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Organisational audit report 2019

The third organisational report presents national level findings on the organisation of lung cancer services in England and Wales as of June 2019. Click below to download the full report, read our executive summary and a blog written by our clinical lead.

Executive summary

This is the third National Lung Cancer Audit (NLCA) organisational report, previous reports having been published in 2014 and 2017. The report aims to reassess the provision of lung cancer services in secondary care across England and Wales, since the last audit period. The report also seeks to highlight any variation in diagnostics, treatment modalities and specialist staffing; provide information for national benchmarking; and measure the extent to which the recommendations made in the 2017 report have been met. A total of 160 units were invited to take part in the organisational survey of which 141 units provided responses (a participation rate of 88%), an improvement from a participation rate of 86% in the 2017 audit and 57% participation rate in 2014.

Key findings across the organisations surveyed included:

  1. Only 5% of units (8% in 2017) had adequate levels of specialist staffing in all of five key areas.
  2. Less than half (44%) achieved the recommended 3-day turnaround for pathological subtyping and 37% achieved molecular diagnostics within 10 days, which may have led to delays in treatment for some patients.
  3. Local on-site access to specialist services varied nationally – for some diagnostic tests such as bronchoscopy and cardiopulmonary physiology testing, there was near universal onsite provision. However, ease and speed of access to other tests was likely to have been compromised by more limited on-site access to (for example) endobronchial ultrasound (EBUS) in 76%, local anaesthetic thoracoscopy in 47% and positron emission tomography (PET) computed tomography (CT) (PET-CT) in 28%. Similarly, palliative and supportive care was available on-site at 96% of units but immunotherapy only at 81%.
  4. The workload in multidisciplinary team (MDT) meetings appeared to have become more manageable; 71% of units (29% in 2017) discussed 30 patients or fewer in a 2-hour MDT meeting. However, attendance of key staff at treatment MDT meetings varied with 74% of MDTs having a medical oncologist and 86% with specialist palliative care representation.
  5. Two-thirds (67%) of units had an MDT member with responsibility for data quality and of these only 18% had time in their job plan for this role.
  6. Only 47% of units had a policy for the treatment of tobacco addiction and pharmacotherapy was prescribed in only 37%.