The Nuffield Trust has today published the report of its independent advice on the proposed model for non-surgical tertiary oncology services in South East Wales.
This report was commissioned by Velindre University NHS Trust, a specialist provider of cancer services in South East Wales, to look at the clinical implications of their integrated regionally networked model. The terms of reference for this review is contained in the full report.
The report found that overall the approach Velindre are suggesting - a network model supported by a cancer centre largely focussed on high-volume outpatient-type activity - represents a reasonable way forward, given some real challenges and constraints on cancer services in SE Wales and assuming some important changes are made to the way services are delivered.
These constraints largely centre around the limitations of the existing cancer centre at Whitchurch, which is outdated and not fit for purpose, and the reality that co-locating a new Velindre Cancer Centre (VCC) at University Hospital Wales - which would have advantages - is not practical for some considerable time.
The changes required include not admitting patients to the Velindre Cancer Centre who are at risk of major escalation and likely transfer to another hospital if they were admitted. The authors recommend developing a cancer hub at University Hospital Wales and at other local hospitals to manage these patients, which is likely to mean fewer inpatients admitted at Velindre in future. They note that work is already underway on revising admissions criteria to VCC which should address this.
They also recommend: an enhanced research hub for cancer trials at University Hospital Wales, as well as trials hubs at local hospitals, which would allow cancer trials to be more equitably spread across the network; that the cancer centre should offer routine low-risk treatments for haematology, transfusions and potentially expanded outpatient clinics; that the new VCC should also potentially include other diagnostic services like endoscopy; and a more joined-up approach to planning cancer care across SE Wales.
Commenting on the report, Chief Executive of the Nuffield Trust and report author Nigel Edwards said:
“Cancer services across South East Wales are faced with a quandary – the current Velindre Cancer Centre is not fit for future purpose, but the option of a fully co-located cancer centre at the nearest acute hospital is not possible within the timescales needed to improve and enhance cancer services in South East Wales.
“With some adjustments, including locating inpatient care for patients at risk of major escalation at relevant local acute hospitals, and co-locating a cancer research and trials hub with inpatient beds at University Hospital Wales, the proposed network model supported by a new cancer centre offers the potential for a safe and high-quality service that provides a good patient experience.”
The Nuffield Trust report notes that advice is based on the proposed clinical model, not a full option appraisal of all the different ways in which services could be sited or distributed across South East Wales. This means it does not make any judgement about the decision to site the new VCC on the Northern Meadows.
- The report is authored by Nigel Edwards, Nuffield Trust Chief Executive and Hilary Wilderspin, a Nuffield Trust Senior Associate. Clinical advice and internal peer review was provided by Dr Louella Vaughan. Their full biographies can be accessed here.
- The report was compiled by interviewing a range of clinicians from Velindre and surrounding health services, speaking to a small number of patients and their representatives, hosting open access sessions for Velindre staff, reviewing papers from working groups, individual testimonies and letters from patients and staff, commissioning analysis of all patients treated for cancer in SE Wales and analysing data on patients urgently transferred to other hospitals from the VCC.
- The findings were presented to a group of eminent cancer experts from across the UK who tested our assumptions and asked us to explore some areas in further detail. A full list of the expert panel is contained in the report.
- The report was commissioned by Velindre University NHS Trust and constitutes independent advice to the Trust.