BREAST CANCER CASE STUDY
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SPAN Cellular Pathology Scotland: Now and Nex SAH, Dunfermline 6 th May 2016 (Lee Jordan, Lead Clinician) Scottish Pathology Net ⌃ (Cellular)
description
BREAST CANCER CASE STUDY. FRAZER BELL STUDENT BMS BSc APPLIED BIOMEDICAL SCIENCE. PATIENT HISTORY. 70 YEAR OLD FEMALE PRESENTED AT GP SURGERY 02/OCT/2012 EXAMINATION: RIGHT NIPPLE DRAWING IN & FIRM PALPABLE LUMP REFERRED TO THE BREAST CLINIC. BREAST CLINIC. ATTENDED 18/OCT/2012 - PowerPoint PPT Presentation
Transcript of BREAST CANCER CASE STUDY
SPAN
Cellular Pathology in Scotland: Now and Next…
SAH, Dunfermline6th May 2016
(Lee Jordan, Lead Clinician)
Scottish Pathology Network⌃
(Cellular)
SPAN
Mission Statement“To improve pathology services by creating and developing a Scotland-wide Managed Diagnostic Network, which will steer modernisation, including service change and redesign, improve quality, ensure provision of an effective pathology service which anticipates and responds to user needs, future requirements, and national guidelines and meets UKAS/ISO Standards.”
SPAN
Ayrshire & ArranDumfries and GallowayFifeForth ValleyHighlandLanarkshireLothian
–R.I.E (Lab Site)–WGH (Receiving/Reporting Site Only)
GrampianGreater Glasgow & ClydeTayside
Current Cellular Pathology Structure
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11
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1
SPAN
SPAN Constituency (1)
(Note a further 1.5WTE SAS grades are in post too)
SPAN
SPAN Constituency (2)• Who are our users?
– Cellular Pathology Departments• Other Organisations: SGHSCD, CMO Office, ISD, Screening,
Regional Planning, Professional Bodies, other Networks, SPAN Subgroups, SPAN spin out entities (Mol. Path. Consortium & Cervical Cytology Consortia), etc.
– Users of Cellular Pathology Departments• Clinicians (predominantly surgeons and oncologists)• Other cellular pathology departments, other laboratories
– Users of Clinical Services• Patients• Other clinicians
SPAN
Since 2014…
SPAN
Since 2014…
SPAN
Achievements (1)• ‘All change’ – a new model:
– Funding changes 2013/14– New Lead Clinician December 2013, 3 year tenure– New NNMS/NSD support model rolled out April
2014– Marked loss of specialist experience and time
resource substituted with general/generic support• Appointment of a Scientific Manager
– August 2014, 3 year tenure
SPAN
Achievements (2)• Ensuring continuity of Cervical Cytology Consortia
funding in time of crisis/collapse:– Funding was ending 31st December 2014
• Despite lobbying from 2013 onwards no clear commitment to renew
• Outside NSD/NNMS remit
– Expectation that activity would fall back to SPAN• Critical priority for community as workforce collapsing and NHS
Boards become unsustainable (Highland) • AW takes on role of Scientific Manager to ensure some form of
continuity
– Funding renewed few days before year end• Consortia Lead Clinician (1PA) & Consortia Manager (2 sessions)
SPAN
Achievements (3)• Moving Cervical Screening Programme to a
sustainable primary screening methodology (1):– Cervical Cytology being replaced around the world by
High Risk HPV testing as primary screening modality with Cytology being the subsequent diagnostic triage modality
– Clear view that no future in Cervical Cytology on current scale
• NHS Boards ceased investing in new training• Ageing workforce• Disinterest/disengagement of trainee and senior staff• Down-sizing of departments and cost-savings pressure
facilitated by prior Imager/MSC initiatives
SPAN
Achievements (4)• Moving Cervical Screening Programme to a
sustainable primary screening methodology (2):– Consortia model critical in providing cross boundary
support (hence need for renewal)– Scientific rationale for Primary HR-HPV testing
accepted by Scot Gov (prior activity)– Succeed in getting initial scoping and final business
case launched• Multiple subgroups• Significant/total use of Scientific Manager resource in
support at present• BUSINESS CASE NOT ACCEPTED OR APPROVED AS YET
SPAN
Achievements (5)• Maintaining pre-existing commitments in the
new model– Molecular Pathology Consortium Roles– Point of advice for those outside Cellular Pathology.
Examples:• Better Cancer Care, HCS NDP, HSST, Rare Diseases, HPS
(Ebola), UKAS views, PQAR (Barnes - England), FetalRemains, 7 Day services, etc.
– Support for the community incl. subgroups– Standard meetings plus extra NNMS/NSD interface
meetings and related comms
SPAN
Achievements (6)• Paediatric and Perinatal Pathology Services in Scotland:
A Review of Current Services and Future Network Planning – Horizon scanning by Steering Group => sustainability gap– SLWG with specialist lead, year long in depth review of
workload, staffing and resource locations– Published May 2015– Specific recommendations for sustainability of perinatal
autopsy provision in Scotland– Paediatric pathology recommendations not provided:
• Service contingent on supervening Managed Service Network for Children and Young People with Cancer (MSNCYPC) Second Review of the Pathways of Care for Children, Teenagers and Young Adults with Cancer in Scotland
SPAN
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Paediatric)and)Perinatal)Pathology)Services)in)Scotland)&
A&Review&of&Current&Services&and&Future&Network&Planning&&
Scottish&Pathology&Network&(SPAN)&
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Dr&Clair&Evans&(Review&Lead)&
Dr&Lee&Jordan&(SPAN&Lead&Clinician)&
Mr&Allan&Wilson&(SPAN&Scientific&Manager)&
Mrs&Alexandra&Speirs&(National&Network&Management&Service)&
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SPAN
Achievements (7)• Expert Opinion Impact Survey
– SPAN requested to carry out survey by constituent NHS Boards
– Concern over resource use by non-NHS Scotland labs– Demonstrated more resource used by non-NHS
Scotland labs than provided to NHS Scotland labs– Non-NHS Scotland labs started charging for services
despite NHS Scotland provision being free– Cost pressures significant in Lothian and Tayside– DSG agreed to allow cross charging at NHS Board
discretion
SPAN
Achievements (8)• Revision of SPAN annual data collection (1):
– Phase I - Improve and standardise definition interpretation. Allow whole systems performance measures (NHS Scotland wide). Direct peer review and discussion at Annual Quality & Performance event – Achieved 2014.
– Phase II – With Phase I success, lead a SLWG on refining collection with a view to introduce notional comparative productivity and financial measures. Aim to equal or surpass Keele but provide service relevance (also cost saving). Piloted April 2015, successful. Rolled out for 2014/15 general collection, successful.
SPAN
Achievements (9)• Revision of SPAN annual data collection (2):
– Phase III – Successful Phase I and II. Successful 2nd
Annual Quality & Performance Event. Aim to further refine, automate and transfer responsibility and delivery from Lead Clinician and Scientific Manager to a more sustainable Information Management Service provided model. Aiming to pilot for 2016 (2015/16 data collection round). Formally replace Keele.
SPAN
Achievements (10)• Creation and acceptance of an Annual Quality
& Performance Event for the network:– Review and discussion of network data– Whole cellular pathology service contribution and
involvement– Discussion of wider quality, performance and
accreditation issues– Formal environment for discussion of variation
and improvement
SPAN
SPAN: Power of Data
To end of 2014/15
SPAN
301739 310329313845
342532 344503 348881 351208 351710 357457360127
408453
450057
495333499424
513283
529338522414
300000
350000
400000
450000
500000
550000
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
Volu
me
Financial Years
All Scotland - Histology Request & Specimen Volume
Requests Specimens Linear (Requests) Linear (Specimens)
Total Change:+27.90%
Total Change:+19.35%
SPAN
19.16%
15.44%
29.38%
31.28%
19.03%
10.10%
16.22%
28.77%
16.05%
19.50%
19.35%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage Change - Requests (Since 2005/6 - 10 years)
All Year Percentage Change - Requests
SPAN
25.12%
23.41%
36.44%
55.66%
28.00%
10.13%
23.12%
38.24%
26.42%
28.65%
27.90%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage Change - Specimens (Since 2005/6 - 10 years)
All Year Percentage Change - Specimens
SPAN
854861
889328900778
981732
10127571016720
1010199
1022886
1049298
1062390
800000
850000
900000
950000
1000000
1050000
1100000
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
Volu
me
Financial Years
All Scotland – Histology Block Volume
Blocks Linear (Blocks)
Total Change:+24.28%
SPAN
2.08
1.70
1.75
1.37
2.22
1.69
1.70
2.44
1.88
2.09
1.98
1.99
1.97
1.79
1.36
2.18
1.91
1.67
2.44
2.08
2.06
2.03
0.00 0.50 1.00 1.50 2.00 2.50 3.00
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Ratio - Blocks : Specimens (2014/15 vs 2013/14)
Ratio - Blocks:Specimens 2014/15 Ratio - Blocks:Specimens 2013/14
SPAN
0.53
0.81
0.38
0.24
0.67
0.64
0.64
0.60
0.67
0.69
0.61
0.54
0.86
0.43
0.33
0.83
0.87
0.57
0.60
0.87
0.69
0.72
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Ratio - ICC Slides : Specimens (2014/15 vs 2013/14)
Ratio - ICC:Specimen 2014/15 Ratio - ICC:Specimen 2013/14
SPAN
34.15%
25.63%
24.30%
11.92%
14.59% 15.06%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
Volu
me
Financial Years
All Scotland - Percentage of Histology Requests Completed in 3 Calendar Days (72 hours)
Turnaround - All Requests in 3 Calendar Days Linear (Turnaround - All Requests in 3 Calendar Days)
*
**
** = Recalculated Data
SPAN
9.58%
36.18%
26.00%
13.10%
10.23%
17.75%
48.00%
17.19%
8.00%
9.05%
14.59%
9.03%
11.74%
29.40%
14.89%
9.98%
7.31%
51.81%
32.58%
7.52%
15.02%
15.06%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage of Histology Requests Completed in 3 Calendar Days (2014/15 vs 2013/14)
% Requests Completed in 3 Calendar Days (72 hours) 2014/15
% Requests Completed in 3 Calendar Days (72 hours) 2013/14
SPAN
76.13%
65.71%61.73%
49.03%
44.68%
47.36%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
Volu
me
Financial Years
All Scotland - Percentage of Histology Requests Completed in 7 Calendar Days (168 hours)
Turnaround - All Requests in 7 Calendar Days Linear (Turnaround - All Requests in 7 Calendar Days)
* = Recalculated Data
*
**
*
SPAN
27.57%
68.63%
78.00%
54.10%
35.33%
40.98%
89.00%
55.00%
38.60%
41.01%
44.68%
32.48%
50.42%
82.61%
64.89%
32.27%
40.16%
91.13%
61.97%
35.78%
60.84%
47.36%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage of Histology Requests Completed in 7 Calendar Days (2014/15 vs 2013/14)
% Requests Completed in 7 Calendar Days (168 hours) 2014/15
% Requests Completed in 7 Calendar Days (168 hours) 2013/14
SPAN
96.14%
95.38%
94.10%
98.32%
99.24%
72.38%
98.52%
91.74%
98.54%
94.12%
94.32%
93.10%
93.05%
92.31%
99.17%
81.37%
99.33%
97.00%
91.28%
99.62%
94.44%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Breast Cores - Percentage Reported in 7 Calendar Days (2014/15 vs 2013/14)
% Breast Cores Reported in 7 Calendar Days 2014/15 % Breast Cores Reported in 7 Calendar Days 2013/14
80% line – RCPath KPI
SPAN
39.35%
98.52%
91.15%
25.31%
15.32%
99.23%
75.06%
7.88%
85.54%
42.80%
0.00% 20.00% 40.00% 60.00% 80.00% 100.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Gallbladder - Percentage Reported in 10 Calendar Days (2014/15)
% Gallbladder Reported in 10 Calendar Days 2014/15 90% line – RCPath KPI
SPAN
402.34
114.96
155.00
330.60
533.23
64.02
198.00
572.00
155.00
345.26
0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Gallbladder - Turnaround - Mean Calendar Hours (2014/15)
Gallbladder Turnaround (Hours) 2014/15
SPAN
921.83
809.38
1254.64
1252.47
851.84
923.67
953.10
748.50
781.60
802.86
871.58
0.00 200.00 400.00 600.00 800.00 1000.00 1200.00 1400.00
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Notional Non-Screening Specimens per WTE based on Establishment –2014/15
Non-Screening Specimens per WTE
SPAN
£8.26
£11.72
£7.67
£7.20
£14.05
£10.80
£11.05
£11.31
£10.12
£8.51
£10.95
£57.10
£63.76
£42.84
£42.32
£58.48
£63.40
£53.82
£67.81
£64.14
£66.49
£59.36
£65.36
£75.48
£50.51
£49.53
£72.54
£74.19
£64.87
£79.11
£74.26
£75.01
£70.32
£0.00 £10.00 £20.00 £30.00 £40.00 £50.00 £60.00 £70.00 £80.00 £90.00
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Notional Costs per Non-Screening Specimen – 2014/15
Total Cost per Specimen Cost of Staff per Specimen Cost of Consumables per Specimen
SPAN
3.22%5.47%
4.49%
-2.69%
7.04%
-0.89%
1.00%
-10.77%
-37.57%-40.00%
-35.00%
-30.00%
-25.00%
-20.00%
-15.00%
-10.00%
-5.00%
0.00%
5.00%
10.00%
Perc
enta
ge C
hang
eWorkload vs Workforce (2010/11 to 2014/15)
Workload Growth - Requests (ALL Histo) Workload Growth - Specimens (ALL Histo)
Workload Growth - Blocks (ALL Histo) Workload Growth - Cytology Requests (ALL)
Medical Staffing Growth (Headcount NHS Establishment) Medical Staffing Growth (Pseudo-WTE NHS Establishment)
BMS & HCSW Growth (WTE Establishment) A&C Staffing Growth (WTE Establishment)
Cytoscreener Growth (WTE Establishment)
SPAN
10.76%
5.66%
7.55%
5.29%
9.36%
5.95%
12.03%
8.17%
10.04%
7.17%
9.44%
6.33%
13.00%
8.73%
10.81%
7.69%
10.04%
6.64%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
WTE
Financial Years
All Scotland - Medical Workforce (Career Grade) Vacancy Rate
Vacancy Rate ALL Career Grade (Headcount) Vacancy Rate ALL Career Grade (Pseudo-WTE)Vacancy Rate NHS Consultant Only Pseudo-WTE
SPAN
Now…BOARD YEARS CARRYING VACANCIES (SINCE 2007/8 – 9 YEARS)
Ayrshire & Arran 3
Dumfries & Galloway 8*
Fife 5
Forth Valley 4
Greater Glasgow & Clyde 8
Grampian 7
Highland 2
Lanarkshire 7
Lothian 7
Tayside 6
* = Guesstimate as 1 year without return
SPAN
Outsourcing/Locum Use
• 2014/15:– 17,407 requests locum reported (more than
Highland workload = 16,348)– 1688.25 DCC PA used additional to contract– Estimate minimum of 12 WTE worth
• Higher than declared vacancies (10.2)
SPAN
343.44
341.33
346.98
346.10
332.67
319.32
303.11
296.89
288.76
280
290
300
310
320
330
340
350
360
2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
WTE
Financial Years
All Scotland - Biomedical Scientists Overview
BMS Staffing (WTE) Linear (BMS Staffing (WTE))
Total Change: -15.92%
Annual Change: -2.74%
2014/15 Vacancy Rate: 2.68%
SPAN
AFC Band 6 = -8.71%
AFC Band 7 = -28.33%
AFC Band 5 = +48.01%31.50
9.0022.60
33.45
150.29
137.20
107.05
76.72
0
20
40
60
80
100
120
140
160
180
2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
WTE
Financial Years
All Scotland - Biomedical Scientists Breakdown (AfC 7 and below)
Trainee AFC Band 5 AFC Band 6 AFC Band 7
SPAN
A&A Surge = ?rebanding, decline in Band 5, Band 7 peak 2008/9
116.67%
0.00%
0.00%
13.75%
-43.71%
-15.00%
-6.33%
-4.86%
-42.50%
-44.44%
-28.33%
-60.00% -40.00% -20.00% 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% 140.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage Change - BMS AFC Band 7 (Since 2006/7)
Percentage Change BMS AFC 7 (since 2006/7)
SPAN
74.15
145.46
0.00
51.0242.54
84.04
31.61
10.40
0
20
40
60
80
100
120
140
160
2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
WTE
Financial Years
All Scotland - Healthcare Support Worker Overview
HCSW (Total) AFC Band 4 AFC Band 3 AFC Band 2
Total HCSW Change: +96.17%
Vacancy Rate: 5.05%
SPAN
88.86%
53.33%
156.33%
72.00%
99.53%
66.67%
43.60%
232.00%
56.47%
217.14%
96.17%
0.00% 50.00% 100.00% 150.00% 200.00% 250.00%
Ayrshire & Arran
Dumfries & Galloway
Fife
Forth Valley
Gtr Glasgow & Clyde
Grampian
Highland
Lanarkshire
Lothian
Tayside
SCOTLAND
Percentage Change - HCSW ALL (Since 2006/7)
Percentage Change HCSW ALL (since 2006/7)
SPAN
Data Conclusion (1)1. Rising workload (?complexity) & administration
1. Insufficient medical resource – provided the system remains the same
1. Poorer Turnaround
1. (Any clinical impact?)
SPAN
Data Conclusion (2)5. BMS establishment has been diminished
6. There has been down-banding
7. Replacement by HCSW
8. Cost saving? Role extension?
SPAN
What Else Happening Now? (1)• Formal External Network Review
– Reporting soon…
• Role Extension Work– HCS NDP (Developing Sustainable
Services/Workforce Re-profiling): BMS Dissection, (BMS Reporting)
• Medical Workforce – Revision of National Modelling
SPAN
What Else Happening Now? (2)• Pathology Quality Assurance Review Issues
– SBSP QA Parameters
• Review of Renal/Liver Pathology Services– Data collection and analysis
SPAN
Horizon Scanning• Steering Group Output:
• Adult Autopsy Provision Review• Endocrine Service Provision Review• Haematopathology review• Semenology review • Revisiting the EM Services Review due to low demand and ageing
equipment• Generate a framework for handling backlogs and service deficits
across the network – mimic profit-making support services within the NHS Scotland context
• Shared storage and retrieval of cellular pathology archives. Consider the bio-resource potential too.
• Digital Pathology revisit• A Consortia model for wider cellular pathology services?
SPAN
What’s Happening Next?• Site Visits Restarting• Cancer Network/Wider Communications• Website Redesign• IHC/ICC Review (Demand Optimisation)
– Explore variation, repertoire and UKAS/ISO related issues
• Shared Services…(top down issue)
SPAN
Shared Services“In Autumn 2014 a ‘Guiding Coalition’ comprising NHS Board Chairs and Chief Executives came together to consider the key strategic challenges facing health services in Scotland, i.e. to ensure the desired outcomes stated within the NHS Scotland 2020 Vision whilst addressing the pressing current and emerging demands upon the system including the growing financial challenge. A number of work-streams were identified as being essential to delivering quality clinical services that are both safe and financially sustainable; one of these is ‘Shared Services’.”
SPAN
Shared Services does includeDiagnostics including
Cell Path
SPAN
Discussion
