Colocate Velindre recently contested a local politician’s claim about the Nuffield Trust’s Advice to Velindre in 2020: It turned out the politician had not grasped Nuffield’s insistence on a large-scale options appraisal prior to everything else.

For Nuffield, transformation of cancer services should only ever begin this way. It comments (italics and bold added by us):

 ‘…we are not making any judgement about the decision to site the new VCC on the Northern Meadows. Such 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. It cannot be outsourced…’ (p.11)

The first surprise

The words ‘on the Northern Meadows’ pull the reader up short. For public information yields nothing about who concluded and sealed this refinement. Nor do reports disclose when it occurred. So nothing ‘large-scale’ there.

But clearly for Nuffield a wide-open process is essential for setting the direction of a major service-change. And New Velindre agrees with this by presenting itself as a follower of Nuffield. To see Nuffield’s point proven beyond doubt see:

The second surprise

Velindre hasn’t even documented a large-scale appraisal for the change that underpins the whole decision process. Instead in 2014 some discreet group did its own options appraisal. It alone chose the option of an antique, ‘stand-alone’ clinical basis for the New Velindre (that is, a new building away from an acute hospital). More of that in another post soon.

The decision took many stakeholder clinicians by surprise in the Spring 2015 engagement. Some even felt pressured to accept the decision.

What it all means

Nuffield did not just cite its terms of reference and leave it at that. No, it also asserted the norm of a large-scale appraisal to inform and empower such major decisions as a new cancer building. This is the exact opposite of advising a go ahead with the ‘stand alone’ build as some claim. For Nuffield must have detected the absence of a proper appraisal in the main documents.

So even at a late stage, Nuffield found a way of propelling New Velindre towards a proper, large-scale options appraisal if none existed. But New Velindre’s leaders continue to defy this direction while loudly claiming to follow Nuffield’s advice.

No wonder the January 2021 letter from 163 senior clinicians (snubbed twice by Welsh Government) stated: “There must be a formal review, including an updated, full options appraisal…This can be done at pace.”


A campaigner informed by the work of Colocate challenged one senior member of New Velindre in December 2021 with this question: ‘When was the Nuffield-style large-scale full options appraisal done?’ The response of the senior official was to pivot, walk away and accuse the questioner of rudeness.

It’s a reaction deeply worrying. The question just seeks safe and best cancer care in Wales. When did New Velindre carry out this obligatory, ground-laying, large scale, full options appraisal?

The Minister of Health should be sure on this by now, right? Can the Senedd Health Committee, shadow ministers and Senedd members reassure us? Not to mention health board managers and cancer clinical leads. For it matters to cancer care in all of Wales.

Anyone can write to these bodies and individuals for an answer, and we urge readers to do just that, urgently but very briefly. Let a link to this post do most of the talking but ask the question in italics above. It needs settling or best cancer care will soon be out of reach.

We predict that no satisfying answer to this question will emerge, in which case the safety and wellbeing of thousands of patients really can’t be assured by Welsh Government right now. It’s not too late to correct such a critical deficiency. Better late than never.