Transcript Velindre NHS Trust Mid Year Review 2006/2007

‘Delivering Non Surgical Cancer
Services for SE Wales’
Strategic Outline Programme
(SOP)
INFORMED STAKEHOLDER EVENTS
JUNE 2007
The Need for Change
Dr Malcolm Adams
Clinical Aims
To deliver timely
radiotherapy and
chemotherapy according to
standards and ensure
optimum population access
over the next ten years.
Why is there a need for Radiotherapy?

Essential
component of
curative and
palliative cancer
treatment

Proportion of
cancer patients
requiring
radiotherapy
increasing
Linacs deliver 80% of
curative radiotherapy
Principles of Radiotherapy (1)


Cancer control related to radiation dose
Radiation toxicity is related to
dose/volume of normal tissue
irradiated

Fractionated radiation reduces
radiation toxicity

Aim : maximise dose to target volume
and minimise to normal tissues
Principles of Radiotherapy (2)
Scan : define tumour
target volume and critical
normal structures.
Plan : maximise dose to
target volume and minimise
to normal tissues.
Target Volume
Prescribe : fractionated
radiation dose.
Critical normal
structure
Why increasing demand for
radiotherapy?
Rising cancer
Site
population
predicted%
increase
2005-2015
Prostate
41*

Rising referrals
Breast
25.3*

New indications
Colo/rectal 28.2*

Improved more
Lung

incidence in ageing
complex treatment Total

Changing case mix
-14.1
28.5
Why are short Radiotherapy
waiting times important?

Increased waiting times reduce survival

Delay of 30-60 days reduces cure rate for
a range of cancers:

head and neck

cervical

breast

prostate
Cancer Standards

Cancer Centre must comply with cancer
standards:
62 day wait from referral to treatment
31 day wait from diagnosis to treatment

Radiotherapy is first definitive treatment in
15% of cancer patients
Existing
Radiotherapy
Delivery
in Wales
Bodelwyddan
Bangor
ALL WALES
2.95 million pop.
3
Wrexham
North Wales
English
Cancer
Networks
Aberystwyth
Cancer Centre
SW Wales
SE Wales
Cancer Unit
3 Cancer
Networks
3
Swansea
Pontypridd
Newport
5
Velindre
SE WALES
1.46 million pop.
8000 new cancers
How much radiotherapy is needed
by 2015 ?
Provision
Model
Wales Scotland
Cancers/m 5,000
Fractions/
m pop.
5,000
England
Actual
Wales
2006
5,000
5,017
58,000 56-69,000 54,000
30,161
Recommendations for all Cancer
Centres in Wales

1st Step
Move to 5 Lin Accs per million
- (min 8000 fr/LA/yr and 4.5 fr/hr)

2nd Step
Explore working patterns and
models for extended working day
Proposed service models for
radiotherapy working day
Service No hrs
Model
/day (4.5
fractions/hr)
Mean
fractions/
linac/ yr
A
8,345
No of linacs
needed by 2016 in
SE Wales (58,000
fractions/m)
10
10,431
8
9,388
9
B
C
100%
8 hrs
100%
10 hrs
50% 8hrs
50% 10 hrs
Review of Cancer Services for the People of
Wales (Health and Social Services Committee) February 2007
Recommendation 1
.......securing the funding of
new and replacement
radiotherapy equipment...
Actions required to meet future
radiotherapy needs
Maximise
efficiency of existing
machines – undertaking capacity and
demand audits, implementing
extended working day
Optimise
configuration of future
machines to :-
(1) ensure quality planning and
safe efficient delivery
(2) maximise patient access
Why increasing demand for
chemotherapy ?
 Rising cancer
incidence in an
aging population
 Rising referrals
 Increasing survival
of cancer patients
 New indications
New targeted treatments
Existing
Velindre
Solid Tumour
-C
hemotherapy
Network
Delivery Bases
Chemotherapy
Network
Royal
Gwent
Hospital
DGH
Llandough
Hospital
DGH
Royal
Glamorgan
Hospital
DGH
Nevill Hall
Hospital
DGH
Prince
Charles
Hospital
DGH
Velindre
Hospital
Cancer
Centre
Ystrad
Mynach
Hospital
CH
Bronllys
Hospital
CH
Princess of
Wales
Hospital
DGH
Tredegar
Hospital
CH
What are the components of a good
chemotherapy service?



Access to specialist decision in
multi disciplinary team
Timely delivery of chemotherapy as
near to home as possible
Optimum management of toxicity
What are the effects of capacity
contraints?

Treatment delays

Worse outcome

Threat to clinical trials

Second class service
Thank you
PLANNING PROCESS
Mrs Georgina Galletly
Planning Process


Requirement for ‘SOP’ –
Strategic Outline Programme
NHS Wales Regional Plans –
April 2006
Background



Velindre Trust has been planning for
increased radiotherapy capacity for
many years
Delayed progress due to All
Wales/Regional focus & uncertainty
Task & Finish Group developed a DRAFT
SOP for submission to WAG on 2nd
November 2006 identifying 5 high level
options for models of service delivery.
Identification of possible
options



Establishment of regional
‘working group’;
Development & agreement of
investment objectives & success
criteria;
Generation of model to identify
possible service models;
Generation of Possible Service Models
Chemotherapy
Centralised
Decentralised
Single Chemo Centre Chemo in level ¾
Chemo in level
1/2/3/4
Single Radio Centre Single Radio Centre
Radiotherapy
Single Radio Centre
1
3
2
Single Chemo Centre
Chemo in level ¾
VCC & satellite▲
Radio
VCC & satellite▲
Radio
4
Chemo in level ¾
9* linacs over several
sites
9* linacs over
several sites
Decentralised
6
5
Single Chemo Centre
7
Chemo in level
1/2/3/4
VCC & Satellite▲
Radio
Chemo in level
1/2/3/4
9* linacs over
several sites
8
9
Current Situation


Formal, comprehensive & inclusive
programme management structure
established
2 Stages to process;


Stage 1 – Informed Stakeholder events
leading to identification of preferred way
forward.
Stage 2 – Wider public engagement with
potential public consultation depending on
option chosen as preferred way forward.
STAGE 1 – 4th – 8th June 2007

‘Informed’ Stakeholder Engagement








Regional Focus
Consider 5 options
Weight Critical Success Factors
Score each option against Critical Success
Factors
Identify ‘Preferred Way Forward’ i.e.
Preferred Option
Then;
Develop detailed plan for submission to
commissioners
Submit to WAG to secure high level
capital funding
STAGE 2




Wider public engagement on
preferred way forward
Process determined by model of
service delivery identified & CHC
involvement
Public Consultation on choice of
location etc to inform further
plans
Involvement of media
OPTIONS
N.B. all options acknowledge the need to
strengthen & localise chemotherapy
across the South East Wales Region as
far as possible
Option A
Do Minimum
‘Strengthen existing
chemotherapy services on the
Velindre Hospital site and
incrementally increase Linacs on
site to maximum capacity of 7
linacs (8 bunkers) within the
confines of existing boundaries’
Option B
‘Strengthen existing
chemotherapy services and redevelop existing Velindre Cancer
Centre by acquiring additional
adjacent land to accommodate
8/9 linacs on the VCC site’
Option C
‘Strengthen existing
chemotherapy services and
build a new cancer centre for
South East Wales’’
Option D
‘Strengthen chemotherapy
services and radiotherapy would
be provided from a cancer
centre (Velindre) and a satellite
radiotherapy unit’
(VCC with 7 Linacs + Satellite
housing 2 linear accelerators.)
Option E
‘Strengthen chemotherapy services and
radiotherapy would be provided from
a cancer centre (Velindre) and a
satellite radiotherapy unit’
(VCC with 7 linear accelerators +
Satellite housing 2 linear
accelerators.)
Implications of the Options
Dr Malcolm Adams/Dr John Staffurth
Consultant Oncologist
AIMS

Improve chemotherapy provision across
South East Wales
 Increased capacity
 Delivery in the most appropriate setting



Close to a patient’s home if possible
Central provision for complex/novel
agents
Improve radiotherapy provision across
South East Wales
 Urgent increase in capacity
 Delivery in the most appropriate setting
Existing Velindre Radiotherapy
and Chemotherapy Network
Royal
Gwent
Hospital
DGH
Llandough
Hospital
DGH
Royal
Glamorgan
Hospital
DGH
Nevill Hall
Hospital
DGH
Prince
Charles
Hospital
DGH
Velindre
Hospital
Cancer
Centre
Ystrad
Mynach
Hospital
CH
Bronllys
Hospital
CH
Princess of
Wales
Hospital
DGH
Tredegar
Hospital
CH
Existing Velindre Radiotherapy
and Chemotherapy Network
SITE A
SITE I
SITE B
Velindre
Hospital
Cancer
Centre
SITE H
SITE C
SITE G
SITE D
SITE F
SITE E
7
Option A
Radiotherapy
Incrementally increase Linacs on
site to maximum capacity of 7
Linacs (8 bunkers) within the
confines of existing boundaries
Chemotherapy
Strengthen existing chemotherapy
services on the Velindre Hospital
site and throughout network
7
Option A
SITE A
SITE I
SITE B
Velindre
Hospital
Cancer
Centre
SITE H
SITE C
SITE G
SITE D
SITE F
SITE E
7
Clinical Impact – Advantages



Improved local access to
chemotherapy services for the
population
Improved chemotherapy
configuration within Centre
Improved day case and inpatient
facilities
7
Clinical Impact – Disadvantages
 Does
not allow sufficient capacity
to meet service forecast demands
to 2016
 Not sustainable long term
 No improvement in local access to
radiotherapy services
 Inadequate research and clinical
trials facilities
 Inadequate teaching facilities
9
Option B
Radiotherapy
Re-develop existing Velindre Cancer
Centre by acquiring additional
adjacent land to accommodate 8/9
linacs on the VCC site
Chemotherapy
Strengthen existing chemotherapy
services on the Velindre Hospital site
and throughout network
9
Option B
SITE A
SITE I
SITE B
Velindre
Hospital
Cancer
Centre
SITE H
SITE C
SITE G
SITE D
SITE F
SITE E
9
Clinical Impact – Advantages




Accommodates all linear
accelerators required to meet 2016
forecast demand on single site
Improved local access to
chemotherapy services
Improved day case and inpatient
facilities
Capacity to respond to increased
patient numbers and increased
complexity of multi-modality
treatments
9
Clinical Impact – Advantages


Improved training, education &
research facilities on clinical site
Improved recruitment & retention
of staff
9
Clinical Impact – Disadvantages
 Obstacles
that need to be
overcome to obtain additional land
 Potential planning permission
problems
 Comprehensive decant plans will
be required to maintain services
during developments
 Congested site during
development
9
Option C
Radiotherapy
Build
a
new
cancer
centre
to
accommodate at least 9 linacs for South
East Wales
Chemotherapy
Strengthened existing chemotherapy
services at new site and throughout
network
9
Option C
SITE A
SITE I
SITE B
SITE H
SITE C
?
SITE G
SITE D
SITE F
SITE E
9
Clinical Impact – Advantages




Accommodates all linear
accelerators required to meet 2016
forecast demand on single site
Minimal service continuity
disruption during transition
No on-site or local congestion
Improved patient flow through
planning of new hospital layout
9
Clinical Impact – Advantages


Improved local access to
chemotherapy services for the
population
Improved day case and inpatient
facilities
9
Clinical Impact – Advantages



Capacity to respond to increased
patient numbers and increased
complexity of multimodality
treatments
Improved training, education &
research facilities on clinical site
Improved recruitment & retention
of staff
9
Clinical Impact –Disadvantages
 High
cost
 Finding suitable land in an
accessible location
 Potential planning permission
problems
 Planning blight on existing site
during transition
 Relocation of equipment to new
site
7
Option D
Radiotherapy
Radiotherapy would be provided from
Velindre cancer centre (7 linacs) and a
new-build satellite radiotherapy unit
housing 2 linear accelerators
Chemotherapy
Strengthen chemotherapy services at
VCC and throughout network
2
7
Option E
Radiotherapy
Radiotherapy would be provided from
extended Velindre cancer centre (7
linacs)
and
a
new-build
satellite
radiotherapy unit housing 2 linear
accelerators
Chemotherapy
Strengthen chemotherapy services at VCC
and throughout network
2
7
Options D & E
SITE A
SITE I
SITE B
Velindre
Hospital
Cancer
Centre
SITE H
SITE C
SITE G
SITE D
SITE F
SITE E
( )
2
7
What is a Satellite
Radiotherapy Unit?



A unit, geographically distanced from the
Cancer Centre, that provides
radiotherapy;
for example a District General Hospital
site
Building constraints and concerns over
patients’ travelling times have led to
satellite units being established
Patients treated at a satellite unit would
have the same level of care and support
as if treated at the Centre
2
7
2
What is a Satellite
Radiotherapy Unit?



Must have a minimum of 2 linacs and
associated planning machines
Technical and professional standards
of treatment would not differ from
that provided by the Cancer Centre
Some patients would still have to
travel to the Centre for specialised
radiotherapy preparation, planning
or delivery
7
Clinical Impact – Advantages


Improvement in local access to
chemotherapy services
Improvement in local access to
radiotherapy services for a
proportion of the population of
SE Wales
2
7
Clinical Impact – Advantages


Improved patient flow through
planning of new hospital layout
Improve day case and inpatient
facilities
2
7
Clinical Impact – Advantages


Capacity to respond to increased
patient numbers and increased
complexity of treatments
Improved training, education &
research facilities on VCC clinical
site (particularly option E )
2
7
Clinical Impact – Disadvantages
 Patients
still need to travel for
treatment planning
 Finding suitable land in an
accessible location for satellite
radiotherapy unit
 Management over 2 sites
2
Summary
Option
Summary
A
Limited long Limited long
term capacity term capacity
7
B
8/9
C
Radiotherapy Chemotherapy
9
Expanded
Expanded
Extensive
Extensive
?site
D
7
2
Expanded
Extensive
E
7
2
Extensive
Extensive
Thank you
Any Questions?
CRITICAL SUCCESS FACTORS
Mr Hywel Morgan
CRITICAL SUCCESS FACTORS





How do we ensure success?
How do we meet the need?
How do we excel?
What are the expectations?
How do we know we’ve
achieved our goal?
CSF 1

Strategic Fit



Supports principles of Calman-Hine Report
 Care as close to home as clinically possible
 Patient-centred
Supports principles of Cameron Report
 Cancer Centre level of service provision
 Working towards common principles across
Wales
 Multi-Disciplinary Team Focus
Supports Designed for Life
 Treat at home or other appropriate location
passing to highly specialised care when
necessary
 Quality care, evidence based
CSF 2

Accessibility
•
Equity of Access
• Access to all service users across SE
Wales
•
Geographically Accessible Services
• Easy access to location of services
•
Links with Transport Services
• Train, bus, and NHS transport services
•
Travel Time
• Location of services to population of SE
Wales
•
Reducing Waiting Times
• Linked to capacity & efficiency of service
provision
CSF 3

Sustainability

Capacity to meet future projected
demand
 Radiotherapy
 Chemotherapy
 Associated
services
 Future-proof solution (within
predictable limits)
CSF 4

Achievability

Affordability
Capital allocation (Welsh Assembly
Government)
 Revenue consequences
(Commissioners)


Workforce
Availability of trained professionals to
meet demand
 Direct & indirect workforce


Site Availability
Greenfield
 Acquire adjacent land

CSF 5

Acceptability

Patients
Benefits/disadvantages
 Personal/Clinical


Staff
Working locations
 Working patterns


Site Availability
Local residents
 Improved/Reduced access to
patients/staff/visitors

CSF 6

Improved Quality & Level of
Service

Links with other services
 Chemotherapy
 Critical





Care Pathways
Clinical Networks
Range of Services offered
Quality of Services offered
Patient Safety & Clinical Governance
Reflects (international) best practice
WEIGHTING OF CSFs
 Total
score of 100%
 Distributed across all
CSFs
 Highest % awarded to
most critical
 ‘Weighting’ according to
importance
SCORING THE OPTIONS
Mrs Andrea Hague
 NEXT
STEPS
 FEEDBACK
THANK YOU
