24 | Cancer Commissioning Strategy Framework Cancer Commissioning Strategy Framework | 25 Appendix 4 - Tumour Specific ERG Cancer Fragility Risk Checklist • Definition: Critical issue that could significantly impair the ability to provide cancer services, meet patient needs, or lead to serious consequences if not addressed immediately. • Indicators: • Large mismatch between demand and capacity (e.g., clinics or theatre consistently overwhelmed). • Significant staff shortages or high turnover, impacting care delivery. • Below-benchmark patient outcomes (survival, satisfaction, etc.). • Prolonged delays in diagnosis or treatment, beyond safe clinical windows. • Severe accessibility issues, causing major disparities or extremely long wait times. High Risk (H): • Definition: Concerning issue that could escalate if left unresolved but is manageable in the short term. Mitigation actions should be taken to prevent it from becoming a high risk. • Indicators: • Occasional mismatch between demand and capacity but manageable with current resources. • Moderate staff shortages or turnover, with some impact on service delivery. • Patient outcomes slightly below benchmarks but not critically low. • Delays in diagnosis or treatment, but within reasonable limits. • Noticeable accessibility issues, with moderate impact on patient care. Medium Risk (M): • Definition: Minor issue that has minimal impact on operations or patient care. It requires monitoring but does not pose immediate danger to service delivery. • Indicators: • Slight or occasional strain on capacity but not affecting patient care. • Minor staffing issues with no significant impact on service delivery. • Patient outcomes and satisfaction at or near benchmarks. • Delays in services are rare or within clinically acceptable limits. • Accessibility issues have minimal or no impact on patients’ ability to receive care. Low Risk (L): Appendix 4 - Tumour Specific ERG Cancer Fragility Risk Checklist Measure Category Criteria Risk Identified Risk Description Level of Risk H/M/L Service Capacity and Demand Analysis Is there a mismatch between patient volume and outpatient clinic capacity? Yes No Are resources for diagnostics (e.g., imaging, pathology) meeting the demand? Yes No Are theatre capacities sufficient to handle the caseload? Yes No Staffing and Resources Is there a shortage of clinical staff (doctors, nurses, etc.) for current patient volume? Yes No Is there a lack of non-clinical support (administrative, technical staff)? Yes No Are staff turnover or absenteeism rates impacting service delivery? Yes No Patient Outcomes Are survival or recovery rates below benchmarks for this cancer type? Yes No Are re-admission rates higher than expected? Yes No Is patient satisfaction with care below acceptable levels? Yes No Service Efficiency Are there delays between referral and diagnosis for patients? Yes No Is the treatment initiation delayed beyond clinically recommended timeframes? Yes No Are resources for completing treatment plans (e.g., chemotherapy, radiotherapy) insufficient? Yes No Accessibility Are there geographic disparities in accessing outpatient care? Yes No Is access to advanced treatment modalities (e.g., precision medicine, radiotherapy) limited? Yes No Are waiting times for specialist appointments beyond recommended limits? Yes No OVERALL Criteria High • 3 or more “High Risk” ratings across domains or any critical issue within key domains such as service capacity or patient outcomes, leading to an inability to meet demand, unacceptable delays in treatment, or patient harm. Medium • 2 or more “Medium Risk” ratings across domains, or a combination of “High” and “Low Risk” ratings, where the overall situation presents significant vulnerability without imminent failure. Low • No more than 1 “Medium Risk” rating across domains and the majority of criteria are rated as “Low Risk.” Appendix 4 - Tumour Specific ERG Cancer Fragility Risk Checklist
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