Cancer Centre Model and Estate

An independent clinical review, and the overwhelming opinion expressed during patient engagement events, concluded that to provide the best cancer care, full replacement of the cancer centre is the preferred option.

A need for strengthening access locally to services such as chemotherapy and blood tests was also highlighted.

Alternative models for delivering the services currently provided at Mount Vernon were explored in depth by the clinicians and patient forums. These included dispersing the service to other cancer centres, investing in the current site and remaining at Mount Vernon and incorporating an ambulatory hub into a revised model.

In December 2021, the Mount Vernon Programme Board agreed the clinical model recommended by the clinical group for a new single specialist cancer centre on an acute site, in conjunction with enhanced local access (for example increased local delivery of chemotherapy, and local options for simple appointments such as blood tests).

The Programme Board also explored detailed analysis of which acute hospital sites met the criteria for the future location of the cancer centre. Based on the criteria of co-located services and geographical access (using driving and public transport travel time analysis for each CCG), only the Watford General Hospital site met all the criteria.

Specific requirements regarding the siting of a clinical cancer centre

A second independent clinical report set out the services that needed to be adjacent to the cancer centre to enable it to deliver the full range of cancer treatments and research trials in future. It concluded:

The clinical cancer centre hub must be capable of caring for its in-patients which have the treatments it delivers, the complications that arise from those therapies and the comorbidities which require acute clinical opinions from other specialties. To do this, there must be the following:

• 24-hour inpatient emergency access to the assessment of need for escalation of care for in-patients, particularly by the on-call on-site acute medical team and also by the acute surgical on-call on-site team

• 24-hour on-site critical care outreach for in-patients with potential transfer to high-dependency and intensive care units located on the same geographical site

• On-site consultation capability for in-patients requiring acute care (diabetology, cardiology, respiratory medicine, gastroenterology, nephrology, endocrinology, dermatology, infectious diseases, ENT, haematology): for the complications of cancer, for the complications of treatment and to maintain timing of treatment plans such that interruptions are minimised (especially for radiotherapy fractionation)

• Immediate access to support pathological services (especially haematology and biochemistry)

• Outpatient access to a wide variety of clinical specialties: diabetes, cardiology, respiratory medicine, gastroenterology, renal medicine, endocrinology, dermatology, neurology, urology, ENT, gynaecology, palliative care, pain management services

• Rapid access for urgent physiotherapy services

  It follows that the adjacent acute hospital facility will have an Accident & Emergency department on the same geographical site.

How services could be organised

The Clinical Group has looked at each of the services delivered by the Mount Vernon team to explore whether they must be on an acute site or if they could be provided on an ambulatory site (a type of walk-in centre). They concluded that overall the acute site model was their preferred option. You can read a summary of their assessment for each service here.