Analysis and Modelling of a Single Cancer Pathway Diagnostics Phase

The Welsh Government has set out its approach to improving cancer services and outcomes with a significant focus on the earlier detection of cancers and greater understanding and efficiency of the pathways patients take. Subsequently, the Cabinet Secretary has announced the introduction of a single cancer pathway (SCP) and its implementation must be properly tested and evaluated to understand the impact on patient care, treatment outcomes and the wider health system. This will help to provide assurance about the effectiveness of the new accelerated pathway, in the context of replacing the existing 31 and 62-day waiting time pathways. Healthcare processes are notoriously complex and stochastic in their nature. Timely diagnostic testing for suspected cancers is critical, and requires the effective and efficient deployment of resources. Underpinning this is the necessity to analyse demand and capacity. In this proposal we will use, in a novel manner, methods drawn from machine learning, operational research (OR) and mathematical modelling, to allow Health Boards in Wales to align capacity to best match demand in an effective and efficient manner, and to ultimately improve patient care and outcomes. Specifically, we will: • Use statistical and machine learning techniques to analyse current complex patient pathways using an extensive database of circa. 20,000 cancer referrals. Pattern recognition methods will permit the clustering of pathways, which will be considered by an expert panel comprising of senior clinicians and managers, alongside findings from a comprehensive review of the literature. • Build a detailed computer simulation model to capture diagnostic pathways and corresponding resource needs. The simulation allows us to model, dynamically, individual patients through their pathway, including waiting (queueing) for diagnostic tests, reporting and related activities. • Perform scenario analysis to aid future demand and capacity decisions, such as capturing in the simulation model changes to resource capacities and quantifying corresponding changes to waiting times. • Make recommendations to Welsh Government on optimal pathway configurations and related resourcing needs for the SCP. • Determine what resources are required where in the pathway from referral to endoscopy and cross sectional imaging and treatments. • Perform pathway modelling to determine what is required to improve current CWT performance, what is required to meet the forecast increased demand related to lowering of referral thresholds in primary care following NICE NG12 guidance and what would be required to transform the pathways even further through for example the use of regional multi-disciplinary diagnostic centres.