Mount Vernon Cancer Centre

https://www.england.nhs.uk/east-of-england/wp-content/uploads/sites/47/2019/08/Independent-Clinical-Panel-Report.pdf

see also the start:

https://www.england.nhs.uk/east-of-england/nhs-england-and-nhs-improvement-east-of-englands-work/mount-vernon-cancer-centre-review/

and the progress:

https://www.watfordobserver.co.uk/news/19707923.flying-hubcap-ambulance-woodmere-avenue-chaos-continues/?ref=nuo

Velindre Cancer Centre

http://www.transformingcancerservices.wales/wp-content/uploads/2020/09/Strategic-Outline-Programme-Engagement-Project-Final-Report.pdf

and

http://www.transformingcancerservices.wales/wp-content/uploads/2020/09/Strategic-Outline-Programme-Redacted.pdf

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 

Mount Vernon

Extensive, independent external review, including the extensive gathering of views from interviewees formally and informally.

Velindre

  • 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 

Mount Vernon

By the Independent Clinical Advisory Panel (commissioned by NHS England and ‘to be led by the East of England Specialised Commissioning Team’).

Velindre

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

Mount Vernon:-

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.

Velindre:-

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

Mount Vernon

Anonymous responses facilitated a ‘Consensus’ on 17 of the 21 propositions set out and a ‘Majority’ on the rest.

Velindre 

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

Mount Vernon

  • 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.

Velindre 

  • 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

Mount Vernon

  • 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.

Velindre 

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:

  1. ‘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).

  1. ‘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.’

  1. ‘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,

  1. 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). 
  1. 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.
  1. 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.

  1. 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)
  1. 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)