5 November 2016 Clatterbridge Cancer Centre: Transforming Cancer Care in Merseyside and Cheshire Dr. Peter Kirkbride, Medical Director
What we do Systemic anti-cancer therapy e.g. chemotherapy, immunotherapy Clinical Research Day case treatment e.g. PICC lines Stereotactic radiosurgery with The Walton Centre Radiotherapy external beam, brachytherapy, Papillon National Centre for Eye Proton Therapy Inpatient wards Supportive cancer care e.g. palliative, benefits advice, social work, additional needs Triage and assessment urgent cancer care Outpatient clinics Acute oncology
Our numbers In 2015/16 We cared for 28,749 individual patients We saw 10,677 new outpatients and 61,667 follow-ups Patients attended 96,502 outpatient radiotherapy appointments (planning & treatment) Patients attended 45,581 outpatient & 1,036 inpatient chemotherapy treatments We cared for 3,760 inpatients (episodes of care) We have 74 beds We have 987 staff and 80 volunteers We have 10.25 operational linacs
Our own sites Clatterbridge Cancer Centre - Aintree Clatterbridge Cancer Centre - Liverpool Clatterbridge Cancer Centre - Wirral
Transforming Cancer Care
The Existing Campus (c 2014)
The Future Campus
CCC view of a future clinical model Case for Change Core Statement The case for change is that the available benefits in terms of: access to research and clinical trials, workload distribution, enhanced patient access, transformed model of care for acute oncology, and further localised provision of level I and level II chemotherapy treatments Significantly exceed the adverse impact of greater travel time for a minority of patients, given that our hubs will be readily accessible to almost all patients. Based on four regions in C&M North, West, East and Central
Hospital Diagram: Sector-Based Approach 723,162 (South Cheshire, West Cheshire, Wirral) HOME SOUTHPORT 384,586 (South Sefton, Southport and Formby, West Lancs) Centre 2M+ Hub 500K+ HOME C H E S T E R RT W E S T CCC - WIRRAL NORTH CENTRAL HOME RT AINTREE Inc. CCCL E A S T Cancer Centre at Liverpool RT CHEMO 465,656 +Wales + IOM E A S T S P O K E CHEMO HOME 649,739 (Halton, Warrington, Knowsley and St Helens CCGs) EAST SECTOR HUB KEY OUTCOME: More than 90% of England resident patients will reside within 45 minutes of their nearest hub, based on transport forms accessible to them, accessibility is increased by hospital transport. All patients can access their spoke. Cancer Centre + Specialist Trusts
Improved service access and provision STRATEGIC BENEFITS Expanded ambulatory hub model for acute oncology admission avoidance, improved quality, LOS Expansion of care at home accessible for patients Workable and sustainable solution for MDTs External visibility from supportive care services Diverse research portfolio, improving outcomes Facility/Service CENTRE HUB SPOKE HOME ACUTE ONCOLOGY COMPREHENSIVE ENHANCED IOG STANDARD TELEMEDICINE CHEMOTHERAPY L IV YES NO NO NO CHEMOTHERAPY L III YES YES NO NO CHEMOTHERAPY L I&II YES YES YES MOST INPATIENT BEDS YES ON-SITE, VIA AO HUB & A&E CLINICAL TRIALS PHASE 1 ONWARDS CLINICAL TRIALS TEAM VIA A&E ONLY N/A PHASE 3 ONWARD NO NO ON-SITE OUT-REACH NO N/A OPD NEW YES YES, EXCEPT RARE NO NO OPD FOLLOW UP YES YES, EXCEPT RARE NURSE-LED (NO CONSULTANT) RADIOTHERAPY IGRT & IMRT ALL ALL COMMON & SOME INTERMEDIATE COMPLEX RT YES NO NO N/A SUPPORTIVE CARE YES, ON SITE YES, ON SITE ACCESSIBLE TOUCH POINTS NO NO N/A NO MDT INPUT DIRECT, ON SITE DIRECT, ON SITE NO / INDIRECT N/A ONCOLOGIST BASE YES YES + CENTRE NO N/A
Benefits from Change Change Drivers Inequitable access to consultant resource across sectors system redesign required based on concept of multi-professional teams Optimising access to clinical trials is a key target for improving patient outcomes Ensuring comprehensive, timely, and consistent availability of supportive care services across the region Acute oncology service structures and model are under-developed Responding comprehensively to the feedback from the National Cancer Patient Experience Survey. Contentious Issues Early and effective dialogue with organisations not designated as hub or spoke relating to population coverage. Coherent resolution of issues relating to hub designation within population sectors. Ensuring that increased travel times for some patients are reasonable, particularly those without private car access. Sensitive messaging to wider public; greater local access in some areas, versus integration and co-location in others.
Centre/Sector Hub/Local Hub Initial Designation Criteria: Optimising patient access within the boundaries of quality, safety, and affordability: Most patients should be able to access their nearest sector hub within 45 minutes travel - sector hubs = comprehensive range of what is safe and effective medical and clinical oncology. Designating based on need, not just geography: The number of sector hubs reflects population levels and accessibility. Capital requirements: Need to be mindful of age, condition, and recent cancer-related investment in the existing estate, and of economic reality that CCC s capital scheme and funding is necessarily focused on development of the new Liverpool Centre, thereby limiting investment in other locations but some funding will be made available to deliver the improved overall vision for cancer service delivery
Centre/Sector Hub/Local Hub Initial Designation Criteria: Emergency Care: Sector hubs need effective and comprehensive emergency care access on site, to facilitate acute oncology and enable the expansion of ambulatory oncology care services. Partner Strategic Intent: of the co-locating provider (where concerned) to support the overall vision (strategic alignment) Responding to the patient perspective: The aspirations and success criteria for hubs, will have reference to the National Cancer Patient Experience Survey outcomes. Avoiding excess sub-division of the aggregate consultant workforce: Model recognises the challenges and inequities in the consultant workforce, with reference where patients are diagnosed, versus where their consultant teams operate.
Centre/Sector Hub/Local Hub Initial Designation Criteria: Optimising patient accessibility to clinical trials, including the supporting infrastructure. Focussing on patient accessibility and overall cohesion of supportive services, including CReST and Imaging. Responding to diverse commissioner expectations: Designation must address the expectations and intentions of local clinical commissioning groups, whilst also taking in to account the requirements of specialised commissioning and national policy. Our overall vision for cancer care must reflect the Healthy Liverpool strategy, and the requisite expectations of colleagues across the sector, and ensure full alignment between the plans for haemato-oncology integration with solid tumour oncology.
Accessibility Analysis: Hubs for Patients (Source: Google Maps (travel and public transport), from population centre to given hospital site)). SECTOR Road Mileage Public Transport (train/bus) Accessibility Compliance NORTH SECTOR CAR OWNERSHIP SEFTON 71.5% SOUTHPORT TO AINTREE 18.6 MILES (35 minutes) 1 hour 3 minutes CAR ONLY ORMSKIRK TO AINTREE 10.9 MILES (27 minutes) 37 minutes CAR AND PUBLIC FORMBY TO AINTREE 11.8 MILES (27 minutes) 45 minutes CAR AND PUBLIC CROSTON TO AINTREE 21.6 MILES (41 minutes) 1 hour 9 minutes CAR ONLY ECCLESTON TO AINTREE 25 MILES (38 minutes) 1 hour 39 minutes CAR ONLY TARLETON TO AINTREE 21.9 MILES (41 minutes) 1 hour 50 minutes CAR ONLY WEST SECTOR CAR OWNERSHIP CHESHIRE EAST CHESHIRE WEST AND CHESTER 83.9% 81.4% CHESTER TO CCC WIRRAL 16.2 MILES (24 minutes) 55 minutes CAR ONLY NORTHWICH TO CCC WIRRAL 33 MILES (42 minutes) 1 hour 30 minutes CAR ONLY WINSFORD TO CCC WIRRAL 30.6 MILES (45 minutes) 1 hour 23 minutes CAR ONLY FRODSHAM TO CCC WIRRAL 21.3 MILES (26 minutes) 1 hour 13 minutes CAR ONLY TARPORLEY TO CCC WIRRAL 23.5 MILES (34 minutes) 1 hour 29 minutes CAR ONLY EAST SECTOR CAR OWNERSHIP WARRINGTON HALTON 80.7% 73% WARRINGTON TO ST HELENS 9.7 MILES (26 minutes) 30 minutes CAR AND PUBLIC LYMM TO ST HELENS 19.6 MILES (29 minutes) 1 hour 33 minutes CAR ONLY RUNCORN TO ST HELENS 8.8 MILES (19 minutes) 53 minutes CAR ONLY
Timelines CCC clinical consensus and support (now) Early NHS England engagement signals in-principle support Partner organisation and commissioner liaison will take place at a corporate level (ongoing) Coherent and shared narrative required to engage with partners, public, and commissioners Implementation will take 3-5 years (but an accelerated approach for key targeted areas).
Site preparatory work August 2016 Construction hand over July 2019 Operational Autumn 2019 Thank you any questions?