WEST MIDLANDS STRATEGIC CLINICAL NETWORK – CANCER

MINUTES OFWEST MIDLANDS HEPATOBILIARY EXPERT ADVISIORY GROUP

Held on Thursday 02 October 2014 at Walsgrave Hospital, Coventry

Present:

Mr Mark Deakin / MD / University Hospital North Staffordshire NHS Trust
Mrs Mandy Wilson / MW / West Midlands Strategic Cancer Network
Ms Elizabeth Hands / EH / University Hospital Coventry and Warwickshire NHS Trust
Mr John Isaac / JI / University Hospital Birmingham NHS Foundation Trust
Mr F T Lam / FTL / University Hospital Coventry and Warwickshire NHS Trust
Mr Saboor Khan / SK / University Hospital Coventry and Warwickshire NHS Trust
Ms Catherine Markham / CM / University Hospital Birmingham NHS Foundation Trust
Ms Jenny Merry / JM / University Hospital Coventry and Warwickshire NHS Trust
Mrs Brenda Stephenson / BS / Patient \ Carer Representative
Dr Jeremey Shearman / JS / South Warwickshire Hospital NHS Foundation Trust
Dr Sharmila Sothi / SS / University Hospital Coventry and Warwickshire NHS Trust
Ms Sue Turnecliff / ST / George Elliot Hospital NHS Trust
Dr Paul Wilson / PW / Heart of England NHS Foundation Trust

In Attendance:

Mr Rob Gornall / RG / West Midlands Strategic Cancer Network
Mrs Danielle Taylor / DT / University Hospital Coventry and Warwickshire NHS Trust

1. Apologies:

Dr Mark Vipond / MV / Gloucestershire Hospitals NHS Trust
Ms Chris Hall / CH / University Hospital North Staffordshire NHS Trust
Dr Stefan Hubscher / SH / University Hospital Birmingham NHS Foundation Trust
ACTION
2. / Minutes of the Meeting Held on 01 April 2014
These were agreed as a true record.
3. / Matters Arising
3.1 Membership
MD reported that he is constantly being asked about membership and the current list circulated to members showed the membership of the Group at the present time.
He continued by reporting that the membership was based predominately on when the Group was the “old” Supra Network Group plus Chairs from the “old” Colorectal and Upper G.I. Network Site Specific Groups.
It was agreed that it is important to encourage as many Trusts to attend meetings as possible, especially the smaller Units, as the majority of those in attendance represented the 3 main Units.
It was further outlined that poor attendance was not solely aligned to this Group but also affected other Expert Advisory Groups as well.
In terms of location of meeting it was outlined that attendance always seemed to better from one Trust than another purely depending on the location of the meeting.
4. / Review of Hepatobiliary Services within the West Midlands – update on progress
RG outlined that the first meeting of the Senate Panel was to be held on 15 October 2014 and it is intended for this to be a short life working panel whose members included experts from outside the Region. The Chair of the Panel is Professor David Luesley a Gynaecologist from Sandwell and West Birmingham Hospitals NHS Trust. Internal members invited to join the panel include MD, SK, JI and PW.
The aim of the Panel is to develop an options appraisal report for the West Midlands for Hepatobiliary services which will then be presented to the Clinical Senate Council for approval.
It was further clarified that the Panel will purely be looking at Hepatobiliary cancers but will take into account and recognise the impact on benign and trauma cases.
ACTION
It was clarified that everyone would like the process to be not only clear and consisive but also open and transparent and that any decision made is acceptable and receptive, if necessary, to criticism.
As previously outlined it was felt that it is important that the Chair, Professor Luesley, be an open and fair person and to this members were informed that he had been elected by the Clinical Senate as an independent representative and he was held in high esteem in the cancer world.
It was clarified that the review is to identify whether the current service provision should continue or should it be changed. Either way there is a need to ensure there is a good service for patients with Hepatobiliary cancers in the West Midlands.
It was outlined that year after year the issue of the 3 Units not being Improving Outcome Guidance compliant is raised by Peer Review and therefore an agreement has finally been reached that this issue needs to be addressed.
Members were informed that once the decision from the Panel has bene made then this would be present to the Clinical Senate Oversight Group for consideration and if there is a clear outcome then it is hoped that this would take affect from 2015 although liaison will need to be undertaken with Specialised Commissioners before any changes are made.
5. / Briefing Document for Panel Meeting on 15 October 2014
MD continued by reporting that he had been asked to produce a report on turnaround times within the West Midlands which for the Hepatobiliary service is based in 3 Units who each have virtually the same population. Although it was noted that there is an additional centre for paediatric service.
It was clarified that the information produced for University Hospital Birmingham NHS Foundation Trust does include Defence Medicine liver cases who are post trauma and will probably need surgery and it was agreed that this information needs to be included.
MD continued this item by tabling a report based on resectional activity within University Hospital North Staffordshire NHS Trust and University Hospital Birmingham NHS Foundation Trust for 2013 (January – December).
ACTION
It was noted that throughout the United Kingdom there are approximately 2000 liver resections annually and the figures in the tabled report shows that regionally Trusts are doing more than their fair share.
It was felt that the data presented should be validated for accuracy and this could be done by comparing the data with information provided by HES.
A question was asked in respect of how information on morbidity and mortality is reviewed and the response to this was that this information is included within the report but generally felt that there would not be a great change.
Following this discussions were undertaken in relation to the Cancer Profile report that had been circulated to members for reviewing and some minor amendments were made which MW will undertake. It was also agreed that additional data was required to complete this report and members would send this to MW for inclusion. / MW\
Group
6. / Review\Development of Clinical Guidelines
Management of Liver Mets
It was agreed Ian Geh, Oncologist from University Hospital Birmingham NHS Foundation Trust, would be asked to undertake the review of this document.
Referral and Management Guidelines for Pancreatic and Related Cancers
JI agreed to be the Lead to review this guideline.
West Midlands Guideline on the Management of Pancreatic Cystic Lesions
MD agreed to be the Lead to review this guideline in conjunction with Brin Mahon.
Guideline on the Management of Gallbladder Polyps
SK agreed to be the Lead to review this guideline.
Leads were asked to endeavour to get these documents completed before December 2014 as the aim is for them to be presented at the Workshop to be organised for early 2015. / IG
JI
MD\
BM
SK
ACTION
7. / 2 Week Referral Form – for reviewing
PW agreed to remind Marcus Mottershead of the need to submit the draft version that he wished the Group to review.
A discussion was then undertaken in respect of waiting times targets RG asked those present if they had been experiencing any specific problems as nationally there are problems being experienced in this area especially in tumour sites such as Breast, Colorectal and Upper G.I., areas not usually prone to high waiting time’s figures.
Those present reported that they are not experiencing any problems and that waiting times for Hepatobiliary cancers are generally quite low.
RG continued that in respect of the areas experiencing a high volume of waiting times plans have been put in place to assist Trusts in this area. For the West Midlands there appears to be 5 Trusts “affected” one of them being University Hospital Birmingham NHS Foundation Trust.
It was felt that at a future meeting a review of the waiting times data could be undertaken. / PW\
MM
Agenda
8. / Plan for Education event 2015 to Launch Guidelines
As mentioned in Agenda Item 6 it is intended for this event to take place in early 2015.
9. / Co-ordination of Trial Participation and Entry into Hepatobiliary Trials in the West Midlands
At this point of the meeting SS introduced herself and informed members that she had been elected to be the Hepatobiliary Sub Speciality Research Lead for the West Midlands and therefore will be able to provide the Group with regular updates on trial recruitment and availability.
10. / Any Other Business
ERCP
JS asked whether it would be possible to undertake a West Midlands review of this service looking not only at Endoscopists but also Units in relation to who is providing the service and where it is being done.
It was clarified that the proposal of the review was also to identify how many slots were available on each list.
ACTION
Radiology Representation
The Group were informed that Kam Mangat is no longer employed at University Hospital Birmingham NHS Foundation Trust and therefore could be removed from the membership list.
It was agreed that MW would contact members to identify a Radiologist from each Unit to become a member of the Group. / MW
MW\
Group
11. / Date and Time of Next Meeting
The date and time of the next meeting is Thursday 08 January 2015 at 9.30 a.m. - venue to be confirmed

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