‘delivering non surgical cancer services for se wales’ strategic outline programme (sop)...

‘Delivering Non Surgical Cancer Services for SE Wales’

Strategic Outline Programme(SOP)

INFORMED STAKEHOLDER EVENTSJUNE 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.

Prescribe : fractionated

radiation dose.

Target Volume

Critical normal structure

Why increasing demand for radiotherapy?

Rising cancer incidence

in ageing population

Rising referrals

New indications

Improved more

complex treatment

Changing case mix

Site predicted% increase 2005-2015

Prostate 41*

Breast 25.3*

Colo/rectal 28.2*

Lung -14.1

Total 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

Wrexham

Bangor

Aberystwyth

Newport

Swansea

Cancer CentreCancer Unit

Pontypridd

Existing RadiotherapyDeliveryin Wales

North Wales

SW WalesSE Wales

English Cancer Networks

3 Cancer Networks

ALL WALES2.95 million pop.

Bodelwyddan

Velindre

SE WALES1.46 million pop.8000 new cancers

35

3

How much radiotherapy is needed by 2015 ?

Provision

Model

Wales Scotland England

Cancers/m 5,000 5,000 5,000

Fractions/m pop.

58,000 56-69,000 54,000

Actual

Wales 2006

5,017

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

Model

No hrs

/day (4.5 fractions/hr)

Mean fractions/ linac/ yr

No of linacs needed by 2016 in SE Wales (58,000 fractions/m)

A 100%

8 hrs

8,345 10

B 100%

10 hrs

10,431 8

C 50% 8hrs

50% 10 hrs

9,388 9

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 Chemotherapy Network

Solid Tumour Solid Tumour -- CChemotherapyhemotherapyNetwork Delivery BasesNetwork Delivery Bases

LlandoughHospital

DGH

Royal Glamorgan

HospitalDGH

YstradMynachHospital

CH

Princess ofWales

HospitalDGH

TredegarHospital

CH

BronllysHospital

CH

Prince CharlesHospital

DGH

Nevill HallHospital

DGH

RoyalGwent

HospitalDGH

VelindreHospitalCancer Centre

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

Chemo in level 1/2/3/4

9* linacs over several sites

9

Chemo in level ¾

9* linacs over several sites

8

Single Chemo Centre

9* linacs over several sites

7

Chemo in level 1/2/3/4

VCC & Satellite▲ Radio

6

Chemo in level ¾

VCC & satellite▲ Radio

5

Single Chemo Centre

VCC & satellite▲ Radio

4

Chemo in level 1/2/3/4

Single Radio Centre

3

Chemo in level ¾

Single Radio Centre

2

Single Chemo Centre

Single Radio Centre1

DecentralisedCentralised

Chemotherapy

Rad

ioth

erap

y

Decentralised

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

N.B. all options acknowledge the need to strengthen & localise chemotherapy across the South East Wales Region as far as possible

OPTIONS

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 re-

develop 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

YstradMynachHospitalCH

TredegarHospitalCH

BronllysHospitalCH

Royal GlamorganHospital

DGH

Princess ofWales

HospitalDGH

Prince CharlesHospital

DGH

Nevill HallHospital

DGH

LlandoughHospital

DGH

RoyalGwent

HospitalDGH

VelindreHospitalCancer Centre

Existing Velindre Radiotherapy and Chemotherapy Network

VelindreHospitalCancer Centre

SITE A SITE B

SITE C

SITE D

SITE E SITE F

SITE G

SITE H

SITE I

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

VelindreHospitalCancer Centre

SITE A SITE B

SITE C

SITE D

SITE E SITE F

SITE G

SITE H

SITE I

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

7

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

VelindreHospitalCancer Centre

SITE A SITE B

SITE C

SITE D

SITE E SITE F

SITE G

SITE H

SITE I

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 B

SITE C

SITE D

SITE E SITE F

SITE G

SITE H

SITE I

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

9

Option D

7 2

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

Option E

7 2

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

SITE E ( )

Options D & E

VelindreHospitalCancer Centre

SITE A SITE B

SITE C

SITE D

SITE F

SITE G

SITE H

SITE I

7 2

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

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 2

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

7 2

Clinical Impact – Advantages

Improved patient flow through planning of new hospital layout

Improve day case and inpatient facilities

7 2

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 )

7 2

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

7 2

Summary

Option Summary Radiotherapy Chemotherapy

A Limited long term capacity

Limited long term capacity

B Expanded Expanded

C Extensive Extensive

D Expanded Extensive

E Extensive Extensive

7

7 2

9 ?site

8/9

7 2

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

RadiotherapyChemotherapy Associated servicesFuture-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 servicesChemotherapyCritical 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

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