SPECIALTY TRAINING PROGRAMME IN HAEMATOLOGY FOR HEALTH EDUCATION ENGLAND - WESSEX

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1 SPECIALTY TRAINING PROGRAMME IN HAEMATOLOGY FOR HEALTH EDUCATION ENGLAND - WESSEX This is a 5 year training programme in Haematology at ST3 aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to support training for a CCT in Haematology. Details of essential competences and qualifications are detailed in the HEE person specification for Haematology at ST3 which is available from This 5 year Specialty Training programme will allow the successful applicant to achieve the award of a Certificate of Completion of Training (CCT) in Haematology, subject to satisfactory progression. The programme is based in hospitals in Health Education England - Wessex including: HOSPITAL Hampshire Hospitals NHS Foundation Trust The Royal Bournemouth Hospital Dorset County Hospital Poole General Hospital Queen Alexandra Hospital Salisbury District Hospital University Hospital Southampton LOCATION Basingstoke Bournemouth Dorchester Poole Portsmouth Salisbury Southampton Health Education England - Wessex is responsible for the planning, development, education and training of the healthcare and public health workforce across Hampshire, Dorset, Isle of Wight and Salisbury. We also provide medical training for the States of Jersey and GP appraisal services for Jersey and Guernsey. We believe that the key to improving the health and healthcare of the 2.8 million people living in Wessex is investment in the skills and values of the 52,000 people working in the NHS and in primary care. Within the field of postgraduate medical education and training, we manage across primary and secondary care for these health communities totalling around 2,400 doctors in training at any one time across 12 Trusts and 160 GP practices. In addition, we support the workforce development for GP Practice Nurses and Public Health practitioners as well managing a bespoke GP appraisal service for established GP Practitioners to meet the requirements for revalidation in accordance with the statutory requirements set by the General Medical Council.

2 We manage training programmes for postgraduate medical training according to the statutory standards set by the General Medical Council (GMC) and have responsibility for establishing and maintaining quality management systems for all posts and programmes as required by the GMC. The work of Health Education England - Wessex is guided by the principles embedded within the NHS constitution. Rotation Information It is usual that trainees will spend at least two of their five years training at University Hospital Southampton where specialist training in paediatrics and allogeneic transplantation is available. The remaining three years will be spent at the other district general hospitals on the rotation. Rotational placements will be made each year with the training need of the registrar being the most important factor. After this, the preference of the trainee for a particular post is taken in to consideration. It may not be possible for a trainee to go to a placement of their choice. Usually each post is for one year s duration. In exceptional circumstances you may need to rotate for a shorter period Study and Training The primary aim of all posts is the training programme developed and there is a region wide syllabus and minimum standards of education agreed by all Trusts within the rotation. Health Education England - Wessex is committed to developing postgraduate training programmes as laid down by GMC, Colleges and Faculties and by COPMED - the Postgraduate Deans Network. At local level college/specialty tutors work with the Programme Director and Directors of Medical Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend meetings with their nominated educational supervisor. All posts within the training programme are recognised for postgraduate training by the General Medical Council (GMC) in accordance with their standards for training. Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service. All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals but the list is aimed at covering the majority of duties:

3 1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached F1. 2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior medical staff. 3. Attend and participate in ward rounds as timetabled 4. Attend outpatient clinics. 5. Take part in rostered emergency work. 6. Dictate discharge summaries. 7. Study for higher examination and maintain continued professional development. 8. Attend weekly educational and multidisciplinary sessions. 9. Undertake audit at various times throughout the rotations. 10. Teach medical students as directed. 11. Co-operate with members of the personnel department when monitoring hours of work and other personnel issues. 12. Attend induction in each hospital or new department 13. Comply with all local policies including dress code, annual and study leave Specialist training may be extended to accommodate less than full time training. One year of specialist training may be approved for research, which is relevant to the specialty and in an area approved by the Chair or Secretary of the Specialty Advisory Committee. Approval will take account will be taken of the generic training value of the research and any clinical experience gained during the period of research. On award of CCT a haematologist will be able to work as a consultant specialist within the National Health Service and will have the competencies required to do so, as well as to develop further special interest expertise if desired. For the full haematology training curriculum please refer to the JRCPTB website specialist haematology page. Teaching The Wessex haematology training programme runs a very successful teaching programme. This involves compulsory training days which are held at one of the rotation placement hospitals on a 6 weekly basis. Trainees must attend >75% of these training days to successfully progress though training. In addition on the job teaching is provided at all the placement hospitals on a regular basis during a placement.

4 Information about Hospital Trusts in the rotation Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Clinical Haematology The clinical haematology unit has adjacent inpatient and day wards. Ward 11 is the Haematology inpatient ward and has 15 beds, which include 2 single rooms with laminar airflow and en-suite facilities, 3 single rooms and a 2 bedded room with filtered air, 5 single rooms and a 3-bedded bay. The inpatient unit has facilities for BCSH level 3 and is JACIE-accredited for autologous stem cell procurement and transplantation. The Unit transplants patients annually. Ward 10 is the day ward, has two 6 bedded bays and is used for clinical assessments, chemotherapy clinics, administration of chemotherapy, blood products and coagulation factors, diagnostic and therapeutic procedures including venesections, aphaeresis, tunnelled central venous catheter (CVC) removals, bone marrow biopsies and intrathecal chemotherapy. Tunnelled CVC and PICC are inserted in Radiology. The day care facilities on ward 10 are shared with medical oncology. In , the day unit managed 7786 Haematology and 8698 Oncology day-case patients. Outpatient clinics include 8 Consultant-led weekly general haematology and diseasespecific LPD, myeloma, transplant, haemostasis and thrombosis clinics. There are, in addition, weekly nurse-led chemotherapy, MPN and venesection clinics. The Department has 6 Consultants, a Consultant Nurse and 5 Specialist Nurses. Most nurses working on wards 10 and 11 have post-registration qualifications in haematology, oncology, blood & marrow transplantation and/or care of the dying. The Department has a Clinical Trials Unit staffed by Trials Coordinator, Data

5 Manager and 3 Research Nurses, and participates in many national and international clinical trials in acute leukaemia, lymphoma, CLL, myeloma, MDS and MPN. The Department houses the Dorset hub of the Wessex Haemophilia Comprehensive Care Network (WHCCN). The Network Comprehensive Care Centre (CCC) is based at Basingstoke and North Hampshire Hospitals NHS Foundation Trust. Comprehensive care for patients with inherited and acquired bleeding disorders in East Dorset is led by a full-time Consultant in Haemostasis and Thrombosis based in Bournemouth. Adult patients are managed in Bournemouth and children are managed in Poole. Elective orthopaedic surgery and GUM services for East Dorset are based in Bournemouth. Paediatrics, ENT and Oral Surgery are based in Poole. The anticoagulation service is led by Consultant Nurse with 4 trained anticoagulation practitioners. There are 4000 patients registered with the anticoagulation clinic. The clinics are managed according to pre-defined algorithms authorised by the hospital s Thrombosis Committee and Drugs & Therapeutics Committee. Majority of patients on oral anticoagulation therapy are managed by postal dosing using DAWN-AC v7.9 software. The team also runs peri-operative bridging clinics for patients on warfarin. The anticoagulant service is linked to the hospital s fast-track DVT service which is run from the Emergency Department. Laboratory Haematology The haematology laboratory is CPA and MHRA-accredited and performs approximately 240,000 blood counts annually using two ADVIA 2120 analysers. About 500 diagnostic marrow aspirates are processed annually. Serum ferritin, B12 and folate levels are analysed on Beckman-Coulter ACCESS 2 analyser. Haemoglobinopathy screening is performed at Poole hospital. The coagulation laboratory uses two ACL TOP analysers. Approximately 100,000 INR samples are analysed annually. Comprehensive thrombophilia screening including molecular tests are performed electively. Thromboelastogram (TEG) is available for 24/7 use. PFA-100 screening test is available at Poole Hospital. Lighttransmission aggregometry is performed to assess platelet function on an elective basis. The laboratory has trained personnel to perform a full panel of special coagulation tests e.g. clotting factor assays. The transfusion laboratory performs 25,000 group and screen and 7000 cross matches per year. There is an automated grouping machine and the department uses DIAMED column technology. All of the laboratories use the Telepath 1 system from i-soft.

6 A Haematological Malignancy Diagnostic Service (HMDS) for Dorset Cancer Network is being developed and is expected to be fully operational by Flow cytometry is performed in-house using a FACSCalibur analyser. Bournemouth provides the immunophenotyping service to Dorset Cancer Network. Molecular and cytogenetic laboratories are on site but are used mainly for research. All routine diagnostic cytogenetic and molecular genetic studies are performed at Wessex Genetics Laboratory in Salisbury District Hospital. Research There is an active laboratory research unit within the department. The main research interests are in diagnosis, genetic abnormalities, prognostic features and management of chronic haematological malignancies, especially chronic lymphocytic leukaemia, low-grade lymphoma and myelodysplastic syndromes. The department attracts funding from the Leukaemia Research Fund as well as other grants and local charities. Duties of specialist trainee in haematology The Department trains 3 specialist haematology (ST3-7) and 2 core medical trainees (ST1-2). The ST3-7 trainees rotate between inpatient ward, day ward and laboratory every 2 months. The ST1-2 trainees rotate between inpatient ward and day ward every month. The trainees are expected to provide inpatient, day ward, outpatient and laboratory haematology services under Consultant supervision to East Dorset population of 500,000. The Haematology on-call service is non-resident, 1-in-5, first-on-call for periods pm and 8-9am on weekdays, 8am-7.30pm on weekends, and second-on-call for periods 7.30pm-8am. The Hospital-at-night (HAN) will take over the first-on-call clinical duties 7.30pm to 8am. All laboratory and coagulation related out-of-hours calls will bypass the HAN team and will go directly to the Haematology doctor on call. The on-call trainee for Haematology on the previous night will have time off in lieu the next day from 3pm.

7 Day Ward 11 Ward 10 Laboratory Monday AM Registrar ward Clinic day ward Haemostasis clinic round PM Ward work Procedures Prescriptions BM reporting Film Q Tuesday AM 1245 Consultant ward round Day ward clinic Morphology BM list Morphology PM Morphology meeting Teach-in session Ward work Film Q meeting Teach-in session Procedures Prescriptions meeting Teach-in session HMDS sign-out Consultations Bridging clinic Wednesday AM Registrar ward round Day ward clinic PM Ward work BM list Prescriptions Thursday AM Registrar ward Day ward clinic rounds PM Ward work Procedures Prescriptions Friday 0830 MDT meeting MDT meeting AM Consultant ward Day ward clinic 1245 PM round Grand round Ward work Grand round Prescriptions Film Q Outpatient clinic BM reporting Outpatient clinic BM reporting Consultations MDT meeting Consultations Grand round BM reporting Training Opportunities The post will provide excellent training opportunities for work-based experiential learning in diagnostics and clinical management of haematological disorders through clinics, Consultant-led and personal ward rounds, consultative haematology on other wards, placements in haematology laboratory, multi-disciplinary team meetings, participation in clinical trials as sub-investigators, supervised on-call experience, audits and teaching of junior trainees. Trainees are well-supported by Consultants who will provide clinical supervision at workplace with regular assessments through standard curriculum-approved assessment tools. Trainees are expected to complete at least one major audit in a year. Although the clinical and laboratory experience offered is primarily aimed towards practice of Haematology in district general hospital, the Unit has acquired a

8 reputation for academic excellence with a sound clinical and laboratory research base, particularly in chronic lymphocytic leukaemia and myelodysplastic syndromes. Trainees will gain excellent experience in clinical management of all haematological cancers in adults including acute leukaemia, lymphoma, myeloma and autologous stem cell transplantation. Diagnostic haematology training will be provided throughout and laboratory placements will allow trainees to acquire expertise in routine diagnostics e.g. morphology, specialist diagnostic techniques e.g. flow cytometry, and laboratory management e.g. NEQAS. In addition, the Consultants will provide regular teaching sessions in morphology, flow cytometry, obstetric haematology, haemostasis and thrombosis. Further Information Detailed information on all aspects of the Department s activities can be obtained from the Unit s web page at Portsmouth Hospitals NHS Trust - Queen Alexandra Hospital Introduction Portsmouth Hospitals NHS Trust is a provider of Acute Health Services under contract to a range of Purchasers in the area of the Hampshire basin and Western South Downs. The current main purchasers are the 3 Local CCGs. The catchment population for the Trust extends from Warsash in the West to the Sussex border and its northern boundaries encompass Petersfield and Liss. With the exception of the rural north, it is an essentially urban area, having grown around the Royal Naval establishments of Gosport and Portsmouth. As well as Naval bases it now provides a wide range of modern high-tech industry and the facilities associated with a commercial port and cross-channel ferry terminal. Southsea and Hayling Island are popular holiday resorts and the city of Portsmouth continues to undergo major development along its waterfront including Gunwharf Quays, the Spinnaker Tower and plans for a new stadium for its football club. There is easy access to the many sailing and water sport facilities on the coast, the countryside of the new South Downs National Park and good transport links to the M27, Southampton airport and, via the ferry terminal, to the Continent. Portsmouth Hospitals NHS Trust provides a range of acute services concentrated at Queen Alexandra Hospital in Cosham. The Queen Alexandra Hospital site has undergone a major redevelopment to create a modern and 'fit for purpose' hospital, which opened in June This work was done in partnership with 'The Hospital Company', a consortium of Carillion plc and the Royal Bank of Scotland. This

9 development includes new spacious ward facilities, a purpose built Main OP department and state of the art pathology laboratories. The Trust is also home to the Wessex Renal and Transplant Unit and it holds prestigious Cancer Beacon Status for the Head and Neck Cancer Services. Hosting a Ministry of Defence Hospital Unit (MDHU), the Trust enjoys strong military connections and is proud of this association. This means that as a Trust, we have wider responsibilities than those of standard NHS organisations. Portsmouth Harbour QA main entrance

10 General Information Portsmouth Hospitals NHS Trust is one of the largest in England with an annual income of 400 million. It provides acute healthcare services for almost 1,000,000 people, has a regional speciality in its renal and Transplant Unit and is a designated Cancer Centre. It encompasses postgraduate teaching facilities and is involved in training of nurses and undergraduate doctors from the University of Southampton. The Trust is the lead body for the local Research and Development Support Unit and has close links with the University of Portsmouth and its new School of Postgraduate Medicine for both education and research. The Trust provides most of its services at Queen Alexandra Hospital in Cosham with 1396 beds. Haematology Services The Haematology service is based at Queen Alexandra Hospital with peripheral clinics in Gosport War Memorial Hospital, St Mary s Hospital Fratton, Petersfield Hospital. The Haematology Department consists of 6 WTE Consultants, a 0.6 WTE consultant with a 0.7 wte Speciality Doctor and two Speciality Registrars from the Wessex Rotation. The post is based at Queen Alexandra Hospital. The department works as a team, with cross-cover of ward patients, and rotation through laboratory duties, liaison patients, but individual clinic lists. At present all the consultants see the full range of haematological oncology, with the exception of lymphoma which is run as a separate clinic service jointly with oncology. Haematology Staff Consultants Dr Helen Dignum Dr Robert Corser Dr Mary Ganczakowski Haemoglobinopathy Dr Hussain Hirri Dr Chris James Clinical Director, General and Malignant Haematology General and Malignant Haematology, Lymphoma General and Malignant Haematology, General Haematology, Haemophilia, Thrombosis General and Malignant Haematology, Pathology Director, Associate Medical Director Dr Charles Alderman New appointee to start Jan 2015

11 Dr Tanya Cranfield General and Malignant Haematology (part time retired) Other Staff Dr Gwynn Matthias Speciality Doctor (0.7 wte) 2 Speciality Registrars from Wessex Rotation, rotating annually Haematology Clinical Nurse Specialist Lymphoma Clinical Nurse Specialist Donna Burgess 1 wte. 0.4 wte Haemophilia Nurse Specialists, secondment from North Hampshire Hospitals 3 wte Anticoagulation Nurse Specialists The size and population base of the hospital mean a busy wide-ranging clinical service. The service is Level 2B, providing the full range of adult haematology care including acute leukaemia induction and complex chemotherapy, as well as the full range of other benign and malignant haematological conditions. Bone marrow transplant referrals are sent to Southampton; the department has an excellent working relationship with the Wessex Bone Marrow Transplant Centre at Southampton which performs autologous, sibling and matched unrelated bone marrow transplants. In future, Portsmouth hopes to become a satellite centre for autologous transplants. The regional Renal Service is based in Portsmouth giving additional exposure to myeloma patients in renal failure and plasma exchange treatment facilities for TTP. Paediatric haematological malignancy is managed at Southampton with shared care at Portsmouth by the Paediatricians. The lymphoma CNS also provides Teenage and Young Adult Cancer CNS expertise. Inpatient Facilities Inpatients are housed on the 45 bedded F5, F6, F7 haematology/oncology ward complex in the new PFI build. F6 has 10 HEPA filtered rooms; further cubicles are on F5 and F7. There are haematology inpatients at any time, principally acute leukaemia treatment, myeloma, elderly haematology and non-malignant haematology. The ward consultant manages all the haematology inpatients, assisted by the ward registrar; ward consultant cover rotates every 1-4 weeks. There is a weekly ward multidisciplinary meeting, supported by microbiology and palliative care. There are seven haematology-oncology SHO doctors covering the 45 beds and day unit..

12 Outpatient Facilities Clinics are held in the Haematology Oncology Centre on Level B. All consultants have two main clinics for general and malignant haematology on weekday mornings which include both new and follow-up patients. There are additional emergency/rapid review clinics on Monday and Friday lunchtimes. Specialist thrombophilia and haemophilia clinics are held weekly. There are two nurse-led anticoagulation education clinics week. Additional general haematology peripheral clinics are held at least once a month at other sites: St Mary s Hospital (Portsmouth), Gosport War Memorial Hospital, Coldeast Hospital (Fareham), Petersfield Hospital. Lymphoma clinics are run led by Dr Ann O Callaghan, Consultant Medical Oncologist, and Dr Corser, Haematology, with Dr James, on Tuesday and Wednesday afternoons. Day Unit The Haematology Oncology Day Unit is adjacent to Outpatients on Level B and administers intravenous chemotherapy, blood and platelet transfusions, immunoglobulin infusions iron infusions, venesections etc. Bone Marrow Biopsies are performed in the Laboratory with MLA support Haematology Activity Outpatient New 757 Outpatient Follow-up 7283 Anticoagulation New 700 Anticoagulation Follow-up 435 clinic, 100,000 Anticoag tests Thrombophilia New 266 Thrombophilia Follow-up 141 Day Unit Activity 1313 Inpatient numbers: elective 144 Inpatients: non-elective 235 Haematology MDT s Haematology has two weekly video conferenced Cancer MDTs with its MDT partner Western Sussex Hospitals Trust, Chichester, supported by an MDT coordinator in a purpose-built MDT room. There is Leukaemia/Myeloma MDT and a Lymphoma

13 MDT which is also attended by a specialist lymphoma histopathologist from Southampton by videoconferencing. Bone marrow transplants are arranged by referral to Wessex Bone Marrow Transplant Centre, with whom there are close working relationships. MDT new diagnosis 2010 (Jan-Dec) April March 2012 AML ALL 4 4 Myeloma CML 2 10 CLL Lymphoma Hodgkins MPD MDS Haemophilia and Thrombophilia The department is a District Haemophilia Centre. Dr Hirri leads the service and works with the Regional Haemophilia Network. Haemophilia Clinical Nurse Specialist and A&C are seconded from North Hampshire NHS Trust at Basingstoke. There are 51 Haemophilia A patients on the database, including 9 severe haemophiliacs. Dr Hirri runs a monthly joint paediatric haematology clinics. Dr Hirri and Dr James run a weekly thrombophilia clinic. Research The department actively participates in a number of NCRI haematology and lymphoma trials and is supported by two clinical trials practitioners and a clinical trials assistant. There is excellent administrative support from the Central South Coast Cancer Research Network.

14 Blood sciences - Automated Haematology Track Laboratory Haematology The Blood Sciences Department is an integrated haematology and biochemistry department in a purpose-built PFI laboratory which opened in There is a high level of automation, with an integrated robotic track system. One of the haematology consultants is the lead clinician for transfusion and attends the Hospital Transfusion Committee, supported by two transfusion nurse practitioners. Currently we have an onsite flow cytometry laboratory. Haemoglobinopathy testing provides a regional service for universal neonatal screening. Future pathology services may be subject to change, for example a network pathology consortium is under consideration, with some redistribution of services, which could involve increased Blood Sciences at Portsmouth. Training will be given in flow cytometry interpretation, morphology. Anticoagulation The department operates a postal anticoagulation service for 8000 patients (2012). Community phlebotomy INRs are analysed in the laboratory and dosed on RAID software by anticoagulation specialist nurses with assistance from the medical staff. Management Structure Haematology works across administrative boundaries:

15 Clinical Haematology is part of the Cancer and Surgery Clinical Service Centre. The Chief of Service is Mr Constantinos Yiangou.. Laboratory Haematology is part of Blood Sciences, Clinical Lead Dr David Sinclair, part of the Pathology Directorate, Clinical Director Dr Chris James, within the Support Services Clinical Service Centre, Chief of Service Dr Simon Ward. Clinic Timetable Mon Tues Wed Thurs Fri Warfarin clinic Gen Clinic QA 9am QA Gen Clinic QA 9am Petersfield Clinic GWMH OP clinic 9 am Once/month Gen Clinic SMH Thrombophilia 11am Acute FU clinic 2pm Lymphoma Clinic Special Clinic alternate weeks, Lymphoma clinic Gen Clinic QA Haemostasis Warfarin clinic QA Acute FU clinic Duties of the post The Specialty Registrar will be involved in all aspects of clinical and laboratory haematology. Routine laboratory work will include the reporting of blood films, bone marrow aspirate and trephine biopsies together with advising on blood transfusion and haemostatic problems. Routine clinical work will include: The day-to-day management of Haematology inpatients. Co-ordinating the treatment of outpatients and day patients. Management of patients with bleeding disorders. On Call Requirement: The Specialty Registrar will be expected to provide laboratory and ward cover on one Weekend in 4, on Saturday and Sunday.

16 Current Time Table for Speciality Registrar Speciality Registrar Ward Monday AM Academic Meeting or Business meeting) Day unit review PM Multi-disciplinary team meeting Consultant ward round (teaching) Tuesday Wednesday Thursday Friday Ward Work Out patients Clinic Ward Work MDT meetings Lymphoma Clinic (optional by discussion) Lymphoma Clinic Ward work / Audit Consultant ward round Day unit review Teaching Speciality Registrar Laboratory Monday Tuesday Wednesday Thursday Friday AM Academic or Business Meeting Laboratory work Out patient clinic (QAH) Out patient clinic (QAH) Thrombosis clinic Day Unit Review Out patient clinic (QAH) Haemostasis Clinic MDT Meetings PM Multi-disciplinary team meeting Consultant ward round (teaching) Laboratory work Audit Laboratory work Audit / Bone marrow reporting Laboratory work Teaching

17 Education and Training In Portsmouth the Specialty Registrar will receive an induction pack and attend Trust induction. The Specialty Registrar will meet regularly with the educational supervisor and the Regional Specialty Education Committee will further assess their progress. The Specialty Registrar will attend the local Wessex training programme and will be encouraged to attend all local and a reasonable number of national meetings. Protected study leave will be given for individual study, research or audit. Teaching will be given for a programme of laboratory procedures. Clinical experience will be gained on a daily basis with consultant supervision. Regular discussions of laboratory findings will take place with the consultant staff. Additional training in blood transfusion will be arranged with the Wessex Blood Transfusion Centre. Research The Specialty Registrar will be encouraged to participate in research. In-patients are entered into the NCRI leukaemia trials. Specialty Registrars are encouraged to develop areas of personal interest where appropriate in active research projects. Recent studies undertaken by the Specialty Registrar and presented at ASH and BSH include: Occurrence of auto antibodies following allogeneic transplantation, Hydroxyurea induced leg ulceration and A Review of Home Chemotherapy for Haematological malignancies. The Specialty Registrar must undertake some specific audit activity either laboratory or clinical. Current and planned audit projects can be discussed with the consultants concerned. Accommodation The post is non-resident in Portsmouth.

18 University Hospital Southampton NHS Foundation Trust The University City of Southampton has a long maritime history and is now a busy container port and cruise liner terminal. It is close to the New Forest and the Cathedral City of Winchester and the area provides excellent housing, schooling and recreational links, particularly for sailing enthusiasts. There are excellent road links via the M3 and M27 and a fast direct rail service to London (Waterloo). Domestic and European air services are provided from Southampton Airport. University Hospital Southampton NHS Foundation Trust (UHS) provides acute healthcare services for the Southampton area (population 550,000). This covers an area bordering on the Solent and extending to the boundary of Winchester in the north, the Wiltshire border in the west and the River Hamble in the east. In addition, many specialist services are provided to a much wider area extending to Chichester, Portsmouth, Winchester, Basingstoke, Salisbury, Bournemouth and Poole, Dorchester, the Isle of Wight and the Channel Islands. These include the defining services of the Trust in cancer, neurosciences, respiratory, gastrointestinal, women and children and cardiothoracic. Southampton forms one of the two teaching hospitals in the South Central Strategic Health Authority and, as a Regional Cancer Centre, provides comprehensive cancer services for a large population in excess of 3 million. UHS encompasses two sites, Southampton General Hospital (SGH), with 1,200 beds and Princess Anne Hospital (PAH) with 124 beds. UHS is one of the largest NHS Trusts in the country. The University of Southampton is one of the country s leading research intensive higher education institutions and its strategy is to become world class in all activities. The Faculty of Medicine has a clear strategy to provide a research environment that will allow it to secure a long term future as a leading biomedical research institution. Central to this are the Biomedical

19 Research Units (BRUs), a partnership between the National Institute of Health Research (NIHR), University Hospital Southampton Foundation NHS Trust (UHS) and the University Of Southampton School Of Medicine. Southampton is home to two units: the Respiratory BRU and the Nutrition, Diet and Lifestyle BRU. Work is underway on a new 2800m² building on the Southampton General Hospital site which, along with the Wellcome Trust Clinical Research Facility, will form a focal point for research at the heart of the hospital, with a total area of 4000 m². This will help to bring more research activity to Southampton and foster a centre of excellence, bringing the best of new research ideas into clinical care. There is an active research program in Haemato-Oncology attracting funds from the LLR and CRUK. The department of Haematology is committed to providing a high quality clinical service and to develop the R&D potential through collaboration with existing successful R&D activity areas. UHS Department of Haematology Medical Staff 5 Consultants 2 Senior Lecturers/Consultants 2 Consultant Paediatric Haematologists Associate specialist 6 Specialty Registrars on Wessex rotation 4 SHOs on medical rotation working partial shift system with oncology SHOs The consultants work as a team and have individual areas of responsibility for both clinical and managerial parts of the service in which they provide leadership. Existing Leads are shown below. UHS Clinical Haematology Clinical Haematology, incorporating Haemato-oncology, Transplantation, General Haematology, Haemoglobinopathy and Haemostasis and Thrombosis services is part of the Cancer Care Group. The Cancer Care Group is part of the Surgical and Cancer Services Division (Division A) and is formed of the departments of Clinical Haematology, Medical Oncology, Clinical Oncology and Palliative Care. All Clinical Haematology services including inpatients, all day cases, chemotherapy and cell separator services and Haemostasis & Thrombosis Centre are located on the UHS site. There is a well-developed clinical service for patients with myeloma, acute and chronic leukaemias with the emphasis on a multi-disciplinary approach to care. There are also comprehensive clinical and laboratory services in haemoglobinopathy, coagulation and general haematology.

20 General Haematology Clinical Haematology has access to 7-day inpatient beds utilised for patients requiring low dependency care, and a busy day care facility operating 6 days a week offering the full range of supportive procedures. Haemato-Oncology All in-patient and day case haemato-oncology services transferred to the UHS site in December An intensive chemotherapy and transplant unit was created at UHS by conversion and upgrading of existing ward accommodation (C6L). Following the opening of the purpose built extension to C6L in 2010, there is currently a 21 bedded acute leukaemia and transplant ward, providing level 4 care for patients with Haematological Malignancies (BCSH Guidelines 1995). The unit provides level 2 care for acute leukaemia for neighbouring NHS Trusts. A dedicated haematology day unit is located adjacent to this ward. Patients with haematological malignancies not requiring intensive chemotherapy and non-malignant haematological disorders are generally admitted to other beds within Cancer Care on wards D2, C4 or D3. The clinical inpatient work of the department predominantly relates to the full range of adult leukaemia, multiple myeloma, myelodysplastic, myeloproliferative and lymphoproliferative disorders. There are approximately new adult acute leukaemia and 30 new myeloma referrals per annum the reference base is growing rapidly. The clinical workload is supported by Clinical Nurse Specialists in Myeloma and Leukaemia. All outpatient haemato-oncology services transferred to the UHS site in March There is a core of oncology trained nursing staff, specialist cytotoxic pharmacy services with a centralised intravenous additive service and nurse/counselling support. The Wessex Blood and Marrow Transplant Service The Wessex Blood and Marrow Transplant Unit based on C6L has been providing an allogeneic transplant programme to a large geographical area encompassing the Central South Coast Cancer Network and Dorset since 2001 to supplement the existing autologous transplant service established in The Transplant Programme received JACIE accreditation in December The program performs approximately 50 autologous transplants per annum, mainly for patients with myeloma or lymphoma (in conjunction with Medical Oncology) for patients from Southampton and surrounding hospitals. The unit provides an allogeneic transplantation service for the Central South Coast Region with approximately allogeneic transplants per year, including unrelated donor transplants. There is active collaboration with other haematologists within the region and a thriving clinical network specifically relating to transplantation. The unit delivers outcomes that are

21 some of the best in the UK. The stem cell collection facilities are accredited with the Human Tissue Authority (HTA). The Transplant Program is supported by a Clinical Nurse Specialist, two WTE Transplant Co-ordinators and a Quality Manager. A Transplant Data Manager is due to be appointed shortly. There is an integral Apheresis service with a lead Apheresis nurse with the support of additional trained nurse operators. This busy unit performs over 250 procedures per year providing peripheral blood stem cell harvesting, plasma exchange, therapeutic leucopheresis and red cell exchange procedures. The Apheresis service received a license from the Human Tissue Authority in September The Wessex Blood and Marrow Transplantation Service works closely with the NHSBT Steve Mills Laboratory which provides stem cell processing and storage services on site. The NHSBT laboratory has MHRA and HTA licenses and JACIE accreditation. Haemostasis & Thrombosis Centre University Hospitals Southampton NHS Foundation Trust is a Haemophilia Comprehensive Care Centre. It mainly serves patients from Hampshire and the Channel Islands although patients from further afield are also registered. At present there are more than 420 congenital bleeding disorder patients including 50 patients with a severe bleeding disorder. A fully comprehensive service from initial diagnosis to the subsequent care in the hospital and community is provided. The Haemostasis & Thrombosis team includes two adult and two paediatric haematologist. The Centre provides diagnostic services for thrombophilia, and follow-up anticoagulation service for outpatients who are not managed in the community. There is also a joint haematology/obstetric clinic for the management of high-risk bleeding or thrombotic pregnancies, every two weeks. The Centre is actively involved in national and international trials and has research collaboration with the University. Haemoglobinopathy Southampton has a growing Asian and Afro-Caribbean population with approximately 70 to 80 patients with haemoglobinopathy using the service. There is a regular haemoglobinopathy clinic, a dedicated haemoglobinopathy laboratory service including antenatal screening and plans to further develop the adult haemoglobinopathy service including transitional care from paediatrics. Paediatric Haematology There is a regional paediatric oncology/haematology service at University Hospital Southampton which covers the Wessex region. The service is responsible for the diagnosis and treatment of children with acute leukaemia, bone marrow failure syndromes, haemoglobinopathies, bleeding disorders and non-malignant haematological disorders. The paediatric haematologists provide a consultative

22 service for the regional PICU, NICU, paediatric cardiology and child health departments as well as the 10 district hospitals. The department performs high dose chemotherapy with stem cell rescue; allogeneic transplants are referred to Bristol Children s Hospital but the immediate aftercare is undertaken at Southampton. Haemoglobinopathy cases have increased significantly, with a specialised clinic being held for paediatric patients. The paediatric haematologist participates in a 1 in 4 rota with the paediatric oncologists, so the Consultant Haematologist on call may need to advise on non-oncological paediatric patients, with the support of the on call Haematology SpR. The haematology SpR is attached to the department for 4 months. Outpatient and Day Care Facilities Outpatient facilities for Haematology are based at UHS, predominantly in the purpose built Oncology Outpatients Department that opened in March There are 2 large combined haematology clinics per week run jointly by the Consultant Haematologists, one for general haematological disorders and one for haematooncology. In addition, there are specialist clinics in transplantation, myeloma, haemostasis, thrombophila and haemoglobin disorders. A clinic for women with highrisk pregnancies is held jointly with the Department of Obstetrics and Gynaecology at PAH. There is also a weekly general haematology clinic at Lymington New Forest Hospital. Overall, there are approximately 660 new referrals and 5300 follow-up patients seen in the haematology out-patient clinics per annum. A new day unit was opened in 2013 providing chemotherapy, apheresis, minor procedures such as bone marrow biopsies and intrathecal chemotherapy and patient follow-up. Clinical Haematology currently has access to beds utilised for patients requiring low dependency care in addition to a number of chairs. Each working day, approximately 15 to 25 haematology patients attend the day care facility. The cell separator unit is also centred at SGH, directed by the Haematology department and is currently an integral part of the day care facility. All haematology day cases, including apheresis services, are now in the new dedicated unit, adjacent to the current in-patient leukaemia and transplant ward at UHS. UHS Laboratory Services Laboratory Haematology is part of the Radiology and Pathology Care Group within Division B, alongside the Emergency Medicine, Specialist Medicine and Ophthalmology Care Groups. Haematology laboratory facilities are provided at UHS. The laboratory has full CPA accreditation and HPC approval for the training of BMS staff. The laboratory has been equipped with the latest instrumentation and has the CliniSys Labcentre laboratory computer system. There is a high degree of automation and recent

23 benchmarking shows its workload and efficiency to be in the upper quartile in the teaching hospital peer group. The services provided are excellent. Laboratory Haematology The laboratory houses a comprehensive, modern diagnostic facility. Specialised haemostasis investigation and haemolytic anaemia investigation are available. Immunophenotyping and molecular studies are performed at SGH. SGH possesses 2 Futura analysers, 2 TEGS, platelet aggregometer and PFA100. In 2009, the laboratory processed 590,000 automated haematology tests, 390,000 haemostasis and special haematology tests and 66,000 blood transfusion requests. 32% of haematology laboratory tests originate from general practice. Laboratory Haematology is organised in to two sections, Blood Transfusion and Haematology & Coagulation. Staff Whole Time Equivalents Senior Manager / BMS 4 band 8c 1.5 BMS 3 band 8 2 BMS 2 band BMS 1 band Trainee BMS band 5 1 MLA band 2 5 Diagnostic bone marrow services are carried out at UHS. The department of cellular pathology processes trephine biopsies which are then returned to Haematology for reporting or reported in conjunction with the cellular pathologists. Regular regional multidisciplinary diagnostic team meetings are held; Thursday mornings for Paediatric reviews and Friday mornings for Adult Haematology. UHS also hosts the Central South Coast Cancer Network (Western) MDT meeting for Leukaemia and Myeloma. Molecular Pathology and Immunophenotyping In addition to the routine haematology laboratory services there is a specialised molecular pathology laboratory under the supervision of a Consultant Clinical Scientist. The laboratory provides essential diagnostic and molecular monitoring assays including chimerism, BCR-ABL quantification by PCR, minimum residual disease analysis, B and T cell clonality. The immunophenotyping labaoratory, managed by the Immunology Department, provides a full repertoire of diagnostic and MRD immunophenotyping for haematological malignancies. Cases are jointly reviewed at the diagnostic MDTs. The Wessex Regional Genetics Laboratory (WRGL) is located at Salisbury District Hospital. There is a close working relationship between WRGL and the Haematology

24 Consultants at UHS with regular clinical meetings. There are plans to fully integrate reporting of haematological oncology specimens with the aim of developing IOG compliant integrated haemato-pathology reporting. Steve Mills Stem Cell Laboratory Bone marrow processing, culture and preservation facilities are located at the Southampton National Blood Service Facility on the UHS site in the Steve Mills Transplant Laboratory. Current Departmental Research Activity Recruitment and participation in NCRN AML, ALL, Myeloma and CML trials. Participation in high quality drug evaluation studies to GCP standards Targeted radiotherapy as part of conditioning for stem cell transplantation Clofarabine pre-conditioning in allogeneic transplantation for high risk AML Development of quality of life as a clinical endpoint in myeloma and chronic lymphocytic leukaemia. Molecular methods for the evaluation of minimal residual disease in stem cell harvest material and in patients following stem cell transplantation. Evaluation of molecular methods for monitoring patients following stem cell transplantation Immune reconstitution post allogeneic SCT Analysis of tumour related immunoglobulin genes in paraproteinaemias. Clinical pilot studies in administration of patient specific DNA vaccines in patients with myeloma. Role of the Speciality Registrar Clinical Duties The Speciality Registrar will be trained and involved in all aspects of clinical and laboratory haematology and blood transfusion. The timetables are enclosed. Clinical work includes: The day to day management of Haematology inpatients Co-ordination of the treatment of outpatients and inpatients Management of patients with bleeding disorders Investigation of patients with thrombophilias and management, including

25 The treatment of recurrent miscarriage in the high risk pregnancy clinic. Supervision of patients receiving plasma exchange (for TTP and inhibitors usually) Attend supervised* outpatient clinics (*until final year) Paediatric haematology Laboratory Duties Laboratory work reporting of blood films, bone marrows, other haematological tests. Training in immunohaematology is an integral part of this. The post holder will be required to participate in medical audit. Undergraduate medical students from Southampton University Medical School are taught throughout the Trust and the post holder is required to participate in formal and informal undergraduate clinical teaching but will not be responsible for curriculum organisation development. UHS Haematology Timetable Overview Mon Tues Wed Thurs Friday Weekend Network MDT- E Handover- SpR Level room Histopathology Junior SpR Morphology Teaching SpR room Haemostasis and Thrombosis Journal Club- SpR room Morphology MDT SpR room pm Transplant Clinic Paediatric handover and clinic from 9am Piam Brown Ward Myeloma Clinic (starts 9am) Paediatric leukaemia Clinic Bleeding Disorder Clinic Transplant Clinic Paediatric morphology MDT Paediatric ward round 1-2 X-ray meeting SpR Teaching with lunch 2-5 Consultant Ward Myeloma Clinic Round Lymphoid Clinic (starts 1.30pm) Thrombophilia Clinic Paediatric haemophilia Clinic General Haematology Clinic (starts 1.30pm) Myeloid Clinic (starts 1.30pm) Inpatient MDT D level Consultant Ward Round Paediatric Clinic Platelet disorder Clinic Haemoglobinopathy clinic (1 st Thursday) Haem lunchtime seminar Weekend Handover SpR Room 4-5pm

26 West Dorset General Hospitals NHS Trust, Dorchester The new Dorset County Hospital was completed in 1997 and achieved the centralisation of all services for acutely ill patients into a modern Hospital on one site, approximately 1 mile from the town centre. The Trust provides excellent facilities to a largely rural population of 220,000 (with concentrations in Weymouth and Dorchester) and many innovative services such as an award-winning art collection to enhance the environment for patients. Housing 500 beds Dorset County Hospital has been recognised as an Exemplar Site by the Department of Health. There are only eight such sites in the country, which have been chosen because of the high quality of the patient environment. In 2001 the Trust won the national 'Clean Hospital Award'. The Trust currently employs around 2,500 personnel, treating more than 100,000 patients each year and provides a wide range of services. The Hospital is recognised as a Cancer Unit within the Dorset Cancer Network for the provision of services for patients with Breast, Colorectal, Urological, Upper Gastrointestinal, Lung and Haematological Malignancies. While most Chemotherapy is given locally, the Radiotherapy Centre is in the Cancer Centre at Poole Palliative Care Services are provided by the local hospice (Joseph Weld) where there are 18 beds. Two Consultants regularly visit patients with malignant and nonmalignant diseases within the Hospital. Dorset County Hospital is the hub of the district's inpatient facilities but community Hospitals are situated in the surrounding major towns and provide the spokes to the central unit. These include, Weymouth Community Hospital, Bridport Hospital, Blandford Hospital and Yeatman Hospital, Sherborne. PATHOLOGY STAFF: General Manager Head Biomedical Scientist Haematology: 3 X Consultant Haematologist Speciality Registrar Staff Grade (Haematology) S.H.O. Chemical Pathology:

27 Consultant Chemical Pathologist Consultant Grade Biochemist Microbiology: 3 X Consultant Microbiologist Histopathology/Cytology: 4 x Consultant Histo/Cytopathologist HAEMATOLOGY DEPARTMENT Nursing Staff - Day Chemotherapy Unit: 1 G Grade Sister 1 F Grade SRN 3 Grade E-F Chemotherapy Nurses Inpatient Nursing with a Ward Sister (Grade G) and 9 Grade D-F Nurses are shared with other medical teams using Ilchester B ward Laboratory Staff: 1 x BMS4 5 x BMS2 (+ funding for Hospital Transfusion Practitioner) 15 x BMS1 4 x Trainee BMS (rotating) Clinical Haematology The clinical facilities at the Dorset County Hospital are excellent. Ilchester B Ward, the inpatient area, has a two-bed suite with en-suite bathrooms and WCs and HEPA ventilation. In addition there is 14-bedded unit containing 2 single isolation rooms. We have used intensive chemotherapy for the treatment of Acute Leukaemia and relapsed Lymphoma since Support facilities within the hospital necessary for the comprehensive care of seriously ill haematology patients include an intensive care unit, the Dorset Renal Unit, full radiology services, echocardiography, bronchoscopy and gastroenterological endoscopy. Consultant Physicians in neurology, rheumatology, dermatology, endocrinology, nephrology, diabetology, cardiology and thoracic medicine are readily available. A palliative care consultant is attached to the unit.