Data Management
The cancer waiting times targets are applicable to adult (over 16 at date of diagnosis) NHSScotland patients with a newly diagnosed primary cancer. To be included, the cancer type must fit into one of the listed cancer types in the New Cancer Targets Definitions Manual Version 3.1 [please see the Guidance section of the website]. Recurring cancers are not covered by these waiting times targets.
The information to support these targets comes to ISD from NHS Boards in each of the three regional cancer networks - South East Scotland Cancer Network (SCAN), North of Scotland Cancer Network (NOSCAN) and West of Scotland Cancer Network (WOSCAN). Tracking systems are used to provide data for both performance management and official reporting against new cancer waiting times targets. Responsibility for collating and submitting the data to ISD lies with the NHS Board that received the patient's initial referral to secondary care. Data are submitted to ISD monthly for quarterly publication.
For some patients in the 31-day target cohort, it is possible that an NHS Board other than the one that submits the data is responsible for delivering the target. NHS Boards are required to have mechanisms in place for submitting and signing off the accuracy of data for these patients.
Data Recording
Approximately 1,800 records from all NHS Boards are submitted each month. The dataset contains 21 fields, the majority of which are mandatory. Data is collected by cancer trackers - their role, in terms of New Cancer Waiting Times (NCWT), is to receive all GP urgent with suspicion of cancer referrals, A&E episodes and patients detected through the national breast, bowel and cervical screening programmes. The trackers manage the patient journey through the system, expediting all local outpatient investigations and appointments and treatments. The trackers record relevant patient information obtained from Patient Administration Systems (PAS), laboratory systems, and medical records and then record it onto the NHS Boards' Tracking system. From this the NCWT submission template is completed, which is based on the previous month of treatment, and submitted to ISD via SWIFT DVL. When in ISD, the data is validated and put on to Business Objects to allow data interrogation and reporting (see the Scottish Cancer Waiting Times System (SCWaTS) User Manual Version 3 on the Guidance section of the website), for further information on submitting and validating data. If NHS Boards discover that data submitted is incorrect, or data is missing, further submissions can be made at any time up to the publication submission deadline and will be reflected in the publication. A detailed cancer waiting times reporting timetable can be found on the Guidance section of the website.
Exclusions and Adjustments
A patient will be excluded from reporting against the Cancer Waiting Times targets for the following reasons:
- The patient chooses to have any part of their pathway out with NHSScotland (if this is before the decision to treat they will be excluded from the 62-day target and if after the decision to treat they will be excluded from both targets)
- The patient died before treatment
- The patient refused all treatment
- The patient was deemed a clinically complex case by the lead cancer clinician of the responsible NHS Board
As part of a patient's pathway there may be some areas of delay not attributable to NHS Board performance, and in these cases an adjustment can be made to discount periods of patient unavailability. If applicable, the cumulative number of days by which the waiting times pathway can be adjusted (before and/or after the decision to treat) is then subtracted from the total wait (in days) to give an adjusted wait. Adjustments can be made for the following patient-induced delays and medical suspensions:
- Patient did not attend an appointment
- Patient cancelled an appointment
- Patient deferred an appointment
- Temporary co-morbidity
- Other patient-induced suspension
- Medical Suspension
NHS Boards are required to record all adjustments for the patient, and add these together before submitting data for reporting against waiting times targets. Documented evidence is required before an adjustment can be made, which must be made available during quality assurance exercises. More detailed information on adjustments and adjusted waiting times scenarios can be found in the New Cancer Waiting Times Data Definitions manual (please see the Guidance section of the website for this).
Data Accuracy
Data Completeness
In order for ISD to gauge if data collected for January - March 2010 was robust enough for publication, a 'fitness for publication' exercise was carried out for the 62-day target. This exercise showed that completeness of the 62-day target was within an acceptable range and is fit for publication. A similar exercise has been carried out to assess the introduction of screened positive patients for the July - September 2010 time period. Click here to view a paper detailing the fitness for publication exercises. 
[51kb]
ISD and NHS Boards are actively working to resolve the remaining quality issues that impact on data reliability.
This information can be found within the 31-day tables in the Performance Against Target statistics of the publication.
Data Quality
Collection of New Cancer Waiting Times (NCWT) data started for patients treated from 1 January 2010. NCWT recording, collection and submission has changed considerably from old cancer waiting times with new definitions and concepts (see the New Cancer Targets Definitions Manual Version 3.1 in the Guidance section of the website), such as waiting times adjustments. The definition of 'decision to treat date' has changed throughout January - March 2010 which may potentially affect figures. Age has also been calculated differently throughout January - March 2010 where initially it was based on 'date of receipt of referral' and changed to 'date of first treatment'.
As NHS Boards were collecting NCWT data, old cancer waiting times were also being collected at the same time for patients diagnosed up to December 2009. An overlap of patients who were diagnosed before January 2010 but treated on or after January 2010 may result in patients being recorded in both old and new targets.
It should be noted that publication reports contain small numbers which may affect comparisons. For example in island NHS Boards there may be a substantial quarter-on-quarter fluctuation in the percentage figures, which may represent the pathway of one or two patients. Due to the effects of small numbers, percentiles have only been calculated where there are 40 or more patients within a population.
Any referrals that NHS Boards have discovered, post publication, to have been recorded incorrectly or not included in the target in error, will be reflected in related footnotes, updated in the next publication release and highlighted as a revision to the publication.
Click here for information on specific data quality issues for NHS Boards. [54kb]
Data Quality Assurance
The Data Quality Assurance (DQA) team on behalf of the NCWT team will be carrying out a data quality audit for patients who fall under the 31 and 62-day targets based on quarter 2 2010 (April-June) as at 28 September 2010. The purpose of the audit is to determine:
- If correct codes/dates are being recorded
- If waiting times adjustments are being applied correctly and consistently
- If the rules and guidance are being appropriately applied
The project outline can be found in the Guidance section of the website. Once the data has been collected and after discussion with the Boards the reports will be produced and published.
It is planned that the DQA team will visit NHS Boards (mainland only) in November/December 2010.
