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