What’s all this about?
A simple comparison reveals a shocking contrast between the New Velindre Project and the parallel Mount Vernon one, at Northwood, Middlesex [updated October 2022]. Very similar challenges in the two cases, but utterly opposite responses. This blog is only a taster for the full, shocking contrast between the two. You can read a more detailed comparison (‘Which way was Wrong’) here https://colocate-velindre.co.uk/which-way-was-wrong/.
So what’s at the heart of it?
‘Which Way was Wrong‘ reveals the New Velindre team autonomously deciding in 2014 to eliminate the prevalent model for new cancer centres: co-location with an acute hospital, from their thinking. Moreover, in contrast to Mount Vernon, Velindre’s documents show no evidence of peer consultation with partners and stakeholders before this far-reaching decision.
What happened in the two settings before the full options appraisal?
Mount Vernon, before making any decision affecting options, underwent an extensive independent external review. The review included interviewees well beyond Mount Vernon’s own staff (see ‘Which Way was Wrong‘ for detail).
Velindre doesn’t even make mention of such formal independent consultation before getting down to impacting the options.
Who was involved at this early stage?
At Mount Vernon, an Independent Clinical Advisory panel carried out the review. The panel were commissioned by NHS England and ‘led by the East of England Specialist Commissioning Team.’
Velindre in its documents mentions only ‘a number of clinical meetings and discussions’ at Velindre. [Note added to this post in October 2022 after a Freedom of Information statement informed the world that Velindre took no minutes and made no records for these or any meetings discarding co-location.] See https://colocate-velindre.co.uk/%ef%bf%bc-freedom-of-information-response-but-where-are-the-minutes-decision/
How thorough was any ‘before options’ process?
Mount Vernon openly and formally reported on wider clinical consultation, with the timeline clearly showing day, month and year.
- 32 Consultants interviewed by phone,
- 39 senior clinicians and executives in personal interviews
- 27 stakeholder interviews representing hospitals, regions and cancer bodies.
All before going anywhere near an option decision stage.
Velindre report no prior consultation at all with external clinicians in the New Velindre project documents, let alone any formal display of data. The Freedom of Information report (see above) explains why Velindre offers no timelines or dates of ‘meetings and discussions’.
What happened with the consultations?
Mount Vernon facilitated formal responses , reporting a ‘consensus’ on 17 of the 21 propositions set out, and a ‘majority’ on the rest. They saw no need to eliminate any options beforehand.
Velindre reported no formal response- its documents show no formal external peer consultation process in the first place.
Who finally decided on the options list?
Mount Vernon options selection was enabled and supervised by the external, expert independent panel supported by a wide clinical consensus and convincing majorities.
Velindre’s formal account of options starts with a list already denuded of the dominant trend and gold standard ‘co-location’ option. But, as mentioned, there’s no record of the deliberations deciding this [see above].
What was the final outcome?
Mount Vernon was led to a new build at an acute hospital with acute care, trials , research and training, for which it has had to wait.
Velindre started with a process not recorded or minuted, before going out to sell the resulting ‘stand-alone’ model to the clinical cancer community.
How does the Nuffield advice play into the comparison?
The Nuffield Trust has emphatically denied that its advice is either a clinical review or about colocation. But unavoidably it still had the effect of demolishing the three main pillars supporting New Velindre’s 2014 stand-alone choice. These were not minor themes. They concerned:
- the safety of patient transfers,
- cancer research and training , and
- a perceived fear for Velindre’s ‘culture’.
See how Nuffield’s evidence dispatches all of these cases in ‘Which way was Wrong’.
How does Welsh Government come out of it?
Not very well. Welsh Government set in stone an autonomous decision against co-location, which lay unsupported by formal consensus or any recorded deliberations. it did this by insisting on locating the New Velindre in Whitchurch, remote from all support.
It has also still been hostile to calls for an independent external clinical review of the new Velindre stand-alone choice.
In June 2021 it was announced that as a result of the Mount Vernon review a new cancer centre will be developed within the building of a new General Hospital in Watford. Probably in 2023, so overtaking the New Velindre target set at 2025 at the time of amending this post.
We presume you don’t want us to decide for you which of these two projects is the
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