The NHS in the East of England and in North London is working together to review the services at Mount Vernon Cancer Centre.
The Mount Vernon Cancer Centre is run by East and North Hertfordshire NHS Trust and delivered from a site in North Middlesex managed by the Hillingdon Hospitals NHS Foundation Trust. It is a standalone cancer centre and primarily serves a population of over 2 million people in Hertfordshire, south Bedfordshire, North West London and Berkshire. The patient pathways involve a large number of other hospitals and arrangements with several other NHS trusts. There is an extremely small number of patients who use the service from other parts of the country. The services are commissioned by NHS England’s Specialised Commissioning team and local Clinical Commissioning Groups.
The Centre provides outpatient chemotherapy, nuclear medicine, brachytherapy and haematology as well as radiotherapy for these populations. There are also inpatient and ambulatory wards.
We are working with the staff at Mount Vernon, with other local hospitals and commissioners, and with the local Cancer Alliances to look at how we can best meet the needs of local people, and develop options that will build on the services, research and patient experience the Centre already delivers.
Why do things need to change?
We want to organise services in ways that provide the best modern care for patients, including access to research trials and new technology and treatments, from good quality buildings and facilities.
Many of the buildings are not in a good state of repair, and concerns have been raised in relation to the long-term clinical sustainability of the Cancer Centre.
As well as ageing buildings, there are limited support facilities on site. For example, there are no high dependency or intensive care beds so patients who become very poorly are sent in an emergency ambulance to Watford General Hospital, or other nearby hospitals.
The limited support at the site creates challenges for the patients and staff, resulting in many patients receiving treatment in a number of different places because of this. As cancer treatment becomes more advanced and as demand for cancer treatment grows, this is becoming less sustainable for patients at Mount Vernon.
Some newer treatments and research trials have high levels of toxicity, and whilst the benefits in treating cancer might be greater, there is more risk of side effects that require the right care. Without the support of services such as high dependency or intensive care, patients will not have access to the latest cancer treatments.
As people live longer, more people with cancer are also living with other illnesses or conditions which require treatment alongside their cancer treatment. This cannot be done at Mount Vernon Cancer Centre.
The staff at the Mount Vernon Cancer Centre have done a good job despite the conditions, in providing high quality treatment and ensuring patient safety. Patient survey feedback regularly shows that most patients are happy with the services they receive. However, everyone agrees that a more permanent solution needs to be found to ensure the sustainability of the services in the long term.
How will the review work?
The review started in May 2019. It is being led by a Programme Board chaired by the Regional Director of Specialised Commissioning and Health and Justice for the East of England. It has representatives from Healthwatch Hillingdon and Healthwatch Hertfordshire, London and East of England Cancer Alliances, local STPs, CCGs, and a number of acute hospitals, including East and North Herts and Hillingdon Hospitals NHS trusts.
The first stage of the review is about developing gathering information of four parts:
- Reviewing data – for example, looking at where patients come from to Mount Vernon and which parts of their treatment they have elsewhere, what patient outcomes are like, travelling times for services such as radiotherapy.
- Interviewing clinical staff and stakeholders – asking the staff who work at Mount Vernon and key stakeholders for their opinions on what the options should be.
- Independent Clinical Review Panel – leading clinicians from other parts of the country accompanied by representatives of Healthwatch Hillingdon and Healthwatch Hertfordshire reviewing the suggestions of clinical staff, speaking to clinical staff and to patients, and visiting the site, before producing a report in July 2019 making recommendations on the long term options and any short term actions that need to be taken. These recommendations included appointing a specialist cancer hospital to run the Mount Vernon Cancer Centre services. This report was published on 25th July 2019 and is available below.
- Patient and public engagement – analysis of existing patient feedback, and hearing patient views and ideas through public events, focus groups and a bespoke survey. Through July, August and early September 2019, patient and public workshops took place in Stevenage, Luton, Uxbridge, North London, Watford and at Mount Vernon. Structured interviews were held with representatives of some patient groups and a patient survey was available for all patients to complete. The patient feedback was analysed independently and the final engagement report is published below.
At the end of the first stage a decision was made to appoint University College London Hospitals to run the Mount Vernon Cancer Centre from April 2021. This will be subject to a period of diligence which will ensure the clinical and business implications are properly understood before a final commitment is made, and that East and North Hertfordshire NHS Trust and University College Hospitals can have important discussions with staff whose contracts would transfer to University College London. This means that future Mount Vernon Cancer services will be provided by UCLH. This will be from the Mount Vernon site at least until a decision is made on the long term future of Mount Vernon Cancer Centre services. If changes are proposed in future, they will only take place after public consultation and will be designed to make access better for patients, not worse.
The next stage of the review is to develop options.
Work will begin in February 2020 to work with clinicians and patients on what the future services need to be in order to meet the needs of the Mount Vernon Cancer Centre population. This will build on the information gathered from patients and clinicians in the first stage. Patients and stakeholders, including local hospitals and Clinical Commissioning Groups, will be involved in developing a range of options. These options will include maintaining services at, or near, the current Mount Vernon site. They will be evaluated on a range of criteria which patients had input into in stage 1, and include local access and interface with other services. We want to ensure people are fully involved in these options and so this stage is expected to take about six months.
Timescale for decisions:
At the moment we anticipate developing options between February and September 2020. We will then need to do some work to find out whether the options will be possible – for example, if they involve new buildings, are we certain we will be able to build where the option recommends, and do we know how we will pay for the building work. We will only shortlist options that are possible.
We expect to run a formal 12-week public consultation starting in January 2021, although this could be a little earlier or later depending on how quickly we can confirm whether options are possible. Only once the feedback from public consultation has been fully considered can a final decision be made. This would be around May 2021.
The independent clinical panel has made some recommendations that will not require changes for patients and these may be made more quickly. We may also be able to run some parts of the project more quickly – for example, if it is possible to bring forward a decision on a satellite radiotherapy unit to improve access for patients in North Hertfordshire and South Bedfordshire, then we will do so.
Independent Clinical Panel Report:
The Independent Clinical Panel Report (July 2019) was commissioned by NHS England to help inform the development of options for the Mount Vernon Cancer Centre services.
The current provider – East and North Herts NHS Trust, NHS England specialised commissioners and the rest of the Programme Board welcomed the report and its recommendations.
If you would like to find out more, or be added to the patient or stakeholder mailing lists, or invite us to attend a patient or community group meeting, you can email email@example.com.