Mount Vernon Cancer Centre
see also the start:
and the progress:
Velindre Cancer Centre
By placing facts alongside each other this comparison provides evidence that the primary, underlying decision of Velindre in 2015 to eliminate (or ‘discount’) the model of co-location dominant in recent times, presented no prior evidence of peer consultation with partners and stakeholders nor produced an independent review to validate it. Mount Vernon and Nuffield are referenced but Clatterbridge can also be cited as having a similar pre-options independent review. The evidence also shows how Welsh Government is ultimately accountable for this.
Nature of process before full option appraisal was undertaken
Extensive, independent external review, including the extensive gathering of views from interviewees formally and informally.
- Internal clinical discussion only in a ‘number of clinical meetings and discussions’ (followed by Trust Board approval). No attendees, times and dates of this engagement are specified in Velindre’s account (Strategic Outline Programme October 2014 137-138).
- No views external to Velindre are reported in the account for the period prior to selecting a clinical options list (3.9.3. ‘Estate Model Options’ non-financial, p.137) whether from clinicians or stakeholders.
This pre-options process conducted by whom
By the Independent Clinical Advisory Panel (commissioned by NHS England and ‘to be led by the East of England Specialised Commissioning Team’).
By an unidentified internal Velindre group and which excluded ‘co-location’ from going forward to the ‘Estates Model Options’ full options appraisal long-list.
Depth of pre-options process
Full Two-Day Programme of interviews (day, time and year dated), phone-calls, group engagement (Some names appear in more than one list).
- 32 consultants interviewed by phone ahead of the dedicated two days
- 39 senior clinicians and executives took part in personal interviews over two days of programmes (of whom only 3 were from the Mt Vernon Cancer Centre) along with 3 junior doctors
- 27 stakeholders interviews (of which only 10 were from Mt Vernon Cancer Centre). These represented hospitals, regions and cancer bodies.
- 21 propositions posed to consultants and stakeholders on: Clinical Delivery; Oversight and Leadership; Service Configurations; Capital & Estate; Sustainable Workforce; Research & Development; Development Opportunities.
No consultation with external clinicians is described for this prior stage of the Strategic Outline Programme, only the views from Velindre internal discussion. In fact Transforming Cancer Services had hardly been established. No dates are referenced of the ‘meetings and discussions’ nor their position in the timeline made clear.
Formal reporting from consultation
Anonymous responses facilitated a ‘Consensus’ on 17 of the 21 propositions set out and a ‘Majority’ on the rest.
No pre-longlist, external peer consultation is described in the Strategic Outline Programme October 2014 with regard to ‘co-location’ or ‘stand-alone’.
Conduct of Full Options Appraisal itself
- Carried out by the externally commissioned independent panel.
- Full option appraisal included selections of both ‘co-location’ and ‘stand-alone’ models.
- By consensus all ‘stand-alone’ models excluded from the shortlist subsequent to interviews, as ‘not considered clinically acceptable’, leaving just two versions of co-location.
- Carried out by an unidentified sub-group in Velindre under the rubric ‘Estates Model Options’.
- Yielded no information presented in the Strategic Outline Programme concerning named participants or the responses of external input.
- Excluded all forms of co-location before assembling the long-list.
- Summarised for readers reasons for the exclusion of co-location including some arguments later contradicted directly by Nuffield Advice (see below).
Outcome of full options appraisal
- Emphatic recommendations made, requiring a new build on an acute site and centralising main operations there, especially acute care, trials, research and training.
- This must happen whether or not a scaled down form of the original cancer centre remains in situ as an ‘ambulatory hub’ and without a rebuild.
- Set measures for safety and effectiveness required to be taken for the period of transition, similar to the holding actions recommended by the Nuffield Advice.
One preferred option was selected after longlist and shortlist consideration from a selection of ‘stand-alone’ options.
New Velindre on co-location and Nuffield Advice:–
Velindre’s account of why co-location was excluded includes three major reasons for the exclusion which are contradicted by Nuffield:
- ‘The critical care /transfer system provides the required levels of safety and responsiveness to manage patients (SOP p.137).
Nuffield: ‘Safety – the management of acute illness can require immediate access to a range of clinical disciplines. Some of this can be provided by telephone or video but there are cases where it is necessary for an expert to examine the patient in person or perform a procedure… Trends in the toxicity and complexity of treatment and the growing number of patients with comorbidities and side effects from treatment mean that access to critical care and advanced support to deal with rapid deterioration is very important.’ (pp.47-48).
- ‘Research and development activities currently are multi-organisational and dispersed across Wales… the mantra must be about ‘relationships’ and not places’ (SOP 138).
Nuffield: There is agreement that the nature of the current and proposed services at the VCC make it unsuitable for some types of research due to the high levels of risk associated with the treatments carried out at the VCC… The future delivery of Phase 1 trials in Wales will largely need to take place on a site where immediate escalation of care is possible, and also the provision of additional medical specialty support. This is not part of the new Velindre site plan and therefore Phase 1 trials will need to take place elsewhere.’
- ‘Co-locating Velindre Cancer Centre on an acute site would potentially weaken the culture of the organisation, its values and beliefs…’ (SOP 138).
Nuffield: the specialist unit can still retain a distinct identity. It may have a separate building… or a physically distinct wing… In some cases the unit may even have a separate organisational form even though it is on the campus of a larger organisation…’ (p.49).
Welsh Government’s role
Welsh government has facilitated and approved this clinical decision for stand-alone without external independent review or apparent clinical consultation with partners and stakeholders, out of line with common preferred practice in the UK (see Nuffield Appendix 1). It did this,
- by approving more than once the Strategic Outline Programme of 2014 with its prior exclusion of the dominant clinical model in the NHS UK for transforming cancer provision, namely that of co-location of cancer centres on an acute site (approvals of the SOP in October 2014, December, January 2015 and finally in July 2015 (all in TCS’s journey account The new Velindre Cancer Centre – Transforming Cancer Services).
- By influencing the options appraisal. The SOP states it this way the rule (ratified in 2015) that ‘the entire nVCC should be built in Whitchurch, Cardiff, and on land under the ownership of the Trust.’ (Velindre: Programme Business Case September 2017 page E4 of E43). This rule specifically necessitated the clinical ‘stand-alone’ model and ruled out relocation to an acute hospital site. It also approved without further requirements an underpinning clinical model without independent review scrutiny or region-wide clinical consensus.
- by refusing to countenance an independent review, based on its confidence in Velindre alone as ‘expert providers’1 of cancer care who are competent to decide ‘what the best model is to treat cancer’ (Letter 22 November 2020 to Ms Beverley Woods). It has doubled down on the explicit absence of an external independent review and has taken pride in replacing clinical review with its own non-clinical body’s investment board, even claiming it to be impartial!
1For clarification: Most of those said by Welsh Government to be calling for an independent review, one like Mt. Vernon’s, are expert providers too. Some work frequently in more advanced cancer treatments. And some work at Velindre anyway but profoundly disagree with the Government decision on the New Velindre project. So the whole clinical community is the Welsh expert provider and has been ignored.
- by itself taking responsibility, for the clinical process, despite the letter cited in 4 above because: ‘it is Welsh Government’s role to ‘assess through its scrutiny process, the strength of the case being made and to make a determination with regard to its approval and funding.’ (Letter to the Senedd Petitions Committee 19th January 2021)
- By its failure to support a petition from STNM (Save the Northern Meadows campaign) merely requiring clarification through an inquiry of how such a decision was made on siting.
Illustrative Appendices for Mount Vernon Breadth of Consultation
Appendix 3 Clinical Advisory Panel Programme Participants (19/20 June) (p.29)
Name Position Jagdeep Kudhail Divisional Chair, Cancer Division
Dr Paul Mulholland Clinical Director, MVCC Sarah James Hospital Director, MVCC
Kelly McGovern Head of Nursing, Cancer Division, MVCC
Neel Bhuva Clinical Oncologist Maggie Fitzgerald Deputy Head of Nursing
Trisha Webbe Associate Director, Cancer Division
Sarah Morgan Matron, Out-patients
Dean Weston In-patient and Palliative Care Manager
Claire Dua In-patient Matron
Humaira Jamal Palliative Care Consultant
Suprotim Basu Consultant, in-patient lead
Zandie Chakunda Acute Oncology, Lead Nurse
Laura Morrison Junior Medical Staff
Jyotsna Bhudia Junior Medical Staff
Mohammed Abdul-Latif Junior Medical Staff
Dr David Miles Clinical Lead for Chemotherapy
Jo Demare Chemo, AOS, OPD and Medical records Service Manager
Michelle Orsmond Chemotherapy Matron
Vikash Dodhia Lead Pharmacist
Andrew Hood Chief Pharmacist
Amanda Webb Palliative Care CNS
Melanie Blyth Lung CNS
Helen Blyth Lung CNS
Helen Johnson Haematology CNS
Cathy Cale Medical Director, Hillingdon Hospital
Beverley Flower Accountable Officer, ENH CCG
Sharn Elton Clinical Lead, Cancer services, ENH CCG
Lizzy Bovill Director of Performance, NWL SRO for Cancer
Edward Bramley-Harker EDGE
Kim Fell NHS E/I
Roberto Alonzi Brachytherapy Consultant
Pete Ostler Breast, Urology and Brachytherapy Consultant
Suzy Mawdsley Head of School for Clinical Oncology, London
Daniel Megias Head of Radiotherapy
Karen Venebles Head of Radiotherapy, Physics and Bioengineering
Claire Strickland CEO, Paul Strickland Scanner Centre
Professor Padhani Consultant Radiologist,
Paul Strickland Cancer Centre
Suzanne Douglas Lead Clinical Scientist, Nuclear Medicine
Andrew Shah Head of Radiations Protection
Rachael Corser Director of Nursing, ENHT
Philip Smith Associate Director, research and Development
Paul Nathan Medical Oncologist
Marcia Hall Clinical Lead, R & D
Anita Holmes Trust Lead Research Nurse
Appendix 4 Clinical Advisory Panel Participants – telephone call interviews
Dr Roberto Alonzi Clinical Consultant Urology
Dr Nicola Anyamene Clinical Consultant Upper and Lower GI
Dr Neel Bhuva Clinical Consultant Upper and lower GI
Dr Kevin Chiu Clinical Consultant Head and Neck
Dr Shirley D’Sa Consultant Haemato-Oncologist Haematology
Dr Jeanette Dickson Clinical Consultant Lung
Dr Rob Glynne-Jones Clinical Consultant GI
Dr Amy Guppy Medical Consultant Breast
Dr Marcia Hall Medical Consultant Gynae
Dr Mark Harrison Clinical Consultant Upper and lower GI
Prof Peter Hoskin Clinical Consultant Urology
Dr Humaira Jamal Palliative Care consultant Palliative Care
Dr Jonathan Lambert Consultant Haemato-Oncologist Haematology
Dr Catherine Lemon Clinical Consultant Head and Neck
Dr Alan Makepeace Clinical Consultant Breast
Dr Andreas Makris Clinical Consultant Breast
Dr Suzi Mawdsley Clinical Consultant Upper and lower GI
Dr David Miles Medical Consultant Breast
Dr Paul Mulholland Medical Consultant Neuro
Dr Paul Nathan Medical Consultant Melanoma
Dr Peter Ostler Clinical Consultant Breast
Dr Andreas Polychronis Medical Consultant Upper and lower GI
Dr Nihal Shah Clinical Consultant Breast
Dr Anand Sharma Medical Consultant Germ cell
Dr Heather Shaw Medical Consultant Melanoma
Dr Narottam Thanvi Clinical Consultant Breast
Dr Ignacio Vazquez Medical Consultant Breast
Dr Anup Vinayan Clinical Consultant Breast
Dr Charlotte Westbury Medical Consultant Breast
Dr Kee Wong Clinical Consultant Head and Neck
Dr Hannah Tharmalingham Clinical Consultant Gynaecology
Appendix 7 Stakeholder Interviewees (p.34)
Caroline Blair NHSE
Christine Moss West Essex & Hertfordshire STP
Jane Brown Healthwatch Hertfordshire
Turkay Mahmoud Healthwatch Hillingdon
Jo Murfitt NHSE Michael Chilvers E&NH (Executive Team)
Laura Churchward UCLH
Cathy Cale Hillingdon Hospitals FT
Sarah James E&NH (MVCC)
Claire Strickland Paul Strickland Scanner Centre Jagdeep Kudhail E&NH (MVCC)
Kelly McGovern E&NH (MVCC)
Julie Smith E&NH (Executive Team)
Sue Douglas E&NH (MVCC) Dan Megias E&NH (MVCC)
Hannah Tharmalingam E&NH (MVCC) Paul Mulholland E&NH (MVCC)
Prof Hoskin E&NH (MVCC)
Harper Brown West Essex & Hertfordshire STP/East & North Herts CCG
Nicky Bannister Herts Valleys CCG
Rachael Corser E&NH (Executive Team)
Sarah Brierley E&NH (Executive Team)
Mandy Sanderson NHSE and I Nicola Hunt RM Partners West London Cancer Alliance
Naser Turabi North Central and East London Cancer Alliance/UCLH
Maggie Fitzgerald E&NH (MVCC)
Mohammed Abdul-Latif E&NH (MVCC)