Specialised Commissioning Alert: patient access

Showing posts with label patient access. Show all posts

31 January 2020

This document is intended to provide some simple, practical ideas which clinicians, commissioners and policymakers could implement to help ensure that consistent and equitable treatment and care options are being offered to patients who present with similar profiles, regardless of where they live. Some of the issues raised require action and support from commissioners and national policymakers.

Only hospitals with a neuroscience centre can meet the requirements for a thrombectomy service and so the hospitals delivering the service will need to cover a wide geographical catchment.
The Clinical Senate reviewed the requirements for safe and effective delivery of a thrombectomy service across a wider geography and looked ahead to the potential delivery of a 24/7 service and the implications for the service in the interim. This report aims to understand the issues from the different perspectives of the local trusts, the hyper-acute stroke unit and the patients and their families.

Patients are defined as approaching the ‘end of life’ when they are identified as being likely to die within 12 months. Concerns have been raised about the variation in the quality of end of life care received by patients, with several reports highlighting poor care. This short report aimed to look at patients diagnosed with colorectal cancer who were at the ‘end of life’.
As expected, patients who did not live for more than a year from diagnosis tended to be older, have metastases, have poorer performance status, and to undergo no surgical procedure.
However, what was not known was that these patients had, on average, two hospital admissions with a length of stay of 18 days each and that a third spent over a month of their last year in hospital.
86% of those who lived for less than one year had at least one emergency hospital admission and, if that admission was in their last month, nearly two thirds died in hospital.
Of concern, patients with higher levels of deprivation appear to be more likely to die within 12 months of diagnosis, despite adjustment for other factors. This suggests that there may be some inequalities in access to colorectal cancer care services.

In 2018 Professor Stephen Powis, NHS National Medical Director, was asked to carry out a clinical review of standards across the NHS, with the aim of determining whether patients would be well served by updating and supplementing some of the older targets currently in use. In this interim report, Professor Powis sets out his recommendations for doing so in mental health, cancer, urgent and emergency care, and elective care.
For background see: Clinical review of NHS access standards

Routes to Diagnosis
PHE updated 17 January 2018

Routes to Diagnosis now includes 10 years’ worth of data, covering more than 3 million cancer cases. Key findings include:

diagnoses from emergency presentations, where outcomes are the worst, have improved falling from 24% to 20% between 2006 to 2015
diagnoses through urgent GP referrals - 2 week waits - have increased significantly from 25% in 2005 to 37% in 2015
diagnoses of pancreatic cancer through emergency presentation has fallen by 6%
diagnoses of colorectal cancers through the national bowel screening programme remain under 10%
the number of cancer cases diagnosed in Accident and Emergency varies across the country regardless of cancer incidence levels

This latest update includes a new interactive tool which presents trends in patient pathways leading to diagnosis for 53 different types of cancer.

A joint response to the Accelerated Access Review, setting out how government will improve patient access to breakthrough technologies and treatments.
Key elements include:

an Accelerated Access Collaborative that will develop an accelerated access pathway to bring breakthrough products to market and then to patients as quickly as possible
£86 million government funding to support innovators and the NHS in overcoming barriers to getting new, innovative technologies to patients quickly
improved NHS England commercial capacity and capability to deliver deals that achieve better value for the NHS and innovators.

BMJ Open 2016;6: e009388. doi:10.1136/ bmjopen-2015-009388

Description of a Health Foundation project to explore the advantages and limitations of video consultations over face to face or telephone consultations. The programme aims to create a virtual consultation unit in 2 contrasting clinical settings (diabetes and cancer) within Barts Health and form a national network of sites.