Approved Minutes of NICaN Breast Regional Group Meeting
Thursday 13th May, 2008NICaN
NICaN Regional Breast Group
Thursday 13th May, 2008
Record of Attendees
Ms Margaret Browne / Ms Janis McCullaDr Alison Clayton / Ms Brenda O’Kane
Dr Graeme Crawford / Ms Jane Rankin
Dr Dermot Hughes / Ms Elaine Shaw
Mr Robert Kennedy / Ms Danny Sinclair
Mr Stephen Kirk / Ms Jennifer Somerville
Ms Jean Lennox / Ms Bridget Tourish
Ms Gillian McCollum / Ms Helen Vennard
Apologies: Gavin Briggs, Mary Brown, Celine Duffy, Mairead Duffy, Dr Angela Garvey, Elaine Heaney, Frances Houston, Elvira Lowe, Clive Majury, Grainne Mccusker, Dr O’Neill and Rosey Whittle.
Welcome and Introductions
Mr Stephen Kirk (Clinical Lead) welcomed everyone to the meeting and advised the group that he would be the Chair for the meeting. Mr Kirk extended a welcome to Dr Dermott Hughes in his capacity as newly appointed NICaN Medical Director. It was noted that a Chair for the group has now been confirmed and that Mr Seamus McGoran (Director, Hospital Services, South Eastern Trust) will be fulfilling this role in future meetings.
Mr Kirk advised the group that the process for electing a Chair person for the group was via the NICaN Board in line with the Group constitution where it is proposed that, where feasible, a NICaN Board member would act as Chair of a Regional Group.
BG-0508-30 Minutes & Matters Arising from Meeting 06/02/08
The minutes of the meeting held on 6th February 2008 were agreed as a true and accurate reflection without amendment.
BG-0508-31Framework Standards for Breast Cancer Services
Mr Kirk provided an update to the group in relation to the development of the standards for Breast Cancer Services highlighting that the aim of the standards was to concentrate on 1 -2 key areas that would have the greatest impact on the services provided for patients.
Ms Tourish circulated copies of the finalised standards for Breast to the Group and advised that the standards had been reviewed by Professor Mark Baker (External QA for the Framework) and some queries had been received in relation to mastectomy rate and stretch within the performance indicators in the treatment and care standard.
It was noted that Mr Kirk had submitted a letter with the standards detailing that the mastectomy rate should stay at 40% as agreed via the sub-group as this is a reasonable and achievable figure. The letter also noted that In relation to invasive disease and endocrine therapy, the target of 95% is also appropriate and that this was set as a minimum target which the group would be happy to see exceeded.
Dr Clayton queried the difference in mastectomy rates and whether there is evidence to suggest why. Mr Kirk suggested that there is regional variation across the UK and Mr Kennedy noted that there is a higher UK average in number of patients diagnosed at screening.
Next steps
Ms Tourish advised that the Framework document will be submitted to the DHSSPS on 14thMay 2008 and that consideration should now be given to the development of an implementation guide for the standards.
Action: Ms Tourish to work with the sub-group on the development of the implementation document once a template has been confirmed by the DHSSPS and to keep the group informed of ongoing progress.
BG-0508-32 Diagnostic Protocol
Mr Kirk asked the group for any further comments on the amended protocol which had been circulated. No further comment was noted and there was a consensus that the protocol was accepted.
Action: Diagnostic protocol agreed and to be uploaded onto NICaN website.
BG-0508-33 Clinical Minimum Dataset
Ms Tourish advised the group that an amended dataset has now been sent
to Mr Seamus McAleer for QA prior to final sign-off.
Action: Ms Tourish to circulate dataset following QA by Mr McAleer to group for final comments. Responses will be required within a two week period to ensure sign-off is achieved on this dataset as soon as possible.
BG-0508-34 Patient Pathway Development – AHP Site Specific
Ms Jane Rankin, Lead Cancer Physiotherapist provided a presentation detailing the work of the AHP sub-group in developing site specific pathways. It was noted that the pathway has now been completed for 5 tumour groups (to include Breast).
These will now be presented to the NICaN Board fro endorsement and then ‘rolled out’ among the tumour groups.
The AHP tumour specific pathways are now available for all professionals to access and use as a training and reference resource. They are to be incorporated into all of the existing tumour multi-professional pathways to help address survivorship issues through increased awareness of role and referral criteria.
Action: Ms Tourish to e-mail electronic copy of pathway to regional group members.
BG-0508-35 Breast Cancer Patient Information Pathway
Ms Danny Sinclair, NICaN Regional Co-ordinator, Patient Information provided update on the work to date and tabled copies of the DRAFT pathway. Ms Sinclair highlighted the process which has been undertaken in the development of the pathway in identifying what information is required and at what stage of the patient journey.
It was noted that the pathway is now nearing completion (expected sign-off at September’s meeting) and Ms Sinclair sought comments from the group in appraising the pathway and gaining agreement on what information is CORE etc.
Mr Kirk highlighted the importance of this key area of work to the group, valuing the development of the pathway which ensures that all patients get the right information at a time that is right for them.
Action:Ms Sinclair to circulate e-mail to group requesting comments/feedback by 30th May 2008.
BG-0508-36 Consent
Ms Tourish advised the group that the area of consent had been raised as an issue in relation to whether written consent should be sought for tests that could be viewed as invasive. Mr Kirk sought comments from the group, highlighting that there was a number of legal issues to be considered within this area.
Dr Hughes advised the group that this issue had also been previously raised in relation to tissue retention and it is quite a grey area for clarity. Dr Hughes highlighted that firstly a clear definition of what constitutes consent is required and that he was not conscious of this being a burning issue.
Ms O’Kane requested clarification and it was noted that the issue had been discussed with Breast care Nurses and Patients (Patient Information Group) as a general topic, however particularly within the context of screening.
Following much discussion it was agreed that this is not a pressing issue at present, however should be kept under review.
Action: Ms Tourish to research what currently happens in the UK and to bookmark this issue for future review.
Mr Kennedy to clarify consent advice from breast screening program.
BG-0508-37 Work Plan
Ms Tourish talked the group through a number of key areas which should form part of the annual work plan of the group, highlighting that key areas identified will need to be in line with the Cancer Services Framework.
Ms Tourish drew the groups attention to the template for producing of the work plan which she had began to populate and to a copy of an annual report from Yorkshire Cancer Network which had been circulated.
Comments were sought from the group in relation to further populating the work plan and agreement of priorities.
Ms Tourish highlighted that one of the key priorities for all of the tumour groups would be that of development of Clinical Management Guidelines (CMGs) to support the standards within the Cancer Services Framework and highlighted that she plans to discuss this area of work with Dr Martin Eatock (Chair, NICaN Drugs and Therapeutics Committee) to ensure an aligned process.
Action: Ms Tourish to circulate e-mail to group asking for all group members to input in the population of the work plan and identifying key priorities.
Item to be further explored at September’s meeting.
Any other business
Attendance at Regional Meetings
Mr Kirk advised the group that the issue of poor attendance at the Breast regional group meetings recently has been noted and sought comment from the group in addressing this to ensure that all relevant disciplines are represented.
Ms Tourish advised that Core members were confirmed via Trust Executive Leads and that the days of the meetings are being alternated to facilitate attendance.
Action: Ms Tourish to discuss with Network Director, Chair and Clinical lead and will provide update to regional group at next meeting.
NI Lymphoedema Network
Ms Rankin advised the group that the NI Lymphoedema Network are holding their 1st Board meeting in June and that she would be happy to provide updates in relation to the work of the Network at the Breast regional meetings.
Action: Ms Tourish to link with Ms Rankin to ensure that this is a recurrent agenda item.
Meeting close and next meeting
Mr Kirk closed the meeting by thanking everyone for their attendance and participation. The next meeting of the Breast regional group will be held on Wednesday 3rd September, 2pm – 5pm, Ewart Room, Holywell Hospital, Antrim.
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