Developing Cancer Centre Services

For people receiving treatment at Mount Vernon Hospital

INTRODUCTION

Over the past few months, a Steering Group of PCT chief executives has been considering the future direction and development of cancer centre services for people who currently use Mount Vernon Cancer Centre.

We are setting out our initial thinking in a discussion document and are inviting comments from a wide range of stakeholdersliving in the areas served by the Cancer Centre.

Crucial to this debate is how we can build capacity for cancer care in the future and bring the availability of cancer services closer to where people live; avoiding the need for people having to travel long distances for treatment unless absolutely necessary.

A key component of the twooptions we are recommending for further work is the retention of specialist cancer centre services on the Mount VernonHospital site.

The importance of research and development is also the subject of our deliberations and in particular, how we can ensure that Mount Vernon’s excellent record in this sphere can be supported in the future. We believe that an academic partner for the Cancer Centre is the way forward.

The discussion document is only the first in a series of documents. Much work still needs to be done to assess current cancer centre services against national standards and to plan for the future. Further reports will be published later in 2008 and in 2009 and the views of patients and key stakeholders sought as the process develops.

WHY ARE WE DOING THIS AND WHY NOW?

Mount Vernon Cancer Centre in Northwood currently provides radiotherapy and specialist chemotherapy services for 2 million people living in

  • Hertfordshire, south Bedfordshire and Luton
  • The London boroughs of Barnet, Brent, Harrow and Hillingdon
  • Parts of south Buckinghamshire and east Berkshire

and a comprehensive radiotherapy and chemotherapy service for its local catchment population.Mount VernonHospital site is owned by The Hillingdon Hospital NHS Trust and the Cancer Centre is managed by East and North Hertfordshire NHS Trust.

There are both national and local reasons why this is the right time to consider the development of specialist cancer services provided at Mount Vernon.

  • National Context

The Cancer Reform Strategy published at the end of 2007 builds on the progress made since the publication of the NHS Cancer Plan in 2000.It provides important guidance and sets a clear direction for cancer services for the next five years.

With greater scientific understanding of cancer there are greater opportunities for prevention, early diagnosis and better treatment. There is considerable potential to introduce new service models for the prevention and treatment of cancer using more local flexibility in how these can be achieved which will improve both convenience and outcomes for patients. We also know that we can do more to improve the experience of care for patients, both during and after treatment.

New national guidance has recently been published forradiotherapy services by the National Radiotherapy Advisory Group and a similar report by an equivalent body for chemotherapy is expected in the Autumn. All the evidence predicts that with people living longer, additional capacity for both radiotherapy and chemotherapy will be needed to meet increasing demand.

  • Local Context

As many people locally will be aware, cancer services on the Mount VernonHospitalsite have been the subject of many reviews over a very long period of time. The most recent, in 2002, recommended that a new cancer centre should be co-located with a new hospital in Hertfordshire. The plan to build such a hospital in Hatfield was revisited in 2007 and it was decided that the new Hatfield development would not proceed.

The reserve position, outlined in the 2002 review, was that if a new hospital did not materialise then the cancer centre should move to an existing district general hospital (DGH) site on the condition that a full range of services was available to complement such a centre.

What the 2002 review could not have foreseen was the gradual shift in policyfor cancer treatment and the impact of significant investment atMount Vernonthat has taken place over the succeeding six years.

Two new and four replacement linear accelerators – machines that deliver high energy X-rays to kill cancer cells – and a new brachytherapy suite have been installed. Anaesthetic support is provided on a 24 hour basis by HillingdonHospital. The ListerHospital in Stevenage provides occasional surgical support.

For both national and local reasons, a fresh look at options for specialist cancer provision is timely.

OPTIONS

We have considered a ‘long list’ of options for addressing the issues relating to cancer centre services and are inviting feedback from stakeholders on these.

  • Option A (DGH option) - Relocate the Mount Vernon Cancer Centre from its current site to a DistrictGeneralHospital (DGH)site (the reserve position proposed in the 2002 review)
  • Option B (Minimal Change)– Retain the Cancer Centre at Mount VernonHospital and restrict future development of cancer services to this hospital site
  • Option C (Satellite Option) – Retain the Mount Vernon Cancer Centre on the Mount Vernon Hospital site but build any new capacity needed at one or more satellite locations where this is possible within agreed standards.

CRITERIA

The following criteria were taken into account by the Steering Group in determining its recommendations and we welcome comments and suggestions as to whether these are the right ones or if not, what else should be included or left out.

  • Consistency with national guidance and ability to meet national targets
  • Offers a safe and continuous high quality service
  • Enhances ability to recruit and retain high calibre staff.
  • Improved access for patients
  • Achievability in terms of practical implementation
  • Amount of disruption - an acceptable balance between short term change and long term gains
  • Scope for expansion as/when additional capacity is required to meet future need.
  • Addresses patient and public concerns about site issues such as car parking and having other relevant services on site
  • Consistency with local health strategies
  • Affordability and value for money in terms of a) capital and b) revenue costs.

PROPOSED SHORT LIST OF OPTIONS

The Steering Group is recommending that Options B and C should go forward onto a short-listfor further consideration but that Option A should not be pursued further.The basis for this are

  • high capital costs of moving the service
  • large capital development costson a new site which may be difficult to implement
  • ongoing uncertainty for staff, many of whom are highly specialised in their field
  • a new site is unlikely to improve overall access.

Again we are inviting views on this recommendation.

NEXT STEPS

We will be using opportunities over the next two months to consider the important questions in the discussion document with the many interested stakeholders and consider the feedback. We will undertake further work on refining the calculations on capacity needs and consider the local implications of national guidance on radiotherapy and chemotherapy services. We will also pursue the search for an appropriate academic partner for the Cancer Centre.

INVITATION TO COMMENT

A response form is included at the end of the discussion document for stakeholders to complete and return.

Additional copies of the discussion document can be obtained at

On request by email: by phone 01707 369701

Anne Walker

Chief Executive

East and North Hertfordshire PCT

West Hertfordshire PCT

Chair, Mount Vernon Cancer Centre Services Steering Group

September 2008

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