Cancer Peer Review – saved and empowered

Last autumn our local Cancer Care group in Shropshire had correspondence via our MP with a junior health minister about slipping cancer standards. The final letter was a bit of a wet afternoon, saying nothing we didn’t already know, and promising nothing better in performance in the future.

Then it seems the Government woke up. There came the realisation that there was a General Election looming, that cancer killed more people than anything else did, and that because just about everyone knows someone with cancer the combination of “NHS and cancer” could be quite interesting.

So some important things have happened.

It doesn’t get publicised but Cancer Peer Review has been saved. Under threat for most of the last year this simple term covers one of the most important processes in the management of cancer treatment. It provides a method by which sarcoma multi-disciplinary teams (MDTs) self-assess and make that performance data publicly available. They have to reflect and review, become self-critical, identify areas for improvement etc. In the first year of the cycle their musings are checked over and agreed (or modified) by their own Trust. In the second year they have a visit from a team of external peer reviewers, including visiting patients, who check and question. Their report is important because the survival of that MDT can depend on it.

In the world of sarcoma the MDT established at Hull has been closed down after Peer Review. The reason is that an MDT should discuss a minimum number of 100 new patients each year and their total was more like 40. The reason for the target number is to ensure that surgical experience grows. New patients are now being referred to Leeds and plans for the follow-up of existing patients have been made.

So Peer Review gave us the assurance that our MDTS met certain standards. We may argue with some of those standards (there are over 30) and wish for more. That’s not going to happen – the workload must be controlled. They will change and the number will fall.

It seems strange that a national programme of clinical peer review should ever have been under threat. We have a growing volume of up to date outcomes data from the National Cancer Information Network (NCIN) which provides unarguable information with which to correlate MDT self-assessments. It needs careful analysis and checking, sometimes it is too easy to come to an erroneous conclusion. We understand that the programme will be revising its methodology to include greater use of clinical outcomes data. I am certain there will be fewer criteria in the self-analysis as well.

To reflect this change the Cancer Peer Review team is being rebadged as the Quality Surveillance Team. Another superficial title change with which the new NHS seems to paint itself, However I welcome what lies behind it because Quality Surveillance will report to NHS England Specialist Commissioning, indicating that it will be able to generate change.