- 10 May 2021
Attendees and apologies
- Seamus Teahan (ST), Regional Lead Cancer Clinician, WoSCAN (Chair)
- Bobby Alikhani (BA), Regional Manager (Cancer), SCAN
- Matthew Barber (MB), Consultant Breast Surgeon, NHS Lothian
- Lorraine Cowie (LC), Regional Manager, Interim (Cancer), NCA
- Jen Doherty (JD), Project Co-ordinator, National Cancer Quality Programme
- Hilary Glen (HG), Consultant Medical Oncologist, NHSGGC
- Rob Jones (RJ), Consultant Medical Oncologist, NHSGGC
- Gregor McNie (GMcN), Team Lead, Cancer Policy, Scottish Government
- Lorraine Stirling (LS), Project Officer, National Cancer Quality Programme
- Catherine Thomson (CT), Service Manager (Population Health), Public Health Scotland
- Evelyn Thomson (ET), Regional Manager (Cancer), WoSCAN
Simon Watson (SW), Medical Director, Healthcare Improvement Scotland
- Lesley Aitken (LA), Senior Reviewer, Healthcare Improvement Scotland
- Hugh Brown (HB), National Primary Care Group, NHS Ayrshire and Arran
- Asa Dahle-Smith (ADS), Medical Oncologist, NCA
- David Dodds (DD), Chief of Medicine for Regional Services, NHSGGC
- Kevin Freeman-Ferguson (KFF), Head of Service Review, Healthcare Improvement Scotland
- Angela Jesudason (AJ), Paediatric Oncologist and Clinical Lead for the MSN CYPC Teenagers & Young Adults
- Gerard McMahon (GMcM), Cancer Coalition, Prostate Cancer UK
- Hamish McRitchie (HMcR), Clinical Lead Scottish Clinical Imaging Network
- James Mander (JM), Regional Lead Cancer Clinician, SCAN
- David Morrison (DM), Director, Scottish Cancer Registry
- Michael Muirhead (MM), Head of Service, Information Services Division Scotland
- Peter Sandiford (PS), Deputy National Clinical Lead, Cancer QPI Review Group, Healthcare Improvement Scotland
- Nadeem Siddiqui (NS), National Clinical Lead, Cancer QPI Review Group, Healthcare Improvement Scotland
- Iain Tait (IT), Consultant Surgeon and Clinical Director, NCA
- Stuart Thomas (STH), Consultant Pathologist and Lead Clinician, Scottish Pathology Network
- Joris Van Der Horst, Consultant Respiratory Physician, NHSGGC
- Lorna Bruce (LB), Audit Manager, SCAN
- Dominic Culligan (DC), Clinical Lead, Haemato-oncology, NCA
- Grant McQuaker (GMcQ), Clinical Lead, Haemato-oncology, WoSCAN
- Fiona Scott (FS), Clinical Lead, Haemato-oncology, SCAN
Items and actions
1. Welcome, apologies and declarations of interest
a) ST welcomed the group and introduced those in attendance. A note of apologies are listed above. No declarations of interest were noted.
2. Action notes and minutes from the previous meeting – Paper 1
a) the group considered the previous action note held on 14th September 2020 (Paper 1) and approved as an accurate record.
6. Assurance of national performance
a) the order of the agenda was changed at this point.
Proposed options for the cancer quality performance indicator review process 2021/21
SW provided an overview of the process to date. A meeting took place on 16th December 2020 between key stakeholders to discuss the process, frequency of reviews and the various challenges for HIS providing external QPI assurance during the COVID pandemic. ST acknowledged that QPIs will provide information on some aspects of cancer management however this data only forms a small part in the overall quality of cancer services at this time. Noted that it will not be until next year’s reporting that any effects of the pandemic are shown. SW agreed that QPIs have their own value in particular from the public’s perspective and any review will take into account the conditions that existed before and likely to continue during the pandemic.
SW advised that the details, timeline and format of report for future reviews continues to be worked on by the team. The process has been designed to contain ‘fire breaks’ in order to account for any requirement to pause due to the pandemic.
SW added that the whole process will be looked at in terms of assurance and if it is clear that all actions have been undertaken then it is unlikely that anything further will be required. This will allow focus on clear lines of enquiry in specific areas. The importance of timely data was highlighted and discussions are ongoing with PHS and regional networks on how to achieve the most current and quality assured data to inform reviews.
SW advised that HIS will host a further meeting early in 2021 to finalise all details, with a view to sharing a fully worked up plan at the next NCQSG in March.
3. Matters arising
a) ovarian cancer – feedback from NCA following preliminary survival analysis
Following discussion at the previous meeting regarding regional differences in ovarian cancer survival analysis, and in particular MDT practices/resources for delivering oncology, the chairs of the NCQSG wrote to Grant Archibald, Chief Executive Officer, NHS Tayside. LC advised that no response has been sent as yet due to the recently received updated survival analysis report which has still to be sent to the Boards for comment.
LC added that in light of the previous report there have been significant changes made in NCA to MDTs, access to surgery and staging. There has also been agreement to peer review cases at a regional level. LC advised that she will be distributing the updated report to Medical Directors ahead of their next meeting on 6th January 2021 and they will respond accordingly.
a) national lymphoma QPI report (2016-2019) – Paper 2
FS presented to the group on behalf of the 3 regions an overview of the Lymphoma QPI results that were published by PHS on 17th November 2020. Overall performance is high across a number of QPIs with many targets being met on a regional / national level. Lymphoma QPIs are currently undergoing the 2nd Cycle of Formal Review and a number of QPIs that have consistently met the target have been proposed to be archived.
The following QPIs were noted for discussion:
QPI 1 (Radiological Staging) & QPI 2: (Treatment Response) – Performing well however challenges highlighted around access and turnaround times in reporting in radiology. Noted that this is a national problem with pressures on radiology services.
QPI 3 (PET CT) – small numbers affect performance in some areas and again timing around reporting is delayed due to radiology. Noted that PET CT is not carried out on in-patients and acknowledges that QPI raises the issue that scanning should be carried out pre-treatment.
QPI 4 (Cytogenetic Testing) – some variation noted in 2018/19 results and noted the complexities in defining a cohort where patients are fit for escalation. Issues noted in the north due to capacity, batch testing and pressure on genetic services. DC noted that if a patient has a double or triple hit lymphoma and is clearly fit for CNS prophylaxis then genetic services will prioritise. The QPI is being amended at formal review to incorporate BCL2/BCL6.
QPI 10 (Primary Cutaneous Lymphoma) – numbers are small and the QPI has raised the profile of skin lymphomas. Issue in the north due to the absence of a designated dermatologist to link in to MDT. Discussion took place around the development of a national Skin MDT to review cases. Agreed that this would require resource and work is in progress to explore further with Dermatology.
ET advised that there is a potential opportunity with the National Recovery Plan for funding a national MDT. Acknowledged that the timeline is tight for 15th January 2021 for bids, however there will be a further opportunity in the spring of 2021 and this will be further explored.
QPI 12 (Treatment Response in Hodgkin Lymphoma) has raised the profile and is being amended at formal review to include further treatment regimens. Noted that there are small numbers but overall the interim PET CTs are being carried out in most patients who receive ABVD chemotherapy.
QPI 14 (Clinical Trials) – national performance is below the 15% target and this has decreased from the previous year. Noted that there are currently no national phase 3 studies for the bigger cohorts in the lymphoma population.
The group discussed the challenges around imaging and turnaround times in terms of reporting which is a consistent theme across many tumour groups and noted that there is no obvious or easy solution at the current time.
FS highlighted the suggestion of a new PET CT QPI for DLBCL patients, however this was not taken forward as this is undeliverable within NHS Lothian at the current time. This would involve around 150 extra scans per annum which will be challenging for colleagues in nuclear medicine. ST stated that the QPIs should be challenging and encourage best practice, and noted that this topic is well evidenced with other areas able to deliver.
No other issues were raised and ST thanked the Regional Clinical Leads for their contribution and ongoing clinical engagement.
5. Survival analysis
d) the order of the agenda was changed at this point.
Survival analysis governance – Paper 3
CT spoke to the proposal outlined in paper 3 on the national governance process for a rolling programme of survival analysis. This has been in consultation with Network Lead Clinicians and Network Managers.
It was highlighted that regions will view the draft reports and have the opportunity to discuss with Medical Directors and Chief Executives prior to any publication by PHS assuming there are no issues. Reports will be formally shared with the NCQSG after being made available for ratification.
CT advised that the three tumour sites undergoing analysis will be agreed by the networks annually on a rolling programme. At present there is not enough resource within PHS to undertake analysis for every tumour site annually and although this will be the aspiration, some sites require analysis at different follow-up points i.e. 1 year, 3 year and 5 year survival.
Agreement from the group that this is a sensible and pragmatic approach in relation on how survival analysis is reported, and are happy to sign off. It was noted that the process will require updating when PHS have access to the patient level data directly from eCASE.
In addition to survival, recurrence data was also highlighted. MB advised that SCAN have added an appendix to their regional breast cancer QPI report with recurrence data for the 2nd year. This has also been done by NHS Highland. The methodology for collecting recurrence data has been shared with the audit teams in NCA and WoSCAN who are keen to undertake, however acknowledge the associated challenge with resource required. The breast cancer audit team are currently fine tuning this with the intention of proposing as a new QPI at the next round of review.
a) ovarian cancer survival analysis – update
Following ratification of the survival analysis governance approach discussed above, the updated Ovarian Cancer report will be shared with this group 4 weeks after agreement and consideration by the Boards. Therefore will be presented at the next meeting.
CT sought clarity on reporting the 2016-18 data separately or having a combined report (2013-2018, that contains the full cohort of patients with longer follow-up). CT advised that if both reports are combined there is a risk of masking the issues in the initial analysis. It was suggested in regard to improvement it would be best to break down by individual years although it was acknowledged that this could produce small numbers which then become unreliable. CT agreed to further look at the reports to see what could be done in terms of individual years that would be robust enough to present as well as working on the combined report.
CT discussed where the survival analysis reports will be stored going forward. Initial thoughts have been to include within the SCRIS QPI Dashboard however this requires further exploring by PHS due to logins and passwords for access.
b) tumour specific survival analysis
CT advised that PHS are currently validating data and carrying out QA checks for upper GI and head and neck cancers. It is hoped at the beginning of 2021 that PHS will be in a position to run analysis on both of these datasets. CT advised that breast cancer data has the same issue with CHI numbers as ovarian cancer and therefore will need to be re-ran. There are no issues to report with the cervical and endometrial cancer data.
The group agreed that in order of priority there is is a requirement for PHS to complete the ovarian cancer survival analysis ahead of upper GI and head and neck cancer.
c) national timetable for survival analysis
CT advised that a timetable for survival analysis will be available when the backlog with the ongoing tumour sites is cleared. This will depend on the addition of any resource and access by PHS to eCASE which is expected in the summer of 2021.
6. Assurance of national performance
a) this agenda item was discussed at the beginning of the meeting.
7. QPI reporting
a) PHS dashboard development / improvements
CT advised that dashboards will be available for forthcoming national meetings i.e. breast, melanoma and ovarian cancers.
In terms of the wider development of the dashboards, CT advised that PHS are limited due to resources with analysts working on COVID related activities. PHS have met with GMcN at the Scottish Government to discuss priorities for funding and are also discussing internally whether any existing analysts can be moved to the cancer team prior to April 2021. It was noted that even with funding support, there are challenges within the employment market at the current time in recruiting analysts.
With regard to eCASE development, ET advised that work has started with Steve Roud and his team in NSS on the reporting element. It is likely to be late spring/early summer before benefits are seen.
b) MDT QPI
ET spoke to this item that has been raised by colleagues in NCA with regards to the core MDT QPI contained within most tumour sites. This QPI currently measures patients referred and discussed at their local MDT rather than multi-centre/regional MDT’s where certain tumour types should now be discussed.
There was a similar issue in the west in relation to haematology and a specific piece of improvement work was undertaken to ensure patients were discussed at the appropriate MDT. The question was raised as to whether the QPI should be adjusted in order to try and accommodate these circumstances.
JD highlighted that some background work has been undertaken in relation to the criteria and definitions for this QPI across the different tumour types. ET added that in the case of haematology in the west it is documented within the MDT constitution, however noted this is not a national approach.
It was proposed that MDT constitutions require to be further developed and noted that there is not a ‘one size fits all’ in terms of how services are organised. The group agreed that individual tumour types need to be defined in terms of the QPI at each round of review.
c) review of clinical trials & research access QPI
This agenda item moved forward for discussion by David Cameron, Clinical Director of the SCRN at the next meeting.
d) SACT 30-day mortality
JD provided an update on progress with establishing QPI reports for SACT 30-day mortality using Chemocare data. This is being progressed on a regional basis in the interim, however now that the national SACT platform has obtained access to all 5 instances of Chemocare, a meeting has taken place to explore transition of this work.
Breast cancer reports have been produced for SCAN, WoSCAN and Grampian to date. These reports will be compared against data from the national platform for validation purposes. It was noted that there may be an issue with consistency in the use of ‘intent of treatment’ in terms of curable/non curable patient splits, and it was highlighted that data from Chemocare has never been reported in this format.
RJ advised that a structured way of classifying curable / non-curable was developed at a national level, however CT feels this may require further work as the disease tree may not have been used in the same way. Further validation is required before data is shared more formally, and a similar exercise will be required for each tumour site before moving over to the national platform.
CT highlighted that COVID activity is taking priority however it is hoped that SACT development can continue to progress in the new year.
The group agreed the importance of reporting the QPI on 30 day SACT Mortality and in order to progress, it could be reported as overall mortality in the short term. It was stressed that the treatment intent breakdown is an important measure and should continue to be progressed as there could potentially be differences in outcomes.
8. Information governance approach for the national analysis of QPI data
a) CT provided an update on the information governance approach discussed at the previous meeting, and the associated Memorandum of Understanding (MoU) which is required.
There has been discussion at the Cancer Data Recovery Group where concerns were raised around multiple MoUs (i.e. SACT, Screening, QPI data) and whether one single MoU would be more appropriate. It was highlighted that the National Data Sharing Accord allows the sharing of data between PHS, the networks and the Boards as long as PHS is a joint data controller. In addition the MoU would allow PHS to publish data according to the agreement and eliminate multiple requests to the Boards for signing prior to publication.
There was agreement that a single MoU covering all of the cancer datasets would be preferable, however this needs to go round the Boards. ET stated that there is a requirement for clarity around the types of analysis that will be done and tight control around this to avoid anxiety from the Boards. The SACT MoU is already with the Boards for signing therefore a decision is required soon.
CT raised concern about the proposal for rapid reporting of SACT data as a weekly activity feed and how to build in the process for sign off. BA noted that ultimately the responsibility lies with the Boards for final approval and although there is a desire for real time data, this needs to be within the accountability framework.
9. QPI formal review process
a) formal review process – 2nd cycle update
JD provided an update on progress with the 2nd Cycle of Formal Reviews.
Pre-COVID reviews - Upper GI Cancer is now complete and the Lung Cancer QPIs are currently with the SCT for final ratification. An additional meeting took place with the 3 Colorectal Cancer Regional Leads to further discuss and agree revisions. These are now out for a six-week public engagement period until the end of January 2021 via the Scottish Government Consultation Hub.
The revised timetable (with 3 month delay) has now started in terms of new reviews:
- Lymphoma and Brain/CNS Cancer have both commenced and drafts are out with the group for comment
- Ovarian Cancer – initial meeting due to take place on 26th January 2021. This is slightly delayed due to a network national discussion around the QPIs taking place on 15th January
- Sarcoma and Head and Neck Cancer – templates have been sent out and both groups due to start in March
JD highlighted that the QPI formal review timetable will be refined when the Regional Audit Managers issue their updated audit reporting schedule for 2021/22. QPI reviews will be aligned with reporting schedules where possible.
JD is seeking Chairs for the remainder of the tumour groups to undergo the 2nd Cycle of Formal Review (Acute Leukaemia, Testicular, Bladder and Cervical and Endometrial Cancers) due to commence between June and September 2021.
10. NCQSG workplan 2019 – 2021 – Paper 9
a) the updated workplan was circulated for information with no further points to note. A revised and updated workplan is due to be developed in April 2021.
11. Risk and issues log – Paper 10
a) the Risk and Issue Log was circulation for information with a few issues updated and risks closed.
a) cancer plan
RJ made reference to the recent published Cancer Plan that notes the centralised resource around Clinical Management Guidelines (CMGs). Noted that there is an opportunity for some integration of work e.g. clinical review pathways, in order to avoid duplication.
ET advised that she will raise this at a call following this meeting with GMcN and Aileen Keel as it is important there is no duplication of work and that clinical resources are utilised efficiently. It was noted that the Cancer Plan defines timelines of March 2021 for developing the required governance infrastructure and Summer 2021 for the resource to be in place. ET added that this is an opportunity to think about aligning the various programmes and encouraging early discussion.
Date of next meeting
Tuesday 9th March 2021, 10:00am – 1:00pm, via MS Teams