Item No | Plan | 2003-04
Allocation | Target Dates | Responsible Lead | Status (Achieved
In Progress - on schedule
In Progress - delayed) | If delayed, Reasons Why and Actions to resolve | Estimated New Target Date | 2003-04
Spent
| 2003-04
Remaining
| Measurable Benefit/
Expected outcome | Evidence |
Rapid Access to Diagnosis |
Highland 02 | Video Endoscopy | 77,000 | Immediate | Mr James Docherty and Mr Robin Pollock | Achieved (equipment purchased) | | | 77,000 | 0 | Better quality image and enables improved review - quantified by: the number of endoscopic images produced.
Reduces waiting times through modernisation and rapid throughput - we are pursuing more robust data to provide further evidence of impact of the endoscopy equipment. It is however proving difficult to isolate the impact of cancer investment due to waiting times monies which were invested and then stopped during the same period. | Equipment in use since January 2002. This equipment has replaced the use of outdated endoscopy equipment throughout Highland and removed the need to transport equipment between hospital sites. The video endoscopy produces a better quality image and enables improved review. |
Tayside 08 | CT scanner - running costs | 497,000 | Installation by November 02 | Dr Alan Cook and Mr Stephen Menhinick | Achieved | | 1/11/2002 - not expected to have 2 scanners operational until at least March 2003 | 484,000 | 13,000 | Reduced waiting times for diagnosis/ meet CSBS standards/SIGN guidelines. | Because of delay in building process at Ninewells, slippage money used to install mobile CT scanner into Stracathro Hospital from April to October 2002. This has reduced Oncology waiting times from 14 weeks to 2 weeks. Extra 14 sessions scanning, 20/21 patients per session . New CT scanner to be online in November 2002 at Ninewells. CT waiting times for oncology patients are currently 4 weeks and maximum CT waiting times are now 6 weeks. |
Tayside 02 | Ultrasound Imaging | 42,000 | June 02 | Dr Alan Cook and Mr Stephen Menhinick | Achieved | | | 42,000 | 0 | Reduced waiting times for diagnosis/ meet CSBS standards/SIGN guidelines. | Ultrasound scanner installed in Stracathro Hospital in April/May 2002. This was permanent replacement for an old machine that has increased imaging quality. Waiting have been maintained at 2 weeks in Angus. Waiting times for ultrasound in Stracathro is currently one week Maintenance of imaging quality with new equipment |
Tayside 09 | Paediatric Colonscope - charges | 8,000 | Installed March 2002 | Evelyn Fleck | Achieved | | | 8,000 | 0 | Reduced waiting times for diagnosis/ meet CSBS standards/SIGN guidelines. | Average wait has been reduced from 40 weeks to 33 weeks. Due to difficulties in appointing to the existing nurse Endoscopist's post at PRI, reduction in cancer waiting times not achieved anticipated progress yet. Additional equipment has allowed the ability to mix the cases on endoscopy sessions. Audit of waiting times March 2003 - PRI 20-40 weeks depending on consulatnt. There is no general list in PRI for colonsocopy. Without new colonoscope, service would have faltered as one colonoscope in Perth was beyond repair. Overall service redesign is still in the pre-implementation phase. Waiting times have reached a plateau at 38 weeks for routine colonoscopy. Urgent colonoscopy is 2-4 weeks. We anticipate waiting time will be reduce with service redesign. Weekend lists established with 194 patients undergoing endoscopy. 125 from waiting lists. 1. Generic list established 2. Review of patients on waiting list underway 3. We have increased elective colonoscopies from 24 to 37 per week with list redesign 4. Use of nurse endoscopists has reduced sigmoidoscopy waiting time to 6 weeks. |
Tayside 07c | Oesophageal Ultrasound; XQ Gastroscope; ERCP/Duodenoscope; Diathermy light source and trolley | 50,000 | June 02 | Evelyn Fleck | Achieved | | | 50,000 | 0 | Reduced waiting times for diagnosis/ meet CSBS standards/SIGN guidelines. | Due to difficulties in appointing the existing nurse Endoscopist's post at PRI the additional activity to reduce waiting times for diagnosis of cancer have not been significantly reduced yet. Additional equipment has allowed the ability to mix the cases on endoscopy sessions. Re audit waiting times March 2003. Oesophageal ultrasound - Training now complete for medical staff, commencment of service October 2002. |
Improving Treatment and Care |
Tayside 03c | Syringe pumps
3 x chemotherapy nurses | 90,000 | Equipment by March 2002. Staffing by June 2002 | Mark Parsons | Achieved | | | 89,900 | 100 | Improved equity of access to chemotherapy treatment | Graseby MS26A syringe pumps purchased, in use for anti-emetics and palliative symptomatic relief use for hospital in-patients. Now meets the CSBS requirement by standardising all syringe pumps and decreasing possible chance of error. Two 1. 0 WTE trained nurses, one E grade (July 2002) and three 1.0 WTE auxiliary A grade staff in post since April 2002. Allowed staff to be released from ward for training in chemotherapy day area. Monitoring system in place collecting weekly activity data in chemotherapy 5 day unit and improved equity of access will be assessed in 6 months once all staff have completed training and day area fully staffed and functional. Rolling education programme continues for chemotherapy administration. Since new posts created 6 nurses have completed course and competent in chemotherapy administration. Further 20 patients have benefitted from use of Graseby syringe drivers. All patients admitted for chemotherapy as per national guidelines where applicable of 166 outpatients only 2 were outwith guidelines and of 118 inpatients 14 were outwith guidelines from April 2003 to August 2003. |
Tayside 04c | Aseptic Dispensing Pressure isolators - Capital Charges | 14,000 | June 02 | Lucy Burrow | Achieved | | | 14,000 | 0 | Improved access and enhanced safety for patients and staff. | In use from June 2003 |
Tayside 04 | Pharmacist Grade D; Senior Pharmacy Technicians x 4; Student Pharmacy Technicians x 2; Asst. Technical Officers x 2; Staff Grade Doctor 0.4 | 177,000 | Appointments April - June 2002. | Lucy Burrow | Achieved | | | 177,300 | -300 | Enhanced capability to deliver chemotherapy. Compliance with SEHD guidance. | Pharmacist Grade D appointed July 2002, Pharmacy technicians still vacant unable to appoint due to national shortages. Extra trainee technicians appointed instead 7 WTE in total, and 7 WTE assistant technical officers all by August 2002. Staff Grade 0.3 WTE appointed August 2002. An audit was completed last year to audit services against the guideline 'Safe Use of Cytotoxic Chemotherapy in Clinical Environments'. This is to be re audited in April/May once new staff have completed training. Re-audit of Safe Use of Cytotoxics will begin at the end of March - now completed. Results will be reported to Tayside Cancer Network. Additional staff has allowed us to improve capacity for dispensing cytotocis chemo. Pharmacy technician posts remain unfilled due to recruitment difficulties, students employed meantime - it is anticipated qualified posts will be filled July 2004. Additional staff has allowed the implementation of a collection/delivery service for prescriptions and pharmancy ward stock management on all oncology wards. These iniatives free up nursing staff time and improve timeous availability of medicines. |
Palliaitve Care |
Grampian 09 | Communications link to Roxburghe House | 4,000 | Immediate | Dr M Leng | Achieved | | | 4,000 | 0 | To improve communication between clinicians re patient and palliative care needs; enhance QA through audit and other clinical systems. | The improved IT links between the Acute Trust and Roxburghe House meant that staff had access to e-mail and other Trust IT systems leading to improved communication between clinicians regarding patient and palliative care needs. |
| Purchase of additional community equipment such as Hoist, Mattresses, syringe drivers | | Purchase and instal by March 2002 | Liz Goss | Achieved | | | | | Will assist in the number of patients who can be cared for at home and reduce number of emergency admissions to hospital. Improve the quality of life of patients and carers | Equipment purchased: Recliners, Bed Cradles, Pressure Relieving Mattresses, Cushions, Baby Alarms, TENS machines and Syringe drivers. Equipment approximately in use 90% of time and 378 patients have accessed equipment between April and September 2002. Out of these 378 patients, 207 patients have utilised this equipment in their own homes. Equipment continues to be in frequent use within patients own home. no further reporting anticipated. 90 bed-days in a year, occupied 601 bed-days.
The decision to have permanently funded palliative beds has not resulted in a proportionate uptake of the service, however the initial pilot study demonstrated that spot purchasing of beds meant that there was no guarantee of availability of beds or opportunities for staff in varying nursing homes to maintain their palliative skills. Staff from both homes were invited to participate in the Palliative Link Nurse Nursing Auxiliary sessions in Spring 2003. The absence of a dedicated support/link nurse for the scheme has a detrimental effect on assisting the homes to prioritise care and reach full potential of services they are capable of. |
| Provision of Videoconferencing equipment | | Purchase and instal by March 2003 | Liz Goss | In progress - delayed | Tendering process - prolonged because of structural work | 01/09/2002 | 0 | | Improve communication and increase the knowledge and skills of those delivering palliative care, especially in remote rural areas. Improve access to specialist advice and support | Additional funding been allocated to upgrade system to allow access outwith Tayside. This is expected to further increase usage.. Videoconference continues to be used regionally and evaluates very positively. Upgrade reduces both staff downtime and travelling costs. Further training events planned. |
Shetland 01 | Additional equipment in the community - Syringe drivers, pressure relieving mattresses, infusion pumps | | March 2002 | Lead Cancer Team | Achieved | | | | 0 | Assists with CSBS standard
Enables more patients, if they wish, to be cared for at home. Improved management of infusion. | Equipment purchased: pressure mattresses for community & hospital use; numbers accessing service; numbers dying at home / in the community: 2001/02 >50% cancer patients died at home. |
W Isles 01 | Purchase of Syringe Drivers (for Home Treatment) | | Jan 2002 | Ms Jane Adams, Director of Nursing | Achieved - equipment purchased | | | | 0 | Assists in compliance with CSBS standard re uniformity of syringe drivers in the community | Have been able to standardise syringe drivers in use, to reduce likelihood of accidental over administration of drugs |
W Isles 02 | Purchase of Pressure relieving mattresses (for Home Nursing) | | Jan 2002 | Mrs Lillian Rogers, MacMillan Nurse | Achieved - equipment purchased | | | | 0 | Enables more terminally ill patients to be cared at home | Matresses are in full use out in the community |
W Isles 03 | Purchase of Infusion Pumps | | Jan 2002 | Mr A Sim, Consultant Surgeon | Achieved - equipment purchased | | | | 0 | Improved management of Infusion | Additional infusion pumps in use. Have improved the quality and quantity of equipment pool. |
Investing in Staff and Technology |
Grampian 01 | Improvements to CT scanning service - dedicated image processing room; image networking; upgraded workstations; digital image archive (Elgin)
Consultant Radiologist; Senior Radiographer; Consumables | 183,000 | Oct 02 | Dr OJ Robb | Achieved | | | 183,000 | 0 | Additional imaging capacity reducing waiting times and minimising cancellations: access to CT scans regardless of location; advanced image processing eliminating need for more invasive procedures. Supported development of managed clinical networks. | Digital CT imaging now available to inform discussion at MDT meetings within multiple sites.,e.g. Aberdeen, Elgin, Orkney and Shetland. This has been an excellent educational oportunity for staff in outlying areas. Increased radiology input to MDT meetings and focus groups due to 'sub-specialisation' among radiologists. Over 2 years the CT activity has increased by 13%. |
Grampian 02 | Mammography equipment, nurse specialist, consumables | 32,000 | Equipment by March 02, appointments by autumn 02 | Dr H Deans | Achieved | | | 32,000 | 0 | Shorten waiting times for radiology and speed up diagnosis; improved accomodation (provacy) and communication through dedicated nurse specialist | Installation of the new mammography unit has allowed increased flow of patients due to reliable equipment now being in place. Appointment of p/t nurse specialist has increased efficiency in the dept. and allowed improved support and reassurance to patients. Mammography workload increased by 20%. |
Grampian 03 | Nurse specialist Radiographer Training | 64,000 | Equipment in place by autumn 02 | Dr M Brooks | Achieved | | | 64,000 | 0 | Improve communications and support for patients after imaging. Minimise waiting times for barium enema; fewer cancellations | Additional radiographer appointed and trained in performing double contrast barium enemas . However, this radiographer has now been promoted to another post and we are currently in the process of appointing another radiographer. |
Grampian 04 | Consultant Pathologist (0.3wte); MLSO/MLA staff; additional Medical Staff; Medical Supplies | 128,000 | Immediate | Dr M McKean | Achieved | | | 128,000 | 0 | Providing additional capacity to ensure more rapid diagnosis and treatment; shortening waiting times by addressing bottlenecks | Improved infrastructure in Laboratories to maintain the turnaround time and prevent a deterioration in the service provided. Pathology staff now regularly attend all cancer MDT meetings, and hold clinical pathology conferences for particularly complex cases. This contributes to the education of a wide range of staff. Pathologists also contribute to site specific groups, and redesign initiatives as appropriate. |
Grampian 05 | Consultant Pathologist; MLSO/MLA staff; additional Medical Staff | 102,000 | Immediate | Dr M McKean | Achieved | | | 102,000 | 0 | Providing additional capacity to ensure more rapid diagnosis and treatment; shortening waiting times by addressing bottlenecks | Improved infrastructure in Laboratories to maintain the turnaround time and prevent a deterioration in the service provided. Also see above. However a national shortage of staff and recruitment difficulties have meant that improvements are less obvious than had been hoped. |
Grampian 06 | 3 Video Bronchoscopes | 8,000 | Immediate | Dr M Nicholson | Achieved | | | 8,000 | 0 | Equityof access and improved standards of care | More accurate diagnosis and assessment of disease. |
Grampian 07 | Video conferencing links between Aberdeen and Inverness | 4,000 | Mar 02 | Mrs May Vobes | Achieved | | | 4,000 | 0 | Improved access to specialist advice without need to travel (patients and clinicians); improved communications | This equipment is used weekely for MDT meetings with staff in NHS Highland, improving communication links between clinical colleagues, and ensuring continuity of care for patients. |
Grampian 08 | Flexible Cystoscopes; Stacking system & camera for Cystoscopy; Piped oxygen & suction points.
Nurse specialist | 12,000 | Within 3 months of Nurse post being filled. | Ms A Hancock | Achieved | | | 12,000 | 0 | Improved patient care and communications
Improved access and more rapid diagnosis | The new stacking system has provided a larger and far clearer image for surgeons to carry out endoscopic urological procedures. The use of these images has provided a better level of record keeping and also visual information for the patients. |
Grampian 10 | Video colonoscopesand related equipment | 29,000 | Mid 2002 | Dr Perminder Phull | Achieved | | | 29,000 | 0 | Service redesign; more rapid diagnosis and reducation in waiting times
Compliance with CSBS standards | The colonoscopic equipment was delivered in april 2002. This has allowed additional colonoscopies to be performed. Waiting time for routine colonoscopy has been reduced from 12 months to 9 months. |
Grampian 11 | Pharmacy equipment - Glove Negative Isolators; Microbiological Safety cabinet | 2,000 | Immediate | Mr Brian Jappy | Achieved | | | 2,000 | 0 | Enhanced facilities to improve safety standards | Equipment purchased. Improvement in safety standards secured. |
Grampian 12 | Extend clinical audit programme | 27,000 | From Oct 02 | Jane Kane | Achieved | | | 27,000 | 0 | Enhancement of QA
Meet CSBS standards | 3 data collector posts filled from Aug 2002. 1.5 whole time equivalent at ARI and 0.5 wte at Dr Gray's. At ARI this equates to 0.5 wte each for breast, colorectal and lung. In Elgin 0.5 is shared across colorectal and breast. This is in addition to the previous clinical auditor input. Audit reports now produced which are helping to inform redesign initiatives within the services. Audit staff currently helping to complete review documentation for CSBS (NHS QIS) standards. |
Shetland | Endoscopy equipment | | Equipment purchsed and in place March 2002 | Dr S Taylor
Dr R Rarity | Due to employment of surgeon with endoscopy skills original funding used to employ locum to clear backlog until substantive postholder in place - full funding achieved | | | | 0 | Develop local endoscopy service, meet CSBS standards, improve patietn access | 5 sessions of lower GI endoscopy delivered, removed backlog of waiting times > 6 weeks. |
Tayside 06a | To extend and enhance quality assurance of cancer services | 31,000 | 2002/03 | Dawn Sturrock | Achieved | | | 31,000 | 0 | Extend QA programme to include wider range of tumour specific services; improved access and quality of care for patients through local review within managed clinical networks; monitoring SIGN or other national clinical guidelines. | PC purchased for use within cancer audit department, replaced old machine that was not functioning. Tayside 06a and 06b have been combined to provide additional audit staff to undertake Palliative pain audit in patients with cancer, Upper GI cancer audit and Head and Neck cancer audit and clerical support to Cancer Audit and Tayside Cancer Network Lead Cancer Team. Total of 2 WTE A&C 4 staff and 1 WTE A&C 3. Slippage money to be used to continue employing Data Manager on a temporary basis to continue the recently complete national audit of head and neck cancer until new posts are filled and national data definitions are defined by Scottish Cancer Therapy Network. Audit extended beyond priority sites to now include skin, urology, head/neck, haematology and upper GI. |
Tayside 06/27 | To extend present Tayside Cancer Audit Programme into Palliative Care, particularly management of pain | 27,000 | 2002/03 | Liz Goss | Achieved | | | 27,800 | -800 | Extend QA programme to include wider range of specific services; improved access and quality of care for patients through local review within managed clinical networks; monitoring SIGN or other national clinical guidelines. |
Tayside 06c | To develop staff skills in IT | 4,000 | 2002/03 | Dawn Sturrock | In progress - delayed | Difficulty in finding adequate educational courses specially for audit staff | Dec-02 | 6,000 | -2,000 | Updating skills in new technology to improve provision and presentation of audit data | Abertay University, Dundee have agreed to design a course to assist in the presentation of audit data especially predicted survival curves. Awaiting purchase of additional software before undertaking course. |
Tayside 06c | To develop staff skills in pain management | 10,000 | From April 02 | Liz Goss | In progress - delayed | Ethical approval recently agreed | Dec-02 | 10,000 | 0 | Enhance patient care through increased knowledge and expertise of staff, patients and carers. | Pilot pain audit with four practice 16/09/2002 and further development of database before implementing to other practices. Pilot completed, because of problems with uptake, project halted. Steering Group considering alternative project proposals. |
Western Isles | Scalp cooler | | Jan-02 | R Pickles | Achieved - equipment purchased | | | | 0 | Improved quality of care and quality of life | Use of scalp cooler offered to all patients who may benefit from it. |
Making it Happen |
NOSCAN 01 | Provision of Management Support to North network through development of North Cancer Manager post, Admin Support | 61,000 | Immediate | Prof N Haites | Achieved | | | 61,000 | 0 | Provide co-ordination and management support for Cancer and Palliative Care across North network. | NOSCAN team now in post. |
Tayside 01 | Provision of local management support to Tayside Cancer and Palliative Care Networks through development of Network Manager and admin/secretarial posts | 19,000 | By April 02 | Dr J Dewar and Dr M Leiper | Achieved | | | 25,000 | -6,000 | Provide co-ordination and management support for cancer and palliative care across Tayside area. | TCN coordinator appointed. Start 4th Nov 02. Lead Cancer Team established. Developing Cancer Services Framework, Communication Training Rollout Package, baseline trials data/activity recorded, monitoring QIS, etc. No further reporting anticipated. |
| Sub-Total | Allocation | | | | | Sub-Totals | Spent | Remaining | |
1,702,000 | | | | | 1,698,000 | 4,000 |