Service Assessment
The Clinical Team have carried out an assessment of each service provided at Mount Vernon Cancer Centre to see which must be provided in a new Cancer Centre on an acute site and which could be provided on an ambulatory site. They have then indicated their preference.
Must be on the acute site (whole service or elements of)? Yes/No | Could be provided on an ambulatory site? Yes/No | Preferred model to deliver the service principles (Why?) | |
Inpatient Care and AOS service | YES – needs critical care and other medical surgical back up | NO – AOS needs adjacency to IP beds, IP beds need adjacency to critical care. Service is not big enough to be split. | Acute Site Option: Essential for safe delivery of IP service |
SACT: Chemotherapy & Immunotherapy | YES – SACT must be available for Inpatients, and more complex regimens (especially some trials)/ patients with complex comorbidities / patients who may become unwell or may require admission for treatment need to be treated on a site with acute hospital adjacencies including critical care support | YES – some simple chemo could be delivered locally but would still need appropriate back up if patient becomes unwell or does have an adverse reaction | Acute Site Option: Consolidate complex chemotherapy and then focus provision of simpler chemo at local hospitals (and consideration of a mobile model, chemo at home, within hospices etc) NB Co-location with Radiotherapy is important (Chemo will need to be delivered alongside RT for Chemo-Rad regimens) Important to consolidate chemo workforce expertise and not dilute this – already a hard to recruit group |
Radiotherapy | YES – there must be RT on the main site to ensure brachytherapy can be undertaken (see below), inpatients can receive RT without transfer (eg MSCC patients) | YES – technically some radiotherapy could be delivered on an ambulatory site Would be for very straightforward protocolised treatments Not where patients might become unwell if there is not the appropriate support on site Not Chemo-Rad Best option would be for an ambulatory site at an appropriate satellite location (to facilitate better access) | Acute Site Option: Focus RT expertise with brachytherapy on the acute site, such that there is then still the option to deliver a satellite radiotherapy unit in the most geographically appropriate location to promote patient access |
Brachytherapy | YES – requires inpatient beds, theatre and anaesthetic cover | NO – requires inpatient beds, theatre and anaesthetic cover | Acute Site Option: Brachytherapy requires acute hospital and RT expertise, see above |
Supportive daycare therapies (non-SACT) | YES – certain treatments must be available to support inpatients, and also work with AOS to ensure admission avoidance, but may not need to exist in specific department on the acute site | YES – with appropriate back up. However, many of these therapies could be delivered at DGHs or on a mobile unit alongside simple SACT Much of this will be driven by what it is possible to deliver locally (at home, or in hospices) Does not require very experienced chemo nurses to deliver many of these treatments | Acute Site Option: Some provision on acute site for more complex patients/ procedures & for AOS for avoidance admission. All other simple therapies should be considered for more local provision (eg at DGHs/ mobile/ home) rather than provision on an ambulatory site |
Nuclear Medicine- radioisotope therapies & radiopharmacy | YES - some radioisotope therapies require inpatient admission (side rooms) Radiopharmacy needs to be on same site Most efficient to have all radionuclide using departments on same site to optimise waste management Some new therapies will need interventional radiology access | NO – service is small and specialised. Focus on acute site for access to IP beds is essential | Acute Site Option: Elements of the service need to be on the acute site. Important not to split a small workforce which is difficult to recruit to |
Nuclear Medicine- diagnostics | YES – access may be required for Inpatients Co-location with the rest of Nuclear medicine brings benefits for example in waste management | YES – service could be provided on an ambulatory site | Acute Site Option: Elements of the service need to be on the acute site. Important not to split a small workforce which is difficult to recruit to |
Interventional Radiology | YES – need acute backup for complications that may arise, may require anaesthetic support or be required for inpatients | NO – unlikely to be able to deliver any elements on ambulatory site | Acute Site Option: Acute site back up required for this service. Specialist nature of service (staff and facilities) supports consolidation, with access for inpatients. |
Imaging | YES – need for specialist cancer imaging for inpatients (including at weekends) Opportunity to make pathways more efficient by bringing complex pathways on one site | YES – some diagnostics could be delivered in OP setting without acute infrastructure Specialisation/scarcity of the workforce may make running a separate ambulatory hub more difficult In addition local changes in RDC provision may make an ambulatory diagnostic hub redundant | Acute Site Option: Promote diagnostics closer to home where appropriate and consolidate specialist cancer imaging expertise alongside the inpatient and AOS services |
Other Medical and Surgical Services | YES – needs to be provided to inpatients but how/ what/ by whom this is provided is awaiting further independent clinical input | YES – pre-dominant requirement is for Inpatients but some OP support could be provided eg oncogeriatrics | Acute Site Option: Key requirement is for input to acutely unwell or deteriorating patients and to support to IP and AOS services should be the focus |
Specialist therapies | YES – these therapies must be available for inpatients as well as in the outpatient setting | YES – these therapies could be provided in this setting without acute infrastructure – rehab for example may be well suited to an ambulatory location | Acute Site Option: Requirement for small workforce to be integrated with wider MDT, and cover IP and OP services requires consolidation on one site |
Specialist Palliative Care | YES – specialist palliative care input to inpatients in conjunction with oncology teams and community palliative care | YES – some clinics could be delivered on an ambulatory site without acute infrastructure | Acute Site Option: Requirement for small workforce to be integrated with wider MDT, and cover IP and OP services favours consolidation on one site. More local & virtual provision should be considered. |
Support & Information | YES – inpatients should have access to holistic support and information services | YES – many of these services could be delivered in OP setting without acute infrastructure | Acute Site Option: This will better enable resources to be shared across IP and OP settings, but also ensure there is still opportunity to work more widely across the geography (taking care closer to home) |
Clinical Trials & Innovation | YES – infrastructure for R&D especially trials with newer agents would be better supported on acute site | YES – a small number of trial therapies might be able to be delivered on an ambulatory site but appropriate support would need to be considered. | Acute Site Option: Focus on an acute site ensures the best future-proofing for the cancer treatment innovations of the future. Consolidation of specialist workforce also key |