North Wales Cancer Network
DRAFT Feb 2007.
A Strategy for Oncology 2007 – 2014.
1)
Introduction
It is now six years since the opening of the North Wales Cancer Treatment Centre
(NWCTC) and this passage of time, along side suggested changes to the
commissioning structures in Wales, now make the need for an agreed strategy all
the more urgent.
This document attempts to provide stakeholders with a vision and strategy that
ensures an equitable and modern service across North Wales for the next seven
years.
The strategy addresses the next seven years on the basis that this both broadly
mirrors the time NWCTC has been opened, and, in ending in 2014 represents the
date the third current linear accelerator will be in need of replacement. In this sense
it provides a useful ‘line in the sand’.
2)
Core Aims
The following aims for the service must be evident within the strategic intentions
identified within this document,
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3)
equity
timeliness
integration
modernity
value and sustainability
Definitions
Oncology for the purpose of this document refers to,
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Radiotherapy including the facilities and personnel required to deliver that
modality.
Brachytherapy
Chemotherapy for all malignant disease and the supportive care resulting from
that treatment
All facilities and personnel related to the administration of chemotherapy
including nursing and pharmacy.
Treatment (only) of haematology oncology
All personnel related to the above.
Services out of area delivering the above to North Wales residents.
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4)
Current Provision – ‘where are we now’
4.1)
Pre 2000
Up until 2000 oncology services were in the main provided by the cancer centres in
Merseyside and Manchester with only NWWT having an inpatient medical oncology
based service. Outreach outpatient services from England, including chemotherapy,
were hosted in C&DT and NEWT by Clatterbridge(CCO) and the Christie respectively.
4.2)
Post 2000
With the opening of the North Wales Cancer Treatment Centre (NWCTC) in 2000
North Wales has developed an oncology services that includes,
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3 x linear accelerators at NWCTC and associated staff
1 x basic NWCTC
40 inpatient oncology beds at NWWT and NWCTC and associated staff
8 hostel beds at NWCTC
chemotherapy day units at NWWT, NWCTC and NEWT and associated staff
oncology clinics at NWWT, NWCTC, NEWT and peripheral hospitals.
7 Consultant Clinical Oncologists
2 Medical Oncologists (inc a Chair in Oncology)
chemotherapy reconstitution facilities in NWWT, NWCTC and NEWT and
associated staff.
Items above include facilities for patients with haematological malignancies though
these patients are overseen by 8 Consultant Haematologists. In NEWT these patients
have access to inpatient facilities within Medicine as there are no inpatient oncology
beds.
4.3)
The role of CCO and Christie Hospitals
CCO and Christie continue to provide oncology services to the North Wales
population on the basis that,
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The care provided is specialist and not currently available in North Wales e.g.
brachytherapy.
Part of a specialist pathway the main part of which is not available in North
Wales e.g. radiotherapy for osteosarcoma
They are the designated local oncology provider for that given population – CCO
and a percentage of the Flintshire population.
Limited sessions are performed by North Wales oncologists at the Christie in order to
facilitate the delivery of brachytherapy to Welsh patients. No sessions are delivered
by oncologists from CCO and Christie inside North Wales beyond those delivered to
the Flintshire population.
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4.4)
Commissioning
NWCTC services are commissioned by the Local Health Boards (LHBs) with
Denbighshire LHB being the nominal lead. Services at CCO and Christies are
commissioned by Health Commission Wales (HCW) and in both cases activity has
diminished considerably over recent years. Activity has largely reached a plateau in
2007.
4.5)
Assessment of the current provision
There is no doubt that the service has developed rapidly since 2000 however issues
remain that serve to shape a strategy over the next seven years. The following are
known issues within the oncology service that either need to be addressed, will need
a response or remain as issues for sometime in the future.
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2 of the 3 linear accelerators at NWCTC are due for replacement at the end of
the decade
the 3 linear accelerators at NWCTC cannot be fully utilised due to incomplete
staffing levels particularly within therapy radiography
the Shooting Star Chemotherapy facility is under utilised and appropriate
measures need to be taken to ensure this asset is fully functional
the chemotherapy day units within NWWT and NWCTC are at now at capacity
the oncology related elements of the pharmacy departments within all three
Trusts are at, or are near to, capacity
within the seven year timeframe at least three of the oncologist will have retired
– possibly within the next 2-3 years.
the Oncology presence within MDTs, though generally high, remains non
compliant with the National Cancer Standards within a few remaining specialties
recruitment to clinical trials has reduced
5)
Shaping Oncology Services in the future
5.1)
Demography and Geography
Recent data supporting the Secondary Review
(1)
suggests that

The demography of North Wales is predicted to change over the next 20-30
years with large growth in the numbers of older people.

Tackling inequalities in health is a key issue, almost one fifth of the population
living within the most deprived wards in Wales are located in North Wales.

There is evidence to show that people with chronic conditions are more likely to
use secondary care services. Reducing admissions requires partnership working
across sectors.
(1)
‘Summary Profile of the Population of Wales. A summary of the key points relevant to the
North Wales region arising from currently available baseline documents - Designed for North
Wales.(2005)’,
3
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The birth rate in North Wales is falling with the biggest decline seen in the North
West area.
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North Wales has a lower number of young people at all ages compared to the
Welsh average.
Though circulatory disease remains the main cause of death there is a significant
cancer population with the known predisposing factors of increasing age, chronic
illness and background poverty. It is these factors that increase the population in
terms of need by approximately 100,000 (2).
Geography will remain a factor though it is suggested that the population will be
distributed more or less as it is now. However regarding geography the
implementation of ‘Design for North Wales’ and the closure of certain community
hospitals may be a factor in the provision of oncology in the future.
5.2)
Trends in Cancer and Oncology
The World Health Organisation have recently predicted further increases in cancer
within the developed world, a world in which Wales already has some of the highest
rates of certain cancers.
Whilst some cancer rates are falling such as lung and stomach others are likely to
increase including breast, bowel, oesophageal and skin cancer and these increases
alone support the need for further developments of cancer treatment. It also noted
that national screening programmes such as that for breast cancer and the
forthcoming programme for bowel cancer will also detect early cancers that may well
be subject to oncology based treatments (3).
Recent papers suggest that though the delivery of radiotherapy may be subject to
change the modality will remain as a viable treatment for cancer and in fact will
increase in its application. Developments will address better targeting of radiotherapy
through shaping of radiotherapy and planning of delivery as well as symptom
management and tumour toxicity through ongoing debate on fractionation regimen
(4).
Arguably it is in the sphere of chemotherapy and supportive care where the most
substantial changes may occur over the next ten years. Already two particular
changes are being seen, the introduction of monoclonal antibodies such as Herceptin
and the move to oral preparations such as Capectibine. Though the issue of cost is
never far from the top of the agenda these developments challenge the traditional
model of chemotherapy management through their inherent flexibility.
Thus the trend would seem to be a definite move away from toxic regimen requiring
expert administration and inpatient management to outpatient delivery and
appropriate monitoring. The question is where this takes place and possibly who
performs the monitoring function.
(2) Population based Palliative care Needs Assessment. P Tebbit. October 2005
(3) P.Boyle, Annals of Oncology 2007.
(4) Radiotherapy in Wales .WASAC 2006.
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Regarding the last point though the current trend is for an increase in novel agents
and oral versions of once intravenous drugs the fall out is an increased pressure on
nurses in particular, especially as the associated reduced toxicity and increase in
adjuvant usage increases the potential for use amongst a wider patient group.
5.3
The Policy Context
It is suggested that at the time of writing three policy items shape the direction of an
oncology strategy,
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National Cancer Standards - WAG 2005.
Design for life – Designed to Tackle Cancer in Wales WAG Dec 2006
Design for North Wales 2006.
National Cancer Standards 2005.
Published in 2005 these Standards should be complied with by 2009. Each Standard
has sections that relate to the delivery of radiotherapy and chemotherapy however it
maybe the need to have an oncology presence at all MDTs and deliver first definitive
treatment within the prescribed timescale that provide the greatest challenge in
terms of meeting the standards by the deadline.
Design for life – Designed to Tackle Cancer in Wales WAG Dec 2006
Provides a wider view of the direction to be taken by the Welsh Assembly
Government.
Design for North Wales 2006.
Design for North Wales has little direct impact on oncology services other than
driving the health community to rationalise its acute facilities. This rationalisation
will, through its impact on support facilities such as laboratory support will influence
where certain oncology services such as chemotherapy administration be developed.
6. Describing Oncology Services in 2014 – ‘where do we want to get to’
The following should be objectives that which the North Wales community wish to try
and achieve by 2014 at the latest.
6.1
Radiotherapy
Radiotherapy services should be sufficient to meet the needs of the population based
on the evidence available in 2007.On this basis by 2014 there should be four
operational linear accelerators in North Wales at NWCTC with an appropriate number
of CT simulators.
All four linear accelerators should be fully operational, with adequate staffing, to
allow equitable access across North Wales in compliance with the waiting times
targets in 2007.
5
Delivery of radiotherapy should be in line with the latest practice in the UK and be
delivered in accordance with the most stringent quality programmes.
North Wales should be self sufficient in therapy radiographers by 2014.
6.2
Brachytherapy
Brachytherapy should continue to be delivered out of area though highly modernised
simple brachytherapy should be developed for local provision if the evidence is
available.
Both radiotherapy and brachytherapy should continue to be offered from a single site
at Glan Clwyd.
6.3
Chemotherapy
Chemotherapy services should be equitable in terms of consistency, geographical
access and timeliness. There should not be issues of capacity problems especially in
relation to the availability of new drugs.
The chemotherapy service should be modern, cohesive on a regional basis and
flexible in terms where and when treatment is delivered.
Pharmaceutical co-ordination and clinical management should be via software used
across all three Trust sites.
Pharmacies should have sufficient capacity to deliver the service and practice
modified to reduce costs and expand capacity on a regional basis.
The introduction of all new cancer drugs should be subject to a single process
overseen by a single, relevant, group consisting of clinicians and commissioners. No
new drugs should be introduced without warning sufficient to ensure resources are
in place to support it.
6.4
MDTs
An oncology presence should be assured at all MDTs in a manner that recognises the
sub specialties of the oncologists, the need for cover and the use of current and
future communication technologies.
6.5
Supportive Care
All three Trusts sites should provide 24 hr inpatient supportive care facilities with
appropriate staffing.
6.6
Heamatology/Oncology
Haematology/oncology should be further integrated into oncology across all three
sites.
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6.7
Medical manpower
Oncology medical manpower should be expanded to secure the above with specific
attention being given to the role of Clinical Oncology and Medical Oncology.
Manpower expansion should however, in terms of seniority, be tailored to ensure
improved local access whilst not losing sight of the need to be part of a fully
integrated North Wales oncology service.
6.8
Nursing
Nursing should be expanded to deliver the above.
6.9
Research
The availability of clinical trials should be equitable across the three Trust sites and
recruitment increased, as a minimum, to equal the rest of Wales
6.10
Follow-up
Oncology practice should be modernised to reduce the amount of follow-up offered
by a consultant only service and viable alternatives developed using other
professions in other settings.
6.11
Diagnostic support
An increase in access to oncology will increase the need for diagnostic support,
specifically radiological imaging. Radiology services should be expanded to cater for
this expansion particularly in NEWT and NWWT.
By 2014 PET-CT should be available as a fixed site service in North Wales and should
be located at Glan Clwyd.
6.12
Management/co-ordination
The oncology service should be both clinically and administratively managed on a
North Wales basis in a fully integrated and compliant manner. This management may
be located at NWCTC but should not be a formal part of that clinical organisation.
NWCTC should be responsible for the co-ordination of the delivery of radiotherapy
and chemotherapy on a North Wales basis and be subject to appropriate scrutiny as
a result.
6.13
Commissioning
There should be a single commissioner of oncology services with a single budget
regardless of geographical delivery. The single commissioner should also be
responsible for oncology treatment delivered in England to North Wales residents.
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6.14
Christie and CCO
The Christie and CCO should continue to be a provider of oncology services but only
in accordance with the demands of the identified commissioner.
7.
Delivering the future – ‘how are we going to get there’.
Having identified above some ends points of how oncology services should look by
2014 what is now described below is some more detail as to how the community
should progress towards achieving the strategic aims identified.
7.1
Radiotherapy – increases in capacity
NWCTC has completed the submission of SOC 1a to WAG which addresses the
replacement of the first two linear accelerators and the construction of two decant
bunkers. SOC1b is now being developed by NWCTC and this should be supported in
order to get to the four linear accelerator capacity required by the beginning of the
next decade.
It is noted that this strategy extends up to 2014 when the next linear accelerator will
be in need of replacement .It is noted that SOC1A requires two decant bunkers to be
built which if left undeveloped should leave one bunker remaining for decant
purposes in 2014.
7.1.2
Physics support staff
Additional physicists will be required both to commission new equipment and address
an expansion in the operational equipment. The requirement for additional physics
staff should be included in SOCs 1a and 1b and a recruitment process put in place to
ensure sustainable radiotherapy delivery.
7.1.3
Therapy Radiographers
Again SOC 1b should address the need for additional staff. However NWCTC at this
time has problems maintaining adequate staffing levels for it three machines and
this, with turnover and other larger units in close proximity on a similar recruitment
pathway,suggests that achieving adequate staffing levels via the established routes
may not deliver.
NWCTC, with appropriate partners should investigate the potential for training a
cadre of therapy radiographers either locally within North Wales or from other
sources e.g. Eire. In addition the role of the therapy radiographer needs to be
analysed further and the modernisation projects already in place built upon to see if
a new type of post can be developed to assist the therapy radiographers.
Either way NWCTC needs to identify how it can recruit and retain the increased
number of staff it will require to utilise four linear accelerators to the maximum.
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7.2
Brachytherapy
The future of brachytherapy is unclear in terms of what is economically appropriate
to be developed in North Wales. Whilst development of a service should not be ruled
out it is equally the case that a sound reason for its development is required.
SOC 1b may be an opportunity to develop a service as capital investment will be a
major requirement and it is suggested that NWCTC take a lead on advising
commissioners and stakeholders alike as to the requirement for such a service in
North Wales.
7.3
Chemotherapy – increases in capacity
Physical space for chemotherapy expansion should be base on three levels of
provision.
A minimal number of five-day bed facilities should be available on all three Trust
sites for those few regimen that require overnight admission – no chemotherapy
administration should take place at weekends. NEWT will be required to identify
appropriate facilities probably relating to the expansion of Shooting Star to an
overnight five-day facility or their haematology service where inpatient
chemotherapy for solid tumour work can be co-located. This should feature in SOC2.
Out-patient chemotherapy facilities should also be available on all three sites and
these facilities, as with those above, should address the needs of the local
population. These facilities should remain co-located with oncology outpatient
facilities and provide adequate space and resources to those patients commencing
chemotherapy or receiving toxic chemotherapy best delivered in that environment.
No expansion of these facilities should be considered at either NWCTC or NEWT until
the full utilisation of the space within NEWT has been achieved.
The third level should be the localised delivery of chemotherapy to the patient using
either a commercial provider such as Healthcare at Home or an equivalent
competitive NHS scheme. Every opportunity should be taken to deliver the
appropriate therapies in this manner by 2014 and immediate consideration should be
given to scoping this development.
Thus SOC 2 should establish the demands of a comprehensive chemotherapy service
in North Wales, however whether this is an expansion in the hospital or community
based facilities is yet to be determined, certainly no expansion of facilities within
secondary care should take place until the third level of care described above has
been explored as a viable clinical option.
7.3.1
Pharmacy development
All three pharmacies are at capacity and development plans need to be outlined
within SOC 2. Again these plans should reflect Shooting Star working to capacity and
the potential development of new agents particularly the change to oral medication.
Consideration should be given to a central production unit off an acute site which
can mass produce chemotherapy for all three Trusts as well as those patients
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receiving agents via other means in the community, it maybe that other commercial
opportunities also exist.
SOC 2 should address this option as such a development may well be more cost
effective than triplicate expansion across North Wales.
All three Trusts should be linked by Chemocare.
7.3.2
Nursing Support
Nursing levels within the chemotherapy environment should equitable across North
Wales and a single consistent approach should be taken to the education of such
nurses and the standards deployed. As a result nursing standards in chemotherapy
should be adopted and rigidly applied.
If a community based model proves viable the nurses in the community will require
appropriate training in order to deliver a specific portfolio of treatment. The nurses
within the chemotherapy units must be prepared and willing to educate their
colleagues and this is probably best done through adequate integration and a central
consistent approach to education as previously mentioned.
Once Shooting Star is working to capacity there should be a review of nursing
numbers within the units and a review of the function of those nurses.
7.3.3
Introducing new cancer drugs.
A single body should be established to consider the entry of new drugs into the
service. This body which should be multi stakeholder in nature should have the
authority and budget to act on both the providers and commissioners behalf with
and explicit remit for planning for new therapies in advance and in a manner that
prevents unplanned financial pressure. Core to the groups existence is consistency in
practice, efficiency in process and equity in access.
7.4
Medical Manpower
Medical manpower should be increased to address the following,
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Consultant contract requirements
Radiotherapy planning sessions to maintain targets
MDT participation
Clinical sessions
On-call
Sub specialisation
The manpower numbers should not only address the different specialties i.e. clinical
oncology and medical oncology but also a skill mix utilising staff grades and training
posts where possible.
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Recruitment up to 2014 should reflect the WSAC (2001) report and increase the
number of Consultant appointments by
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4 Clinical Oncologists
3 Medical Oncologists.
Noting that these recommendations preceded the outcome of the Consultant
Contract negotiations in Wales these posts should be seen as a minimum.
Recognising this it will be a requirement that these posts are appropriately supported
by sufficient Staff grade positions.
Accommodating this expansion in staff should feature in SOC2.
7.4.1
Location of Medical Manpower
The location of medical manpower needs to be re-assessed in light of the
commitments required of oncologists, radiotherapy capacity and changes to
chemotherapy practices.
As a result it is recommended that by 2014, from within the recruit profile
highlighted, that the following recommendations are implemented,
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NWCTC has at least one Medical Oncologist on site with clinical commitments
within Conwy & Denbighshire
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NWWT has at least one Clinical Oncologist based at NWWT who ‘reaches in’ to
NWCTC.
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NEWT has at least one Medical Oncologist and one Clinical Oncologist who ‘reach
in’ to NWCTC.
The rationale for this approach is the attempt to find a balance between the need to
provide planning sessions in the centre with sub specialisation versus the need to
provide MDT input and chemotherapy clinical input and leadership at a local level.
7.4.2
Recruitment priorities
Recruitment priorities are difficult to define as they will be dictated by the retirement
or movement of the current post holders and the recruitment market place at the
time.
Assuming the status quo is maintained the following prioritisation is recommended.
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Table 1.
Oncology Consultant manpower – recruitment priorities.
Post
Med Onc 1
Location
NWCTC
Clin Onc 1
NWWT
Clin Onc 2
Med Onc 2
NWCTC
NEWT
Clin Onc 3
Med Onc 3
Clin Onc 4
NWCTC
NWWT
NEWT
7.5
Rationale
Aid chemotherapy issues
Provide clinical lead for chemotherapy
Provide additional support to Oncology
establishment
Feed into MDTs
Additional support
Oncology leadership with specific emphasis
on chemotherapy service
Additional support
Additional support
Provide additional support to Oncology
establishment
Feed into MDTs
Supportive care
As a result of an expansion in patients receiving both radiotherapy and
chemotherapy it is likely that the need for supportive care will be increased and this
may refer to drugs, rehabilitation or some other intervention.
Inpatient beds and hostel beds providing supportive care for radiotherapy patients
are likely to be integrated within SOC 1a but inpatient beds for other supportive
needs may not be accounted for. Beds should be available on all three sites and
managed by an on site designated team (see 7.4.2).
Beds should be limited to patients who require symptomatic support for ongoing
treatment and care should be consistent across North Wales.
There should be a designated lead for supportive care who, with the identified
teams, ensures consistent practice and equitable access to supportive care facilities
across North Wales.
7.5.1
Psychological Care
Though not the preserve of oncology designated psychological care services
specifically for cancer sufferers is anchored in NWCTC and serves the populations of
NWCTC and NEWT. Thus by implication there is not the same access for cancer
sufferers in NWWT.
The provision of psychological support should come under the umbrella of supportive
care and be part of the remit of the clinical lead for that service.
All patients should be assessed for their psychological state of health and care
provided according to the patients need.
Whilst it is reasonable that the designated psychological care services is based in
NWCTC is it essential that the full development of the service as described by
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R.Corney and J.Wilcox-Jones (2004) and supported by the Palliative Care Network is,
as a minimum, implemented as part of this strategy.
7.5.2
Palliative Care
Palliative care is increasingly a free-standing specialty within North Wales and rightly
so. However the provision of palliative care is part of supportive care and as such
links should be formalised as part of the process identified above.
It is suggested that many patients within the current inpatient oncology facilities are
admitted for the delivery of palliative or specialist palliative care and as part of the
assessment of inpatient needs in SOCs 1a to 2 there should be the parameter that
bed numbers identified reflect only those beds required for patients receiving
oncological treatment or supportive care attributable to oncological treatment.
Patient requiring palliative care should utilise beds resourced to deliver that care but
these should not be in a treatment centre.
This strategy should be shared with the Palliative Care Network with a view to
gaining their insights and views on the impact of this approach. It may be that within
NWCTC, NEWT and C&DT in particular, that SOC 2 includes a sub section that
ensures some limited palliative care beds for those patients who need to be in an
acute setting because of palliative care interventional procedures e.g. nerve blocks.
Fundamentally though the Palliative Care Network needs to agree its own approach
to inpatient facilities and it is assumed that these will be within the local hospices
and community facilities.
7.6 Clinical Research
With an expansion in medical manpower it is hoped that not only and increase in
recruitment to clinical trials can take place but also that it can take place in an
equitable fashion with all three locations recruiting and running trials.
Whilst administrative support and Welsh Cancer Trials Network (WCTN) management
should be retained at NWCTC the local units at NWWT and NEWT should be the
permanent location of their local WCTN trials staff. This approach would be
supported by the local oncology appointments and the supportive care teams. This,
and any additional resource, should be considered as part of SOC 2.This approach
should lead to equitable access to trials across North Wales.
As with drugs the way in which clinical trials are adopted and implemented needs to
be refined and the oncology service needs to establish a once only mechanism for
consideration of trials. This will involve further development of the current WCTN
approach in terms of building upon their consistent approach to streamline it into a
single approach.
The research leads within WCTN need to become more involved with the oncology
service and the academic department of cancer at the University of Wales, Bangor
and lead all those professions those working in oncology of to embrace clinical
quantitative and qualitative research.
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7.7
Education
Many of the strands that support the delivery of this strategy rely on staff being
adequately educated in specific elements of oncology whether this be in
chemotherapy practice or as locally trained therapy radiologists.
Age demographics coupled with the rest of the United Kingdom pursuing the same
agenda suggests that North Wales will continue to face problems wit recruitment and
retention. It would therefore seem essential that North Wales looks for alternative
methods of obtaining highly skilled, appropriately educated staff and one option
should be to provide enhanced education and training locally.
It is suggested that each specialty investigates options for further training and
education of staff and dialogue is opened up with local educational establishments as
to the delivery of relevant, and possibly novel, educational programmes. It is
important that some leadership is provided around this issue and it is suggested that
a small multi disciplinary, multi organisational committee be formed to establish the
potential educational requirements of the workforce over the next seven years in a
manner that reflects the key elements of this strategy.
7.8
Modernisation
All areas of oncology should be subject to modernisation with particular emphasis
being given to the following,
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Increased efficiency within oncology pathways
Wider use of nursing, pharmacy and professions allied to medicine
Wider use of communication technology
A particular group within the oncology environment should be tasked with analysing
opportunities for modernisation and their implementation.
Modernisation related developments should support the model identified for
chemotherapy services, rectification of the capacity issues in chemotherapy and
consistent achievement of the waiting times targets within radiotherapy.
Part of achieving the above is done through the modernisation agenda being
reflected in the education programme provided to the oncology service by the
various academic/teaching departments.
7.9
Management
It is essential that the oncology service in 2014 is seen as a Network based service
that, despite being co-ordinated from NWCTC, is managed and delivered in an
overtly linked and mutually supportive manner, across all three delivery sites. Thus
management should exist on a number of levels.
Local level
Clinical management and clinical governance should be provided and assured by the
clinical team established on each of the three sites. These clinical teams should be
assisted by appropriate organisational management on the three sites, with both sets
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of staff being implicitly integrated into the Network oncology service structure.
Essential to this process is clinical sessions within NWCTC and clinical, practice
supported by Network wide protocols.
Co-ordination level
A certain level of clinical co-ordination will be required especially regarding medical
staff and their sessional commitment and cover requirements. The provision of
chemotherapy in the primary/community care setting and clinical research will also
require similar co-ordination.
This co-ordination should stem from NWCTC with all oncology staff seeing this as
their base or as a minimum, their administrative hub. By 2014 clinical management
arrangements should be in place that reflect these responsibilities, key will be the
appointment of a Clinical Director and departmental manager for Oncology on a
Network basis.
Network management level
As mentioned above by 2014 the oncology service in North Wales should be coordinated and managed as one with the ‘management’ hub being at NWCTC.
Day to day management should be delivered through the Clinical Director and
departmental manager through close liaison with the site managers and resident
oncologists.
The service in its entirety should be accountable to a Service Board that is
representative of the various delivery sites, the commissioners and users. This Board
should not only oversee delivery of the service but also be the forum for delivery of
the oncology strategy.
This development should be delivered as soon as is practicable and the Regional
Oncology Group disbanded once this level of change has been achieved.
7.10
Commissioning
Building upon the model of a lead commissioning LHB and the yet to be finalised
model of a Regional Commissioning Unit, there should be single commissioner of
oncology services for North Wales.
The single commissioner should commission all oncology services accessed by the
North Wales population and have full responsibility for local provision, capital
projects and any additional all Wales issues. In addition the lead commissioner
should be the single source of commissioning advice on cancer drugs.
By 2014 a clear understanding of oncology expenditure should be established and
this investment extracted into a free standing but not ring fenced oncology budget
held by the lead commissioner.
The lead commissioner should have a seat on the Service Board previously
mentioned.
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7.10.1 Christies and Clatterbridge
Even by 2014 it is assumed that some services will be required from Christies and
Clatterbridge and these services will be commissioned by the lead commissioner
rather than a single all Wales specialist commissioner as is the case at present.
8)
Conclusion
This strategy aims to address a vision for oncology over the next seven years on the
basis that this doubles the time NWCTC will have been established and takes the
community up to the next known major capital investment, replacement of the
current third linear accelerator.
There are several themes for the next seven years namely, expansion of treatment
facilities both within the hospital setting and beyond, expansion and modernisation
within the human resources available and finally a cultural shift from a hub and
spoke model to a flatter equal access model.
It is believed that all of these strategic objectives are desirable and with each one
being achieved the service has the best chance of meeting the challenges in
oncology over the next seven years.
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