Published on 12 September 2024
Improving patient safety is always of the highest priority across NHS organisations in Cheshire and Merseyside.
This year’s World Patient Safety Day (September 17th) has a theme of improving diagnosis and how correct and timely diagnosis, including in cancer, can improve patient safety and, ultimately, save lives.
Over the past year, teams across diagnostics, including in cancer through interventions by Cheshire and Merseyside Cancer Alliance (CMCA), have been focussing on improving our services for patients to help them have better access to diagnostic tests, correct and timely diagnosis and in turn meet our goal of improving health outcomes.
Here are just a few ways in which Cheshire and Merseyside Cancer Alliance ‘improving diagnosis for patient safety’ in cancer…
Faster diagnosis services
Speeding up diagnosis is crucial to improving the chances of successful cancer treatment – and hospital trusts across Cheshire and Merseyside are introducing new initiatives to do this.
With the help of CMCA, The Clatterbridge Cancer Centre in partnership with Liverpool University Hospitals has introduced a Haematology Rapid Diagnosis Service which speeds up tests for blood cancer. The aim is to have all relevant tests completed within a few of weeks of referral by a GP, with treatment beginning within a couple of weeks of a diagnosis being given.
A similar service has been launched at Wirral University Teaching Hospital. The Non-Specific (NS) Rapid Diagnosis Service focuses on patients with concerning symptoms suspicious of a cancer diagnosis but not fitting into a ‘site specific’ urgent cancer pathway. The service includes dedicated weekly CT scan slots for the NS rapid diagnosis referrals and the team meet weekly to discuss outcomes and further management. This means that CT scans can be performed and reported faster than the current direct access imaging.
Targeted Lung Health Checks
CMCA continues to lead the Targeted Lung Health Check programme across Cheshire and Merseyside, with support from ICB Place teams where the checks are being conducted, and in partnership with Liverpool Heart and Chest Hospital, which administers the checks and associated CT scans.
Around 130,000 appointments for the checks have been sent out during the past few years in Liverpool, St Helens, Halton, Knowsley and south Sefton and more than 500 lung cancers have been found. The checks have recently launched in Wirral and Warrington and the whole of Cheshire and Merseyside will be covered by 2027.
The lung health check programme is successfully shifting a proportion of diagnosis of lung cancer in the areas it covers from later stages 3 and 4 to early stages 1 and 2. This has a significant impact on outcomes for these patients with a much higher proportion of them having successful curative treatment, which is also simpler to perform.
Cancer-related Serious Incident Reviews
CMCA’s role as the ‘cancer arm’ of the integrated care system for our sub-region involves sharing key learning for our colleagues, partners and stakeholders to improve patient safety.
CMCA worked with the ICB central quality team to develop a process whereby the Cancer Alliance receives and reviews serious incidents that involve cancer patients, to identify any shared learning for our cancer system.
The CMCA process is in place to highlight key themes and shared learning across the system and complements the NHSE Patient Safety Incident Response Framework (PSIRF).
Cheshire and Merseyside diagnostics is also helping to speed up diagnosis in a number of ways. These include:
Improving waiting times
Cheshire and Merseyside is holding one of the top spots as one of the best performing ICSs (Integrated Care System) out of 42 for diagnostic waiting time performance. As of June 2024, Cheshire and Merseyside ranks 2nd out of 42 ICSs for Diagnostic Performance.
The sub-region remains one of only two ICSs to be delivering waiting time performance of 90% of patients receiving a diagnostic test within six weeks. The ranking includes waiting times for a number of diagnostic tests that are offered across Cheshire and Merseyside at various hospitals and community diagnostic centres, including computed tomography (CT) and magnetic resonance imaging (MRI) scans, sleep studies, colonoscopies, hearing assessments and echocardiography tests to name only a few.
In comparison to 12 months ago, waiting list times have been reduced by over 9,000 patients and ensures that all patients in Cheshire and Merseyside wait less time.
June 2023 76,047 patients waiting
June 2024 66,452 patients waiting
10 CDCs across Cheshire and Merseyside
Over the last three years, we have opened 10 Community Diagnostic Centres (CDCs) in Cheshire and Merseyside, which gives us more sites where tests are provided, as well as the additional test capacity for our population. Our CDCs have delivered over 400,000 additional diagnostic tests, and they currently provide around 7,000 tests a week, with services accessible (in some sites) for up to 12-14 hours a day, seven days a week.
Many of the CDCs in Chesire and Merseyside can be found near or on the same sites as local hospitals while others are found in new central locations, such the shopping centre setting at the Halton Health Hub.
Introducing Mutual Aid
In Cheshire and Merseyside, we are also helping patients to get quicker access to their diagnostic tests through the use of the Cheshire and Merseyside Mutual Aid Process.
The Mutual Aid Process is a collaborative approach which enables trusts with patients who face a longer wait for their tests, to have an alternative faster appointment from a local CDC or participating trusts. To date, around 1,500 patients have opted to be seen in a CDC or local trust rather than wait to be seen in their local hospital.
This team or system approach means that we can offer patients greater choice and drive waiting times down. Very few systems are operating like this and we are regularly asked to support other systems to develop such an approach. We all have a collective duty to work together to ensure that no one waits longer than they need to.
Endoscopy Transformation Programme
Endoscopy services across Cheshire and Merseyside have been undergoing an extensive transformation aimed at improving waiting times, access, and the quality of services. Endoscopy in Cheshire and Merseyside serves a population of 2.7 million across nine trusts and 13 units.
The programme will be delivering four different models of care aimed at improving endoscopy diagnosis including:
- Development of an additional central Hub site for endoscopy services, creating further capacity to deliver services
- Providing service users with less invasive alternatives to endoscopy at an increasing number of locations including transnasal endoscopy, and pill on a string alternative
- Delivering specialist procedures/advanced endoscopy at a limited number of sites to retain specialist skills and resources
- Testing the use of innovative digital programmes to help reduce duplication of administrative processes.
The purpose of the programme is to transform endoscopy services across Cheshire and Merseyside, ensuring they are fit for purpose, that they are using the latest and best technology and to create an ‘endoscopy without borders’ service that allows for better access.
Introducing AI into diagnostics
Up to £1.2m was awarded to Cheshire and Merseyside to accelerate the implementation of an AI imaging and support tool which can analyse chest X-ray images and identify possible signs of lung cancer.
When the AI technology identifies a potential lung cancer case, the information is relayed to the radiologist in under a minute. If they confirm the solution’s findings, the patient is booked for a CT scan on the same day, fast tracking both diagnosis and treatment.
In this project, led by CAMRIN, AI imaging will be integrated across nine NHS trusts across the Cheshire and Merseyside Integrated Care System (see the story here). This project aims to enhance efficiency and quality of care within the lung cancer pathway by streamlining the process and facilitating same-day CT examinations, as recommended by the National Optimal Lung Cancer Pathway (NOLCP). The technology will be supplied by Annalise.ai a global health company offering AI solutions for clinicians.