North Wales Cancer Network

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North Wales Cancer Network
North Wales
Haematological Cancers
Multidisciplinary Team (MDT)
Operational Policy
DRAFT 5 – January 2007
Policy agreed . . . . . . . . . . . . . . . . . . . . .
Policy to be reviewed by . . . . . . . . . . . .
Draft 5 Haematology Operational Policy
January 2007
1
CONTENTS
1.0
INTRODUCTION
4
2.0
SCOPE OF THE SERVICE
4
2.1
RESOURCES AVAILABLE AT EACH SITE
5
3.0
MDT STRUCTURE AND IMPLEMENTATION
6
3.1
NORTH WALES MDT MODEL
6
3.2
CORE MDT MEMBERS
6
3.3
ROLE OF THE CORE MDT
7
3.4
CORE MDT LEAD CLINICIAN
7
3.5
LOCAL CLINICAL TEAM MEMBERS
7
3.6
ROLE OF THE LOCAL CLINICAL TEAMS
9
3.7
LOCAL CLINICAL TEAM LEAD CLINICIAN
10
4.0
ACCESSING THE SERVICE
10
4.1
URGENT ‘SUSPECTED CANCER’ GP REFERRALS
10
4.2
OTHER REFERRALS
10
4.3
EMERGENCY ACCESS TO CLINICAL TEAM
10
4.4
WAITING TIMES
10
5.0
TREATMENT PLANNING DECISIONS
11
5.1
YSBYTY GWYNEDD
11
5.2
YSBYTY GLAN CLWYD
11
5.3
YSBYTY MAELOR
11
5.4
JOINT/COMPLEX MEETINGS
11
6.0
ACCESS TO OTHER SERVICES
12
6.1
PSYCHOLOGICAL SUPPORT
12
6.2
FERTILITY SERVICES
12
6.3
OTHER SUPPORT SERVICES
12
6.4
PALLIATIVE CARE
12
7.0
PATIENT PATHWAYS
12
Draft 5 Haematology Operational Policy
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8.0
CLINICAL GUIDELINES AND POLICIES
13
9.0
RISK MANAGEMENT
13
10.0
COMMUNICATION
13
10.1
COMMUNICATION BETWEEN TEAM MEMBERS
13
10.2
COMMUNICATION BETWEEN MDT AND PATIENT/CARER
14
10.3
COMMUNICATION SKILLS TRAINING
14
10.4
PATIENT WRITTEN INFORMATION
14
10.5
COMMUNICATION WITH GPs
14
11.0
DATA COLLECTION AND INFORMATION
14
12.0
AUDIT
15
13.0
CLINICAL TRIALS
15
14.0
NEW DRUGS
15
15.0
ONGOING EDUCATION
15
16.0
SERVICE IMPROVEMENT
15
17.0
AGREEMENT TO OPERATIONAL POLICY
16
APPENDIX 1 CORE MDT TERMS OF REFERENCE
17
APPENDIX 2 CORE MDT LEAD CLINICIAN JOB DESCRIPTION
19
Draft 5 Haematology Operational Policy
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3
1.0 INTRODUCTION
This operational policy details the scope and organisation of services offered by the North Wales
Haematological Cancers MDT. It sets out the agreed standards and processes to which all
members of the MDT should work in order to ensure the delivery of high quality patient focused
care.
The policy has been developed in accordance with national guidelines on the delivery of
haematological cancer services, including NICE guidance on Improving Outcomes in
Haematological Cancers (2003), the WAG National Standards for Haematological Cancer Services
(2005) and JACIE Standards for Haematopoietic Progenitor Cell Collection, Processing and
Transplantation (2005).
The objectives of this policy are to:




Provide a detailed description of the foundations that support the single MDT model adopted in
North Wales
Describe the operational policy by which MDT members should function
Provide an indication to policy makers, commissioners and other stakeholders of how the
service is configured and how it functions
Establish a framework for the future assessment of the service
This policy will be reviewed annually by the North Wales Haematological Cancers MDT and
updated as appropriate.
2.0 SCOPE OF THE SERVICE
The North Wales Haematological Cancers MDT provides care to a total population of
approximately 665,000 (2001 census). The MDT acts as a single team with services based on
three sites:



Ysbyty Gwynedd, Bangor, part of North West Wales NHS Trust
Ysbyty Glan Clwyd, Bodelwyddan, part of Conwy and Denbighshire NHS Trust
Ysbyty Maelor, Wrexham, part of North East Wales NHS Trust
The MDT manages adults with leukaemia, lymphomas and myeloma. All children presenting with
a haematological malignancy are referred to the specialist service at Alder Hey Hospital in
Liverpool.
The MDT offers treatment up to BCSH level 3 ie up to and including high dose therapy with
autologous transplantation. Patients requiring level 4 services (ie allogeneic transplantation) are
referred to hospitals outside the North Wales Cancer Network, dependent upon the exact nature of
the disease and treatment required.
The stem cell harvest service is based at Ysbyty Gwynedd with subsequent re-infusion taking
place either at Ysbyty Gwynedd or Ysbyty Glan Clwyd. Wrexham patients are referred to the
Christie Hospital in Manchester for stem cell transplantation; the MDT is working towards the
repatriation of this work to North Wales in 2007/08. The service at Ysbyty Gwynedd currently
performs an average of 13 autologous transplants p.a. and is preparing for JACIE accreditation in
2007/08.
Draft 5 Haematology Operational Policy
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Radiotherapy is provided at the North Wales Cancer Treatment Centre at Ysbyty Glan Clwyd. In
addition, Wrexham lymphoma patients requiring therapeutic radiotherapy are referred to the
Christie Hospital in Manchester and all patients requiring total body irradiation prior to allogeneic
transplantation are referred to the hospital undertaking the transplantation.
Diagnostic services are available at all three sites. In addition the MDT has access to specialist
pathology services via the All Wales Lymphoma Review Panel and the cytogenetics service in
Cardiff. Patients requiring PET-CT scanning are referred to Mount Vernon Hospital, Watford, in
line with the Health Commission Wales service level agreement.
2.1
RESOURCES AVAILABLE AT EACH SITE
YSBYTY GWYNEDD
Inpatient facilities
Day care facilities
Support services
Medical staff
Nursing staff
Pharmacy
Alaw Ward - an 18 bedded haematology, oncology and palliative care
ward; 8 single rooms, of which 6 are ensuite
Alaw Day Unit - a dedicated haematology/oncology day case and
outpatient unit; 5 beds and 5 chairs for day case treatments
All laboratories on site; on-site CT, MRI, bronchoscopy, ITU and HDU
4 consultant haematologists (inc. 2 part-time); 1 full-time and 2 parttime Staff Grades; 1 Associate Specialist in Oncology for stem cell work
1 specialist nurse in haematology; chemotherapy and haematology
trained nurses on Alaw Unit (inc. venous access)
On-site pharmacy using open laminar flow system; Trust developing
business case for on site aseptic unit. Lead pharmacist for oncology
YSBYTY GLAN CLWYD
Inpatient facilities
Day care facilities
Support services
Medical staff
Nursing staff
Pharmacy
Enfys Ward - a 20 bedded haematology and oncology ward within the
North Wales Cancer Treatment Centre (NWCTC); 8 single rooms with
ensuite including 3 with HEPA filtration for stem cell re-infusion.
Heulwen Day Care Unit – a dedicated haematology/oncology treatment
unit within the NWCTC; 16 chairs/beds for day case treatments
All laboratories on site; on-site CT, MRI, bronchoscopy, ITU and HDU
4 consultant haematologists (of whom 3 are full-time haematooncologists); 1 Staff Grade and 1 ST1
1 haematology nurse practitioner; chemotherapy and haematology
trained nurses on Enfys and Heulwen (inc venous access)
On-site aseptic unit; dedicated pharmacist for haematology
YSBYTY MAELOR
Inpatient facilities
Day care facilities
Support services
Medical staff
Nursing staff
Pharmacy
Access to 6 inpatient beds on Mason Ward (medical ward) with scope
for more if required; 5 single rooms inc. 2 en-suite
Shooting Star Unit - a purpose built, dedicated haematology/oncology
day case and outpatient unit; 5 beds and 6 chairs for day treatments
All laboratories on site; on-site CT, MRI, bronchoscopy and ITU
2 consultant haematologists; 1 Associate Specialist and 0.5wte Staff
Grade
1 haematology clinical nurse specialist; chemotherapy and
haematology trained nurses on Mason Ward and the Shooting Star unit
(inc. venous access)
On-site aseptic unit; dedicated pharmacist for haematology
Draft 5 Haematology Operational Policy
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3.0 MDT STRUCTURE AND IMPLEMENTATION
The North Wales Haematological Cancers MDT recognises that a multi-disciplinary approach is
essential to the management of haematological cancer patients.
MDT working ensures the provision of high quality care through the sharing of knowledge and
expertise. Both policy development and individual patient treatment planning decisions are
improved through review, discussion and agreement by experienced clinicians from a range of
specialties.
3.1
NORTH WALES MDT MODEL
The North Wales Haematological Cancers MDT has adopted a model whereby the service is
overseen by a core North Wales MDT with care delivered to patients on three different sites; this
ensures access to a high quality local service for the entire North Wales population.
The North Wales MDT membership therefore reflects two levels of involvement:
1. Core MDT members – these members are responsible for the overall running of the North
Wales haematological cancers service by defining its operational policy
2. Local clinical team members – these members are the local arm of the North Wales MDT
and are responsible for local service delivery in line with the overarching MDT operational
policy
3.2
CORE MDT MEMBERS
The core MDT is representative of each core discipline and each site providing treatment as part of
the North Wales Haematological Cancers MDT. Additional members of the clinical teams may be
invited to attend core team meetings as required.
Name
Dr D Edwards
Dr J R C Seale
Dr C F Hoyle
Dr M J Goodrick
Dr E Heartin
Dr D Watson
Dr J Duguid
To be agreed
Dr A Nethersell
Dr D J Widdowson
Linda Jones
Steph Jackson
Jayne Samuels
To be agreed
To be agreed
Nicola Andrews
Damian Heron*
Caroline Williams*
Gillian Evans*
* where appropriate
Title
Consultant Haematologist and lead clinician
Consultant Haematologist
Consultant Haematologist
Consultant Haematologist
Consultant Haematologist
Consultant Haematologist
Consultant Haematologist
Pathologist (local/Lymphoma Panel rep)
Consultant Clinical Oncologist
Consultant Radiologist
Specialist Nurse in Haematology
Haematology Nurse Practitioner
Clinical Nurse Specialist, Haematology
Ward sisters
Palliative care specialist
Data lead
Director
Project lead
User advisor
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Location
Ysbyty Gwynedd
Ysbyty Gwynedd
Ysbyty Glan Clwyd
Ysbyty Glan Clwyd
Ysbyty Glan Clwyd
Ysbyty Maelor
Ysbyty Maelor
Ysbyty Glan Clwyd
Ysbyty Glan Clwyd
Ysbyty Gwynedd
Ysbyty Glan Clwyd
Ysbyty Maelor
Ysbyty Glan Clwyd
NWCN
NWCN
NWCN
3.3
ROLE OF THE CORE MDT
The core MDT meets regularly (as a minimum quarterly).
The role of the North Wales Haematological Cancers core MDT is to:













Agree an operational policy for the delivery of haematological cancer services across North
Wales based on current national guidance and accepted best practice
Ensure the operational policy is implemented effectively on all three sites and reviewed and
updated annually
Agree referral and clinical guidelines for haematological malignancies in North Wales
Agree optimum patient pathways for each disease type
Ensure service improvement is embedded in local teams and initiate MDT wide initiatives
Agree a minimum data set and analyse clinical data capture, performance and outcomes
Agree and implement an annual audit programme
Address any MDT wide governance or operational issues raised by the local clinical teams
Identify core MDT training needs and agree an ongoing educational programme
Agree a list of clinical trials and prepare any submissions for clinical trials
Prepare any submissions for new drugs
Agree an annual work plan
Act as the Network advisory group for haematological malignancies, advising on service
provision and making recommendations for service development/reconfiguration
Full terms of reference are attached as Appendix 1.
3.4
CORE MDT LEAD CLINICIAN
The core MDT lead clinician has responsibility for the development and overall running of the North
Wales Haematological Cancers MDT, in particular:








To agree the membership and role of the core MDT and ensure it meets at least quarterly
To ensure the core MDT agrees an operational policy and clinical guidelines for the optimum
management of haematological cancer patients based on accepted best practice.
To ensure the operational policy is reviewed and updated annually
To ensure clinical guidelines and patient pathways are reviewed and updated regularly
To ensure that care is delivered on all three sites in line with the agreed operational policy and
clinical guidelines
To ensure the MDT fulfils its full role as defined in its terms of reference
To agree an annual work plan for the core MDT
To attend both Trust and Network cancer meetings and provide expert advice on the tumour
site as appropriate, including fulfilling the role as the designated Network Board member
The lead clinician’s duties are included in his/her job plan.
A full job description is attached as Appendix 2.
3.5
LOCAL CLINICAL TEAM MEMBERS
The local clinical teams comprise members of each core discipline required to provide treatment as
part of the North Wales Haematological Cancers MDT. In addition each has extended members
who offer advice to the team as required.
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7
YSBYTY GWYNEDD
Name
Dr J Seale
Dr D Edwards
Dr H Korn
Dr H Parry
Title
Consultant Haematologist; lead clinician
Cons Haematologist; transplant lead
Locum Cons Haematologist (part-time)
Locum Cons Haematologist (part-time)
NB Leaves March ‘07
Dr E Mitchell
Staff Grade Haematologist (part-time)
Dr S Griffiths
Staff Grade Haematologist (part-time)
Dr I Tahan
Staff Grade Haematologist
Dr T Caslin
Consultant Histopathologist
Dr M Lord
Consultant Histopathologist
Dr S Andrew
Consultant Histopathologist
Dr T Nethersall Consultant Clinical Oncologist, NWCTC
Dr R Williams
Associate Specialist, Oncology (haem)
Dr S Wenham
Consultant Radiologist
Linda Jones
Specialist Nurse in Haematology
Manon Jones
Senior Nurse, Alaw Unit
Jackie Jones
Ward Sister, Alaw Ward
Laura Edge
Ward Sister, Alaw Day Unit
Elaine Wain
Deputy Sister, Alaw Day Unit
Dr A Fowell
Macmillan Consultant in Palliative Care
Tania Seale
Haematology Research Nurse
Alice Thomas
Haematology Research Nurse
Mark Hankey
Data co-ordinator
Plus the following extended team members:
Dr S Darcey
Consultant Microbiologist
M Hughes
Pharmacist
Telephone
01248 384370
01248 384369
01248 384384 x5227
01248 384369
01248 384369
01248 384369
01248 384369
01248 394719
01248 394719
01248 394719
01745 445157
01248 384150
01248 384690
01248 384384 x5171
01248 384945
01248 384945
01248 384008
01248 384008
01248 384384 x5142
01248 384994
01248 384995
01248 384384 x5191
Cover
Internal crosscover
Internal crosscover
No cover
No cover
No cover
Internal crosscover
L Roberts
Internal crosscover
Sec team
01248 384367
01248 384140
YSBYTY GLAN CLWYD
Name
Title
Dr C Hoyle
Consultant Haematologist; lead clinician
Dr M Goodrick Consultant Haematologist
Dr E Heartin
Consultant Haematologist
Dr M Hassan
Staff Grade Haematologist
Dr M Atkinson
Consultant Histopathologist
Dr T Nethersell Consultant Clinical Oncologist
Dr Widdowson Consultant Radiologist
Dr P Travis
Consultant Radiologist
Steph Jackson
Haematology Nurse Practitioner
Gwyneth Davis Clinical Trials Nurse
Nerys Wilkes
Sister, Enfys Ward
Dr C Usborne
Consultant in Palliative Care
Sue Randles
MDT co-ordinator
Plus the following extended team members:
Dr D Edwards
Transplant Director, Ysbyty Gwynedd
Dr N Looker
Consultant Microbiologist
Dr P Manion
Consultant Microbiologist
Dr C Bell
Consultant Anaesthetist
H Flint
Clinical Lead Pharmacist, Haematology
C Wood
Radiotherapist
C Vickering
Dietician
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Telephone
01745 534881
01745 536739
01745 534377
01745 534881
01745 534064
01745 445157
01745 534115
01745 534516
01745 445272
01745 445211
01745 445251
01745 445909
01745 445170
01248 384369
01745 534356
01745 534708
01745 534650
01745 535242
01745 445130
01745 445239
Cover
Internal crosscover
Dr Giles
Dr Azam
Internal crosscover/SpR
Internal crosscover
Yvonne Rose
Anne Hughes
YSBYTY MAELOR, WREXHAM
Name
Dr D Watson
Dr J Duguid
Dr L DeSoysa
Dr P Smith
Dr R Williams
Dr A Burdge
Dr K Pradeep
Dr A Al-Samarraie
Dr M Elias
Dr J Klafkowski
Jayne Samuels
Anne-Marie
Humphreys
Sr T Vipond
Dr M Makin
Sandra Davies
Title
Consultant Haematologist; lead clinician
Consultant Haematologist
Associate Specialist, Haematology
Staff Grade, Haematology/Oncology
Consultant Histopathologist
Consultant Histopathologist
Consultant Histopathologist
Consultant Clinical Oncologist, NWCTC
Consultant Radiologist
Consultant Radiologist
Clinical Nurse Specialist, Haematology
Sister, Shooting Star Day Unit
Telephone
01978 725100
01978 725866
01978 725081
01978 727603
01978 725610
01978 725079
01978 725611
01745 445158
01978 727800
01978 725493
01978 727130
01978 727603
Ward sister, Mason Ward
Consultant in Palliative Care
MDT co-ordinator/patient tracker
01978 725443
01978 290919
01978 725199
Plus the following extended team members:
Dr E Liailopoulou
Transplant Director, Christie Hospital
Dr C Cefai
Consultant Microbiologist
A Ellis-Jones
Pharmacist
Cover
Internal crosscover
Internal crosscover
No cover
Internal crosscover
Internal crosscover/Wenna
Hammond
Macmillan CNS
Other cancer
co-ordinator
0161 446 8488
01978 725861
01978 725959
In addition the MDT has access as required to the following specialities on each site: dietetics,
orthopaedic surgery, dermatology, gastroenterology, ENT, interventional radiology, renal medicine,
social work, physiotherapy, occupational therapy, psychology and counselling.
3.6
ROLE OF THE LOCAL CLINICAL TEAMS
The role of local clinical teams is to:













Deliver care in line with the agreed MDT operational policy
Review all patients, establish and record a diagnosis and agree a treatment plan
Discuss responses to treatment during and at the end of therapy and agree any necessary
changes in management
Consider all facets of individual patient’s needs including their psychological needs and liaise
with primary care, palliative care, elderly services, voluntary organisations as appropriate
Identify requirements for staff and facilities for the treatment it offers
Ensure adequate information, advice and support is given to patients and carers
Ensure GPs are given prompt and full information on patient management and contact details
of relevant clinical team members
Record the minimum data set for all haematological malignancies
Identify members’ training needs and ensure these are met
Participate in clinical trials and research
Collaborate in MDT audit
Lead local service improvement initiatives and participate in MDT wide initiatives
Review any local clinical governance issues including untoward incidents ensuring appropriate
action is taken
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3.7
LOCAL CLINICAL TEAM LEAD CLINICIAN
Each of the three sites where care is delivered has a lead clinician who is also a member of the
core MDT. He/she is responsible for ensuring that:




The delivery of care at a local level is compliant with the policies, guidelines and protocols
adopted by the North Wales MDT
The local team at all levels of involvement are familiar and compliant with the policies,
guidelines and protocols adopted by the North Wales MDT
Local clinical governance issues are addressed
Any conflict between local requirements and that of the MDT are raised with the MDT lead and
the employing Trust is informed of the need to do so.
4.0 ACCESSING THE SERVICE
4.1
URGENT ‘SUSPECTED CANCER’ GP REFERRALS
All patients meeting the criteria set out in the NICE ‘Referral for suspected cancer’ guidelines
(www.nice.org.uk) should be referred to the appropriate local clinical haematological cancers team
without delay, as set out in each Trust’s Directory of Cancer Services. This Directory is available
on each Trust intranet site and is circulated to local GP practices.
All referrals are reviewed by a consultant within 24 hours and if deemed to be appropriate, the
patient will be seen within a maximum of 10 working days. If the referral is inappropriate, an
alternative course of action is offered eg a routine appointment.
4.2
OTHER REFERRALS
Many patients with haematological malignancies, in particular lymphomas, are referred initially to
other specialty teams. As soon as a haematological malignancy is diagnosed, a copy of the
pathology report should be sent to the local haematological cancers team; in addition any
abnormal electropherysis result should be copied by the biochemistry laboratory to the
haematology department to follow-up.
4.3
EMERGENCY ACCESS TO CLINICAL TEAM
All patients and their GPs should be given details of how to access members of the local clinical
team in an emergency. North Wales triage standards are currently being developed and will be
implemented by each team.
4.4
WAITING TIMES
All patients diagnosed with a haematological malignancy will, where appropriate, start definitive
treatment within national waiting times targets. In reality treatment usually begins much earlier
than this in line with clinical need.
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5.0
TREATMENT PLANNING DECISIONS
All patients with haematological cancers should be managed by a member of the North Wales
Haematological Cancers MDT. Any patient with a haematological malignancy initially presenting to
another speciality should be referred to the Haematological Cancers MDT without delay.
All patients should be reviewed by their local clinical team and multi-disciplinary treatment planning
decisions made in line with agreed MDT clinical guidelines and protocols through daily ward
rounds and weekly clinical meetings held on each site.
5.1



5.2



5.3




5.4


YSBYTY GWYNEDD
All patients are reviewed on daily consultant-led ward rounds
A clinical team meeting is held every Wednesday morning to review all new malignancies, premalignancies and other complex cases; the outcomes are recorded on an MDT proforma. This
meeting is attended by all members of the local clinical team (see section 3.5) with the
exception of the histopathologists and consultant oncologist
A pathology meeting is held on alternate Mondays with the haematologists and pathologists
YSBYTY GLAN CLWYD
All patients are reviewed on daily consultant-led ward rounds
A clinical team meeting is held every Friday to discuss all new cancer patients; a list of patients
to be discussed is sent out in advance of the meeting, based on new diagnoses made in clinics
or via emergency admissions and any additional cases highlighted by histology. The meeting
is recorded with minutes circulated to all members of the team; a register of attendance is kept.
This meeting is attended by all members of the core local clinical team (see section 3.5) with
the exception of the histopathologist, palliative care consultant and ward sister
A pathology meeting is held every Tuesday with the haematologists and histopathologist
YSBYTY MAELOR
All patients are reviewed on daily consultant-led ward rounds
A clinical team meeting is held every Monday morning to review all patients to be treated that
week with the medical team, day unit nursing team, pharmacist and co-ordinator/tracker
A radiology meeting is held on the first and third Friday of each month to review old and new
patients; the medical team, radiologists, CNS, day unit nursing staff attend this meeting
Discussions are held with the histopathologist, oncologist and palliative care team on individual
cases as required
JOINT/COMPLEX MEETINGS
Stem cell meetings are held at Ysbyty Gwynedd on the first Friday of every month to review all
stem cell transplant patients. The team from Ysbyty Glan Clwyd attend every other month.
The Wrexham team will join this meeting when their stem cell transplantation work is
repatriated to North Wales
Where individual complex cases arise, the North Wales Haematology Cancers MDT is
available via email, telephone, video-conferencing or the case may be added to the agenda of
an existing meeting eg the Blood Club or MDT meeting. Alternatively, members of the MDT
may contact nationally recognised experts for advice prior to the local clinical team meeting in
order to ensure the delivery of best possible clinical care.
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6.0 ACCESS TO OTHER SERVICES
6.1
PSYCHOLOGICAL SUPPORT
Psychological support is offered by the clinical nurse specialists/nurse practitioners in the local
clinical teams who also provide patients with details of any local support groups. Where specialist
support is required patients from Ysbyty Glan Clwyd and Ysbyty Wrexham can be referred to the
psychology support team based at Ysbyty Glan Clwyd. Patients at Ysbyty Gwynedd can access
specialist courses in stress reduction (Mindfulness). The teams can also access their local
psychiatric liaison services if required.
6.2
FERTILITY SERVICES
The MDT supports patients who wish to access fertility services prior to treatment. It is the agreed
policy of the MDT that male patients should be referred to St Mary’s in Manchester and female
patients should be referred to the specialist gynaecology service at the Liverpool Women’s
Hospital. Ysbyty Gwynedd currently provides a sperm storage service but this is under review
following the introduction of more stringent legislation in this area and it is likely Bangor patients
will soon be referred to St Mary’s in Manchester in line with MDT policy.
6.3
OTHER SUPPORT SERVICES
The MDT has access to dieticians, physiotherapists, OTs and benefits advisors at each site.
6.4
PALLIATIVE CARE
The transition from active treatment to palliative care is handled sensitively in accordance with the
patient’s individual needs and wishes. Local clinical teams have access to specialist palliative care
where appropriate via the individuals listed in section 3.5 above. Each local clinical team follows
its Trust’s agreed end of life pathway.
7.0
PATIENT PATHWAYS
The North Wales Haematological Cancers MDT has agreed to adopt the All Wales patient
pathways for haematological cancers where they exist. The lymphoma pathway has been
published and is included as Appendix (need to add); work is ongoing to develop All Wales
pathways for CLL and AML.
For disease types where there is no All Wales pathway, the MDT will work to develop a local
agreed pathway.
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12
8.0
CLINICAL GUIDELINES AND POLICIES
All patients must be treated according to agreed clinical guidelines or as part of a formal clinical
trial.
The North Wales Haematological Cancers MDT has agreed the following clinical guidelines:
 The British Committee for Standardisation in Haematology (BCSH) Guidelines– see
www.bcshguidelines.com
 The North West Region Haematology Guidelines – see www.nwhaems.co.uk
 The Myeloma Forum Guidelines – see www.myeloma.org.uk
 The CLL Forum Guidelines– see www.cllforum.com
(Can these be pulled together and do they include imaging and follow-up?)
All treatment should also be conducted in accordance with the following Network wide policies:
 The North Wales Cancer Network Cytotoxic Chemotherapy Policy 2006
 Chemotherapy protocols for each agreed regimen; these will be collated in the next Network
Formulary
 The North Wales triage guidelines (when agreed)
In addition local clinical teams should deliver care in line with local Trust policies on:
 chemotherapy administration (including intrathecal chemotherapy)
 infection prevention and control
 the use of all medical devices
 management of side effects, anaphylactic shock etc
 risk management and incident reporting
These policies and protocols are available on individual Trust intranet sites.
9.0 RISK MANAGEMENT
All risk management issues and clinical incidents should be addressed by the relevant local clinical
team in line with their Trust policy on risk management and incident reporting. Any necessary
action should be taken by the local clinical team and the lessons learnt shared with the core MDT.
Any risk management issue involving the whole MDT should be raised with the core MDT by the
Trust identifying the issue and dealt with according to their local policy.
10.0 COMMUNICATION
10.1
COMMUNICATION BETWEEN TEAM MEMBERS
There is regular communication between on site team members via daily ward rounds and weekly
clinical meetings. Where treatment planning decisions are required between these events,
telephone and email communication should be used.
Members of the North Wales Haematological Cancers MDT meet regularly at quarterly MDT
meetings, audit and educational meetings. In addition there is regular telephone and email
communication between all members of the MDT.
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10.2
COMMUNICATION BETWEEN MDT AND PATIENT/CARER
All patients and carers should be given details of how to contact members of the local clinical team
when they are given their diagnosis; this may be the contact details of the consultant and/or the
clinical nurse specialist.
Patients should be encouraged to bring a family member or friend with them to any consultation
where important news is likely to be given. Such consultations should be held in a private room
with a nurse present where possible who can then offer further support to the patient. All treatment
options should be explained to patients who are then given adequate time to consider their options
and make a decision.
10.3
COMMUNICATION SKILLS TRAINING
Communication skills training is available to all members of the MDT involved in direct patient care.
All members of the MDT who are likely to give bad news should be encouraged to attend such
training.
10.4
PATIENT WRITTEN INFORMATION
Written patient information should be offered to all patients by their consultant, clinical nurse
specialist, trials nurse and/or day case senior nurses; senior nurses should also ensure such
information is available in ward and outpatient areas.
The North Wales wide patient information folder should be given to all new patients with local
information and national leaflets added as appropriate to the individual patient. This information
will include leaflets from BACUP, LRF and Macmillan, clinical trials information sheets and local
information on MDT arrangements and support groups.
10.5
COMMUNICATION WITH GPs
Following a diagnosis of haematological malignancy, the consultant should write to the patient’s
GP informing them of the diagnosis and outline treatment plan.
11.0 DATA COLLECTION AND INFORMATION
The Cancer Network Information System Cymru (CaNISC) does not yet have an agreed minimum
data set for haematological malignancies. However all sites within the MDT enter basic
demographic and clinical data on haematological malignancies onto CaNISC and will complete the
haematological dataset when agreed.
Each hospital submits Patient Episode Database for Wales data based on clinical coding
information.
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12.0 AUDIT
The MDT participates in all Wales clinical audits as specified by CSCG All Wales Haematological
Cancer Steering Group.
In addition, the MDT audit group agrees an annual audit plan of two or three network wide audits
per year including audits of practice against agreed clinical guidelines. The MDT is currently
undertaking an audit of new DLBCL diagnoses and will then agree its audit plan for the forthcoming
year.
13.0 CLINICAL TRIALS
The MDT will review the national list of clinical trials once available and agree which trials it will
take part in.
All eligible patients should be given the opportunity to enter an agreed clinical trial. At present this
does not occur at Wrexham due to a lack of resources. This issue will be taken forward by the
MDT.
14.0 NEW DRUGS
The North Wales Cancer Network is setting up a network wide drugs and therapeutics committee
to consider the adoption of new drugs as they appear. The MDT will work with this committee on
all new haematological drugs.
15.0 ONGOING EDUCATION
The Blood Club meets three or four times per year for a programme of education. The Blood Club
includes Merseyside services.
In addition members of the MDT regularly attend North West Haematologists meetings and the
British Society for Haematology, European Society for Haematology and American Society for
Haematology annual meetings as well as meetings of the Myeloma Forum, CLL Forum, ALL
Forum, BNLI and British Blood Transfusion Service.
Both the core MDT and local clinical teams will review their training needs and agree an
educational/training programme as appropriate.
16.0 SERVICE IMPROVEMENT
Service improvement should be discussed at MDT meetings and be embedded within each local
service. User involvement should be encouraged in all service improvement initiatives.
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17.0 AGREEMENT TO OPERATIONAL POLICY
Signature ………………………………………………….. Date ………………………………………..
Dr David Edwards
Lead Clinician of North Wales Haematological Cancers MDT and Lead Clinician,
Haematological Malignancies, Ysbyty Gwynedd
Signature ………………………………………………….. Date ………………………………………..
Dr Christine Hoyle
Lead Clinician, Haematological Malignancies, Ysbyty Glan Clwyd
Signature ………………………………………………….. Date ………………………………………..
Dr David Watson
Lead Clinician, Haematological Malignancies, Ysbyty Maelor
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Appendix 1
North Wales Haematological Cancers Core Multi Disciplinary Team
Membership and Terms of Reference
1.
Purpose

The core MDT is responsible for the overall running of the North Wales haematological cancers
service. It aims to achieve the best possible outcomes for patients by ensuring access to a
uniformly high quality of care across North Wales. It does this by defining and monitoring the
operational policy by which all clinicians providing haematological cancer services in North
Wales should operate; this operational policy is based on best clinical practice and national
guidance.

The core MDT is also the main source of clinical advice to the North Wales Cancer Network
Management Board on all matters relating to haematology.
2.
Membership

The membership of the core MDT includes representatives from each site providing treatment
as part of the North Wales Haematological Cancers MDT:
o Ysbyty Gwynedd, Bangor, part of North West Wales NHS Trust
o Ysbyty Glan Clwyd, Bodelwyddan, part of Conwy and Denbighshire NHS Trust
o Ysbyty Maelor, Wrexham, part of North East Wales NHS Trust

The membership includes representatives of all disciplines involved in the provision of
haematology services, in line with Improving Outcomes in Haematological Cancers (NICE,
2003):
o Haematologists
o Pathologists
o Oncologists
o Radiologists
o Clinical Nurse Specialists
o Ward sisters
o Palliative care specialists
o Data co-ordinators

In addition the Network Director, Project Lead and User advisor may be invited as required.

The Chair must ensure there is adequate representation from each site and each staff group at
the MDT meeting to ensure their full involvement.
3.
Chair and Deputy Chair
The Chair and Deputy Chair roles are each for a maximum of five years’ duration. The Chair and
Deputy Chair will be nominated by members of the MDT. If there are two or more people
nominated, there will be a vote to decide who is elected. The Chair and Deputy Chair will both be
agreed by the North Wales Cancer Network Board. The Chair and Deputy Chair will not be from
the same Trust.
4.
Administrative support
Administrative support will be provided.
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5.
Frequency of meetings
Meetings will be held at least quarterly.
6.
Terms of reference
Service planning
 To act as the Network advisory group for haematological malignancies, advising on service
provision and making recommendations for service improvement/development/reconfiguration
 To advise the Network on the implications of national policy issues as they arise
 To agree an operational policy for the delivery of haematological cancer services across North
Wales based on current national guidance and accepted best clinical practice. To review and
update this policy annually
 To agree referral and clinical guidelines for haematological malignancies. To review and
update these guidelines annually and audit their implementation
 To agree the optimum patient pathways for each disease type and audit implementation
Service improvement and redesign
 To ensure service improvement is embedded within each local team and initiate MDT wide
improvements as appropriate
 To ensure users are involved in the planning and redesign of services
Service quality monitoring
 To ensure clinical services are delivered in accordance with required national standards i.e.
JACIE, WAG cancer standards and NICE Improving Outcomes Guidance.
 To ensure that the MDT operational policy is implemented effectively on all three sites
 To ensure adequate facilities and staff exist on each site to allow full implementation of this
policy
 To ensure adequate processes are in place on each site to allow full multi-disciplinary
involvement in treatment decisions for individual patients. Where necessary to ensure
mechanisms are in place for the North Wales MDT to advise on complex individual cases
 To agree a minimum data set for haematological malignancies and ensure it is collected on all
three sites; to analyse performance and outcome data and take necessary actions
 To agree and implement an annual audit programme and review the results of these audits
 To ensure services meet national performance targets and quality standards
 To address any MDT wide clinical governance concerns raised by local clinical teams
Workforce development
 To identify core MDT members’ training needs
 To agree an annual educational programme
Research and development
 To agree a list of clinical trials, prepare submissions for new trials and ensure all eligible
patients are offered the opportunity of entering a clinical trial as appropriate
 To work with the Network Drugs and Therapeutics group to agree the implementation of new
drugs, preparing all necessary submissions
Annual work plan
 To agree an annual work plan for the MDT
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Appendix 2
North Wales Haematological Cancers Core Multi Disciplinary Team
Lead Clinician Job Description
1. JOB TITLE:
Lead Clinician, North Wales Haematological Cancers Core MDT
2. ACCOUNTABLE TO: Employing Trust
3. OVERALL RESPONSIBILITY:

To be responsible for the development and overall running of the North Wales
Haematological Cancers MDT

To ensure that a high quality service is delivered to patients under the care of the MDT

To establish and maintain appropriate links with all three Trusts involved in the MDT
and with colleagues in the North Wales Cancer Network, primary care and the All
Wales Haematological Cancers Group

To be responsible for providing professional advice within and outside the North Wales
Cancer Network on the tumour site and the MDT’s services
4. KEY WORKING RELATIONSHIPS:







Members of the core multi-disciplinary team
Cancer and Haematology Clinical Directors of the three Trusts involved in the MDT
Medical Directors of the three Trusts involved in the MDT
Cancer and Haematology Directorate Managers of the three Trusts involved in the MDT
Director, North Wales Cancer Network
Lead Nurse, North Wales Cancer Network
Project Co-ordinator, North Wales Cancer Network
5. SPECIFIC DUTIES:
1. To set up the North Wales Haematological Cancers Multi-Disciplinary Team in line with
NICE guidance and supported by the North Wales Cancer Network
2. To agree the membership and role of the core multi-disciplinary team
3. To ensure that the core multi-disciplinary team meets at least quarterly with an agreed core
membership, records of attendance, and appropriate records of issues discussed.
4. To ensure that clinical services are delivered in accordance with required national
standards i.e. JACIE, WAG cancer standards and NICE Improving Outcomes Guidance.
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5. To agree an MDT operational policy for the delivery of haematological cancer services
across North Wales based on current national guidance and accepted best clinical practice.
To ensure this policy is reviewed and updated annually.
6. To ensure that clinical services are delivered in accordance with the MDT operational policy
7. To agree with all relevant parties optimum patient pathways, referral guidelines and clinical
guidelines for each disease type and ensure these guidelines are reviewed and updated
annually.
8. To agree an annual audit programme and ensure its outcomes are reviewed.
9. To agree a minimum data set for haematological malignancies and ensure mechanisms are
in place to collect and review this data
10. To agree a list of recognised clinical trials and ensure consistent mechanisms are in place
to assess all cancer patients for eligibility into clinical trials.
11. To ensure the MDT and local clinical teams review service improvement opportunities and
embed them within clinical operational practice wherever possible.
12. To identify appropriate training needs of all members of the multi-disciplinary team, and
agree at regular intervals how to meet these needs.
13. To work with other members of the MDT to ensure patient and carer views of the service
are taken into account when planning and delivering services.
14. To ensure any MDT wide clinical governance issues raised by local clinical teams are
addressed by the core MDT
15. To agree an annual work programme for the MDT
16. To advise the North Wales Cancer Network Board on issues likely to affect the strategic
development of haematological cancer services.
6.
TENURE:
The post is tenable for a period of up to five years from the date of acceptance.
Signed
Signed
………………………………………………….
……………………………………………
Date: …………………………………………...
Date: ……………………………………..
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