Cancer Alliance Data, Evidence and Analysis Service (CADEAS)

Cancer Alliance Data, Evidence and Analysis Service (CADEAS)
NHS England and Public Health England

• CADEAS was established during 2017/18 and supports Cancer Alliances’ analytical needs enabling them to lead transformation using a whole pathway and cross-organisational approach. 
• CADEAS aims to influence, inform and share best practice ensuring data, analysis and evidence and evaluation are at the heart of local decision making.
• CADEAS publish a variety of products for the 19 Cancer Alliances in England including
• Cancer Alliance, STP and CCG summary grid of key indicators
• Cancer Alliance data packs by CCG

Our data-driven future in healthcare

Our data-driven future in healthcare 
The Academy of Medical Sciences, 30 November 2018

• The report outlines principles that must be adopted by the NHS and industry, including medical technology developers and regulators, so that patients can benefit from digital information about them being used in smarter, more joined-up ways to revolutionise healthcare and support life-saving research.

National Vascular Registry: Annual Report 2018

National Vascular Registry: Annual Report 2018
HQIP  28 November 2018

• Comparative information on five major interventions for vascular disease plus the findings of an organisational audit which evaluated the current arrangement of hospital vascular services, which are in the process of being re-organised into vascular networks in England.
• Interventions are:
• Carotid endarterectomy
• Repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms
• Lower limb bypass
• Lower limb angioplasty/stenting
• Major lower limb amputation

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report
Getting It Right First Time, 28 November 2018

• The GIRFT review into oral and maxillofacial surgery across England outlines the need to centralise services and build on existing hub and spoke networks for the specialty, especially in the treatment of patients with head and neck cancer and those needing corrective jaw surgery. This configuration will enable central hubs to focus on in-patient work, while outlying spoke hospitals take care of day cases and out-patients, which form a high proportion of oral and maxillofacial work.
• The report also urges providers to consider allocating dedicated oral and maxillofacial theatre time for emergency cases, which in turn will help prevent out-of-hours operations and the cancellation of planned procedures, and reduce pre and post-operative length of hospital stay.
• It further calls for a standard protocol to be introduced across the country to reduce unwarranted variations in the number of hospital follow-up appointments after surgery. In the most straight-forward of cases, eg; dental extractions, the report suggests a target of zero follow-up appointments.

Recommendations fall within four key themes:

An assessment of the national approach to improving cancer services in England 1995–2015

Unfinished business: An assessment of the national approach to improving cancer services in England 1995–2015
Health Foundation November 2018

• This report offers an account of what has changed since 1995 in cancer services in England and explores what factors might have contributed to success and failure in how cancer services developed
• It finds that while progress has been made on reducing mortality, and improving the chances of survival and the experience of care, for people in England diagnosed with cancer,  the gap in survival rates has not been closed. 
• The report sets out recommendations to help bring about radical improvements in early diagnosis and detection of cancer, such as increasing investment in diagnostic equipment, building public understanding of cancer symptoms, improving resourcing of primary care, greater support for GPs to refer more patients and supporting collaboration across primary and secondary care.

Hepatitis C treatment monitor, patient re-engagement

Hepatitis C: guidance, data and analysis
Public Health England updated November 2018

• Guidance on the characteristics, diagnosis, management and epidemiology of hepatitis C (Hep C, HCV). Two new documents have been added to the collection: 
• Hepatitis C treatment monitoring in England
• Hepatitis C: patient re-engagement exercise

National Cardiac Audit Programme (NCAP) Annual Report 2018

National Cardiac Audit Programme (NCAP) Annual Report 2018
HQIP 22 November 2018

• Aggregate report on six major national clinical audits of care of patients treated in the UK for heart disease. The six audits are: Congenital audit, Heart Attack audit, Angioplasty audit, Adult Surgery audit, Heart Failure audit and Arrhythmia audit. 
• Includes highlights of best practice.

Brain and spinal stimulation therapies for phantom limb pain: a systematic review

Brain and spinal stimulation therapies for phantom limb pain: a systematic review
Health Technology Assessment 22(62) November 2018. https://doi.org/10.3310/hta22620

• Studies of neurostimulation treatments did not provide robust results; therefore, there is much uncertainty about which treatments are best for chronic phantom limb pain.

Cancer screening review

Cancer screening to be overhauled as part of NHS long term plan to improve care and save lives
NHS England 15 November 2018

• Professor Sir Mike Richards is to lead a major review of national cancer screening programmes.
• The review will look at how latest innovations can be utilised, including the potential use of artificial intelligence, integrating research and encourage more eligible people to be screened. It will also look to learn lessons from recent issues around breast and cervical screening.

South of England Cancer Alliances Dashboard

South of England Cancer Alliances Dashboard V3.3
Thames Valley Strategic Clinical Network,  updated 9 November 2018

Paediatric Intensive Care Audit Network: Annual Report 2018

Paediatric Intensive Care Audit Network: Annual Report 2018
HQIP 8 November 2018

• In addition to the standard headline figures on PICU activity, mortality, transport referrals, staffing, occupancy and the five quality measures (case ascertainment, retrieval mobilisation times, number of qualified nurses per bed, emergency readmissions within 48 hours and mortality in PICU), the report also focuses on referral and transport data examining the impact of winter pressures.

Service specification: Hyperbaric oxygen therapy

Service specification: Hyperbaric oxygen therapy (all ages)
NHS England 8 November 2018

• Hyperbaric oxygen treatment services include hyperbaric oxygen treatment services provided by Specialist Hyperbaric Oxygen Treatment Centres for specified conditions. This applies to provision in adults and children.

Pan-London Guideline for In Utero Transfer

Pan-London Guideline for In Utero Transfer
NHS London Clinical Senate 7 November 2018

• This guideline provides information on key areas of the in utero pathway and will help inform both the content and structure of local guidelines. The goal of the guideline is to better inform clinicians, support their decision-making process and reduce inappropriate variation in practice.

Liver disease profiles: November 2018 update

Liver disease profiles: November 2018 update
PHE November 6 2018

• Mortality data for 2015-17 for Alcohol-related liver disease, hepatitis B, hepatitis C and Non-alcoholic fatty liver disease.
• For trends see the Liver disease profiles: short statistical commentary

Understanding the Performance and Potential of Specialist Hospitals

Understanding the Performance and Potential of Specialist Hospitals
UCL Partners and the Innovation Agency 5 November 2018

• A review of around one-third of England’s 21 specialist trusts looked at why they consistently score higher than their counterparts in ratings for performance and satisfaction. 
• The review recommends seven ways in which local systems can benefit more widely from the role of specialist trusts. 
• The review focused mainly on the North West and London where there are clusters of specialist trusts, to explore the reasons for higher performance indicators – and to identify whether there is potential for them to do more. 

The recommendations are:

Knee replacement - future developments

Knee replacement
Price, Andrew J;  et al.

The Lancet; London Vol. 392, Iss. 10158, (Nov 3, 2018): 1672-1682. DOI:10.1016/S0140-6736(18)32344-4 [Available through NHS OpenAthens embargoed til February 2019]

• Summary
• Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. 
• Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. 
• Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. 
• New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.

Risk factors associated with revision for prosthetic joint infection after hip replacement

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study
Lancet 25 July 2018 DOI:https://doi.org/10.1016/S1473-3099(18)30345-1

• Analysis of National Joint Registry data for 623,253 hip replacement procedures carried out in England and Wales from 2003 to 2013 provides useful quantification of the risk of revision surgery due to infection. The paper highlights non-modifiable risks that will allow for improved counselling of patients prior to surgery and targeting of follow up as well as modifiable risk factors that can be used to reduce the risk of infection for patients undergoing hip replacement
• (NIHR Signal available here.)

Safety and feasibility of home-based chemotherapy.

Safety and feasibility of home-based chemotherapy.
Dan Med J. 2018 May;65(5). pii: A5482.

• This research study found that home-based chemotherapy is feasible and safe for patients who had undergone radical surgery for colon cancer, and that it might be a valuable alternative to treatment at an outpatient clinic.
• Location of study: Denmark

Are Angioplasty Waiting Time Inequalities Growing Again?

Are Angioplasty Waiting Time Inequalities Growing Again?
CHE Policy & Research Briefing April 2018

• This report examines angioplasty, a common heart revascularization procedure performed more than 20,000 times a year in England. 
• In the early 2000s, when waiting times were long, patients in the most income deprived fifth of neighbourhoods waited about 50% longer for non-emergency angioplasty than those in the least income deprived fifth. This gap occurred within hospitals, and was not primarily due to richer patients choosing to travel further to hospitals with shorter waiting times. 
• The gap fell to 10% by 2008 when waiting times were shortest, but started rising thereafter to around 20% by 2015 as waiting times started to grow again.

Warning Signs: Challenges to delivering the Cancer Strategy for England by 2020

Warning Signs: Challenges to delivering the Cancer Strategy for England by 2020
Macmillan Cancer Support February 2017

• This report seeks to understand how successfully the Cancer Strategy for England can be implemented in the NHS while the latter is under unprecedented pressure.
• One of the issues discussed are unclear responsibilities, both locally and regionally (p15), including
• 1. Fragmentation of commissioning responsibilities
• 2. Difficulty navigating statutory and non-statutory structures and reporting lines
• 3. Mixed messages
• 4. Mixed priorities

Figure 4. Generic cancer pathway – commissioning responsibilities p16

Figure 6. Who’s in charge? Attempting to map statutory and non-statutory organisations, initiatives and reporting lines affecting the delivery of the Cancer Strategy for England in 2017 p18