Independent Review?

Regular readers of these blogs will know that we have repeatedly called for an independent clinical  review of the stand-alone model for the new Velindre Cancer Centre. 

As an example, we’ve described the process undertaken in the independent review of the Mount Vernon Cancer in this blog: https://colocate-velindre.co.uk/jaguar-electric-vs-rickshaw/.

Many people think that the Nuffield Trust carried out an independent review of the model in late 2020, so therefore all is well.  Velindre and Welsh Government are very happy for people to believe this, but sadly it isn’t true.

 The Nuffield published advice to Velindre on 1.12.20. It can be found here: https://www.nuffieldtrust.org.uk/files/1606833630_advice-on-cancer-services-in-se-wales-velindre.pdf)

We’ve touched on the Nuffield advice briefly in a previous blog https://colocate-velindre.co.uk/what-about-the-nuffield-trust-advice/. This blog looks further at the Nuffield advice, what it covers and what it doesn’t.  You can read a more detailed synopsis of the entire report here: https://colocate-velindre.co.uk/nuffield-synopsis/

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.

The following highlights how an extremely common scenario unfolds in a stand-alone centre versus a co-located site. The hypothetical patients could be any of us or our loved ones. The details used are fictitious but standard and will be only too familiar to every medical professional who reads this

Patient S

Patient S is currently attending an oncology clinic in a stand-alone cancer centre. She is 52, a librarian and lifelong smoker who enjoys walking her dog. She is going to be admitted for the management of pain and feeding problems following her radiotherapy for laryngeal cancer.

S’s husband has been trying to feed her soup and mashed potato to keep her energy up but notices that she has been coughing when she eats. The team explain that she may have been inhaling some of the food because of her abnormal swallow. 

S’s prognosis is excellent and her treatment should be curative.  She currently can’t cope at home because she struggles to swallow her pain killers. She is becoming dehydrated and is in severe pain. Her team have decided that she should have a tube placed for nasogastric feeding and pain relief with supportive nursing for a few days whilst they regain control of her symptoms. S is admitted to a stand-alone cancer centre, about three miles from the nearest acute hospital.

Several hours later

S is much more comfortable. She has a nasogastric tube in place so she can be fed and receive pain killers. Unfortunately, later that night, S starts to develop temperatures and a cough. The nurses notice she is becoming confused and sounds breathless. A chest x-ray shows pneumonia with the nasogastric tube in the correct location.

It’s fun, it’s easy to fill in, and it seems to be pretty popular. We’re keeping it open for a while longer so there’s still time to complete it if you haven’t already. it usually takes less than two minutes, so why not give it a go!

Here at co-locate Velindre we are keen to hear your thoughts and views. on the location and structure of cancer services in South East Wales. 

To make this easier, we’ve devised a quick survey which is completely anonymous. 

The survey is for anybody, not just those who agree with us, although we would ask for civility in responses. 

you can find the survey here:

 https://www.surveymonkey.com/r/Q6TM7FR

Thanks for all your feedback!

Edit

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. You can read the letters in full on Welsh Government’s own website: https://gov.wales/sites/default/files/publications/2020-12/atisn14500doc2.pdf

This conversation is fictitious. But free of alternative facts.

‘North Cardiff doesn’t know it. Cancer patients don’t know it. Many cancer clinicians throughout Wales don’t know it. Even you, a rookie reporter, don’t know it. ‘

‘Uh? Know what’?

‘How the New Velindre Cancer Centre became destined for a strange location. We should run the story at the weekend. People just don’t know that the Government, around 2015, instructed the Velindre Board to build its new Cancer Centre on a ‘stand-alone’ site. You know, not at a big hospital (1).’

We’ve described the emergency ambulance transfers of critically ill patients from Velindre to better equipped hospitals previously on this site .

https://colocate-velindre.co.uk/are-ambulance-pressures-putting-velindre-emergency-transfers-at-risk/.

Two patients a week from only forty beds and one junior doctor on the premises out of hours.

But there are many other transfers every week between Velindre and larger hospitals. Some are patients from Velindre needing investigations that are available as a matter of course in Cancer Centres colocated with acute hospitals. Others carry patients with cancer who are too sick to be looked after in Velindre from their acute hospital beds to Velindre for radiotherapy. 

Anyone who has travelled by ambulance will recognise the discomfort, anxiety and fatigue that result. These transfers would be unnecessary if Velindre was co-located on an acute hospital site. 

What you should know if you are to be treated at the current or future Velindre Cancer Centre.

Anaphylaxis is a severe, potentially life-threatening allergic reaction.

It can occur within seconds or minutes of exposure to something you’re allergic to- such as peanuts, bee stings…or chemotherapy given in Cancer Centres like Velindre.

The Resuscitation Council UK issues and updates guidelines for the treatment of anaphylaxis. Here are the most recent guidelines, from 2021.

Hint: it’s not Velindre

We’d all like a world class cancer hospital in Cardiff. Wouldn’t we? Well, guess what, we’ve already got one.

But its not Velindre

Here at co-locate Velindre we are keen to hear your thoughts and views. on the location and structure of cancer services in South East Wales.

To make this easier, we’ve devised a quick survey which is completely anonymous.

The survey is for anybody, not just those who agree with us, although we would ask for civility in responses.

It’s fun, its easy to fill in, and it seems to be pretty popular: over 100 responses in the first 20 hours. But of course we’re greedy and we’d like more!

you can find the survey here:

https://www.surveymonkey.com/r/Q6TM7FR

Thanks for all your feedback!

Today the opposition showed its true colours with a declaration of intent to start work to development of the New Velindre. This despite their many failures: to get planning permission, to discuss their work with local residents, to await the formal legal position with the Judicial Review not being heard until next month and finally, their failure to discuss the issues we have raised on this website in any way, shape or form.

And yet…

Local residents managed to raise tangible objections to the planned works presented so shoddily and inaccurately. They put off the contractors from carrying out their intended works on the day, and raised public consciousness about the aim of getting New Velindre leadership to consider colocation.

The ITV news coverage included coherent factual interviews with some protesters who clearly have a proper understanding of the medical issues, along with the environmental concerns that also have.

We’ve reproduced this comparison chart kindly provided by the Save the Northern Meadows Campaign to demonstrate again the folly that the New Velindre Cancer Centre will be.

UHW, Velindre, Welsh Cancer Research and Questions…

Why has the projected new University Hospital of Wales disappeared from public view for more than half a year?  Can the well-publicised vision for the new UHW really be stalled already? And wouldn’t a general, acute and teaching hospital (UHW2) bring hope to many times more cancer patients than even the planned New Velindre Cancer Centre would? 

If so…

What could have put such an important project as UHW2 on pause? Is Welsh Government really mothballing the programme while heaping funding on a stand-alone New Velindre project that can only yield an outpatients’ cancer unit?

Or should we buy into the speculations going about that UHW2 is just another casualty of post-Covid austerity? A natural surmise, but then how could half a billion pounds (likely much more) still be heading towards New Velindre, with millions already pouring down on its troubled enabling project? Why this seeming extravagance for a (much needed) new radiotherapy centre but stinginess with the urgency for a major, replacement research and teaching hospital?

We’ve seen a lot in the media in the last couple of days about patients being transferred between hospitals in Wales.

https://www.bbc.co.uk/news/uk-wales-58999131https://www.bbc.co.uk/news/uk-wales-58967159

Yesterday’s blog drew the uncanny parallels between the sorry situation now affecting patients in the Grange Hospital, and the much less well publicised reliance on ambulance transport for patients in Velindre.

https://colocate-velindre.co.uk/what-can-we-learn-from-the-grange-experience/

Velindre relies on ambulance transport for patients needing investigations and treatments they can’t provide on their Whitchurch site. This includes an average of two emergency transfers per week for the very sickest patients. Even before the recent pressures on the ambulance service, emergency transfers from Velindre to UHW could take up to six hours.

We’d like to hear from you

We know that patients receive excellent care from the clinical team in Velindre, and we appreciate all that they do. But some patients will need care from a bigger hospital. It’s not always possible to predict who will need this. If you, or a relative, has experienced a transfer from Velindre to another hospital, in an emergency or just for routine tests and treatment, we’d like to hear your experience. Tell us the good as well as the bad! You can contact us in confidence at colocatevelindre@gmail.com

‘Trainee doctors too scared to come to work’

That is the headline of a damning news story by the BBC’s Welsh Health Correspondent. The story describes a report by the Royal College of Physicians following a visit to the newly opened Grange Hospital in Cwmbran. You can read the story here: https://www.bbc.co.uk/news/uk-wales-58967159 .

Junior doctors described facing numerous problems trying to make the Health Board’s model of care work. Many of the problems sound eerily similar to those we can expect to see with the New Velindre Cancer Centre.