Velindre: Email exchanges towards truth.
Background to Email correspondence regarding Code of Conduct
At a historic meeting of Senedd’s Health & Social Care Committee 30th September 2020, Welsh Government (WG) responded to the concerns of many clinicians working in cancer that no independent, external clinical review had ever scrutinised the proposed cancer centre standalone model. This was the heart of the issue raised at that meeting with safety being just the most pressing aspect. From this point, WG claimed on several occasions that the Nuffield Trust panel was commissioned to review the cancer centre model.
This claim endured into September 2023, stopping only when challenged by our email. The email trail below starts at around this point: ‘You have raised concerns associated with the proposed new Cancer Centre. The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been independently reviewed by the Nuffield Trust. The Welsh Government will continue to oversee the new Cancer Centre proposals etc.’ (We leave aside here a seeming superior tone of correction which itself turned out to need correcting.)
The ensuing correspondence below, is re-ordered for easy chronology, and seen by many politicians and stakeholders and its faithfulness to the original thread assumed and not challenged.
THE EMAIL EXCHANGES: COLOCATE VELINDRE & DEPARTMENT OF HEALTH & SOCIAL CARE September-December 2023 (non-WG email addresses redacted)
Topic: an apparent breach of the Ministerial Code of Conduct
27 Sep 2023, at 11:07, HSS.GovernmentBusinessTeam@gov.wales wrote:
Dear Dr Owen and Dr Kearsley
Thank you for your email below and letter attached. I have been asked to reply.
You have raised concerns associatedwith the proposed new Cancer Centre. The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been independently reviewed by the Nuffield Trust.
The Welsh Government will continue to oversee the new Cancer Centre proposals to ensure that the development would be sufficient to keep pace with increasing demand as the number of people referred with cancer grows every year.
The points raised continue to be considered as part of the detailed and on-going scrutiny of the proposed Centre with patient safety being core to the challenges put to Velindre University NHS Trust.
I hope this information is helpful.
Yours sincerely,
Richard Morgan
Tîm Busnes y Llywodraeth/Government Business Team
Yr Adran Iechyd a Gwasanaethau Cymdeithasol/Department for Health and Social Services
19th October (Attachment to email)
Dear Eluned Morgan MS, Minister for Health and Social Care
Thank-you for your 27th Septemberemail answering our letter of the 9th [September], through your official, a response which was much appreciated. We’ve invited colleagues in Co-locate Velindre to join us in composing this reply.
Interestingly, you use exactly the same words in your email of the 27th September as those used by the First Minister in similar correspondence that found its way to us.1 Unfortunately, however, these replies put us in an awkward position. We know for sure that certain content in your email is highly inaccurate, and to make no challenging comment would leave us endorsing a fallacy as fact.
In that case, we have run into what seems like an infringement of the Ministerial Code of Conduct, since no MS may use an official to circulate a false statement.2 Merely dropping it from future statements would still leave the misinformation out there and flourishing. So we just assume Ministers will be eager to retract publicly anything false and so dispel it. The problematic words, therefore, are in bold:
‘The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been independently reviewed by the Nuffield Trust…
The Welsh Government will continue to oversee the new Cancer Centre proposals to ensure that the development would be of sufficient size to keep pace with increasing demand…
The points you have raised continue to be considered as part of the detailed and on-going scrutiny of the proposed Centre with patient safety being integral to the challenges put to Velindre University NHS Trust.’
The focus of the Nuffield Advice
The opening two lines above, sadly, are simply erroneous. Your third line and last two lines confirm to us that you see the Nuffield Advice (2020) as there to address the appropriateness of a ‘stand-alone’ model of the cancer centre. But this assertion about Nuffield too, we suggest, is misleading.
The fact is, the panel could not review, lift the lid on, the original, historic ‘stand-alone’ deliberations. That route was not open to it from the terms of reference. Rather, its strict remit concerned only immediate operational matters, management issues for the whole network. These arose from a long-fixed, non-revisable decision to ‘rebuild… separate from a main hospital site’ (see quotation below). So your first two lines above can only mislead.
The function of the Nuffield Advice
Equally, the report was not a ‘review’ anyway. Relevant here isa key witness that has emphatically denied the truth of your opening two lines – that witness is none other than Welsh Government (WG)!Your official, two years ago, agreed with an enquirer that the Nuffield Advice was most certainly not a review. He apologised for the Health Minister’s ‘misspeaking’ to the contrary. And gave assurance that WG did not see Nuffield as a ‘review’!3But your words above flatly contradict this.
We leave aside the problem that the said Health Minister committed this same ‘misspeak’ several times in an earlier meeting of Senedd’s Health Committee.4 The point is that now WG misspeaks yet again, except this time it is thought-out, written and unambiguous.
Baffling self-contradiction?
Inexplicably, then, Health Minister and First Minister both put forward a claim in public discourse from which they themselves have already heartily dissented. Nuffield also dissented from it, in both the Proposal and Advice, insisting that the panel had not carried out a review. Rather its work concerned only management of the wider cancer network (with Velindre a part):
‘…[the] scope of this report is tightly defined and relates specifically to the clinical management of the planned network model for non-surgical tertiary cancer services and new cancer centre.’ (Advice p.10). Nuffield has even confirmed this in a personal letter to a Co-locate Velindre supporter:
‘[We’ve] tried to be clear that it’s not a review…It would be regrettable if it was seen as anything other than the tightly defined advice that it is…[On] the question of the Northern Meadows site, our advice is limited to the clinical and research issues the decision to rebuild the hospital separate from a main hospital site pose’5 (italics added). These turned out to be practical and considerable.
Clearly Nuffield, therefore, did not see itself reviewing or digging up for review the appropriateness of the new cancer centre’s underpinning deliberations, as your words above claim.
Not a matter of semantics
You’ll agree, we trust, that rejecting the word ‘review’ for Nuffield’s work is not petty semantics. Otherwise Nuffield would not have gone out of its way to deny doing a review. Nor would Government and Velindre have, seemingly, re-cycled the word. These strong standpoints surely arise because a ‘review’ really is a big deal. It is the radical testing of a proposal right down to its roots, a deep and comprehensive scrutiny encompassing location choice and much else.6 We can safely say no such expert, external, clinical ‘review’ has ever been done on the historic, undocumented, founding choice of a ‘stand-alone’ model for New Velindre. Certainly Nuffield never did one and could not go there.
Therefore, we suggest it is unfortunate that the myth of a Nuffield ‘independent clinical review’ of the new cancer centre still circulates. It continues to mislead the public, even some in the cancer care community. It also still subverts expert clinical objections to the project which spring from an overwhelming, worldwide consensus. That consensus supports the dominant trend of only building new cancer centres beside acute and surgical services, normally at district general hospitals.
But Nuffield was not allowed leeway by Velindre’s contract to circle back, and to pronounce on the original underpinning choice of the ‘stand-alone’ cancer centre model. Therefore a current Minister was quite wayward when emailing to a constituent that Nuffield ‘said the new build should go ahead’. Nuffield never said any such thing and was not empowered to do so. It could not approve or otherwise the proposed location, because its narrow terms of reference barred this avenue.
The WG statements we quote above, therefore lay bare that a review has never been done.
Nuffield did not get to review the underpinning decision for a ‘stand-alone’ centre, even though it has come across to the public as filling that gaping hole. Hence we are left with no grounds at all for believing the ‘stand-alone’ model has ever undergone any review by an external clinical panel.7
In passing, the Nuffield project was not, in fact, ‘independent’ in the particular sense required of clinical reviews. These don’t usually allow an NHS proposal to constrict terms of reference for a visiting panel as Velindre did. Nor to commission the review and pay for it. No fault implied in Nuffield at all. It did what it was asked.
After Nuffield
Almost three years after Nuffield’s report, the fulfilment of some of its most urgent requirements have run aground.8 Despite these ominous signs, Cardiff & Vale Health Board has been exemplary in forging ahead with its Strategic Outline Case for the research and treatment cancer hub at UHW, widely welcomed. Nuffield insisted on this requirement and it lay at the heart of all the report’s conclusions, fully embraced by the region’s health boards, a fact not disputed.
Following through on Nuffield
The facts traced above warn against pressing on into colossal financial indebtedness before fulfilling all Nuffield’s urgent conditions for the whole network. These, for example, include an emergency oncology service at every Hospital Emergency Admissions. Velindre and the Health Boards are committed to such requirements. New Velindre is not even viable until all are in place.9
In summary
It is a serious misrepresentation to say that New Velindre’s underpinning model has undergone an independent, clinical review. And it seems safe to conclude from Welsh Government’s own statements on Nuffield that this misleading narrative emanates downwards from cabinet itself.
Equally, the assumption of WG’s ‘ongoing scrutiny’, claimed above, barely stacks up either. That supposed scrutiny failed to spot the complete absence of founding documentation! New Velindre was allowed to skip formal clinical inspection of its very foundations and legitimacy, a fact exposed by the Freedom of Information report from Velindre.10 And WG’s eye on the proposals allowed the Acorn consortium to be the preferred bidder, even though its lead companies have received convictions for serial bid-rigging. Accordingly, the Public Accounts and Public Administration Committee is investigating the matter. And the Auditor General’s office will audit financial issues.
Meantime, UHW, a major research and teaching hospital, is denied desperately needed resourcing for its very existence and for patient safety. Happily, it’s not too late to correct this inequitable path so damaging to cancer care. Government could now justifiably divert UHW repair spending (projected at £700m over the next 10 years) to help fund a phased roll-out of UHW2. And this programme could encompass an adjacent world-class Velindre Cancer Centre. According to Nuffield, the new centre could still enjoy its own boundaries, ethos and even management (p.49).
It is interesting that the transitioning Velindre already has new linear accelerators, so is digging in for a longer wait than predicted for its new centre. A further small spend would iron out most accommodation deficiencies for now. Almost three years after Nuffield, the receding entry date of New Velindre is eating at its timetable lead on any revived UHW2 project. The new Velindre, a mainly outpatients, unit will finally cost almost as much as the entire new Watford General Hospital plus refurbishment of two others. And it encompasses a new cancer centre at one of them.
We urge, then, a prudent, straightforward and powerful plan for cancer services, one already in competent process at UHW with regional Health Board support. It’s the only road to a state-of-the art, 21st century cancer service that almost half of Wales’s population will ever have. But as a start, WG has to correct publicly the statements we have contested above. This way, it could also genuinely put the highest aspirations in reach.Of course, only an independent panel consulting with a wide breadth of the region’s senior clinicians in cancer could facilitate and kick-start that.
For our part this email ‘replies to all’, and copies in a few more, especially stakeholders, to enable scrutiny of our evidence too. Some, perhaps, will welcome more light on Nuffield. After all, stakeholders can’t be expected to align themselves to what seems a glaringly untrue premise.
We look forward to your response to these concerns.
Kind regards
Dr Penny Owen
Dr Roy Kearsley
REFERENCES FOR EMAIL 19TH OCTOBER
1 Replying to an enquiry 19th June 2023:
From: HSS.GovernmentBusinessTeam@gov.wales <HSS.GovernmentBusinessTeam@gov.wales>
Cc: Correspondence.Eluned.Morgan@gov.wales <Correspondence.Eluned.Morgan@gov.wales>
We also refer to an earlier communication Wed, 12 Apr [2021] at 09:28 from HSS – Government Business Team Mailbox: ‘The clinical model for the proposed hospital has previously been independently reviewed by the Nuffield Trust as an appropriate right model for the hospital at Velindre.’
Note: the interpolated word ‘right’ is significant. No such conclusion was drawn by the Nuffield Advice
2 https://www.gov.wales/ministerial-code Ministers ‘Accountability’ ii, iv (p. 4/50) Ministers and The Civil Service 3.1 (2nd bullet point)
3 Email Monday, 12 April 2021, 11:21:09 BST, hss-corres.aqs-main@gov.wales
‘…The Minister [Vaughan Gething] acknowledges that he misspoke during the radio interview and he meant to use the word advice rather than review. The Welsh Government has consistently referred to it as advice, therefore I apologise for any distress that this inadvertent error has caused you.’
Obviously not true.
4 Senedd webcam transcript paragraphs 26-30
5 Email November 2020: The Nuffield director’s words in an email to a now Co-locate Velindre supporter dated 13th November 2020: at 12:18. The relevant part reads: ‘…we’ve tried to be clear that it’s not a review… It would be regrettable if it was seen as anything other than the tightly defined advice that it is.’ On ‘the question of the Northern Meadows site, our advice is limited to the clinical and research issues the decision to rebuild the hospital separate from a main hospital site pose[s].’ (Italicising added)
Compare, the report’s own explanation that it was ‘examining the benefits and risks facing management of a ‘proposed integrated network model’, especially acute care’ p.7, italics added).
See also: https://www.pressreader.com/uk/south-wales-echo/20221110/281749863331112
6* Contrast the New Velindre origins with a typical description of the formal clinical expertise and scrutiny required before approval of any NHS major service change for most of the UK. https://www.england.nhs.uk/wp-content/uploads/2016/12/Methods-National-clinical-policies-updated-July-2020.pdf Wales has been aligned with this UK best practice but not with this project.
For a wide sample of clinical reviews, see* below https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf
We note especially p.17 and in particular the two panels:
Velindre’s contract should have asked for a review of that ‘stand-alone’ decision but instead it asked for ‘advice’ on the aftermath, namely the ‘issues the decision… pose[s]…’
7 Interestingly, New Velindre managers did not allow for revisiting location in their 2015 stakeholder engagement programme. Hence, after the 2022 FOI revelations, they still could not offer to the March Senedd Petitions Committee any records for stakeholder support for co-location. Management has also claimed varied exercises as reviewing that decision, when they did not. Seeits text in https://www.juliemorgan.wales/news/your-questions-about-new-velindre-clinical-model
In these events, it was only ongoing management matters that were handled. None of them did a full clinical review of the underpinning model for the new cancer centre (its ‘stand-alone’ nature).
8 Seemingly, a joint health boards business case on the required Acute Oncology Services (cancer care in emergency admissions) suddenly disappeared. An experimental acute cancer ward at UHW, as Nuffield demanded, failed for poor resourcing. Yet a high-risk, non-validated New Velindre project continues spending money with gusto while almost doubling its budget over seven years. At the time of writing, the Full Business Case has still not been presented to Welsh Government, four months after ministers approved the Project Agreement regardless. A breach of all Welsh good practice and a Government move without precedent.
19 January 2022. See unedited FOI at: https://colocate-velindre.co.uk/%ef%bf%bc-freedom-of-information-response-but-where-are-the-minutes-decision/
8 November 2023 at 11:56:18 GMT
From: HSS.GovernmentBusinessTeam@gov.wales
Dear Dr Owen and Dr Kea[r]sley
Thank you for your further response of 19 October raising a number of concerns under the Ministerial Code.
Our response to you of 27 September was prepared and issued by officials of the Welsh Government and the reference to ‘independently reviewed by’ should have said ‘subject to independent advice from’ and I apologise to you for this inadvertent error. The same error was made in correspondence to the First Minister, which you refer to, and this is in the process of being corrected.
This information was given to you in good faith and there was no intention on the part of either Ministers or civil servants to deliberately supply misleading or incorrect information. So while we apologise for the error, we are satisfied that neither the Ministerial Code, nor the Civil Service Code has been breached.
I would like to point out a number of elements of the advice from Nuffield that indicate the networked clinical model is viable for south Wales. Including the following passages of the advice:
“Co-location would be in line with practice elsewhere, address the questions of how to provide safe acute inpatient care, improve support from other specialties, and create a better base for research…Whatever may be possible in the future, we are satisfied that a co-location option is not available at present nor for some considerable time to come…”
“…the proposed solution of a network model supported by a cancer centre focussed on high-volume ambulatory care represents a reasonable way forward. With a number of service changes detailed below, this can offer a safe and high-quality service that provides a good patient experience.”
“For most inpatients and emergency ambulatory patients many of the benefits of co-location in terms of access to other specialists, critical care, surgery, endoscopy, etc. can be realised through the development of local acute oncology and inpatient care.”
The Welsh Government continues to scrutinise the proposals developed by Velindre University NHS Trust and its commissioners as part of the Final Business Case. The scrutiny of the clinical aspects of the Final Business Case are overseen by the Chief Medical Officer and the Deputy Chief Medical Officer of the Welsh Government.
I hope this is helpful.
Yours sincerely
Dean Calnan Government Business Team/Tîm Busnes y Llywodraeth /Health and Social Services Group/Y Grŵp Iechyd a Gwasanaethau Cymdeithasol Welsh Government/Llywodraeth Cymru
22d November 2023
Dear Eluned Morgan, Minister of Health & Social Care MS,
Thank-you for your 8th Novemberemail answering our letter of the 19th October, which is appreciated. We note its contents. We take it to be the Health Minister’s reply as the recipient of our original email.
We’re concerned in the first place with your replacement words shown in italics, second line below, so your original paragraphs now read as follows with the first paragraph amended by you:
‘The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been subject to independent advice from the Nuffield Trust Welsh Government will continue to oversee the new Cancer Centre proposals to ensure that the development would be of sufficient size to keep pace with increasing demand…
The points you have raised continue to be considered as part of the detailed and on-going scrutiny of the proposed Centre with patient safety being integral to the challenges put to Velindre University NHS Trust.’
Our correspondence with you has always concerned the ‘proposed’ clinical model for the cancer centre raised in your reply. This is the so-called ‘stand-alone’ centre as opposed to the mainstream ‘co-located’ model. You now claim its appropriateness ‘has been subject to the independent advice’ from Nuffield.
But in fact, the Nuffield Advice does not address the clinical model’s appropriateness at all. One sentence notes a justification for the location based on parking (p.35) and another relates to Covid. Neither of these are relevant. There is no possibility that the ‘appropriateness’ of the standalone could be called subject to Nuffield. Appendix 1, however, does discuss the appropriateness of the mainstream co-location model and scores it highly (pp.37, 48-50).
In fact Velindre was careful not to ask for advice upon the appropriateness of proposed cancer centre model. Indeed the location/model was placed out of bounds in the report:
‘Co-location… is not possible… within the timescales needed to improve and enhance cancer services in South East Wales. In response to this, the network model has been developed.’ (p.44, italics ours.)
‘[Velindre] commissioned this report, asking us to provide an independent advice on the integrated regionally networked model… the proposed model of networked cancer care in South East Wales.’ (p.7).
The Advice specifically excluded the cancer centre model as an already left-behind topic and contains virtually nothing on the clinical appropriateness of the proposed standalone centre at all. That is because the Nuffield Trust’s report is about the network model. This fact rules out your replacement wording which is a novel phrase in the debate but still stubbornly prolongs a major falsehood.
So the proposed model’s appropriateness was not ‘subject to’ the Advice as you claim above. This means the Ministerial Code is further breached by this misrepresentation, and now is a more considered one. This breach proves as serious as those perceived in earlier phrasing. It errantly implies that the proposed cancer centre model has received an all-clear by Nuffield’s report. A public correction to this is still urgently needed.
In passing, even less did Nuffield advise a 25-year long standalone centre. What’s more, the panel did not know the plan would cost at least £800m (only known to Senedd months later). If the Minister really believes that the standalone model’s appropriateness was subject to Nuffield the whole 30-year long project should be pulled, as the report did not endorse the model and noted much evidence against it.
On the Nuffield passages your letter cites, we are unsure what you intend to show from them regarding the cancer centre model to which Nuffield was obliged to give scant attention. But none of them consider, let alone validate, the ‘appropriateness’ of the proposed, long-term standalone provision for the cancer centre.
But we note the following relevance of these quotations for related matters:
1) The context for each quotation is that of an ‘immediate’ action needed in 2020. It specifically concerned safety for cancer patients at risk of serious deterioration (‘inpatients and emergency ambulatory patients’). The issue, for Nuffield, accordingly now had to be tackled through increasing the admissions at General District Hospitals, especially UHW, and reducing them at Velindre.
2) Even this is no more than ‘a reasonable way forward’ for the present regional crisis, the immediate or ‘foreseeable’ future. So a first step only, not a long-term plan (let alone one for the next 30 years).
3) Similarly, the prospect of ‘many of the benefits of co-location’, only refers explicitly to these very ill patients who can’t wait for a long-term resolution of whatever cancer centre model ensues. It does not describe a rosy future for all aspects of cancer provision in South East Wales or its new cancer centre.
4) A press release from Nuffield, following the publication of the report, makes clear that this ‘way forward’ only has the ‘potential’ to deliver these ‘benefits’ https://www.nuffieldtrust.org.uk/news-item/nuffield-trust-publishes-report-on-cancer-services-in-south-east-wales-1 (see italicised paragraph). Hence the words in the report itself say ‘can offer’ but not ‘will deliver’. This, however, is not clear from Ministerial statements (especially of 19th March 2021).
5) Even these early ‘benefits’ are achieved predominantly through increasingly co-located cancer care at the region’s hospitals, especially UHW. The appropriateness of a ‘standalone’ clinical model to this new situation does not even get a mention.In fact it’s clearly the odd one out, even though ‘a high capacity ambulatory treatment centre is a sensible strategy in a number of different scenarios’ (Italics ours).
6) When Nuffield observed that ‘full’ co-location was a long way off, that did not mean ‘off the table’ but rather that co-location should be planned for (p.52). But Nuffield’s panel could not know anyway of later critical developments, such as:
a) a Velindre Freedom of Information report divulging in early 2022 the total lack of documentation for deliberations alleged to back the standalone model’s appropriateness. For the same reason, nor is there a trace of the customary region-wide formal consultation essential for any major service change.
b) three years later [from 2020], the project has still not reached the signing of a construction contract agreement. New Velindre is way off its timeline, and creeping towards the decade’s end. But meantime UHW has a new hospital Programme Business Case and has received regional welcome for its UHW hub proposal.
c) Welsh Government readiness to splash huge money on a single, predominantly outpatient treatment unit destined to eat £800m + of public money. Enough to rebuild an entire, new general hospital.
In summary, the Nuffield quotes seem not to relate to the Ministerial Code of Conduct and therefore only increase the sense that a misrepresentation to the public is indeed present here. Since the issues are so far-reaching, we would expect, and assume, that both your letters are faithfully conveying the Ministerial view. Hence we have never raised the Code of Conduct for Civil Servants or made comments on it.
We would expect a correcting announcement to the Senedd Health Committee, the cancer community and the nation, as this ‘inadvertent error’ enjoyed repeated official free passage before the 2021 Senedd elections. It has since persisted, despite being challenged in the press.
We look forward to hearing of the ministers plans for correcting the record.
The message above is replicated in the attached file.
Yours sincerely.
Penny Owen (Dr)
Roy Kearsley (Dr)
(a non-clinical co-ordinator for Co-locate-Velindre)
Friday, 1 December 2023
hss.governmentbusinessteam@gov.wales> wrote:
Dear Drs Owen & Kearsley
Thank you for your further correspondence of 22 November. As described in our response of 8 November, our reply was not from the Minister for Health and Social Services, but does reflect the Welsh Government’s position.
We fully appreciate your underlying concern that the new Velindre Cancer Centre offer a clinical model of care that is safe and effective. We understand the benefits of a co-located model and the mitigations that are required as part of a networked clinical model. As the Nuffield Advice states, the option for co-location is not currently available, and through our scrutiny of Cardiff and Vale University Health Board’s programme business case (which includes the reprovision of the University Hospital of Wales), we can confirm this is the case.
In the absence of the opportunity to co-locate a cancer centre with the University Hospital of Wales, our scrutiny of the Outline Business Case for the new Velindre Cancer Centre focused on whether or not the networked clinical model is a viable alternative. You confirm in your email of 22 November that the Nuffield Trust provided advice on “the integrated regionally networked model”. This is why we are in a position to state the clinical model has been subject to independent advice from the Nuffield Trust. For clarity, we have not defined the clinical model as a ‘standalone cancer centre’, as you have in your letter of 22 November. We have defined it as a networked model that includes the new Velindre Cancer Centre and other components. Therefore, it is reasonable to state that the clinical model as proposed has been subject to advice from the Nuffield Trust.
11th December 2023
Dear Government Business Team and Elunedd Morgan MS, Minister for Health and Social Care,
Thank-you for your most recent email and for promising ongoing scrutiny. Thank-you for the pledge that your emails reflect the position of the Health and Social Care Minister. Our reply, then, includes the Minister when using the plural ‘you’.
We confess to difficulty with your key statement: ‘[We] have not defined the clinical model as a ‘standalone cancer centre’, as you have …We have defined it as a networked model that includes the new Velindre Cancer Centre and other components’. This is a problematic oversimplification as it contradicts your own words to us:
‘You have raised concerns associated with the proposed new Cancer Centre. The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been subject to independent advice from the Nuffield Trust.’ (italics ours) Then: ‘The Welsh Government will continue to oversee the new Cancer Centre proposals’ with ‘on-going scrutiny of the proposed Centre’. Clearly, you respond here to our questioning of the cancer centre model, just as the ‘previous occasions’ concerned this, not the network.1
Moreover, your first response did not signal any switch of topic from the stand-alone cancer centre’s non-viability as a decades-long solution. So we credit you with giving a rational response rather than ignoring us and taking an unannounced diversion into the network model. Your therefore, could only be referring to the cancer centre model and underpinning, not to the network. And even when earlier jettisoning the word ‘review’ you saw no need to correct our focus on the cancer centre model.
It is regrettable that such shifts have succeeded in obscuring a lack of engagement so far with our original letter’s substantial questioning of finance and viability. Hasty changes have succeeded in blocking out such grave issues and adding unnecessary complexity and obfuscation. There is still a need to publicly correct ministerial distortion of The Nuffield Trust’s Report. Also:
ï On Nuffield’s supposed validation of the stand-alone cancer centre, it rather stated: ‘…we are not making any judgement about the decision to site the new VCC on the Northern Meadows…’ (Advice p. 11).2 It merely recognised the value of ‘a high volume treatment centre’ in a variety of scenarios (p.11).
ï We also suggest that whatever the timetable hurdle for a fuller co-location, the approved New Velindre programme after Nuffield is not faring much better. Though enjoying lavish funding and an accommodating planning process, its entry date now looks late in this decade. Hence a new UHW could lie only a few years behind. Nuffield had confirmed that the building of UHW2 from 2032 onwards is a reasonable goal.3 Your appeal to ‘deliverability’ can cut both ways.
ï We have discerned bewilderment in UHW staff over a perceived Welsh Government coolness and ambivalence towards UHW2’s detailed proposals. This contrasts with Government support for its MIM New Velindre priced at £800m+. The blame laid on a crumbling UHW2 began in 2013. So it’s no compliment to Welsh Government cancer policy that it still depends on this plea.
ï Nuffield did not endorse replication of the cancer Centre’s current approach. It questions whether the inpatient service is ‘a robust approach for the future’ (p33). In fact, even the outpatient contribution will be reduced not expanded. This is due to the Nevill Hall Radiotherapy Satellite Centre, the complex oncology hub at UHW and the acute provision at regional hospitals. The Trust itself puts 55% of SACT activity outside of Velindre. Nuffield insisted that immunotherapy needed the back-up of acute services so shouldn’t be done at Velindre. It all significantly reduces the demand for patient treatment at VCC.
ï It is hard to see how a such an expensive, diminished, mainly ambulatory service away from acute support can be justified. The ‘reasonable way forward’ for Nuffield merely concerned emergency rearrangements in the network for the immediate needs of very vulnerable patients. The new Centre is not so described but it clearly can never be a key agent of transformation.
ï This is the brute truth about the ‘clinical model’ specifically in mind for the Cancer Centre. But from your choice of phrase, the IIB in December 20204 would have likely heard Nuffield cited as supporting the ‘standalone’ as the ‘appropriate clinical model’ for Velindre. If so, the IIB was gravely misled by those speaking to them. This means they also misled the then Minister’s decision-making when granting prolific funding (March 19th 2021). This, surely, is very serious.
ï Nuffield encouraged co-location as the controlling ambition for cancer in decades ahead.5 The UHW hub is a strong start and the ‘way forward’ an adequate ‘on hold’. But the proposed, long-term plan for an outdated cancer centre is something else. It has jostled out this superior option for an entire generation. It seems impossible to justify such an exorbitant facility contributing less than before, and in a time of extreme financial stringency. We must get this right first time. It will be our only shot.
ï We note that ‘the Welsh Government did its own assessment of the clinical model…not solely dependent on the Nuffield Trust’s advice.’ Then it must surely have seen a red flag when, in response to Nuffield, 163 senior clinicians in a single speciality strongly criticised the cancer centre proposal model. They intensely doubted best service for patients from the proposal or best use of public money. The Health Minister refused them a meeting and did not offer direct access to the Infrastructure Investment Board which made the recommendation to the Minister.
Thank-you for recognising our concerns. Our disquiet, however, goes well beyond ‘safety and effectiveness’. We are concerned that there will be no world-class cancer centre of excellence to serve half of Wales’s population for near 30 years, seeing no earlier alternative is planned. The delay will undoubtedly by then prove too exorbitant for a future government to shoulder. This is nothing less than a tragedy.
Yours sincerely,
Penny Owen (Dr)
Roy Kearsley (Dr)
(a non-clinical co-ordinator for Co-locate-Velindre)
On behalf of Co-locate Velindre
REFERENCES FOR EMAIL 11TH DECEMBER
Sources
1 For example, the letter from 163 senior clinicians working in cancer who were refused a meeting by two Ministers of health: https://colocate-velindre.co.uk/letter-from-163-clinicians/
Also: https://colocate-velindre.co.uk/eminent-clinical-reviewers-on-velindres-plans/
2 From Nuffield:‘a number of interviewees raised the question about the desirability of a co-located model…In Appendix 1, we look at this question and our analysis is that this will not be an option for some considerable time, but may be possible as part of a redeveloped University Hospital of Wales (UHW) in the longer term.’ (p.11).
Also, the virtues of the defended stand-alone model are not up for discussion in the 11 Recommendations (pp.44-46) and therefore the topic migrates to Appendix 1 where it enjoys no preference as the appropriate model for a new cancer centre, only accepted as a reasonable (‘immediate’) way forward for the meantime. In fact co-location is the clearly preferred model, blocked only by current circumstances.
3 ‘Looking at other schemes of this complexity and size in the UK and EU I would maintain that our assessment [November 2020] – informed by external expertise – that 12-15 years to be ready to build a cancer centre remains a reasonable estimate.’ (Nigel Edwards letter to a campaign supporter 20th April 2021).
4IIB’s deciding meetings were held on 9th and 16th December 2020.
5See note 2 above.
END OF EMAIL THREAD
