Patient engagement – Diagnostic Breast Services

We are carrying out a 12 week period of engagement looking at Breast Diagnostic Services and how they work for patients in South Tees (Middlesbrough) and Redcar and Cleveland. The engagement will last for 12 weeks from Friday 1st November 2019 to Friday 7th February 2020.

Background

In October 2015 the Breast Diagnostic Service at James Cook University Hospital (JCUH), Middlesbrough, temporarily moved to University Hospital of North Tees due to an inability to recruit breast radiologists. This affected their ability to support patients presenting with a breast symptomatic concern and obtaining the appropriate investigations to diagnose the issue.

 

North Tees and Hartlepool NHS Foundation Trust (NTHFT) agreed to provide the service on behalf of South Tees patients (South Tees covers the areas of Middlesbrough, Redcar and East Cleveland), which meant that patients would need to travel to North Tees Hospital in Stockton-on-Tees for their symptomatic appointment.

 

In September 2019, NHS South Tees Clinical Commissioning Group (CCG) agreed with Middlesbrough Health Overview and Scrutiny Committee that it would carry out a period of patient engagement with people from the Middlesbrough and Redcar & Cleveland areas, who currently access the breast symptomatic service at University Hospital of North Tees and key stakeholders.

What does this mean?

Women with suspected breast cancer following an appointment with their GP (and for the purposes of this engagement – not via the breast screening service) are referred into a specialist breast service (breast diagnostic service – also sometimes known as a breast symptomatic service) and are offered a triple diagnostic assessment in one single hospital visit in accordance with National Institute of Clinical Excellence standards (NICE 2016). Under NHS Standards all breast patients should be offered an appointment within two weeks whether the GP suspects cancer or not. South Tees CCG is responsible for the commissioning of the Breast Symptomatic Service for South Tees patients.

The triple assessment involves;

  • Clinical examination
  • Breast imaging (mammography and/or ultrasound)
  • Taking a sample of breast tissue

This ensures rapid diagnosis whilst reducing anxiety associated with multiple hospital appointments.

It was the breast symptomatic diagnostic service outlined above that closed temporarily at JCUH in October 2015. Since then women in South Tees have attended University Hospital of North Tees hospital for that service.

What we want to talk to you about

During this period of engagement we would like to talk to you about the following;

  • Your experience of the Symptomatic Breast Service at North Tees as someone who lives in the South Tees area
  • Your understanding of the definition of breast services (Breast Screening Services, Breast Diagnostic Services, Breast Treatment Services) – you may not know what the ‘symptomatic’ service is and how this relates to Breast Screening Units (BSUs) and the way each service is delivered
  • The current service including why the service was removed from James Cook University Hospital
  • What happens elsewhere in the country
  • What are the barriers that may exist that prevent women attending their appointments and how we can improve
  • Talk to you and get your views about the findings of the Northern Cancer Alliance report and the challenges we face locally

How to get involved

We are asking people to complete a survey online using the following link

Survey

If you require a paper survey and freepost envelop please e-mail NECSU.engagement@nhs.net or call 01642 745401.

We are posting a survey with freepost envelope to all patients in the South Tees area that have been referred to the Symptomatic Breast Service by their GP at University Hospital of North Tees since 1st January 2018.

We are engaging with the voluntary and community sector via a series of targeted focus groups. If you would like join one of those focus groups please call us on 01642 745401.

Engagement summary

Stakeholder briefing

Press release

Challenges

Workforce

  • There is a national shortage of radiologists, (120 vacancies across the North East and Cumbria) and it is recognised that radiology workforce growth has not kept pace with the increase in clinical demand [RCR 2016].
  • In a statement provided by Chair of the Cumbria and North East Imaging Group (Workforce Sub-group) on 2 July 2018, they have explained that “England has a significant shortage of radiologists, sonographers and radiographers. For example, England has half the number of radiologists per head of population compared with the European average.
  • The service at University Hospital of North Tees is also facing challenges due to the national shortage of radiologists and the fact that a number of radiology staff have retired and returned on a temporary basis.

What you have already told us

The CCG is keen to build on previous patient engagement undertaken and understand how patients from the South Tees area are accessing breast symptomatic services, any barriers to service, what ‘good’ looks like to them in order that they can build a more detailed picture of the service and feed this into work ongoing across the region that is looking closely at the way hospital services are organised.

Some patient engagement has already taken place in 2017 in two phases. Patient experience questionnaires were provided to patients who attended the symptomatic breast service at North Tees in August 2017 and November 2017.

In November 2017, 150 questionnaires were distributed to patients from the South Tees area who travel to North Tees for their appointment. 50 questionnaires were returned (33% response rate). A report of the 2017 feedback is available on the CCG website www.southtessccg.nhs.uk

Key themes

  • People in South Tees told us that they travelled anywhere between 5 and 20 miles to attend the breast clinic at North Tees
  • The majority of respondents in South Tees (82%) travelled by car
  • 76% of respondents said they were happy to travel to the clinic (North and South Tees patient survey August 2017)
  • The majority of South Tees patients (88%) said they did not experience any difficulty in travelling to the clinic
  • 86% of South Tees patients said they did not have any difficulty finding the clinic when they arrived at University Hospital of North Tees
  • 100% said they were dealt with promptly and efficiently at reception
  • When asked about the facilities at the breast clinic 54% of respondents in South Tees said they were good and 46% said they were excellent
  • 88% said they had received a clear explanation from staff regarding what would happen during the appointment
  • 96% of South Tees patients said that they had had privacy at the breast clinic at University Hospital of North Tees
  • 68% of South Tees respondents said that they had had clear answers to important questions
  • 86% of respondents had received an explanation from staff regarding how they would receive their test results
  • 100% said they were treated with dignity and respect
  • 94% said that the services worked well together to give the best quality of care
  • 80% said the care received was rated as excellent
  • 84% said they were extremely likely to recommend the clinic to friends and family that may need tests/investigations

Overall comments from South Tees patients surveyed in 2017 were;

  • Friendly helpful staff
  • Very informative
  • Put at ease
  • Receiving immediate results
  • Rapid referral time
  • Professional team
  • Long waiting times
  • Busy and small waiting area
  • Difficulty finding hospital
  • Clinic should be at James Cook University Hospital – closer (3 Responses)
  • Should allow a companion during scans
  • Give choice of appointments
  • Information on what happens after the scan – future appointments/ treatments

Also in 2017, The Northern Cancer Alliance (NCA) carried out a regional review of Breast Services. The aim of this work was to provide an overview of current breast services for Cumbria and the North East and look at how those services could best be provided in the future taking into consideration the challenges we face locally with regard to recruitment. The report acknowledged that the region’s services need to be changed to enable them to be sustainable into the future.

The NCA recommendation at this time was to develop a ‘Hub and Spoke’ model for the service through Breast Screening Units (BSU) with outreach clinics delivered locally, where this was possible to do so based on the availability of staffing.

‘Hub and Spoke’ model

Breast Screening Units (BSU) would provide a hub and spoke service with outreach clinics delivered locally. BSU will be the anchor site (hub) providing an integrated care model with spoke sites providing local services to a wider population utilising existing facilities and equipment where possible. The BSU would be responsible for the whole service and the workforce within it.

Advantages:

  • Single point of access with additional options [where to attend for clinics].
  • Uniform operational system.
  • Improved recruitment opportunities as part of a screening service.
  • Should improve retention of staff.
  • Remove competition.

Disadvantages:

  • Large populations and case load.
  • Potential data sharing and IT issues if services are incompatible.
  • Organisational barriers to ways of working.
  • Potential negative public perception.

What does good look like?

NICE referral quality standards [2016] state that commissioners should ensure they commission specialist services that provide a service whereby people with suspected breast cancer are referred to specialist services and offered a triple diagnostic assessment in a single visit. Whilst quality standards are aimed at driving the quality of care, NICE acknowledges this may not be appropriate in practice and that local arrangements can be developed.

The “Gold-Standard” recommendation for a One-Stop Breast Clinic in the diagnosis of symptomatic breast cancer requires provision of a facility staffed by professionals with the combined abilities to perform triple assessment:

  • Clinicians [Doctors and/or Nurse Practitioners] with the necessary clinical skills to take histories and perform clinical examination of patients.
  • Radiologists and radiographers to perform mammography and ultrasound examination.
  • Expertise to undertake biopsy.

Summary and next steps

NHS South Tees CCG is carrying out a 12-week period of engagement with patients from the Middlesbrough and Redcar & Cleveland areas, who currently access the breast symptomatic service at North Tees Hospital in Stockton-on-Tees

The CCG is keen to understand how patients currently access the service, their views on the service and the impact of travelling to North Tees for the symptomatic element of the service

The feedback will be independently analysed and a report will be produced which will be made public. The report will be taken to a future meeting of the Joint South Tees Health Overview and Scrutiny Committee

The CCG will then consider feedback from the committee and next steps, alongside wider regional work in the ICP before updating patients and stakeholders on what will happen next and whether or not any proposals will be developed that could constitute significant service change and therefore formal public consultation.

This leaflet can be made available in large print, other formats and languages on request, by e-mailing NECSU.engagement@nhs.net or by calling 01642 745401.