Many people know that senior cancer clinicians wrote twice to Welsh Government about the plans for the new Velindre Cancer Centre. They asked for an independent clinical review.

https://colocate-velindre.co.uk/clinical-letter-to-ministers-7/

Those clinicians (57 signed the first letter, 163 the second) worked in the Health Boards whose patients travel to Velindre for radiotherapy and chemotherapy.

Velindre clinicians also wrote

There are other, less well known letters. This time from clinicians in Velindre themselves, spelling out their concerns about the Velindre plans. Again, asking for an independent external review. They wrote to Welsh Government Ministers and Officials, as well as their own Chief Executive and Medical Director:-

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RE. The persistent and on-going attempts to gain access to our website, most notably since recent articles in the Welsh media have shone the spotlight on the very serious issues we have raised. These many hundreds of illegal access attempts every day are being noted and our legal representatives have been informed. Further unscrupulous attempts to gain control of our website in an attempt to stifle our freedom of speech, will be publicised widely on social media and the press for the public to draw their own conclusions as to who is responsible.

We will not be silenced.

Team Co-locate

Dear Acorn. Our medical campaign wishes to share with you information that is professionally and morally important to you. We are not a fringe group. Our views align with the dominant clinical cancer expertise throughout the world. The real fringe view is that which deviates from this best practice, namely New Velindre.

• The World Health Organisation’s 120-page document Setting Up a Cancer Centre (2022) makes clear that new cancer centres, including day treatment units, must be located on hospital sites.

• By going against leading expertise, New Velindre invites ridicule from international health groups, however ‘green’ the build claims to be.

• Controversy around the site and model in 2020 forced New Velindre to take advice from the Nuffield Trust (terms of reference and funding provided by Velindre – access the report below). Velindre alleges that the report approved the planned long-term infrastructure at Whitchurch. However, Nuffield did not say that the current planned build should go ahead.

• Velindre’s quote misconstrues Nuffield’s words, wrenching them out of context:

‘[Nuffield] advised that collocation would not be an option for some considerable time. It also emphasised that solutions to the immediate issues facing cancer services were ‘required now rather than an indeterminate point in the future. [It] concluded that with the implementation of its recommendations, the proposed model for tertiary cancer services in south-east Wales would ‘offer a safe and high-quality service’.

• What the Nuffield press release actually said in order to make clear its recommendation here was: ‘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.’

• Notably it’s only a potential not a certain outcome. Moreover, the passages from Nuffield quoted by Velindre focus only on the ‘immediate issues’, namely patients at risk of deterioration in the current Velindre. And it stipulates that these will require admission to acute hospitals, especially University Hospital Wales. In fact, this stipulation marks the beginning of co-located care. Hence it does NOT refer to the planned new build.

• What’s more, the number of such patients at risk will increase with available new treatments. Nuffield here gives no approval of a long-term ‘stand-alone’ cancer unit but approves what is only a ‘reasonable way forward’, including ongoing work towards a more future-proof solution on an acute site in the coming ten years. The currently intended building to serve for decades is therefore a wasteful, over-the-top response to advice meant only as immediate measures.

• Moreover, the Nuffield report elsewhere made very plain that only research based at an acute hospital site can be the ultimate driver of world-class cancer excellence. Just as WHO’s manual has also made plain.

• Nuffield did not say that the proposed network will transform cancer services. Because they know it won’t. Not without a co-located hub at an acute hospital for world-class cancer research and treatment.

• When mentioning ‘flexible design’, Nuffield did not say, ‘just get on and build it here anyway and you can always get some kind of “change of use” afterwards’.

• However, it did stress that choice of site could only be made through a large-scale options appraisal. But Velindre never did this in 2014, nor got it done post-Nuffield. See definitive links below, especially the first one.

• Nuffield did not give reassurance to the residents of Cardiff and its environs. These many South-East Wales residents will lack a local comprehensive cancer therapy service sited at a general hospital. All stakeholders are complicit in this provision of substandard care.

• If you think we exaggerate, why not get a third disinterested opinion? Ask clinicians working in cancer outside Wales about the advisability of building a brand-new cancer unit away from a hospital setting.

• Lastly and most importantly, we respectfully urge you to familiarise yourself with the WHO report in the interest of protecting your established professional reputation: Setting Up a Cancer Centre: A WHO–IAEA Framework | IAEA

Our campaign through the blog Co-locate Velindre – Supporting Best Cancer Care, will continue even if this cancer unit is built, whatever other campaigns choose to do. This is because it’s a fight for best cancer care. The case for co-location is primarily about the siting of cancer services so will continue to have prominent media coverage just as it has already. This will still oblige us to focus on what some locals already call ‘that Acorn white elephant.’ To which might get added: ‘those developers who took the money that might have given us a quality cancer service.’

Respectfully,

Co-locate Velindre

Nuffield Trust report: Nuffield Trust publishes report on cancer services in South East Wales | The Nuffield Trust. See especially pages 3, 37-39

Nuffield Trust Press-release – https://www.nuffieldtrust.org.uk/news-item/nuffield-trust-publishes-report-on-cancer-services-in-south-east-wales-1

See some disconcerting links regarding the missing, initial, appraisal process (even yet not corrected):

See especially the update of a January 6th 2022 blog

Where’s New Velindre’s large-scale options appraisal?

Jaguar Electric v Rickshaw?

and

Nuffield Myths. Always look twice.

and

Freedom of Information – but ‘where are the Velindre minutes?’

See also recent newspaper reports:

https://www.pressreader.com/uk/western-mail/20221008/281827172662311

https://www.walesonline.co.uk/news/no-records-exist-meetings-set-24499250

[This presentation of the letter follows the original closely but is an electronic version, includes a few minor edits for a blog and adds three further links]

Where’s New Velindre’s large scale options appraisal? Yes, at the time of this blog updated from January, that spectre’s still haunting New Velindre. In December 2021 Colocate Velindre contested a local politician’s claim about the Nuffield Trust’s report to Velindre in 2020: https://colocate-velindre.co.uk/nuffield-myths-always-look-twice/. The claim was that ‘Nuffield said the build should go ahead’. This assertion was a fiction.

The politician had just not grasped the significance of Nuffield’s insistence on a large-scale options appraisal. It preceded and determined everything else in any major process of clinical change. The words are strong, surely because some lack was suspected. So, it wouldn’t and couldn’t say ‘go ahead’:

 ‘…we are not making any judgement about the decision to site the new VCC on the Northern Meadows. Such a large-scale option appraisal exercise is not only well beyond our terms of reference but is fundamentally about values and the choices that need to be assessed and taken by all involved.’ (p.11)

Further points appeared in the original version of today’s blog on the 6th of January. These are updated here too:

The obvious implication

The public have still been told nothing about who initiated, concluded and sealed this exact location detail. Hence one thing is sure. With such invisibility nothing ‘large-scale’ can have taken place.

So New Velindre cannot simply go on ignoring its non-compliance with this condition, especially when presenting itself as a follower of Nuffield. To see Nuffield’s wisdom proven beyond doubt see: https://colocate-velindre.co.uk/jaguar-electric-vs-rickshaw/

The obvious implication now set in stone

To repeat the question, where’s New Velindre’s large scale options appraisal? Our original post noted a New Velindre fog around the NHS requirement for a large-scale appraisal. But we couldn’t foresee what would happen a few days later. New Velindre, in a Freedom of Information email reply, now reported that no evidence ever existed for any such groundwork exercise.

Shockingly, it holds no records, e.g. minutes, for the biggest deliberations in its history informing and empowering the main driving decision. An undocumented process had determined the destiny of New Velindre and ultimately its £562m + final price-tag. In particular, that destiny was the somewhat antique, ‘stand-alone’ model underpinning everything (i.e. built away from an acute hospital). All alleged decision-making for this is undocumented, unofficial and invisible. For the full story exposed, visit:

Freedom of Information – but ‘where are the Velindre minutes?’

What it all means

From the above we see that the Nuffield panel had found a way of raising this exercise with New Velindre, surely on the suspicion that the requirement had not been met.

But even now New Velindre’s leaders continue to ignore the matter while loudly claiming to follow Nuffield. It’s a misleading claim. No wonder the January 2021 letter from 163 senior clinicians (snubbed twice by Welsh Government) had stated: “There must be a formal review, including an updated, full options appraisal…This can be done at pace.” https://colocate-velindre.co.uk/letter-from-163-clinicians/

Action

The first version of this blog urged the Minister of Health, Senedd Health Committee, shadow ministers and Senedd members to reassure us of sound procedures and foundations for the New Velindre programme. In fact, the Health Committee did indeed ask for clarification regarding the astounding disclosure. The end result left New Velindre itself confirming the truth of our blog. In a further, even more shocking, response it confirmed there were no records, and none were needed! https://www.walesonline.co.uk/news/no-records-exist-meetings-set-24499250

It’s a sentiment that can’t be squared with what Nuffield had spelt out so clearly. Surely this New Velindre precedent, and the hubris and audacity lying behind it, matters hugely to cancer care in all of Wales. In fact, all health care in Wales. Perhaps even all government spending in Wales.

A Senedd group passes over fresh evidence? How could it be? 

In its defence the Petitions Committee had originally been conscientiously pursuing this evidence. It had asked Velindre Cancer Centre for missing documentation essential to legitimise New Velindre’s cancer programme. This is still the case. 

What is this fresh evidence?

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Well, how did they select the location of New Velindre? And why plump for that particular choice of clinical underpinning for the new cancer programme? Only a few brief paragraphs are publicly available to answer these questions, and resting on an even smaller number of key lines (see extract end of this blog). But there’s a big back-story available.

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The battle for right is turning. The wire today carried news of a historic legal judgement capping the legal costs of Cat Lewis, an environmental campaigner. She attempted against all odds to stop the wrong clinical model for cancer care being also built on a very wrong choice of site. Co-locate Velindre wishes wholeheartedly to congratulate Ms Lewis on her hard-fought victory. She is now a legend and deserves to be.

This verdict emerges as an environmental legal precedent with profound implications, as Ms Lewis’s lawyers have pointed out. They write: ‘the Aarhus Convention should be broadly interpreted to provide access to environmental justice.’ https://dpglaw.co.uk/welsh-court-judgment-protects-campaigners-from-legal-costs-in-environmental-cases/

Ms Lewis herself hopes that the case will give confidence to other campaigners to challenge decisions. The battle for right is turning.

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A recruitment crisis ahead?

Our last blog welcomed the call in Senedd for a ‘workforce recruitment and retention plan for cancer specialists.’ https://colocate-velindre.co.uk/483-2/

But the Board scrutinising cancer research in Wales has pointed out a major threat to Welsh recruitment and retention. It’s the proposed New Velindre Cancer Centre itself.

Professor Neil Burnet’s letter came from the heart. He himself formerly worked at Velindre. Now he’s Chair to the Board of seven world-class professors monitoring cancer research quality throughout Wales. He reaffirmed in September his Board’s unanimous message to the Welsh research community:

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There’s a cancer workforce crisis in Wales. But most of the parties in Senedd have shown themselves switched on to the need for purpose and action. Conservative, Plaid and Liberal Democrat have demanded a Welsh 5-year Cancer Strategy. And soon.

They’ve also called for a speedy ‘workforce recruitment and retention plan for cancer specialists’. And they enjoy the support of 20 Welsh cancer charities, including Cancer Research UK in Wales. Seemingly only Welsh Labour is not switched on to this urgent need.

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2022 is upon us, the days are getting longer and the crocuses are proudly anticipating the grand reveal of their colour and beauty over the coming weeks. It is impossible not to feel renewed hope and positivity in spite of oneself. And so hope we will – that we can continue to raise awareness of the medical model needed to provide the best and safest care for cancer patients in south east Wales.

Our continuing efforts in this area are not personal. Our criticism of the proposed model is not personal. Endeavours to encourage scrutiny of the nVCC project are not personal. We simply believe that there is a far better, safer, cheaper way to care for patients with co-located care and that the current proposals WILL fail to guarantee safety and joined-up thinking across multiple specialities.

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‘Where are the Velindre Minutes then? A routine enquiry has thrown up major questions about the legitimacy of the new Velindre Cancer Centre being built away from a general hospital. A recent Freedom of Information response (13th January) signals that Velindre did not generate key documentation for this decision. In particular, the reply clearly can’t confirm that there are minutes or even agendas for the crucial clinical meetings behind the choice of site.

So when the FOI requested dates, agendas and minutes in September 2021, none proved forthcoming in the reply. Rather, it reported that no ‘separate outputs’ from the meetings existed, not even ‘notes’, so inevitably no minutes.

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The purpose of this piece is not to educate any readers to buy into the professional values of doctors, or to enter into debate about specifics of professional behaviour. Rather it is to consider the behaviour of a group of doctors who have differing opinions on the future of cancer care and to remind us all of our duties of professional behaviour towards each other, and that this matters.  To this end we re-read a General Medical Council booklet entitled ‘Good medical practice: Professionalism in Action’ (henceforward shortened to GMP: PIA) and this blog will refer to this document frequently. 

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Co-locate is back. Slightly late, we wish you all the good things you need for navigating life in 2022. We are still in the fray this year, and still on the side of best cancer care. Our previous post depended on events as they broke and got posted just too near Christmas to have full impact. But it really brought vital information found only here so visit it anyway and do take a look at the brief YouTube clips. We work on to see truth out in the open and wise decisions on the rise. A new blog follows shortly.

Co-locate Velindre

Can it really be that New Velindre devalues stakeholders and fellow professionals in cancer? We ask the question since a Velindre spokesperson has apparently devalued the following:

1: The 7 members of the External Advisory Board (EAB)

This body monitors the Wales Cancer Research Centre (WCRC). All its panel members are NHS professors with international reputations in cancer. It is the eminent panel of doctors that assures standards for cancer research in the whole of Wales.
See the Board’s letter at:
https://colocate-velindre.co.uk/eminent-clinical-reviewers-on-velindres-plans/
The letter warns that the New Velindre ‘stand-alone’ cancer centre is against patients’ interests. The current plan will damage Velindre’s recruitment, research, brand and reputation.

2: The 163 senior clinicians specialising in all aspects of cancer throughout S E Wales, their names known to successive Health Ministers.
See their letter at:
https://colocate-velindre.co.uk/letter-from-163-clinicians/

3: An award-winning NHS cancer centre critical for north Wales patients.

The New Velindre attitude on all three surfaced in October with a video clip showing its spokesperson publicly replying to questions.
See this and other brief clips at:
https://www.youtube.com/channel/UCsKXkeYLS68savA_m5nzi9g

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