Report to: Trust Board Agenda item: 3.1 Date of Meeting: 12 May Head and Neck Cancer Services Review Briefing

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1 Report to: Trust Board Agenda item: 3.1 Date of Meeting: 12 May 2010 Title of Report: Status: Board Sponsor: Author: Appendices Head and Neck Cancer Services Review Briefing Information John Waldron, Medical Director Ruth Hallett, Project Manager, NHS Bristol 1. Purpose of Report (Including link to objectives) This briefing paper provides information on progress on the Head and Neck Services Review which covers patients within the NHS Bristol, NHS North Somerset, NHS South Gloucestershire, NHS Bath and North East Somerset, NHS Wiltshire and NHS Somerset areas. The review will deliver a clinical model for Head and Neck Services which fulfils the requirements of the Improving Outcomes Guidance. 2. Summary of Key Issues for Discussion An awareness of the clinical model to help understand the limited impact on Royal United Hospital Bath 3. Recommendations (Note, Approve, Discuss etc) The Board is asked to:- Note the progress made on the Head and Neck Service Review Note that an advisory panel will be meeting in mid May to recommend the location for the hub services, which will be considered by the Project Board, which will itself make a recommendation to PCT Boards in June for agreement. 4. Standards for Better Health (which apply) The recommendations are in line with the following standards for better health: Second domain: Clinical and cost effectiveness, particularly C5. Fourth domain: Patient focus, particularly D8 and D9 Fifth domain: Accessible and responsive care, particularly C17, C18 and D11. Sixth domain: Care environment and amenities, particularly C20, D Legal / Regulatory Implications (NHSLA / ALE etc) There are no legal issues raised in this paper Agenda Item: 3.1 Page 1 of 6

2 6. Risk (Threats or opportunities link to risk on register etc) The key risks relate to not being able to receive clinician, patient and organisation support for a decision on site location. These are being actively managed through the process. 7. Resources Implications (Financial / staffing) A finance workstream has been established as part of the project to identify the existing spend and the future financial framework within which the clinical model can be delivered. 8. Equality and Diversity The completion of an equality impact assessment has been built into the project plan. A workshop with service users has been arranged for April in order to undertake this. The data workstream, led by an officer from the Avon, Somerset and Wiltshire Cancer Services Network, is producing a Health Profile which will inform the equality impact assessment. 9. Communication There is a communication plan which ensures all stakeholders are involved in the project. The communication activities include:- A clinical leadership group has been established who are responsible for ensuring their discipline view is fed into project Clinical workshops have ensured all clinicians have had the opportunity to feed into the development of the clinical model A user reference group gives patients and LINKs the opportunity to view and comment on key documents produced and inform any decision making. Interested users who are not able to attend meetings of the user reference group are encouraged to feedback their comments via , telephone or in writing. Local support groups are being visited regularly. Clinicians, Users and Local Involvement Networks (LINks) are represented on the Project Board. All stakeholders receive a regular update newsletter. 10. References to previous reports No previous reports have been submitted 11. Freedom of Information There have been no FOI requests relating to this project Agenda Item: 3.1 Page 2 of 6

3 Head and Neck Cancer Services Review Briefing 1 Purpose This briefing paper provides information on progress on the Head and Neck Cancer Services Review which covers patients within the NHS Bristol, NHS North Somerset, NHS South Gloucestershire, NHS Bath and North East Somerset, NHS Wiltshire and NHS Somerset areas. 2 Background 2.1 In November 2004 the National Institute for Clinical Excellence (NICE) issued Guidance on Cancer Services: Improving Outcomes in Head and Neck Cancers stating that head and neck cancers should be managed in services covering a population of one million people treating over 100 cases per year. 2.2 Previous attempts to centralise head and neck cancer services in the Bristol area had failed to reach sufficient consensus and a new independently facilitated process was consequently begun in November 2009 to establish a clinically led and patient endorsed model of care with proactive engagement of local clinicians and patients. 2.3 A Project Board has been established to oversee delivery of the review and to ensure that the process followed is robust and effective in developing an appropriate solution. Membership of the Project Board includes patient and public representatives, clinicians involved in the delivery of head and neck services, representatives of the Avon, Somerset and Wiltshire Cancer Network, local commissioners and provider trusts and project team members. The Board is chaired by Deborah Evans, Chief Executive of NHS Bristol. 2.4 From the outset of the process the clinicians involved in providing head and neck cancer services from North Bristol NHS Trust, University Hospitals Bristol NHS Foundation Trust and Royal United Hospital Bath NHS Trust have aspired for the best possible model of care through consensus. This process has worked well and there has also been enthusiastic participation from a wide range of patients and other stakeholders. At a stakeholder event on 2 nd March clinical representatives presented their proposed new clinical model which was unanimously endorsed by patients, clinicians, PCTs and Trusts. 3 The Clinical Model The proposed clinical model is explained below. 3.1 Scope Although head and neck cancer is the focus of the review all clinicians and Trusts recognise that the centralisation of head and neck cancer services needs to be considered alongside the configuration of other linked services. Ear, Nose and Throat (ENT) and Oral Maxillofacial services are particularly relevant with the same facilities and the same surgeons engaged on both benign and malignant treatments. Agenda Item: 3.1 Page 3 of 6

4 Consequently through the review process, clinicians have recommended that all Ear, Nose and Throat and Oral Maxillofacial inpatient surgery, both benign and malignant, should be co-located along with relevant support services. 3.2 Vision The clinicians shared vision is for the creation of a high quality service operating on a hub, satellite and spokes model. Achievement of the vision demands a single team working cohesively with the optimum mix of services co-located in the hub. 3.3 Hub, satellites and spokes Hub It is proposed that centralised services will be delivered from a Bristol hub at either a North Bristol NHS Trust or University Hospitals Bristol NHS Foundation Trust site. The hub will be home for Multi-Disciplinary Team (MDT) assessment, treatment planning and case management and will have all Ear, Nose and Throat and Oral Maxillofacial inpatient surgery, both benign and malignant, with good access to essential diagnostic services (histopathology, cytology and radiology), specialist cancer nursing services and therapists e.g. speech and language and dietetics. Clinicians have agreed that collectively they are location neutral on the optimum site for centralised services. Decisions on hub location together with co-locations of other important services e.g. oncology, dental services, neurosurgery and plastic surgery will be taken by an Advisory Panel (see 4 below) Satellites Satellite services will provide less complex ENT and Oral Maxillofacial surgery, diagnostics and oncology services, where these currently exist, plus initial and follow up consultation. This will provide patients from across the region with a choice of treatment sites and reduce the need for travel. Case management will continue through the Multi Disciplinary Team at the hub Spokes Spoke services will provide initial consultation and follow up clinics and community based rehabilitation with clinicians travelling from the hub to visit patients rather than vice versa. This further extends patient choice and reduces their travel. The number and location of spokes will be considered as part of the review based on the demand for services from across the region. 3.4 Infrastructure and facilities Clinicians and patients are in agreement that the current multi-site infrastructure makes joint working more difficult. Infrastructure and facilities need to improve regardless of centralisation and this is an important feature of the clinical model. A modern, patient friendly, Head and Neck ward in the same building as theatres, Intensive Treatment Unit (ITU) and High Agenda Item: 3.1 Page 4 of 6

5 Dependency Unit (HDU) will reduce the current need for ambulance transfers of seriously ill patients. It has also been recognised that there is an opportunity to improve the quality and consistency of rehabilitation services through this review. 4 The hub site and location of services 4.1 The review has established that UHB and NBT are the only viable options for hub centralisation, but each has their advantages and disadvantages. Ideally all linked services should be on a single site, but that is not possible given Bristol s existing infrastructure. 4.2 UHB would be able to co-locate oncology and dental services with ENT and Oral and Maxillofacial surgery. NBT would be able to co-locate neurosurgery and plastic surgery services with ENT and Oral and Maxillofacial surgery. 4.3 It has been agreed that an Advisory Panel chaired by an independent clinical expert will address all critical adjacency issues and consider each Trust s capacity to deliver against the clinical model in order to reach an objective assessment on the preferred location. This panel will make a recommendation to the Head and Neck Service Review Project Board. The recommendation will be subject to a due diligence process to ensure the chosen site is fully capable of meeting the requirements of the clinical model before a recommendation by the Project Board is made to the boards of respective Primary Care Trusts. 5 Benefits of the new model Benefits of the new model will include: 5.1 Better patient outcomes maintain and then improve on good patient outcomes treat a larger number of specialist/rare cancer cases and attract the very best clinicians increased research capacity which can be applied to develop improved and innovative treatments 5.2 Better patient experience Head and Neck ward with surgical treatment, ITU and HDU in one building more convenient local clinics, but with fast track to the specialist centre strengthened community rehabilitation 5.3 Improved effectiveness and productivity improved working environment will enable better use of clinicians time standardisation and best practice will arise from working together and sharing learning Agenda Item: 3.1 Page 5 of 6

6 increased clinical dialogue will enable more effective treatments to be considered 5.4 Increased efficiencies 6 Next steps there will be economies of scale, including potential savings in junior doctor posts smarter training programmes in a high profile regional centre with better working conditions will lead to lower staff turnover Work is underway to ensure, where possible, that these benefits are measured and quantifiable. 6.1 The Head and Neck Service Review Project Board is asking PCT and Trust Boards to note the good progress made on developing the proposed clinical model. 6.2 It is planned that the Advisory Panel will consider the hub location in mid May and make a recommendation to the Project Board. The Project Board will consider the recommendations of the Advisory Panel and will itself make recommendations to PCT Boards in June. If the PCT Boards are in agreement then it is planned that the location decision will be submitted for consideration by the Overview and Scrutiny Committees in October The Project Team will then work closely with all relevant organisations to develop a high-level implementation plan for approval by the Trusts in November Agenda Item: 3.1 Page 6 of 6