Research, Transformation, Improvement and Innovation Award winners providing 'Gold Standard' service

A first in Wales service, providing speedy diagnoses for specific cancers, has won a Betsi Cadwaladr University Health Board Achievement Award.
Caroline Williams is acting network manager for cancer within the health board and she nominated the One Stop Neck Lump Clinic.
The team of multi-disciplinary professionals provides a same-day diagnostic clinic for patients referred as “urgent suspected cancer”, due to a suspicious neck lump.

As a result of this cooperation between specialties, the first of its kind in Wales, patients receive a same day diagnosis, reducing the anxiety of waiting, and ensuring those patients who are diagnosed with cancer can access treatment sooner than before.
The views of patients were vital in designing the service – and the feedback has been excellent.

Caroline said: “The One Stop Neck Lump clinic is an example of service users, clinicians and managers working together to create an innovative, effective, efficient and patient focussed model of care. 

“One patient referred to the service as ‘gold standard’, saying ‘I think it’s difficult to put into words how anxious people are when they have a lump and have to go to hospital.  The beauty of this rapid access clinic is you can go in on one day and get an initial diagnosis’.”
Prior to establishing this clinic, patients would wait up to six weeks for a diagnosis. They would initially be seen in an ear, nose and throat (ENT) outpatient clinic, be referred for an ultrasound FNA (fine needle aspiration) which would take approximately two weeks to organise and then be seen back in clinic two weeks later with the result.

If the original sample was insufficient, this would require a further referral to radiology for a repeat scan. The prolonged wait for a diagnosis led to increased anxiety for patients and a long wait from suspicion of cancer to treatment, where required.
In the first nine One Stop Neck Lump Clinics, which began in June 2022, 53 patients were seen. Forty-five were reassured and eight cancers diagnosed.

An audit of waiting times in the clinics revealed samples were reported within 63 minutes of the FNA procedure. The time to diagnosis for patients was reduced by an average of 14 days. Initially just for patients in the Central Integrated Health Community (IHC), effectively Conwy and Denbighshire, funding is now in place to extend the service to patients across North Wales.

Other Health Boards in Wales, inspired by the success of the service up here, have also approached the BCUHB team to learn from their experiences when developing their own services.

A multidisciplinary project team of clinicians from both primary and secondary care, service users and managers developed the clinic.
Managers researched best practice models in England and worked together to cultivate the idea.

The development of the clinic required clinicians to agree the model of care, identify sufficient resources and reorganise consultant job plans.
Clinic space had to be found and room had to be made on radiology lists and within pathology, to guarantee the comprehensive, one-stop diagnostic service.

All patients attending are assessed by an ear, nose and throat surgeon and have an ultrasound scan conducted by a consultant radiologist with a fine needle aspiration (FNA), if required. The FNA involves a local anaesthetic being administered and a fine needle is inserted into the affected area, aided by imaging. A sample of the fluid is then collected for analysis. The sample is taken to the pathology laboratory, where a specialist consultant pathologist makes a determination within an hour. The patient is then seen back in clinic by the ENT surgeon with the result.
If the original sample is insufficient for diagnosis, a repeat ultrasound FNA can be undertaken within the same clinic.
The patient therefore receives their diagnosis in the clinic and the Head and Neck Cancer Clinical Nurse Specialist team attend to support any patient whose result confirms a cancer.

Professor Edmund Burke, Vice Chancellor of Bangor University, the award sponsor, said: "North Wales is home to a significant community of individuals dedicated to undertaking valuable and innovative research. The projects showcased by the three finalists demonstrate the diverse approaches that NHS staff in North Wales employ to enhance healthcare services and patient well-being. I extend my congratulations to all three finalists for their commendable efforts."

Jez Nash, Chief Executive for overall awards sponsor Centerprise International, said: “In our sixth year sponsoring the BCUHB Achievement Awards, I continue to be impressed by the outstanding commitment of NHS staff in North Wales.
“They are innovative in their approach to care provision and demonstrate relentless compassion for their patients and colleagues.
“We were delighted to share the occasion with the 500 NHS staff at the awards, and proud to be able to continue our association with a great night celebrating their efforts.

“Huge congratulations to everyone shortlisted at this year’s awards.”