for EOECA. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data-led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for EOECA. The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across EOECA
• Optimised treatment timings and utilisation of services within SACT day units across EOECA
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

•  Increased treatment capacity to fulfil current and future demand
• EOECA has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between EOECAand MSD.

GB-NON-10576 | November 2024

Project Title

West Midlands Cancer Alliance (WMCA) SACT (Systemic Anti-Cancer Therapy) demand and capacity project

Organisations involved

West Midlands Cancer Alliance (WMCA)

University Hospitals Birmingham NHS Foundation Trust

Birmingham Women’s & Children’s NHS Foundation Trust

University Hospitals Coventry and Warwickshire NHS Trust

South Warwickshire NHS Foundation Trust

George Eliot Hospital NHS Trust

Wye Valley NHS Trust

Worcestershire Acute Hospitals NHS Trust

The Shrewsbury and Telford Hospital NHS Trust

University Hospitals North Midlands NHS Trust

The Dudley Group NHS Foundation Trust

Sandwell and West Birmingham NHS Trust

Walsall Healthcare NHS Trust

The Royal Wolverhampton NHS Trust

Summary

This project is to be conducted in partnership with West Midlands Cancer Alliance (WMCA) and will impact the following Trusts: As Listed above.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for WMCA. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data-led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for WMCA. The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across WMCA
• Optimised treatment timings and utilisation of services within SACT day units across WMCA
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

•  Increased treatment capacity to fulfil current and future demand
• WMCA has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

•  Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between WMCA and MSD.

GB-NON-10575 | November 2024

Project Title

East Midlands Cancer Alliance (EMCA) SACT (Systemic Anti-Cancer Therapy) demand and capacity project

Organisations involved

East Midlands Cancer Alliance (EMCA)

Nottingham University Hospitals NHS trust

Sherwood Forest Hospitals NHS Trust

United Lincolnshire Hospitals NHS Trust

Northampton General Hospital NHS Trust

Kettering General Hospital NHS Trust

University Hospitals of Derby & Burton NHS Trust

University Hospitals of Leicester NHS Trust

Summary

This project is to be conducted in partnership with East Midlands Cancer Alliance (EMCA) and will impact the following Trusts: As listed above.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for EMCA. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data-led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for EMCA.The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across EMCA
• Optimised treatment timings and utilisation of services within SACT day units across EMCA
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

•  Increased treatment capacity to fulfil current and future demand
• EMCA has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between EMCA and MSD.

GB-NON-10571 | November 2024

Project Title

SACT Capacity and Demand Modelling Service

Organisations Involved

Northern Cancer Alliance

Newcastle Hospitals NHS Foundation Trust

South Tees Hospital NHS Foundation Trust

County Durham and Darlington NHS Foundation Trust

North Cumbria Integrated Care NHS Foundation Trust

Northumbria Healthcare NHS Trust

South Tyneside and Sunderland NHS Foundation Trust

Gateshead Health NHS Foundation Trust

North Tees and Hartlepool NHS Foundation Trust

MSD UK

Summary

This project is to be conducted in partnership with Northern Cancer Alliance and will impact the following Trusts: Newcastle Hospitals NHS Foundation Trust, South Tees Hospital NHS Foundation Trust, County Durham and Darlington NHS Foundation Trust, North Cumbria Integrated Care NHS Foundation Trust, Northumbria Healthcare NHS Trust, South Tyneside and Sunderland NHS Foundation Trust, Gateshead Health NHS Foundation Trust, North Tees and Hartlepool NHS Foundation Trust.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Northern Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Northern Cancer Alliance. The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Northern Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across Northern Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• Northern Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Northern Cancer Alliance and MSD.

GB-NON-10352 | November 2024

Project Title

North East London Cancer Alliance SACT Capacity and Demand Project

Organisations involved

North East London Cancer Alliance c/o North East London ICB

Barts Health NHS Trust

Barking, Havering and Redbridge University Hospitals NHS Trust

MSD

Summary

This project is to be conducted in partnership with North East London Cancer Alliance and will impact the following Trusts: Barts Health NHS Trust & Barking, Havering and Redbridge University Hospitals NHS Trust. The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for North East London Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for North East London Cancer Alliance. The project is expected to run over a 12 month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across North East London Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across North East London Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

•  Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

 NHS Benefits

•  Increased treatment capacity to fulfil current and future demand
• North East London Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

•  Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between North East London Cancer Alliance and MSD.

GB-NON-10353 |  October 2024

Project Title

Wessex Cancer Alliance (WCA) and NHS Trusts Systemic Anti-Cancer Therapy (SACT) Day Unit Capacity Insights project

Organisations involved

• Wessex Cancer Alliance
• MSD
• University Hospitals Southampton NHS Foundation Trust
• University Hospitals Dorset NHS Foundation Trust
• Portsmouth Hospitals University NHS Trust
• Hampshire Hospitals NHS Foundation Trust
• Dorset County Hospital NHS Foundation Trust
• Isle of Wight NHS Trust

Summary

The aim of this project is to derive data-led insights on the demand and resource capacity of each Trust’s SACT Day Unit (SDU) to deliver existing and future treatment across Wessex Cancer alliance using MSD’s capacity insights model (CIT*). The visibility of the data, when added to narrative from day unit staff, can then support decision making that optimises SACT services to ensure timely access for patients to treatment with minimal waiting times.

• The insights from the model will highlight gaps and opportunities, including quick wins, within the services’ ability to deliver current and future SACT.

Facilitated capacity workshops (led by the Cancer Alliance SACT Project Lead, supported by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SDUs, can address current/future service gaps. The data-led decisions will be incorporated into an action plan for Trust cancer services to influence and facilitate changes within a 5-year planning timeframe as part of a Trust’s cancer strategy.

• The intent is for treatment service capacity to improve (measured via a second report from the CIT model) and therefore allow for more timely access to the optimal SACT.

 *CIT – The Capacity Insights Tool supports SDUs to understand directionally how their capacity, in terms of chairs and workforce, can meet demand on the service now and in the future. The report from the tool demonstrates the outputs of current business as usual, and can model future scenarios which assume the impact of potential changes that mitigate for growing demand.

Background

1. To mitigate demand in SACT Day Units exceeding capacity in future circumstances.
2. Allocation of SACT resources and staff not sufficiently targeted using actual demand data.

Context

• Cancer alliances have been directed in their 2024 NHSE planning pack to evaluate bi-annually the Capacity and Demand of SACT service-provision across their footprint.
• An increasing number of oncology and haematology appointments (OPAs) for SACT are leading to resource-challenged service provision (2024 growth +6%).
• Workforce pressures within SACT aseptic units are leading to capped compounding means that a limited number of treatments can be delivered each week.
• Pharmacy aseptic services, some of whom are managing capacity well, are now raising concerns about the number of new therapies and related licences impacting their ability to deliver a safe and robust service.
• Increasing demand on SDUs, pharmacy and related OPs now or soon will result in delays, deferred, or missed treatment. The impact is a negative patient and staff experience, which ultimately impacts patient outcomes.
• SACT Managers have no, or limited, access to tools to support their analysis of Capacity and Demand and have limited time and/or management process to develop their Capacity and Demand data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.

Project Objectives

The objectives of this collaboration are as follows:

1. Working together with Systemic Anti-Cancer Treatment Day Unit (SDU) staff, scope the capacity and demands of each Trust’s SDUs by completing bi-annual Capacity and Demand measurement (Ref 1) reports to show their current ability (chair and workforce capacity) to deliver sufficient SACT, i.e., existing attendance demand now and in 12 months and beyond.
2. Deliver modelled demand and resource data for the 6 Wessex Trusts to WCA key clinical Stakeholders (Treatment Board, Integrated Care Boards (ICB), SACT Clinical Advisory Group (CAG) and SACT Nurses Site Specific Group (SSG)) to support decision making on SACT resource planning.
   • Predict likely changes in demand and support service development to meet those changes by improving SACT capacity to reduce the 31-day cancer wait times for 1st and follow-up treatment.
   • Reduce the frequency and impact caused to patient care and workforce by deferrals and delays.
3. Develop action plans with each Trust to make improvements to their capacity, as indicated by scenario modelling.
   • The Cancer Alliance Project Lead & MSD will recommend an approach for periodic Trust planning workshops, with a confirmed quorate, that enables SDU-level decision-making for services to be sufficiently resourced to meet future demand.
4. Develop an SDU performance dashboard that visualises the Trusts’/MSD report data, hosted by WCA, accessible to relevant Trust cancer services and the key clinical Stakeholders.

Benefits

Patient Benefits

• Put patients first by improving patient experience and outcomes.
• Patients receiving treatment at new tiers of service (i.e., outreach cancer centre/unit) should not be disadvantaged in any way.
• Reduction in waiting times and delay to treatment ‘on the day’ or from being deferred to a later date.

NHS Benefits

• WCA has regional overview of their SACT services Capacity and Demand status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where addition of resource is required.
• Align with WCA values of courage, accountability, kindness, and equality (CAKE).
• Support Wessex partner Trusts understanding of the wider capacity and demand picture across the region.
• Reduced pressure on workforce and treatment service.
• Equitable and earliest access for patients to SACT treatment.

 MSD Benefits

• Enhanced reputation for MSD through partnership work.
• Better understanding of SACT treatment services.
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines.

Funding & Resources

This project is a shared contribution of time between Wessex Cancer Alliance (University Hospitals Southampton NHS Foundation Trust) and MSD

GB-NON-10226  |  September 2024

Project Title

SACT Capacity and Demand Modelling service, West Yorkshire & Harrogate Cancer Alliance

Organisations involved

West Yorkshire & Harrogate Cancer Alliance

Leeds Teaching Hospital NHS Trust

Mid Yorkshire Teaching Hospitals NHS Trust

Harrogate and District NHS Foundation Trust

Calderdale and Huddersfield NHS Foundation Trust

Bradford Teaching Hospitals NHS Trust

Airdale NHS Foundation Trust

MSDUK

Summary

This project is to be conducted in partnership with West Yorkshire and Harrogate Cancer Alliance and will impact the following Trusts:  Leeds Teaching Hospital NHS Trust, Mid Yorkshire Teaching Hospitals NHS Trust, Harrogate and District NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, Bradford Teaching Hospitals NHS Trust, Airedale NHS Foundation Trust.

The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for West Yorkshire and Harrogate Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for West Yorkshire and Harrogate Cancer Alliance The project is expected to run over a 12 month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across West Yorkshire and Harrogate Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across West Yorkshire and Harrogate Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• West Yorkshire and Harrogate Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between West Yorkshire and Harrogate Cancer Alliance  and MSD.

GB-NON-10230 | September 2024

Project Title

South Eastern Health and Social Care Trust Chemotherapy Day Unit Pathway Development Programme (PDP)

Organisations involved

MSD

South Eastern Health and Social Care Trust

Summary

There is an opportunity in South Eastern Health and Social Care Trust to optimise the Chemotherapy Day Unit pathway to improve the understanding of the current patient pathway for each tumour site served, understand the challenges of these pathways and identify ways to address these challenges. It will also look at a consistent referral approach defined and implemented across all specialty’s to potentially improve treatment time and MDT decision making to progress patients through the treatment pathway in the Chemotherapy unit. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of the Chemotherapy Day Unit Pan Tumour pathways across South Eastern Health and Social Care Trust. Specifically contributing towards; –

• Improving the 31-day treatment target Cancer Waiting Time targets

Benefits

Patient Benefits

• An improved patient experience through pan tumour Chemotherapy Unit pathways in the South Eastern Health and Social Care Trust
• Quicker time to treatment pan tumour, improving the chance of successful treatment

NHS Benefits

• Smoother & Quicker Referral Process pan tumour following treatment decision
• Improvement of the Pan Tumour 31-day Cancer Waiting Time targets
• Optimisation of service delivery through the Chemotherapy Day Unit

MSD Benefits

• Better understanding of chemotherapy patient journey
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09926 | September 2024

Project Title

SACT Capacity and Demand

Organisations involved

South Yorkshire and Bassetlaw Cancer Alliance

Sheffield Teaching Hospitals NHS foundation Trust

Barnsley Hospital NHS Foundation Trust

Rotherham NHS Foundation Trust

Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust

Chesterfield Royal Hospital NHS Foundation Trust

Summary

The aim of this project over a 12-month period is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for South Yorkshire & Bassetlaw Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for South Yorkshire & Bassetlaw Cancer Alliance.

Background

SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity, plus workforce pressures, are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.

Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.

Cancer Alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.

To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

To deliver two rounds of capacity insights and scenario planning delivered via PDF reports for all SACT day units within the project.

Identification of potential improvement activities through a capacity planning workshop and a corresponding action plan for SACT day units to implement to address gaps in current and future SACT delivery service capacity.

Evaluation report of the impact of changes made to demonstrate whether the SACT delivery service capacity across South Yorkshire & Bassetlaw Cancer Alliance has been optimised because of the project.

Benefits

Patients

Reduces delay to SACT treatment

Reduction in the ‘on the day’ delays and deferrals

NHS 

Increased treatment capacity to fulfil current and future demand.

An oversight of their SACT service demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required.

MSD

Enhanced reputation for MSD through partnership work

Better understanding of SACT treatment services and improvement opportunities

As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved capacity may be that MSD see more appropriate usage of NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between South Yorkshire and Bassetlaw Cancer Alliance, Sheffield Teaching Hospitals NHS foundation Trust. Barnsley Hospital NHS Foundation Trust, Rotherham NHS Foundation Trust, Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust and MSD.

GB-NON-09875 | August 2024

Project Title

Lancashire & South Cumbria SACT Capacity, Demand & Utilisation Project

Organisations involved

Lancashire & South Cumbria Cancer Alliance and MSD

Summary

This project is to be conducted in partnership with Lancashire & South Cumbria Cancer Alliance and will impact the following Trusts: Lancashire Teaching Hospitals NHS Foundation Trust, Blackpool Teaching Hospital NHS Foundation Trust, East Lancashire Hospitals NHS Trust, The University Hospitals Morecambe Bay NHS Foundation Trust. The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Lancashire & South Cumbria Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Lancashire & South Cumbria Cancer Alliance. The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Lancashire & South Cumbria Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across Lancashire & South Cumbria Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• Lancashire & South Cumbria Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Lancashire & South Cumbria Cancer Alliance and MSD.

GB-NON-09876 | August 2024

Project Title

Kent & Medway Cancer Alliance SACT Day Unit Demand & Capacity Project

Organisations involved

Kent & Medway Cancer Alliance (Kent & Medway Integrated Care Board (ICB)), MSD, Dartford & Gravesham NHS Trust, East Kent University hospital NHS Trust, Maidstone and Tunbridge wells NHS Trust, Medway Foundation NHS Trust

Summary

This project is to be conducted in partnership with Kent & Medway Cancer Alliance  and will impact the following Trusts: Dartford & Gravesham NHS Trust, East Kent University hospital NHS Trust, Maidstone and Tunbridge wells NHS Trust, Medway Foundation NHS Trust The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Kent & Medway Cancer Alliance This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Kent & Medway Cancer Alliance The project is expected to run over a 12 months timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Kent & Medway Cancer Alliance.
• Optimised treatment timings and utilisation of services within SACT day units across Kent & Medway Cancer Alliance.
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• Kent & Medway Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Kent & Medway Cancer Alliance  and MSD.

GB-NON-09806 | August 2024

Project Title

SACT Demand and Capacity planning across hospitals within SWAG Cancer Alliance

Organisations involved

SWAG Cancer Alliance and MSD

Summary

This project is to be conducted in partnership with SWAG Cancer Alliance and will impact the following Trusts: University Hospitals Bristol & Weston NHS Foundation Trust (UHBW); North Bristol NHS Trust (NBT); Gloucestershire Hospitals NHS Foundation Trust (GHFT); Somerset NHS Foundation Trust (SFT); Salisbury NHS Foundation Trust (SDHFT); Royal United Hospitals Bath (RUH).The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for SWAG Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for SWAG Cancer Alliance. The project is expected to run over a 12-month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across SWAG Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across SWAG Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefit:

• Increased treatment capacity to fulfil current and future demand
• SWAG Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefit:

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between SWAG Cancer Alliance and MSD.

GB-NON-09805 |  August 2024

Project Title

Peninsula Cancer Alliance Demand and Capacity Modelling using the Capacity Insights Tool

Organisations involved

Peninsula Cancer Alliance and MSD

Summary

This project is to be conducted in partnership with Peninsula Cancer Alliance and will impact the following Trusts: Royal Devon University Hospitals (North and East) (RDUH); Royal Cornwall Hospital (RCHT); University Hospital Plymouth (UHP); Torbay & South Devon Hospital (T&SD). The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Peninsula Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Peninsula Cancer Alliance. The project is expected to run over a 12 months timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Peninsula Cancer Alliance
• Optimised treatment timings and utilisation of services within SACT day units across Peninsula Cancer Alliance
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefit:

• Increased treatment capacity to fulfil current and future demand
• Peninsula Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefit:

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Peninsula Cancer Alliance and MSD.

GB-NON–09877  |  August 2024

Project Title

Cheshire & Merseyside SACT Capacity, Demand & Utilisation Project

Organisations involved

Cheshire & Merseyside Cancer Alliance and MSD

Summary

This project is to be conducted in partnership with Cheshire & Merseyside Cancer Alliance and will impact the following Trusts: Countess of Chester Hospital NHS Foundation Trust, East Cheshire NHS Trust​, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool University Hospitals NHS Foundation Trust, Liverpool Women’s NHS Foundation Trust, Mid Cheshire Hospitals NHS Foundation Trust, Mersey and West Lancashire Teaching Hospitals NHS Trust​, The Clatterbridge Cancer Centre NHS Foundation Trust​, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Wirral University Teaching Hospital NHS Foundation Trust. The aim of this project is to provide data-led insights into demand and capacity of systemic anti-cancer treatment (SACT) delivery in current and future services for Cheshire & Merseyside Cancer Alliance. This analysis will be conducted using MSD’s capacity insights tool (CIT*) and aims to support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the model will highlight gaps and opportunities within the services’ ability to deliver current and future SACT. Facilitated capacity workshops (led by MSD) will enable a review of the insights report and a discussion on potential modelled scenarios that, if implemented by SACT day units, could address current/future service gaps. The data led decisions will be incorporated into an action plan for Trust cancer services to influence and implement changes. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments for Cheshire & Merseyside Cancer Alliance. The project is expected to run over a 12 month timeframe.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT day units across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients.
• Many SACT managers have no, or limited access to tools to support their analysis of demand and capacity, have limited time and/or management processes to develop their demand and capacity data into actionable insights. This degrades their ability to address capacity issues due to their operational pressures.
• Cancer alliances have been directed in their 2024 NHSE Planning Pack to evaluate bi-annually their demand and capacity of SACT service provision across their footprint.
• To understand future SACT delivery options and models, it is important to understand the current demand and capacity and plan for sustainability.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT day units across Cheshire & Merseyside Cancer Alliance Region
• Optimised treatment timings and utilisation of services within SACT day units across Cheshire & Merseyside Cancer Alliance Region
• Improved cancer waiting times to begin SACT in line with national guidance
• Trust level service development initiatives implemented based on insights generated through this work

Benefits

Patient Benefits

• Reduced delay to treatment
• Reduction in ‘on the day’ delay and deferrals

NHS Benefit:

• Increased treatment capacity to fulfil current and future demand
• Cheshire & Merseyside Cancer Alliance has an overview of their SACT services demand and capacity status to help deliver a more regional approach recommending a plan optimising resource use and highlighting where additional resource is required

MSD Benefit:

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services and improvement opportunities
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Cheshire & Merseyside Cancer Alliance and MSD.

GB-NON-09772 |  August 2024

Project Title

Patient Education Programme – Clatterbridge NHS Foundation Trust

Organisations involved

MSD UK (Ltd)

&

Clatterbridge Cancer Centre NHS Foundation Trust

Summary

The objectives of this collaboration are as follows: The proposed pilot will be a collaboration between MSD and The Clatterbridge Cancer Centre. MSD will provide funding with project management support to support the recruitment of a Patient Education Programme Lead. This role will be funded by MSD for a 12-month period only. The Programme Lead at Clatterbridge Cancer Centre will develop patient education workshops (breast/skin/urology), train relevant team members to deliver the workshops, and monitor and audit implementation of workshops. They will collate patient resources and clinician training materials to support the patient across the treatment pathway. The patient resources will relate to cancer and information on what to expect throughout the patients’ journey and will not relate to any individual drug.

The aim will be to provide consistency, monitoring and review of the Patient Education Programme and to ensure all resources are up to date and regularly audited.

Background

The Clatterbridge Cancer Centre is one of the UK’s leading cancer centres providing highly specialist cancer care to a population of 2.4m people across Cheshire and Merseyside. The numbers of cancer patients are continuing to grow- estimated to reach 4.5 million nationally by 2030.  New treatments and combination treatments have also increased the capacity demands and pressures on, resulting in significant capacity challenges and delays to treatment.  Additionally, post COVID the backlog has still not been cleared.

As the rate of patients increases it will be increasingly difficult to ensure these patients are effectively managed and treated within agreed cancer waiting time, and there is an increasing need to ensure patients are fully educated and informed about their cancer at all stages of the pathway. This can help reduce consultation time at appointments and allow access to available resources to support their care. This will also help provide consistent education and access to resources across all trusts. Through this project, the patient education lead will develop and implement the patient workshops and resources and implement across spoke trusts, with project management support by MSD to aid with facilitation.

Project Objectives

The project will be a collaboration between MSD and The Clatterbridge Cancer Centre, to fund an education lead to develop a cancer education program which will be rolled out across Clatterbridge and 7 hubs across Cheshire & Merseyside.  An unmet need has been identified to deliver consistent education, aligning resources, and training across the 8 sites. The lead will also develop processes to ensure all resources are up to date and regularly audited, and to ensure all patients have access to the same level of education and resources across the locality. The Clatterbridge Cancer Center will provide consultant time to advise and review the educational materials, and project management support to aid with implementation.  They will also provide IT and admin support to help with content development and uploading to The Clatterbridge Cancer Centre intranet.

Benefits

Patient Benefit:

• Workshops will encourage networking between patients which may be an additional support system.
• Greater understanding of cancer and treatment which may help patients feel more empowered and able to make more informed decisions.
• Improved patient experience.
• Online resources may result in patients being able to access information without having to contact NHS outside NHS working hours.

NHS Benefit:

• Access to resources may result in fewer queries which could aid capacity challenges.
• Consistent and auditable resources available to support with patient care.
• Access to resources may result in fewer patient queries which could aid capacity challenges.

MSD Benefit:

• Supporting NHS to develop resources.
• Deeper understanding of patient education and optimal way to deliver education.
• This intended collaboration may enable more patients to have access to treatment options in line with NICE guidelines which may or may not include MSD medicines.

Funding & Resources

This project is a shared contribution between Clatterbridge Cancer Centre NHS Foundation Trust and MSD. The total project cost is £115,026 [MSD £64,044, Clatterbridge Cancer Centre £50,982.]

GB-NON-09098 |  August 2024

Project Title

Western Health and Social Care Trusts Chemotherapy Day Unit Pathway Development Programme (PDP)

Organisations involved

MSD

Western Health and Social care trusts

Summary

There is an opportunity in Western Health and Social Care trusts to optimise the Chemotherapy Day Unit pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is improvement of the Chemotherapy Day Unit patient pathway and of the Pan Tumour 31-day Cancer Waiting Time Target. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of the Chemotherapy Day Unit Pan Tumour pathways across Western Health and Social Care Trust. Specifically contributing towards; –

• Improving the 31-day treatment target Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the Chemotherapy Day Unit pathways in the Western Health and Social Care Trust
• Faster time to treatment pan tumour and hence improving treatment options

NHS Benefits

Optimised Pan Tumour pathways in the Chemotherapy Day Unit across Western Health and Social Care trust hospital sites resulting in

• Smoother and Quicker time to treatment process following treatment decision
• Potential to improve the pan tumour 31-day cancer waiting time target
• Optimisation of service delivery through the Chemotherapy Day Unit

MSD Benefits

• Better understanding of chemotherapy patient journey through the Chemotherapy Day Unit and patients requiring hospital admission
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09634 | July 2024

Project Title

RM Partners SACT (Systemic Anti-Cancer Therapy) capacity, demand and utilisation project

Organisations involved

RM Partners

MSD

Croydon Health Services NHS Trust

Chelsea and Westminster Hospital NHS Foundation Trust

Epsom and St Helier University Hospitals NHS Trust

Kingston Hospital NHS Foundation Trust

London Northwest University Healthcare NHS Trust

Imperial College Healthcare NHS Trust

St George’s University Hospitals NHS Foundation Trust

The Hillingdon Hospitals NHS Foundations Trust

The Royal Marsden NHS Foundation Trust

Summary

The aim of this project is to gain insights into the capacity and demand within the SACT delivery sites across RM Partners cancer alliance using MSD’s capacity insights tool (CIT*) and support optimisation of cancer treatment services to ensure timely access to optimal treatment. The insights from the tool will highlight gaps within their current and future SACT delivery services. Facilitated capacity workshops (led by MSD) will include a review of the report which summarises the insights generated and possible scenarios to allow actionable improvement activities to be identified (by the SACT delivery sites and cancer alliance lead) in order to address any SACT delivery service gaps. These improvement activities will then be pulled through into an action plan which will be implemented by the individual SACT delivery sites. The intent is for SACT delivery service capacity to improve (measured via a second report from CIT) and therefore allow for more timely access to optimal treatments across the cancer alliance.

*CIT – The Capacity Insights Tool is a directional tool to support SACT delivery sites to understand how their capacity (in terms of chairs and workforce) can meet the patient demand on the service now and in the future. The tool can model future scenarios to illustrate how growing demand will impact the SACT delivery service and model the impact of potential changes. The report provided as a result of the tool can be used to identify which potential changes are needed to future proof the service.

Background

• SACT delivery sites across the country are being challenged with increased demand stemming from increasing cancer patients, increasing SACT treatments, novel immunotherapy and combination treatments plus more treatments being delivered in the ambulatory setting. This increased demand for capacity plus workforce pressures are resulting in a stretched SACT delivery service sometimes resulting in delays to treatment for cancer patients. Even those infusion services who are managing to keep their service within capacity are worried about what the future demand may bring in terms of increased volume of patients requiring treatment. This could overload the infusion service in the near future and result in delays to treatment for cancer patients and a poor treatment experience.
• SACT delivery sites don’t currently have a tool that is fit for purpose in enabling them to visualise their current and future capacity and demand to plan accordingly. This along with limited resources to deliver the SACT delivery service makes focusing on optimisation difficult.
• Cancer alliances are being asked in their workforce plan to model SACT delivery service provision across all their regional SACT delivery sites.
• The NHS don’t always have the time even with access to this information and insights to address capacity issues in their SACT delivery service and plan for the future.

Project Objectives

• Visibility of current and future capacity and demand (workforce and chair capacity) within SACT delivery sites across the cancer alliance
• Optimised treatment timings and utilisation of services across at SACT delivery sites
• Improved patient experience in relation to SACT delivery across SACT delivery sites
• Improve cancer waiting times to begin SACT in line with national guidance.
• Standardisation of practices in SACT delivery

Benefits

Patient Benefits

• Reduced delay to treatment
• Improved experience of treatment due to improved capacity
• Reduction in ‘on the day’ delay and deferrals

NHS Benefits

• Increased treatment capacity to fulfil current and future demand
• Cancer Alliance has regional overview of the region’s capacity and is able to support where needed
• Reduced pressure on workforce and treatment service

MSD Benefits

• Enhanced reputation for MSD through partnership work
• Better understanding of treatment services
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of improved treatment capacity may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between RM Partners cancer alliance and MSD.

GB-NON-09631  |  June 2024

Project Title

South Yorkshire & Bassetlaw Cancer Alliance MDT optimisation project for Lung, Skin, Urology and Upper gastrointestinal (UGI).

Organisations involved

South Yorkshire & Bassetlaw Cancer Alliance

Sheffield Teaching Hospitals Foundation trust

Doncaster & Bassetlaw Foundation trust

Rotherham Foundation Trust

Barnsley Foundation Trust

Chesterfield Foundation Trust

MSD UK (Ltd)

Summary

The project will provide project management support 1.5 days per week for 12 months to support South Yorkshire and Bassetlaw Cancer Alliance to implement MDT optimisation in Lung, Skin, Urology and Upper Gastrointestinal (UGI) tumour sites in the 5 foundation trusts – Sheffield, Doncaster & Bassetlaw, Rotherham, Barnsley, and Chesterfield.

The pre-MDT standards of care will be developed by the Trusts in conjunction with the Cancer Alliance, and MSD will support in implementing the standards across the local and regional MDTs. MSD will only be involved in the implementation and not the development of the standards. The project will aim to drive forward National recommendations and guidance for MDTs to deliver an improved MDT process (1). This will be done by ensuring streamlined processes/ standards of care pathways are developed and implemented to make the best use of clinical time and resources therefore improving the efficiency of the MDT meetings.

As a result, patients may benefit from an accelerated review through the pathway, either in MDT, or outside of MDT, using pre-agreed protocols for those less urgent or severe cases.  This could allow for treatment decision to be made earlier and therefore earlier access to treatment, moreover reducing patient anxiety and potentially improved access to personalised treatment options, and will also support the NHS trusts to achieve the NHSE 62 day cancer wait time target.

Background

Research has shown that by 2035, the number of patients diagnosed with cancer in the UK could reach 500,000 (1), a material increase from the 357,000 who were diagnosed in 2014.

Multidisciplinary Team meetings are seen as the ‘gold standard’ to cancer management whereby a cross sector of health professionals including of histopathologists, radiologists, surgeons, cancer nurse specialists, oncologists, and administrators/MDT coordinators with additional members dependent on the individual cancer tumour site meet to discuss individual patients’ cases and make treatment recommendations. Multi-disciplinary working continues throughout the patient pathway through diagnosis to treatment and ongoing care however the multi-disciplinary team meeting is a key discussion forum where cases are presented, a range of information shared and reviewed, and care management discussed and documented.

MDT meetings typically occur weekly and can last several hours.  (2) Staff increases have not kept pace with the increase in the number of cases and so this has meant that proportionately more of clinician’s time is spent preparing for and being involved in MDT discussions with a significant amount of organisation, scheduling, clinical input and administration time/oversight processes are involved in MDT working in general and more specifically in preparing/contributing to and following up to/from the MDT-meeting. The number of patient discussions per MDT has increased with proportionately the amount of time available for each patient discussion being reduced.

Project Objectives

• An assessment of MDT meetings operating efficiencies within lung, skin, Urology, upper GI pathways across the South Yorkshire & Bassetlaw region.
• Identification of improvement initiatives to address inefficiencies linked to MDT streamlining principles and promote geographical equitable patient experience of care across all the foundation trusts.
• Provide a regional consistent approach of MDT referrals via proformas with minimum MDT referral data sets for both trust level MDTs, and regional specialist MDTs to drive quicker treatment decisions.
• Development and Implementation of localised standards of care which will be based on national or international standards, guidelines and protocols, and best practice as determined by the Cancer Alliance tumor pathway board.

Benefits

Patient

• A potential for earlier communication of a treatment plan, due to a more efficient MDT process.
• Through reduced delays, more efficient communication to patient from the MDT, and therefore the potential for less anxiety related to process.
• Improved patient outcomes.

NHS

• Improved cancer wait times to support achievement of NHS 28 -day and 62-day cancer wait time targets.
• Standardisation and optimisation of practice through sharing of knowledge and  experience.
• Fiscal savings due to decrease in patient breaches.

MSD

• Greater understanding of MDT process and decision making within the NHS.
• Increased collaborative working opportunities through building trust and effecting change.
• The intended collaboration may enable more patients to have access to treatment options in line with NICE guidelines which may or may not include MSD medicines.

Funding & Resources

This project is a shared contribution of time between South Yorkshire & Bassetlaw Cancer Alliance and MSD.

GB-NON-09376  |  May 2024

⁽¹⁾Cancer Research UK (2017) Meeting Patients Needs – Improving the Effectiveness of Multidisciplinary Team Meetings in Cancer Services, https://www.cancerresearchuk.org/sites/default/files/full_report_meeting_patients_needs_improving_the_effectiveness_of_multidisciplinary_team_meetings_.pdf [Accessed May 2024]

⁽²⁾ Independent Cancer Taskforce. (2015). Achieving World-Class Cancer Outcomes: A Strategy for England 20152020. London: Independent Cancer Taskforce. https://www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf  [Accessed May 2024]

Project Title

Lancashire Teaching Hospital Trust Skin and Urology Diagnostic histopathology Pathway Development Programme

Organisations involved

Lancashire Teaching Hospital Trust / MSD

Summary

The intent of this collaboration is to optimise the Skin and Urology diagnostic histopathology pathway in the Lancashire Teaching Hospital Trust laboratory with the purpose of improving pathway service quality, efficiency, and productivity. This will aim to ultimately support the achievement of the Royal College of Pathology KPI of 90% of samples received have diagnostic results reported within 10 calendar days, which directly impacts the NHS 28-day Cancer Wait Time target¹. The achievement of the cancer waiting time targets has the potential to lead to improvements in patient experience of care. The desired outcome of this project is to see an improved turnaround time for histopathology diagnosis in the skin & urology diagnostic pathway at Lancashire Teaching Hospital Trust laboratory within 6 months of completion. This will be delivered through pathway mapping and gap analysis, pathway optimisation workshops and pathway improvement implementation.

Background

The Lancashire Cancer alliance is looking to identify common areas of issues within its histopathology pathways, which, if improved could positively impact the 28-day Faster Diagnosis Standard (FDS) target which is currently below the 75% target. Lancashire Teaching Hospital Trust are seen as leaders in the area of histopathology, their aim on improving the Skin and Urology diagnostic pathway could lead to improvement of the pathology target of 90% of diagnostic cases being reported within 10 days of sample receipt. This can significantly impact patients’ diagnosis and experience.

Project Objectives

• Gap analysis and pathway mapping of the Skin and Urology diagnostic histopathology pathway
• Achievement of the improved turnaround times measured against the Royal College of Pathology KPI
• Optimisation of service delivery by improving the laboratory processes
• Quicker diagnosis of Skin and Urology Tumours with an increase in number of patients receiving timely diagnosis within NHS guidance timelines.

Benefits

Benefits/ Impact to patients (if any)

• An improved patient experience of the Skin and Urology Tumour Diagnostic Pathology pathway in Lancashire Teaching Hospital Trust.
• Reduction in turnaround time 12 months post change and hence improving the time to diagnosis.

Benefits to the NHS partner

• Achievement of the improved turnaround times and measure against Royal College of Pathology KPI of 90% of samples received reported within 10 calendar days
• Earlier referral, diagnosis and treatment of Skin and Urology cancer patients
• Optimisation of service delivery

Benefits to MSD

• Better understanding of Skin and Urology tumour patient needs
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between Lancashire Teaching Hospital Trust and MSD.

References

1. https://www.thepathologycentre.org/wp-content/uploads/2018/06/CP-WEB-INS-016.UN-16.1-Turnaround-times-V1.1-1.pdf [Accessed April 2024]

GB-NON-09194 |  April 2024

Project Title

Earlier Diagnosis of Ovarian & Kidney Cancer in Brighton & Hove

Organisations involved

Sussex Integrated Care Board and MSD-UK

Summary

This project aims to address the apparent inequalities in Brighton and Hove around mortality rates for ovarian and renal cancers identified within the 2023 Cancer Joint Strategic Needs Assessment [JSNA] report & the Inequalities in mortality involving common physical health conditions England: Office for National Statistics, Aug 2023. The collaboration aims to increase early detection and diagnosis of people with ovarian and renal cancers.

MSD will work in partnership with Sussex Integrated Care Board to provide project management support to the implementation and evaluation of work to address this.

The project is planned to run for 12 months with the final evaluation 6 months post implementation of all healthcare professional educational activities.

Background

The early detection & diagnosis rate of patients with ovarian cancers is lower in Brighton & Hove vs. other Sussex localities, partially due to its often-asymptomatic presentation or symptoms that appear later that are not obvious/non-specific (often)^1,2. The mortality rates for ovarian and renal cancers in Brighton & Hove are higher than in other Sussex localities³. People with symptoms can confuse ovarian and renal cancer symptoms with symptoms of “non-malignancy”, resulting in people delaying attending or being diagnosed by their General Practitioner [GP].

Symptom awareness for both cancers amongst clinicians involved in primary diagnosis needs to be heightened and current diagnostics support tools are being sub-optimally used to support the possible/probable flagging of ovarian or renal cancer which may require further specific diagnostic intervention.

The plan is to improve the recognition of the symptoms of both cancers earlier. Better use of cancer diagnostic support tools should lead to more accurate referrals, resulting in earlier diagnosis & treatment. The longer-term ambition is that this will start to address the higher levels of mortality for renal and ovarian cancers in Brighton & Hove, preventing further increases above the national average.

Project Objectives

1. Reduce the current inequalities by increasing early detection & diagnosis rate of patients with ovarian and renal cancers.
2. Support the provision of enhanced education and training support to increase knowledge regarding symptom awareness in undiagnosed Ovarian and Kidney Cancer including a clear definition of the issues that currently contribute to later stage diagnosis in ovarian & renal cancers to all GPs, Nurses and Pharmacists (+other Allied Healthcare Professionals [AHP’s]) who make clinical assessments of patients in primary care.
3. Drive increased uptake in the use of the already integrated Ardens Pro and Ardens-EMIS urgent ‘Suspected Cancer Referral Forms’ templates for Gynaecological & Urology cancer.
4. Produce a report/case study capturing the learnings that make a case for further prioritisation of ovarian & renal cancer symptom awareness and education on the best practice diagnostic steps to be adopted at scale across the Surrey & Sussex Cancer Alliance [SSCA].

Benefits

Benefits to the patient

• Recognition of the current population diagnosis inequality will be translated into improved symptom education for healthcare professionals to support earlier identification of ovarian & kidney cancer.

Benefits to the NHS

• Educational programme delivered through project management support, to help primary care HCPs in identifying symptoms of ovarian and kidney cancer.
• An understanding & a sequential plan of education activities to raise the importance & increase the clinical awareness around the diagnostic criteria for Ovarian & Renal cancer & their overlap with more common conditions as part of non-specific symptoms pathway.
• An increased cancer referral conversion rate (i.e., percentage of urgent suspected cancer referrals which result in a diagnosis of ovarian and kidney cancer)
• Development of a case study, which can be used to spread any learning and improvements in care across Sussex & nationally.
• A report of the data systems included specifically for ovarian cancer within gynaecology and renal within urology datasets.
• An audit baseline survey, at project completion (12-months from project start date) plus full evaluation 6-month post project completion of primary care Healthcare Professionals [HCPs] regarding the use of Ardens-Pro decision support tool to aid diagnosis and current detection rates for the 2 cancers.

Benefits to MSD

• Experience supporting earlier diagnosis of kidney & ovarian cancer in primary care aligned to the Long-Term Plan goal of increasing the number of patients diagnosed at stage 1 & 2.
• A better understanding of the challenges experienced along the diagnostic pathway to ensure informed conversations internally and with external stakeholders.
• A clearer understanding of the impact of clinical decision support tools to increase earlier diagnosis rates (vs national average) in an ICB setting (importance and value) in the identification of early-stage kidney& ovarian cancer.
• An enhanced reputation through partnership work and supporting the at scale replication of this approach across a system population.
• An increase in patients diagnosed at earlier stages may enable access to appropriate treatment options in line with NICE guidance, which may or may not include MSD medicines.
• Case study, which can be used to share any learning and improvements in care across Sussex & nationally.

Funding & Resources

This project is a shared contribution of time and expertise between Sussex Integrated Care Board and MSD.

GB-NON-08643  | November 2023

References:

• 1. Cancer in Brighton & Hove, 2022 – Published 6^th April 2023
• 2. Ovarian cancer: the recognition and initial management of ovarian cancer – NICE CG122
• 3. Inequalities in mortality involving common physical health conditions England: 21 March 2021 to 31 January 2023 Office for National Statistics (ONS), released 31 August 2023

Project Title

MDT Reform Project- Cheshire and Merseyside Cancer Alliance

Organisations involved

Cheshire and Merseyside Cancer Alliance c/o The Clatterbridge Centre NHS Foundation Trust

MSD UK (Ltd)

Summary

The project will provide project management support two days per month for 8 months to support Cheshire and Merseyside Cancer Alliance to implement multi-disciplinary team (MDT) reform. The project will focus on implementing MDT triage at The Countess of Chester Hospitals (COCH), and will initially focus on breast, skin, urology and colorectal.  The pre-MDT triage standards will be developed by the Trusts in conjunction with the Cancer Alliance, and MSD will support in implementing the standards across the four MDTs. MSD will only be involved in the implementation and not the development of the standards. The project will aim to drive forward National recommendations and guidance for MDTs to deliver an improved MDT process (1). This will be done through improving the effectiveness of cancer MDTs; ensuring streamlined processes/ standards of care pathways are developed and implemented to make the best use of clinical time and resources.

As a result of this project, patients may benefit from an accelerated review through the pathway, either in MDT or outside an MDT, using pre-agreed protocols for those less urgent or severe cases. As a result, treatment decisions are likely to be made earlier than in current practice, thus facilitating accelerated treatment timelines, less anxiety for patients waiting for this decision, and potentially patients deemed as fit for additional treatment options.

Background

Multidisciplinary teams (MDTs) were introduced in the late 1990s and early 2000s. Their purpose was to increase evidence-based practice and prevent implementation of treatments outside of accepted standards. MDTs are considered the gold standard for cancer patient management and mandated by the National Cancer Plan in 2000 ⁽²⁾; with the pledge all patients with cancer have their care reviewed by an MDT⁽³⁾. However, the health services have changed significantly since their introduction and MDTs have come under increasing pressure due to:

• Significant increases in caseload
• A change in case-mix including patients with greater comorbidities because of an ageing population and increasing number of complex treatment options
• This increase in numbers/ complexity of cases to be discussed has not been matched by any increase in time set aside for the MDT
• Some MDT meetings are sometimes poorly attended by individuals, others by speciality expertise, and there are issues relating to consistent, reliable information technology, data collection and infrastructure such as videoconferencing

Cheshire and Merseyside Cancer Alliance require project management resource to support the implementation of MDT reform standards, and to implement these standards into The Countess of Chester Hospital.

Project Objectives

To provide project management support in the implementation of MDT triage process, as part of the MDT reform standards at The Countess of Chester Hospital to streamline MDT processes and improve the effectiveness of MDTs

• Implementation of Pre-MDT triage meeting
• Responsibility of the communication of outcomes to the patient should be made clear on the MDT outcome
• Consistent process to ensure that patients’ wishes are represented at MDT, to inform meeting discussions and to ensure patients are part of the planned treatment process
• Review of MDT co-ordinator training to ensure all co-ordinators have completed relevant training
• To use this as a pilot, and learnings will be shared across Cheshire and Merseyside with the aim that MDT reform will be rolled out across the region, to include all MDTs

Benefits

Patients:

• Treatment decisions in a shorter timeframe, which may give access to wider treatment options
• Potential to maintain fitness levels in a pathway with shorter duration
• Improved patient experience

NHS:

• Work more efficiently to address capacity challenge and reduce backlogs
• More time to devote to complex patients
• More appropriate patients reaching a broader treatment decision

MSD:

• Supporting our NHS collaborators in the early identification of patients suitable for treatment
• Deeper understanding of MDT processes and decision making
• This intended collaboration may enable more patients to have access to treatment options in line with NICE guidelines which may or may not include MSD medicines

Funding & Resources

This project is a shared contribution of time between Cheshire and Merseyside Cancer Alliance and MSD

GB-NON-08252 |  October 2023

References:

(1) NHSE -Streamlining Multi Disciplinary Team meetings- Guidance for Cancer Alliances, 14^th January 2020 NHS Gateway reference number: 000590

(2) A policy framework for commissioning cancer services: A report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales (The Calman-Hine Report) April 1995

(3) The NHS Cancer plan: a plan for investment, a plan for reform. Department of Health, September

Project Title

The Christie Post operative/ Adjuvant Clinic Pilot for Cancer Patients

Organisations involved

MSD (UK) Ltd and The Christie NHS Foundation Trust

Summary

The project will be an eighteen-month pilot at The Christie, with a proposed start date of September 2023.  Currently, post-operative renal and melanoma patients are managed in a mixed clinic setting. This pilot proposes a dedicated post-operative/ adjuvant service for this patient cohort. Patient throughput in both the mixed clinic and post-operative/ adjuvant service will be measured throughout the duration of the project. The service would be nurse led, supported by a cancer nurse specialist (CNS) team and clinical expertise provided by an oncology consultant.

Background

The Christie NHS Foundation Trust is the largest cancer network in the UK, managing patients from the 3.2 million population across Greater Manchester and providing second opinions for patients nationally. The Christie historically sees 250-300 new patients per year within the renal oncology service, and 150 new patients per year within its melanoma service. With increasing numbers of new patients, and a national drive to diagnose and treat early-stage cancers, clinicians are faced with a backlog of patients and increasing capacity challenges. The Christie estimates that an additional 100-120 new renal cell carcinoma (RCC) patients and 60-70 new melanoma patients will be referred for post-operative management over the next 12 months. This represents nearly a 50% uplift in new patient activity. It will be increasingly difficult to ensure these patients are effectively managed and treated within the mixed clinic setting and there is a real need to streamline this service further.

Project Objectives

• To demonstrate the viability of a nurse led post operative/adjuvant service, for patients with renal cell carcinoma or melanoma requiring post-surgery management to achieve future funding from the NHS
  • The nurse will be a full-time post, providing dedicated support, developing protocols, providing psychological support, patient information and offering adverse event management support. This will include attendance at multi-disciplinary team meetings (MDT) and offering support for patients via telephone, virtual and face-to-face appointments
  • To ensure patients who are eligible for adjuvant therapy will be reviewed during their therapy and for a final safety visit prior to being referred back to the local surgical service for long-term follow-up
• A partnership resource input with MSD to fund a Band 6 nurse and the NHS to provide clinical expertise through the consultant and existing nurse team

Benefits

Patients

• Dedicated service and point of contact to manage their treatment
• A bespoke service in the post operative setting could provide patients with more tailored care

• Addressing patient concerns will continuously improve and develop the service for subsequent patients
• Patient experience data may prove sufficiently compelling to lead to wider adoption of such a service in other Trusts and thus provide equity of care across the NHS
• Patients will receive standardised, consistent education, support and point of contact
• Dedicated service may improve treatment options, adherence to treatment and experience for patients

NHS

• Patients managed within a nurse led clinic may result in consultants having more time available to deal with complex cases and thus reduce capacity challenges in the NHS
• Service evaluation will support the NHS to be able to continuously improve the service (e.g., highlighting areas of need or dissatisfaction) and adapt to the increased needs of patients
• Data from the project may be supportive and compelling to lead to wider adoption of such a service, therefore reducing variation for patients across the NHS
• Dedicated clinic to providing additional nurse time will aid with reducing post COVID backlog

MSD

• NHS Stakeholders may be willing to share experience of working with MSD to support future partnerships with the wider NHS
• Reputational benefit from partnering with The Christie
• The intended benefits of piloting an Adjuvant Clinic may mean that more patients have access to treatment options in line with NICE guidance, which may or may not include MSD medicines

Funding & Resources

This project is a shared contribution between The Christie NHS Foundation Trust and MSD.

The total project cost is £60,000

GB-NON-08022 |  September 2023

Project Title

Virtual SACT pre-assessment using the MySunrise App across Devon and Cornwall Hospitals

Organisations involved

Peninsula Cancer Alliance, Technical Health Limited and MSD Ltd

Summary

MSD intend to work in partnership with Peninsula Cancer Alliance (PCA) and Technical Health Limited, to provide project management support to implement and evaluate a virtual pre-assessment option for cancer patients waiting to undergo systemic anti-cancer therapy (SACT). The virtual clinic pre-assessment option will reside within the already established MySunrise App. Within the 12 months of planned project duration, our aims are to:

• Provide a virtual option for patients to undergo SACT pre-assessment prior to coming into hospital to receive treatment
• Release clinical capacity and healthcare professional time through providing a virtual pre-assessment option
• Provide a better patient experience from not having to travel to their hospital for a clinic appointment that can be conducted virtually
• Create an evidence base and list of benefits realised to enable wider adoption of virtual pre-assessment
• Creation of a ‘blueprint’ that will enable wider adoption of the virtual pre-assessment capability

Background

The number of patients being referred for and diagnosed with cancer is increasing due to better detection and early diagnosis programmes. Patients are also living longer with cancer meaning that the overall patient volume is increasing¹. This in turn increases the demand for cancer services and puts additional pressure on service capacity.

Treatment regimens are becoming increasingly more complex, adding to workforce pressures within the SACT Day Units as more time is needed to both prepare the regimens, and to administer SACT to patients. These factors further compound the capacity challenge. The Covid pandemic has proven to be a catalyst for the wider adoption of digital and virtual engagement options for patients². This technology can be furthered harnessed by cancer services looking for ways to release capacity (measured as HCP time and outpatient appointments (OPA)) from existing pathway processes and achieve activity with the same (or less) resource.

Project Objectives

Through a pooling of project management time, subject matter knowledge and implementation experience between Peninsula Cancer Alliance, Technical Health and MSD, the virtual pre-assessment capability will deliver the following as project outcomes:

• Each hospital within the Peninsula Cancer Alliance region will have their cancer pre-assessment pathway mapped and reviewed and then developed to include an option for patients to receive a virtual pre-assessment prior to coming into hospital for SACT therapy
• Clinical capacity will be released in terms of healthcare professional time and clinic space through providing a virtual pre-assessment option
• PREMs (patient related experience measures) will be used to survey patient experience
• A service evaluation and benefits realisation summary for the use of virtual pre-assessment in cancer patients
• A best practice/ case study example that can be used to showcase the benefit of running virtual pre-assessment clinics
• A blueprint to inform and aid the wider adoption of virtual pre-assessment by other Cancer Alliances

Benefits

Benefits to the patient

• More convenient option to complete pre-assessment, removing the need to travel to the hospital
• Improved and more informed experience of the cancer treatment pathway
• Use of virtual pre-assessment clinics may potentially mean patients start on treatment earlier
• Improved options to access treatment

Benefits to Peninsula Cancer Alliance and Trusts across the region

• Reduction in OPA clinic time spent on pre-assessment in hospitals
• Release of SACT nurse capacity as time is freed up in hospitals
• Project management support for PCA to implement virtual pre-assessment across the region
• Measurement of SACT treatment rates changing as access is improved
• Reduction in physical patient volume attending clinic, freeing up space and improving room availability
• Helping to keep vulnerable groups of patients out of hospital

Benefits to Technical Health Limited

• This project will support Technical Health to test and evaluate virtual pre-assessment across the Peninsula Region
• Gain usage data to further drive adoption of virtual pre-assessment across other Cancer Alliances
• Opportunity to work with MSD and their cross-functional teams to share expertise

Benefits to MSD

• Opportunity to work with Technical Health and PCA to share expertise
• Enhanced reputation of MSD through partnership work and opportunity to scale this approach
• This intended collaboration may enable more patients to access innovative treatments in line with NICE guidance which may or may not include MSD medicines.

Funding & Resources

This project is a shared contribution of time, expertise and funding between Peninsula Cancer Alliance, Technical Health Ltd. and MSD. The total project cost is £7,250

1. https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence#heading-Zero
2. https://www.openaccessgovernment.org/covid-19-and-the-digital-transformation-of-the-nhs/89606/

GB-NON-07651 |  June 2023

Project Title

Immuno-oncology nurse-led service

Organisations involved

University College London Hospitals (UCLH) NHS Foundation Trust

MSD

Objectives

• Establishment of a dedicated immuno-oncology (IO) nurse-led service to run for 12 months within the scope of the project, followed by a 3-month evaluation and publication to share the learns with peers and the wider NHS.
• Recruitment of an immunotherapy clinical nurse specialist (CNS) who will set up and lead IO service delivery.
• To secure funding through UCLH to continue the service after the project.

The service aimed to achieve the following:

• All new patients will have access to the educational element of the service including those that are changing therapy to immune checkpoint inhibitors (ICIs).

• Patients requiring additional management of ICIs will be flagged to the service and advice given will be tailored support to meet the patient’s needs and circumstances.  Advice can be given either to the patient directly or via the managing clinician. The aim is that all eligible ICI patients believe they have been adequately educated and given the correct information to manage their treatment.

• All staff working with patients being treated with ICIs feel adequately upskilled to support patients through their journey, measured via questionnaire across nurses, pharmacists and oncologists.

Responsibilities of the Immunotherapy CNS:

• Management of the immuno-oncology service, including participation in clinics, meetings and follow up.
• Supporting the patient’s journey when on immuno-oncology treatment; specifically ICIs.
• Educating patients on their treatment, developing and providing patient information for a diverse population.
• Offering treatment support including advising treating clinicians on an individual case basis.
• Education of specific patient needs for staff including nurses, pharmacists and oncology clinicians and the wider HCPs involved in cancer patient care.
• Co-ordination of care, supporting patients, managing investigations and appointments as appropriate for patients on ICIs.
• Support innovation and improving services by adopting best practices.
• Ensuring adherence to best practice and local guidelines.

Summary

This collaboration supported the set up and development of an “immuno-oncology nurse-led service” for patients receiving ICIs.  This involved UCLH recruiting an immunotherapy CNS to deliver and evaluate the nurse-led service for the duration of 12 months (an extension of 6 months was made to the project duration due to difficulties in recruiting for the immunotherapy CNS position; a variation agreement was used to document and formalise this extension). This service was supported by a specialist team at UCLH with project management from MSD and financial input from both parties.

The project demonstrated the value of an IO nurse-led service for patients who are treated with ICIs, reducing the variation of education and treatment support across different cancer types ensuring consistency throughout the trust.

Long term funding for the IO nurse service and immunotherapy nurse was achieved and a successful service was created that received 101 referrals from November 2023 to October 2024.

Graphs created from UCLH IO Nurse Referral Data, November 2023 – October 2024.

Patient survey – To assess the impact of the project on patients’ education and understanding of their ICI treatment, pre- and post- project surveys were conducted. Participation rose from 32 to 53 patients, reflecting increased engagement. Additionally, the percentage of patients willing to contact CNSs for significant bowel movements increased from 71% to 90.5%. There was also a notable increase in patients expressing their intention to seek help for worsening fatigue, rising from 44% to 66%. These findings underscore the project’s effectiveness in enhancing patient education and promoting proactive health-seeking behaviours.

The survey responses represented roughly a quarter of the 215 patients undergoing active ICI treatment. There has been a notable improvement in patients’ ability to manage their treatment, and this knowledge is anticipated to grow further with the upcoming CNS training and the dissemination of patient information resources about ICI treatment.

Staff survey – The primary objective of this survey is to evaluate the knowledge and confidence levels of staff regarding their understanding of ICI management. The response rate for this survey was lower compared to the previous one; however, all respondents reported having encountered ICIs in their clinical practice.

Overall, approximately 67% of participants reported being either very confident or somewhat confident in ICI management, up from 58% in the previous year.

Notably, the use of trust guidelines has risen significantly, with 100% of respondents now utilising them, compared to just 80% previously. Additionally, the number of reported opportunities for formal training has increased dramatically, from 7% last year to 82% this year, highlighting the positive impact of the role played by the immunotherapy CNS.

It is important to note that the survey did not receive any responses from junior doctors, pharmacists, or research nursing staff, and there were very few responses from ward or chemotherapy day care staff, despite them having participated in most training sessions led by the immunotherapy CNS. This underscores the necessity for greater involvement of tumour CNSs in training initiatives and the continuation of group training sessions to further enhance knowledge and confidence among the staff.

Benefits Realised

Benefits impact to patients

• Patients received a dedicated service and indirect point of contact to manage their treatment.
• Patient survey demonstrated marked improvements in patient’s basic knowledge of ICIs
• Further perceived improvement with publication of patient information sheets on ICIs.
• Better understanding of the difference between IO and chemotherapy.

Benefits to the NHS partners

• Continued funding of the IO service and dedicated immunotherapy CNS nurse role
• Improved confidence of staff managing patients on ICIs
• Consistent approach and education in ICI treatment management
• Internal study event – first ever Immunotherapy only study event, delivered by specialists, 92% of the attendees rated this as extremely useful.
• Tailored teaching sessions- feedback from 47 participants ranges from staff nurses, research teams and junior doctors showed improving confidence in managing ICIs after sessions
• Joint working with NCL partners, study events and conferences

Benefits to MSD

• Reputational benefit of working collaboratively with UCLH
• Improved management of ICI treatment due to increased education of staff and patients
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines

Funding & Resources

This project was a shared funding commitment from UCLH & MSD. The total project cost was £70,000.

Project Stakeholder Quote 

”The MSD project has been very vital to develop and deliver a service which focuses on patient experience, patient safety, continuity of care and improved efficiency mainly through patient education and staff training. I am very optimistic that this service will improve patient safety and outcomes, increase awareness amongst staff, to prepare to equip them with the impact of the introduction of new immune checkpoint inhibitors. Thank you so much’’. – Ganga Sasidharan Pillai, Immunotherapy CNS at the University College London Hospitals NHS Foundation Trust

Lessons learnt

• Recruitment of the IO nurse position took significantly longer than anticipated which led to the project requiring a time extension.
• Having a network of these types of roles enables best practice sharing and continued improvement of these types of service throughout the NHS.
• The importance of understanding the success criteria and expertise required to navigate the process to secure continued funding of the IO service and IO CNS.

Publications

No intended publication plans outside of this Outcomes Summary.

GB-NON-11173 | April 2025

Project Title

Immunotherapy Service Mapping in Swansea Bay and Hywel Dda University Health Boards

Organisations involved

MSD, Swansea Bay University Health Board and Hywel Dda University Health Boards

Summary

Swansea Bay University Health Board (SBUHB) and Hywel Dda University Health Board (HDUHB) together as an immunotherapy service task group worked in collaboration with MSD UK to map out and baseline the current service for dealing with oncology patients that receive immunotherapy (IO).

SBUHB and HDUHB together form South West Wales cancer services with SBUHB being the hub for IO support. The two Health Boards wished to map out their current service with the aim of then enhancing and upskilling services across the hub and spoke service.  It is anticipated that the project will be completed within 4 months. The project started in November 2023 and finished in March 2024.

Benefits Realised

• Through implementation of this project with the SBUHB and HDUHB teams, MSD provided project management support to assess the current state of the service for patients receiving IOs. The mapped pathway was used to provide a baseline which informed a subsequent business plan for providing a dedicated IO service across the two Health Boards. As a result of the project, the following benefits were realised:

Patient Benefits

• The aim of providing a dedicated IO service is for patients to receive better and more efficient care whilst receiving immunotherapy. This is the aim within the service redesign if the business case is successful. At this point the business case is in the final stages of development before submission.
• Patient experience was not measured as part of this project.

NHS Benefits

• This project provided the baseline for the development of a business case for a dedicated IO service. This business case will be submitted in the near future and if successful will hopefully provide:
  • Potentially scalable service changes that could be rolled out across the two Health Boards
  • The expansion of existing skill base within SBUHB and HDUHB.
  • The ability to release capacity for existing expertise in SBUHB and HDUHB through the expansion of skills and services.
• Additionally, the project provided a detailed baseline and comparison of how IO patients receive care across the two Health Boards. This highlighted the need for a better understanding of the data and services across the two organisations due to acute oncology services having so many differences between the two Health Boards.

MSD Benefits

• Enhanced reputation of MSD through partnership work. Five NHS stakeholders completed a survey following the project and the results are shown below:
  • Average score of 8.6/10 and 7.8/10 was scored for being satisfied with MSD’s collaborative working project and believed MSD contributed to their organisation’s cancer service pathway respectively
  • Average score of 8.8/10 in the likelihood of working with MSD and the pharmaceutical industry in the future (up from 7/10 prior to the PDP)
• Quotes taken from the survey when questioned, “what has improved in your service/pathway following this collaborative working project” from NHS Stakeholders:
  • “More clear in depth understanding the pathway and the way the service now and the points of improvement”
• When questioned on feedback of your experience of working in collaboration with MSD:
  • “Great staff – helpful and also respectful of our clinical time. I would collaborate again.”
  • I was unaware of MSD prior to this project, they have been really helpful and flexible finding the time to work around my shifts when I have been busy on the unit. They made discussions easy and straight forward and helped develop the pathways.”
  • “Personable, clear and professional interactions with MSD
• Additionally, the project helped MSD to have a better understanding of IO patient needs

This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Swansea Bay and Hywel Dda University Health Boards & MSD-UK.

Lessons learnt

• Communication is key between all parties which is especially important between departments to optimise decision making and establish the appropriate intervention for the patient as early as possible
• Regular touch points to ensure clarity of expectation and outcomes
• Clear plan of action and review within stakeholder meetings
• The care of patients receiving immunotherapy remain challenging. There are significant workforce challenges across Swansea Bay and Hywel Dda University Health Boards.

Publications

There are currently no plans to publish the outcomes of this project by the Health Boards as per the date of this summary.

GB-NON-10692 | December 2024

Project Title

South Yorkshire & Bassetlaw Cancer Alliance Pan Tumour Pathology Pathway Development Project (PDP)

Organisations involved

Sheffield Teaching Hospital NHS Foundation Trust, Barnsley Hospital Foundation Trust, The Rotherham NHS Foundation Trust, Doncaster and Bassetlaw Teaching Hospital Foundation Trust and Chesterfield Royal Hospital Foundation Trust

Summary

There is an opportunity in the South Yorkshire & Bassetlaw and Chesterfield area to optimise the pan-tumour pathology testing pathway to improve the service quality, efficiency, productivity, as well as patient experience. The desired outcome of this project was an improved pan-tumour histopathology molecular testing pathway within the regional trusts and demonstrate improvements of the relevant targets associated with head and neck/skin/breast/lung/gynaecological cancers, 28 day Faster Diagnostic Standard and the 31- and 62-day Cancer Waiting Time Targets. The project began on 1^st October 2022 and finished on 30^th September 2023.

Benefits Realised

Patient

• Improved timelines for patients to receive a cancer diagnosis.
• Improved timelines for patient access to personalised medicines.

NHS

• Greater understanding of regional workload for cancer histopathology services.
• Created engagement & collaboration across previously siloed histopathology laboratories.
• Consolidation of regional specialised cancer histopathology services.
• Sheffield Teaching hospitals approved to become a Regional Cellular Pathology Genomic Hub.
• Inhouse pilot of regional Lung NGS testing service resulted in a pathway reduction of 12 days (March 2024 data of NGS request to authorised result Inhouse Tat = 8 days v Referred TaT = 20 days)
• % of patients achieving 31-day CWT improved from 92% to 94% in the lung pathway, and from 78% to 86% in the head and neck pathway from July 2022 to December 2023.
• % of patients achieving 62-day CWT improved from 63% to 67% in the lung pathway, and from 74% to 78% in the breast pathway from July 2022 to December 2023.
• HER2 FISH testing planned to be brought inhouse in 2024 which has the potential to reduce pathways with associated HER2 FISH testing by 14 days

MSD

• Greater understanding of the complexity of molecular testing pathways which allow patients access to personalised systemic anti-cancer treatments.
• Enhanced reputation of MSD through partnership work.
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from South Yorkshire and Bassetlaw cancer Alliance & MSD.

Lessons learnt

• In depth stakeholder engagement plan is critical to ensure timely decisions can be made to enable service improvements are implemented as soon as possible.
• Ensure that NHS stakeholders build protected time into their working schedule so that the project milestones can be completed on time, and therefore eliminated the need for project overrun.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-10208 |  September 2024

Project Title

East Lancashire Hospitals NHS Trust Pan Tumour (Breast, Lung, Skin, Upper GI) Diagnostic Pathology Pathway Development Project (PDP)

Organisations involved

MSD-UK

East Lancashire Hospitals NHS Trust

Summary

A national optimal Pan Tumour (Breast, Lung, Skin, Upper GI) Diagnostic Pathology pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all (Pan Tumour (Breast, Lung, Skin, Upper GI) patients receive optimal cancer care. There is an opportunity in East Lancashire to optimise the Pan Tumour (Breast, Lung, Skin, Upper GI) Pathology pathway in line with the national optimal Pan Tumour (Breast, Lung, Skin, Upper GI) Diagnostic Pathology pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved Pan Tumour (Breast, Lung, Skin, Upper GI) Diagnostic Pathology pathway aligned with the national optimal pathway and achievement of the Pan Tumour (Breast, Lung, Skin, Upper GI) Diagnostic Pathology pathway turnaround times reduction, 28 day Faster Diagnostic Standard and the 31 and 62 day Cancer Waiting Time Targets. The project intends to run for approximately 6 months.

Benefits Realised

Due to significant and unanticipated capacity issues within East Lancashire Hospitals NHS Trust which needed to take priority, the outcome summary for the East Lancashire Hospitals NHS Trust Pan Tumour PDP has not been initiated and has been delayed.

Funding & Resources

This was a project with shared time commitment from University Hospitals of Birmingham (UHB) & MSD

Lessons learnt

Creation of a formal contingency plan should any of the key stakeholders and MSD project manager have time capacity issues, leave their post or their organisation during the implementation of the project.

Publications

No publications are planned.

GB-NON-09802 |  August 2024

Project Title

Clatterbridge Cancer Centre (CCC) Cancers of Unknown Primary (CUP) Pan Tumour Diagnostic Pathway Development Project (PDP)

Organisations involved

MSD-UK

Clatterbridge Cancer Centre

Summary

A national optimal CUP Pan Tumour Diagnostic pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all CUP patients receive optimal cancer care.  There was an opportunity in Merseyside to optimise the CUP Pan Tumour diagnostic pathway in line with the national optimal CUP Pan Tumour pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project was an improved CUP Pan Tumour Diagnostic pathway aligned with the national optimal pathway. This pathway does not fall under the 28-day Cancer Waiting Time targets so had to access on its own entity. The project intended to run for approximately 6 months.

Actions taken which resulted in the benefits realised

Patient benefits

• Optimised the CUP genomic pathway across systems by facilitating Whole Genomic Sequence (WGS) pathway and reducing turnaround time.
• Highlighted system-wide challenges in the CUP genomic pathway, such as delays in CT guided biopsy and lab processes.
• Established a Genomic Education group to support access to genomic resources and tools for patients and staff.
• Trialling innovation tag tracking Radio Frequency Identification Device (RFID) system for tissue specimens to avoid duplication of having to acquire the sample again and the stress to the patient due repeat the procedure.
• Created a tracker to capture turnaround time (TAT) and patient outcomes for the CUP pathway.
• Developed a patient story video to share with relevant leads and a wider audience to raise awareness of pathway changes.
• Developed a genetic form and communication plan to support easy access to genomic test results within the Clatterbridge Cancer Centre Meditech system to improve treatment rate and patients’ outcomes.

NHS Benefits¹

During the six months of the optimised pathway project, 14 patients with CUP were eligible for WGS via the NHS test directory. 57% (n8) had an additional biopsy for WGS, 42 % (n6) did not have the WGS biopsy as they needed to start chemotherapy urgently, and the additional time to arrange biopsy would delay their treatment. At the time of this report (July 2024), 36% (n5) patients are still awaiting the results, it is difficult to present accurate data to demonstrate the turnaround time improvements in the pathway.

Following the improvements from this project multiple benefits can be actualised:

• The communication process with the lab teams has improved, there have been no further missing samples.
• There has been wider communication of the pathway and process, staff are now more aware of the differences in the sample storage for WGS samples.
• Overall turnaround times appear to have improved, however we are still awaiting further results to be able to show this. This is something we can re-visit 6 months after full implementation of all the changes. There have been additional improvements from the project which include the Genomic Tumour Advisory Board (GTAB) now happening fortnightly, instead of every month.
• Set up a generic email address to simplify access to CUP Whole Genome Sequencing (WGS). The result has enabled earlier diagnosis, and treatment of CUP Pan Tumour patient.
• Developed staff satisfaction surveys to understand and mitigate challenges in the CUP genomic pathway.
• WGS for patients with CUP is now available via the NHS genomic test directory. The professional survey found that staff feel the pathway is complicated but they are aware that is available on the NHS. However, they are either unaware of how to access it, or they have experienced issues with it in practice. The main issues focus on lack of standard pathway, lack of information, lack of digital tracking and recording of the request of samples. Delays at all parts of the pathway were highlighted. The final issues raised by the survey was lack of education and training. All the survey findings mirror the issues raised by the CUP WGS pathway process mapping, and are addressed in the process mapping action to aim to improve the pathway and make staff more aware of how to access the pathway and reduce delays.
• Trialling innovation tag tracking Radio Frequency Identification Device (RFID) system for tissue specimens to avoid additional cost and time implications and impact of the CWT.
• Detailed progress report on the CUP genomic pathway provided to the Outpatient Transformation Programme Board which has led to the development of a genetic form and communication plan to support easy access to genomic test results within the CCC Meditech system.
• There are still further planned improvements to be implemented including improved communication of the results to the CUP team from the Manchester team, electronic pathways from order to results, and tracking of samples.
• 28-day Cancer Waiting Time targets was not measured in this project as it was not relevant to the CUP pathway

Furthermore, the NHS and Clatterbridge Cancer Cancer (CCC) Strategy related to the outcomes is as follows:

• Be Collaborative: Collaborating with MSD, LCL/GLH, Mathew Krebs (NHSE), and the TRANSFORM project to improve the CUP pathway and reduce TAT.
• Be Outstanding: Faster diagnosis and access to cancer treatment, achievement of cancer targets (although CUP not within CWT).
• Be Research Leaders: Engaging in CtDNA research and working on CUP blood samples in advance of tissue samples.
• Be a Great Place To Work: Providing interim solutions for CUP genomic test results on the Meditech system, and providing access to CUP genomic education and resources on the CCC intranet.

MSD Benefits

• Better understanding of CUP Pan Tumour patient needs
• Enhance their reputation through partnership work

This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Clatterbridge Cancer Centre & MSD

Patient Story²

Jane (pseudonym) is a 58-year-old female patient with Cancer of Unknown Primary (CUP).

She presented with dysphagia, vomiting and weight loss.  After multiple investigations a CT scan showed a large posterior mediastinal mass, pleural and pericardial effusions. A biopsy showed an undifferentiated neoplasm of unknown origin. She was referred to the CUP MDT who agreed this was a cancer of unknown primary and care was taken over by the CUP team. A biopsy was taken for whole genomic sequencing (WGS) and she was started on standard chemotherapy, carboplatin and paclitaxel.

Jane told us:

“I didn’t really understand about the genomics tests, or why they might help, but after having a diagnosis of CUP, you would do anything to get more information about the cancer and you just hope it will help them (the team) have more understanding and more treatments”.

“I had almost forgotten about the genomic test when they called me. I had started chemo and was just focused on getting the treatment and fighting the cancer. When I came to clinic and explained the results, I didn’t really understand the details, but they told me the test had helped with finding a change in the cancer, but it also had signature that showed that I had a lung cancer, and they would refer me to the lung team for treatment moving forwards. This was a shock, but in a weird way I was pleased, it seemed like good news, I have a primary, and there were other treatments I could have”.

With the WGS findings Jane was referred for treatment under the lung team and had lung cancer specific chemotherapy.

Recent CT scan shows that the cancer is responding to the chemotherapy.

NHS Stakeholder quotes^3,4:

“The collaboration has been excellent, working with MSD helped us process map the pathway and the outline issues, which we would have never done as well on our own. Also, regular project plan and clear actions helped me to account for the work I was supposed to be doing, to ensure timely actions and outcomes. Working with Wale has been fantastic, his support has meant we have made major service improvements, that on our own would not have happened this quickly.”

“Wale Ajet has been extremely knowledgeable, supportive and a pleasure to work with. He has ensured that the project remains on track but has done so without the small project group feeling under pressure. He ensures that every meeting is enjoyable and that is a skill set in itself. I should also pay credit to Nicola Harman who was instrumental in setting this project up.”

Lessons learnt

Maintaining patient privacy and confidentiality in the Cancer of Unknown Primary (CUP) pathway was crucial, given the small volume of patients involved. Ensuring appropriate consent was obtained and anonymising patient information were essential steps to protect privacy and confidentiality.

To increase the likelihood of implementing potential improvements identified through the output of the gap analysis, it was important to identify key stakeholders with decision-making responsibility. Engaging these stakeholders in the project helped translate identified improvements into actionable changes.

Outlining the roles and responsibility at each stage of the pathway, and then communicating clearly to all the stakeholders has been crucial to ensuring each step is correctly completed.

Ensuring visibility of the issues at multiple forums has helped engage stakeholders and make the improvements.

Engaging the digital team at an early point has been vital to making timely improvements.

There are still issues that are out with the gift of the project, and CCC, however, by demonstrating the issues at the correct forums this has helped provide evidence that change is needed.

Small team, expert knowledge, dedicated time, clear direction, expectations and shared vision. Knowledge of what is within gift to deliver and what is outside of scope – all of which were defined and therefore able to deliver to plan.

Publications

Genomic CQG

UK Acute Oncology Society Conference, Transforming Acute Oncology, is Everyone’s Business – September 28^th Birmingham – Abstract to be submitted for a poster presentation.

References

1. Clatterbridge Cancer Centre CUP 2024 patient tracker
2. Feedback from cancer of unknown primary patient at The Clatterbridge Cancer Centre June 2024.
3. MSD_Clatterbridge Cancer Centre CUP Pan Tumour PDP Workshop Survey
4. MSD_Clatterbridge Cancer Centre CUP Pan Tumour PDP End of Project Survey

GB-NON-09803 |  August 2024

Project Title

Blackpool Teaching Hospitals NHS Foundation Trust Pan Tumour (Skin, Gynaecology, Upper GI) Diagnostic Pathology Pathway Development Project (PDP)

*Pan Tumour refers to the 3 tumour types been reviewed in this project Skin, Gynaecology & Upper GI

Organisations involved

MSD & Blackpool Teaching Hospitals NHS Foundation Trust

Summary

A national optimal Pan Tumour Diagnostic Pathology pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all Pan Tumour patients receive optimal cancer care. There is an opportunity in Blackpool to optimise the Pan Tumour Pathology pathway in line with the national optimal Pan Tumour Diagnostic Pathology pathway to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved Pan Tumour Diagnostic Pathology pathway aligned with the national optimal pathway and achievement of the Pan Tumour Diagnostic Pathology pathway turnaround times reduction in line with the Royal College Pathology KPI (90% Sample received reported within 10 calendar days)¹ and 28 day Faster Diagnostic Standard Cancer Waiting Time Targets. The project intends to run for approximately 6 months

Benefits Realised²

Through implementation of MSD’s Pathway Development Programme with Blackpool Teaching Hospital NHS Foundation Trust Histopathology team, MSD provided project management support to assess the turnaround times of their histopathology pathway from receipt of sample to diagnostic result reporting.

A gap analysis was carried out and the areas below were identified as area of improvement to reduce the turnaround times (TAT) reduction in line with the Royal College Pathology KPI (90% Sample received reported within 10 calendar days)¹:

• Workforce – recruitment
• Increase Quality of Clinical information on request form.
• Weekend Working / extended working day.
• Skin diagnostic/skin treatment variation at triage to prioritise.
• Review rotas start times to cover full day use of H&E Stainer (particularly with additional staff now in lab).
• Competency assessment to ensure quality H&E image.
• Correct balance of staffing vs workload.

Patient Benefits:

Although patient experience was not directly measured as part of this project and any direct/indirect contact with patients were out of scope of this project, it is reasonably expected that the improved diagnostic pathway and reduced turnaround time would lead to quicker diagnoses and time to treatment. This could potentially result in improved patient outcomes. See NHS benefits below:

NHS Benefits:

The implementation of the suggested changes gradually reduced the diagnostic turnaround time in the histopathology laboratory despite high number of samples. With the September turnaround time showing for the first time all three-cancer type diagnostic and treatment samples reported below the 10-day turnaround time target. The improved laboratory process and new staff recruitment made a positive impact on the turnaround times.

As demonstrated below, the sample preparation was completed within 5-10 days in most cases and with a full consultant complement reported within 10 days target. However, due to the loss of two consultants in October and November, this negatively impact the progression seen.

³The graphs below highlight the phases of the project and the turnaround time (pre and post consultant) reporting achieved against the KPI of reporting 90% sample received within 10 days at each phase. Skin (TAT on average reduce from 14 to 12) GI (TAT on average reduce from 13 to 10), Gynae (TAT on average reduce from 11 to 10)

The project also aimed to achieve the 28-day cancer wait time target, however the data did not conclusively show a clear correlation between histopathology turnaround time and this target.

Earlier referral, diagnosis and treatment was not measured or used as a baseline.

Increase in treatment rates was not measured or used as a baseline as it was not relevant to histopathology diagnostic pathway.

MSD Benefits:

Through this project, MSD gained a better understanding of the histopathology diagnostic pathway and the needs of the NHS. The collaboration enhanced MSD’s reputation through partnership work. Additionally, the improved pathway may indirectly result in more appropriate usage of MSD’s NICE/SMC approved oncology medicines.

Quotes from NHS Stakeholders⁴

“The sessions we had supported by MSD were well planned and organised, the facilitators were well prepared with materials for the session and kept to time which was important. The sessions proved very informative and valuable for the team.”

“There were several improvements noted and implemented as a result of the work done with MSD that have made a difference to our service.”

This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Blackpool Teaching Hospital NHS Foundation Trust, Lancashire Cancer Alliance & MSD

Lessons learnt

Several lessons were learned during the project, including the importance of sequential stakeholder engagement (have a series of touch point regularly) and clear communication plans, the need for a strong NHS project champion, and the impact of wider NHS workforce challenges on project delivery. It was recommended to engage project sponsors to ensure continuous prioritisation of the project throughout its duration.

The collaboration with non-promotional pharmaceutical implementation leads proved beneficial in supporting specific improvement work and utilising ‘free to the NHS’ additional capacity to benefit patients and providers. Kaye Davies, Lancashire South Cumbria Cancer Alliance (LSCCA) Programme Manager

Recommendation

Data revalidation and repeat audits around the turnaround time from receipt of sample to report on Skin, GI and Gynae diagnostic over 3, 6,9 month period separating diagnostic samples from treatment.

Publications

BTHT histopathology improvement presentation shared at LSCCA Cancer Board 23/24, LSCCA Stakeholder briefings 23/24

Planned to return to LSCCA Cancer Board 24/25 now complete and evaluated.

Sharing with secondary care stakeholders in Trusts via stakeholder briefings and cancer alliance bulletin

Sharing with Pathology Collaborative stakeholders via stakeholder briefings and cancer alliance bulletin

Reference:

1. CP-WEB-INS-016.UN-16.1-Turnaround-times-V1.1-1
2. Highlight report – Histopathology Improvement at BTH – BTH Histopathology Highlight report – Smartsheet.com.pdf
3. Blackpool Histopathology Turnaround Time data – MSD Data (inc Date Sent).xlsx
4. Sogolytics survey – Sogolytics – Omni Report

GB-NON-09632 | July 2024

Project Title

Greater Manchester (GM) Cancer Alliance – Multi-disciplinary team (MDT) Reform Implementation project

Organisations involved:

GM Cancer Alliance

MSD UK Ltd

Summary

The aim of the project was to provide project management support for 6 months to support the implementation of the Greater Manchester (GM) Cancer Multi-Disciplinary Team (MDT) standards within NCA (Northern Care Alliance), focusing on usage of the patient Impact Statement and to implement these standards into the annual quality assurance process. The standards were developed by GM Cancer Alliance, as part of an eighteen-month MDT Reform project.

Additionally, MSD provided funding for an MDT toolkit to be utilised by MDTs to share best practice and advice on how best to achieve the GM MDT standards, and the toolkit was rolled out as part of the project.

At the start of the project an initial baseline was taken of usage of the Patient Impact Statement by MDTs within NCA, with the majority of MDTs stating that this was already being done, although there was no formal or consistent process in place. It was decided that project management support would then be dedicated to one MDT- Salford Royal colorectal team. MSD supported with development of an action plan for MDT reform, and the GM team would then implement the agreed MDT reform standards and utilisation of the Patient Impact statement. The aim was to also develop consistent processes that could be audited and replicated.

Benefits Realised

By providing project management support, MSD has supported GM Cancer to create an MDT reform toolkit, and to implement MDT reform standards at Salford Royal colorectal lower GI MDT.  The project supported with implementation of the following standards:

• MDT reform toolkit to support implementation of MDT reform and standards across Greater Manchester and wider NHS
• Utilisation of patient impact statement (piloted in patients through fast-track endoscopy)
• A standardised referral proforma has been developed with mandatory fields regarding performance status, frailty and any other issues which may effect MDT decision- thus improving quality of information to appropriately discuss patients at MDT. Which has proceeded to be live on the electronic referral system.
• Pre MDT triage meetings
• Communication of outcomes to patients via telephone (CNS led) within 2 days of MDT

Patient benefits:

• Utilisation of the patient impact statement ensures the patient voice is heard at MDT, to ensure their wishes are part of the MDT decision making process and allowing patients to decide how they would receive their MDT decision.
  • June -December 2023 40 patients completed patient impact statement. 23 patients requested a telephone appointment in nurse led clinic directly after MDT, 10 patients requested a face-to-face consultant appointment, 5 requested any method felt suitable.
  • The patient impact statement is live on the electronic referral system. This was initially trialled in patients through the endoscopy department and has now been extended across MDTs within Greater Manchester

Patients receiving MDT decision via the CNS telephone service have been selected from the patient impact statement or at MDT. This new service has resulted in patients receiving faster outcome of MDT decision, with the clinic taking place directly after MDT. The clinic has dedicated admin support and a tariff attached, with letters being sent to the patient and GP within 48 hours of MDT.  May 2023 to 4^th January 2024- 106 patients have received telephone appointments in the nurse led clinic.

NHS benefits:

• MDT reform tool-kit has supported clinicians across GM and wider NHS with resources on MDT reform. There have been 314 views of the main GM Cancer MDT Reform webpage, 146 collective downloads of the MDT Reform Standards and MDT reform Toolkit between18 Sept 2023 – 18 Jan 2024.
• Standardising referral to improve quality of information to meet the minimum data set required for effective decision making and care planning
• Pre MDT triage meetings led by CNS team and supported by colorectal consultant uses an agreed algorithm to remove patients or delay discussions. This has improved efficiency of MDT and time spent of patients needing discussion.
• The CNS led telephone service post MDT reduces the number of face-to-face appointments and has resulted in patients receiving MDTs results sooner (aim is within 48 hours of MDT).
• NCA adding MDT reform standards to the annual quality assurance process to ensure consistency across MDTs within NCA.
• Greater Manchester Cancer Alliance have now committed to a full time project manager to continue MDT reform implementation within Greater Manchester.

MSD benefits:

• Greater understanding of MDT processes and challenges to implement MDT reform.
• Enhanced reputation of MSD through partnership working.
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance. which may or may not have included MSD medicines.

Funding & Resources

This project was a shared funding commitment from Greater Manchester Cancer & MSD.

Lessons learnt

• MDT reform is complex and a lengthy process, involving multiple stakeholders. A short duration project should focus on specific parts of the MDT process. Greater Manchester Cancer Alliance will now be continuing with MDT reform and have recruited a dedicated project manager to lead the project, with ongoing evaluation of the effectiveness of the changes.
• IT changes to support MDT reform are difficult as often different systems are involved and any planned changes should be addressed at the start of the project to allow for time delays.
• Tight project planning and a clear communication plan, with an NHS champion to ensure all stakeholders are aware of the project and to support with buy in to the project.

Publications

At the time of writing there are no plans for the NHS to publish this data.

GB-NON-08947 |  April 2024

Project Title

Oxford University Hospitals NHS Foundation Trust Cancer Prescription Screening and Treatment Pathway Development Programme.

Organisations involved

Oxford University Hospitals NHS foundation trust and MSD.

Summary

There is an opportunity in Oxfordshire to optimise the cancer treatment and prescription screening pathway   to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved treatment pathway and achievement of the 31 and 62 day Cancer Waiting Time Targets.

Benefits Realised

Due to significant and unanticipated time capacity challenges within the Oxford system which needed to take priority, the full benefits of this prescription screening project were not fully realised as the project was not completed.

Funding & Resources

This was a project with shared time commitment from Oxford University Hospital NHS FT & MSD

Lessons learnt

Creation of a formal contingency plan should any of the key stakeholders have time capacity issues, leave their post or their organisation during the implementation of the project.

Publications

No publications are planned.

GB-NON-08941 |  February 2024

Project Title

University Hospitals Plymouth Chemo capacity and treatment delivery Pathway Development Project (PDP)

Organisations involved

University Hospitals Plymouth NHS Trust and MSD

Summary

There is an opportunity in Plymouth, Devon to optimise the Cancer treatment and prescription pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved Treatment pathway and achievement of the 31- and 62-day Cancer Waiting Time Targets. The primary objective of this project is the optimisation of treatment and prescription pathways across Plymouth, Devon.

Benefits Realised

Due to significant and unanticipated capacity issues within the Plymouth system which needed to take priority, the Trust made the decision to cancel the Chemo capacity and treatment delivery planned pathway development workshops, the mainstay of the project plan.

Funding & Resources

This was a project with shared time commitment from University Hospitals Plymouth & MSD

Lessons learnt

The importance of a strong sequential stakeholder engagement & communication plan to support time management. The need to gain agreement from service management to clinical & administrative stakeholders for protected time to prioritise improvement project.

Publications

No publications are planned.

GB-NON-08940 | February 2024

Project Title

Somerset Wiltshire Avon and Gloucestershire (SWAG) Cancer Alliance Prehabilitation Patient Information Platform

Organisations involved

SWAG Cancer Alliance and MSD

Summary

The goal of this project was to provide project management support to engage and facilitate stakeholder healthcare professionals (HCPs) around regional prehabilitation services and their input into developing a SWAG Regional Cancer Prehabilitation Information Platform. Also, to further engage regional HCP stakeholders to drive adoption and usage of the platform across their respective Trusts within the region. In doing so we aimed to:

• Reduce the variation in the quality of prehabilitation services across the region
• Provide project management support to facilitate regional standardisation of prehabilitation services
• Involve healthcare professional leads and charities to be involved in the building of the platform, ensuring that it was fit for purpose
• Increase patient engagement and education, enabling people to make more informed choices regarding their health
• Improve patient’s abilities to build mental and physical resilience’s during and beyond their cancer journey

Benefits Realised

• Patient Benefits

  • As a result of the new digital prehabilitation platform, patients and carers within the region have benefitted from the ability to access prehabilitation information, instruction, and guidance, enabling them to best prepare mentally and physically for their treatment journey

• NHS Benefits

  • The creation of a digital prehabilitation platform built using feedback, insights, and recommendations from a multi-disciplinary team of HCPs representing each of the Trusts from across the region
  • Increasing access to and viewing of the platform as measured through the number of views on a weekly and monthly basis (see appendix)*. From August 23 to December 23:
    • Monthly views increased from 140 to 222
    • Monthly users increased from 77 to 138
  • Provision of a prehabilitation resource for healthcare professionals to access, irrespective of location or position, reducing variation in access to resources across the region
  • Identification of prehabilitation as a regional priority that is now listed as such on the SWAG Cancer Alliance Webpage
  • Dissemination of the Prehab Hub as a digital resource to a wide range of NHS stakeholder organisations, institutes, networks and charities through presentations and written communications both regionally and nationally, including:
    • A case study written for the National Living With and Beyond Cancer team who have published the case study on their NHS Futures site, and have also circulated the case study in their December 2023 newsletter
    • A case study blog written for the Cancer Care Map team and posted on their web page
    • Poster containing prehab digital platform details to be circulated to relevant HCPs in the region

• MSD Benefits

  • Contributing towards a new regional digital capability that has the potential to positively impact up to 14,688 patients annually**, although it’s acknowledged that not every single patient diagnosed with cancer will access the platform
  • This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.
  • Enhanced reputation of MSD through partnership work

References

* – Google Analytics

** – UK cancer incidence figures – https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/all-cancers-combined#heading-Two. SWAG Cancer Alliance regional population estimate – https://www.swagcanceralliance.nhs.uk/about-us/

Funding & Resources

This was a project with shared time commitment from SWAG Cancer Alliance and MSD

Lessons learnt

A variation agreement was issued and signed to extend the running time of the project

A project lead deputy could be assigned for continuation should unforeseen circumstances disrupt the core project team

Publications

None

GB-NON-08801 | January 2024

Appendix

Data from Google Analytics for the SWAG Cancer Alliance Webpage. Access granted by SWAG Cancer Alliance

Data from Google Analytics for the SWAG Cancer Alliance Webpage. Access granted by SWAG Cancer Alliance

Project Title

University Hospitals Sussex Foundation Trust Melanoma Surveillance, Follow up and Discharge Pathway Development Programme (PDP)

Organisations involved

MSD-UK

University Hospitals Sussex Foundation Trust

Summary

There is an opportunity in University Hospitals Sussex NHS Foundation Trust to implement and optimise patient pathway in melanoma following their adjuvant treatment. The aim of this project is to agree, document and implement new patient pathways for patients following their adjuvant therapy with Oncology, Dermatology and Plastics. This will ensure there is a standardised approach for all patients following their adjuvant therapy to ensure their surveillance, follow-up, and discharge, if appropriate from Oncology, is consistent. This will be achieved by documenting and mapping the new pathways with Oncology, Dermatology & Plastics in a workshop via a LUCID chart, followed by GAP Analysis Pathway Implementation workshops to identify actions to take forward, and project management to implement the required changes to the new pathways.

Background

The demand within Oncology for melanoma has increased following the introduction of adjuvant treatment. Prior to adjuvant therapy, patients were discharged from oncology to dermatology or plastics with a clear standardised pathway in place, however since adjuvant therapy has been introduced, there has been no new pathway created therefore the pathways are not joined up and oncology have been reluctant to discharge these patients creating increasing demand in oncology follow-up appointments.

Currently there is no agreed standardised pathway for patients based on their stratified risk following their adjuvant treatment. Therefore, the current utilisation of dermatology, plastics and oncology appointments for follow-up are not optimised, in some cases all 3 specialties follow up these patients. Implementing an agreed standardised pathway for follow up following adjuvant treatment in line with the NICE Guidance (NG14)- Melanoma: Assessment and Management will ensure optimal usage of follow-up appointments within Oncology, Dermatology and Plastics.

Project Objectives

• Agree, document and standardise patient pathways for patients following their adjuvant treatment with Oncology, Dermatology & Plastics for each different stage of disease (stage 2B and above).
• Implement these patient pathways to reduce variation and to ensure patients are receiving the right follow-up & surveillance following their adjuvant treatment.
• Reduce the number of follow-up appointments given by Oncology by increasing the number of appropriate discharges from Oncology to Dermatology and Plastics to increase capacity within the Oncology team to be able to treat the increasing patient demand whilst optimising the current utilisation of dermatology and plastics follow-up appointments.

Benefits

Patient Benefits:

• Improved experience of surveillance, follow-up and discharge pathway

NHS Benefits:

• Standardised patient pathway for surveillance, follow up and discharge
• Clarification of follow-up decision making between oncology, dermatology & plastics
• Increased capacity in Oncology to support improvements in 31-day treatment target and 62 day referral to treatment Cancer Waiting Time targets

MSD Benefits:

• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding & Resources

This project is a shared contribution of time between University Hospitals Sussex Foundation Trust and MSD.

GB-NON-09814 |  August 2024

Project Title

University Hospitals Sussex Foundation Trust Pathway Development Project (PDP)

Organisations involved

MSD

University Hospitals Sussex Foundation Trust

Summary

A national optimal skin cancer pathway has been created with the intention of improving patient experience through promoting quality cancer care and ensuring all skin cancer patients receive optimal cancer care.  There is an opportunity in Brighton and surrounding Sussex area to optimise the melanoma pathway in line with the national optimal skin cancer pathway  to improve the service quality, service efficiency, productivity and patient experience. The desired outcome of this project is an improved melanoma pathway aligned with the national optimal pathway  and achievement of the skin cancer type here  28 day Faster Diagnostic Standard and the 31 and 62 day. Cancer Waiting Time Targets. The project intends to run for approximately 12 months.

Project Objectives

The primary objective of this project is the optimisation of melanoma pathways across Brighton and surrounding Sussex area. Specifically contributing towards; –

• An optimised melanoma pathway aligned to the national optimal timed skin cancer pathway
• Achievement of the skin cancer 28 day Faster Diagnostic Standard, 31-day treatment target and 62 day referral to treatment Cancer Waiting Time targets
• Measurement of the outcomes of the project and disseminating these outcomes within 6 months of the project completion

Benefits

Patient Benefits

• An improved patient experience of the melanoma pathway in Brighton and surrounding Sussex area.
• Quicker diagnosis and treatment of melanoma and hence improving the chance of successful treatment

NHS Benefits

An optimised pathway in melanoma across University Hospitals Sussex hospital sites resulting in

• Achievement of the skin cancer 28 day Faster Diagnostic Standard, 31-day treatment target and 62 day referral to treatment Cancer Waiting Time targets
• Earlier referral, diagnosis and treatment of melanoma patients
• Increase in treatment rates for skin cancer
• Optimisation of service delivery

MSD Benefits

• Better understanding of melanoma patient needs
• Enhanced reputation of MSD through partnership work
• As a pharmaceutical manufacturer of oncology medicines, an indirect result of an improved pathway may be that MSD see more appropriate usage of their NICE/SMC approved medicines

Funding

No funding is associated with this project. The project is a shared contribution of time from both the NHS organisation and MSD

GB-NON-09628 | June 2024

Project Title

Writing of a business case for development of skin cancer services in Thames Valley

Organisations Involved

Oxford University Hospitals NHS Foundation Trust (OUH) and MSD

Summary

The project aimed to address increasing patient demand, the introduction of adjuvant treatments approved by NICE, and the challenges in retaining staff at the OUH, all of which result in variation in treatment uptake, monitoring and ongoing surveillance. The objective was to provide project management support to understand the current state running of the service and write a business case for the permanent funding a senior band 7 cancer nurse specialist. This specialist would work to ensure seamless and coordinated care for all patients undergoing adjuvant therapy and surveillance monitoring within the skin cancer pathway at Oxford University Hospitals and all peripheral referring hospital sites. Once appointed the nurse will be able to provide care closer to the patient’s home, removing the need for travel and the likelihood of patients refusing adjuvant treatment. This will free up hospital consultant clinic slots for seeing all new patients, any patient with newly relapsed disease, patients on treatment for metastatic disease, and those patients with complications of treatment. At the time of writing, the OUH has agreed in principle to funding this new post and we are just waiting for the budget to be drawn down.

Benefits Realised

Benefits listed below include benefits realised as a result of the project as well as anticipated benefits once a senior band 7 cancer nurse specialist has been appointed. It has been stated where benefits listed are anticipated:

Patient Benefits (all are anticipated)

• Delivery of care closer to home – As the nurse will spread their work across Milton Keynes, Banbury, and Oxford – meeting one of the key tenets of the NHS Long Term Plan.¹
• Increased accessibility for patient as clinics will be more accessible to individuals with limited mobility, those who rely on public transportation, or those who cannot afford the cost of travel. This will ensure that everyone, regardless of their socio-economic status, has better access to healthcare.
• Referral coordination if needed will ensure a seamless transition to surgical intervention or prompt systemic treatment for metastatic disease if the melanoma progresses.
• Seamless and coordinated care will potentially improve treatment outcomes.
• The nurse will provide emotional support and help to address any concerns that patients may have. This will ensure patients are able to express their anxieties and receive reassurance throughout the programme.
• Patient-focussed service with the creation of a more patient-centred and efficient active surveillance programme.
• Self-skin examination techniques and sun protection advice will empower patients to take an active role in managing their health.

NHS Benefits

• A business case has been written that justifies the need for the employment of a senior band 7 skin cancer nurse specialist who would provide seamless and coordinated care for all patients undergoing adjuvant therapy and surveillance monitoring within the skin cancer pathway across the region.
• Service data has been researched and included in the business case demonstrating:
  • Increasing Patient Volumes: Significant growth in new and follow-up skin cancer patients, leading to immense pressure on consultants and service capacity.
  • Clinical Risk: Inadequate follow-up appointments for surveillance, risking unobserved recurrence of skin cancer.
  • Administrative Burden: High turnover of administrative staff due to constant rescheduling and booking challenges.
  • Geographical Accessibility: Travel requirements for patients from Milton Keynes to Oxford, impacting patient acceptance of adjuvant therapy.
  • Cost and Efficiency: Financial benefits of employing a nurse specialist, freeing up consultant time and improving service efficiency.

NHS Benefits (anticipated)

• The new nurse will be able to deliver patients’ appointments closer to their homes in Milton Keynes and Banbury, reduce the admin burden associated with ‘further reach’ patients travelling into Oxford, and improving patient experience.
• Consultants will have clinic slots freed up for seeing all new patients, any patient with newly relapsed disease, patients on treatment for metastatic disease, and those patients with complications of treatment.
• By seeing all the follow-up patients, the new nurse would release 846 hours of consultant time every year (time cost equivalent to £61,512 of consultant time released each year).
• £15.23 will be saved for every follow-up patient seen by a skin cancer nurse rather than the consultant.²
• Future service resilience will be created to meet the anticipated >10% annual growth rate in patient demand (12% anticipated average growth in new patients and ~12% anticipated growth in ‘follow-up’ patients).³

MSD Benefits

• Once the nurse has been appointed and operating fully, we believe that 1835 patients will be positively impacted each year. This has been calculated using NHSE cancer waiting times data.⁴
• An opportunity to contribute towards the development of cancer services in the skin pathway, gaining experience of how to create a business case that draws attention to under-resourced areas of the pathway.
• Collaborating on a project that has the potential to positively impact patients through a business case that may be applicable to other geographies and speaks to the NHSE cancer workforce agenda.⁵
• This collaboration may ultimately have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Oxford University Hospitals & MSD.

Lessons Learnt

• It is worth investing in a business case should the justification be strong enough, even when no recognised funding stream is apparent in the first instance. This is because writing a business case formalises the requirement and quantifies and qualifies the need in a formal document that is then more likely to be acted upon.
• Speaking to a broad range of clinical stakeholders enables a more diverse perspective to be included in the case for change.
• Uptake of adjuvant therapy has increased the need for senior skin cancer nurse specialists to be appointed, whose remit is adjuvant patients and those in surveillance programme.

Publications

None

References

1. The NHS in England at 75 (NHS@75) – Priorities for the Future (2023)
2. Figures calculated by subtracting top tier band 7 nurse salary from consultant salary (with 8 years completed service)
3. Data obtained from OUH service data analysis measuring skin cancer patient demand changes year on year over the last 6 years
4. NHSE Cancer Waiting Times Data, total skin cancer patients seen in the 31-day pathway over a 12-month period from Jan to Dec 2024

5. NHSE Cancer Workforce Plan

GB-NON-11077 | March 2025

Project Title

Maidstone & Tunbridge Wells NHS Trust Skin Cancer Pathway Development Project (PDP).

Organisations Involved

MSD.

Maidstone & Tunbridge Wells NHS Trust.

Summary

There is an opportunity in Maidstone & Tunbridge Wells to optimise the skin cancer pathway to improve the service quality, service efficiency, productivity, and patient experience. The desired outcome of this project is an improved skin cancer pathway and achievement of the skin cancer 28 day Faster Diagnostic Standard and the 31- and 62-day Cancer Waiting Time Targets. The project ran from June 2023 to June 2024.

Benefits Realised

Through implementation of MSD’s Pathway Development Programme with Maidstone & Tunbridge Wells NHS Trust, MSD provided project management support to assess the current state of the Incidental Findings of Melanoma Pathway and provide a gap analysis workshop to identify areas for improvement. MSD then supported the implementation of improvement initiatives to close these gaps and assisted with the measurement of their impact. As a result of the project, the following benefits were realised:

Patient Benefits

• Quicker diagnosis and treatment of Skin Cancer and hence improving the chance of successful treatment has been reported through this project potentially leading to improved patient outcomes, see NHS benefits below.
• Patient experience was not measured as part of this project.

NHS Benefits

An optimised pathway in skin cancer across Maidstone & Tunbridge Wells hospital sites resulting in:

• Optimisation of service delivery – Implementation of an updated regional referral pathway for incidental findings of Melanoma into specialist MDT.

“By way of feedback to you Dr X has already used the new referral form and it has worked very well – certainly better than his last experience” Lead Pathway Nurse Coordinator, General Surgery.

• Skin Cancer 28 day Faster Diagnostic Standard- was not measured as part of this project and was out of scope as patients are already diagnosed before entering the incidental pathway.
• Skin Cancer 31-day Treatment Cancer Wait Time Target increased from 86.4% June 2023 to 100% June 2024.
• Skin Cancer 62-day Referral to Treatment Cancer Wait Time Target- was not measured as part of this project as not reflective of the incidental findings pathway.
• Earlier referral, diagnosis and treatment of skin cancer patients as demonstrated by:
  • Decision to treat to subsequent treatment (Oncological) decreased by 3 days average from 20 days (Feb-June 2023) to 17 days (June-Oct 2024).
• Increase in treatment rates for skin cancer – Number of patients treated by Oncology (First definitive, subsequent & recurrence) increased from 9 per month on average (Mar-June 2023) to 10 per month on average (June-Sept 2024).

MSD Benefits

• Better understanding of skin cancer patient needs and the need for rapid referral into specialist MDT to enable earlier treatment decisions.
• Enhanced reputation of MSD through partnership work.
• This collaboration may have enabled more patients to access innovative treatments in line with NICE guidance which may or may not have included MSD medicines.

Funding & Resources

This was a project with shared time commitment from Maidstone & Tunbridge Wells NHS Trust & MSD.

Lessons Learnt

• From the outset understanding deliverables required for optimisation of a pathway and the data required to demonstrate the success of the deliverables. We experienced challenges extracting the data required from hospital IT systems. Ensuring data services are bought in at the scoping phase of project to establish what can or can’t be measured.
• Ensure regular touch points throughout the project to ensure clarity of expectations and outcomes.
• Communication is key between all parties which is especially important between departments to optimise the decision making and establish the most appropriate intervention for the patient.

Publications

There are currently no plans to publish the outcomes of this project by the hospital trust as per the date of this summary.

GB-NON-10665 | November 2024