What are we proposing?

Given the recommendations of the Clinical Review, the challenges that mean Mount Vernon Cancer Centre is not sustainable on its current site, and following discussions with patients, carers, clinical staff and other stakeholders, we are recommending re-provision of Mount Vernon Cancer Centre on an acute hospital site. This means the cancer centre would benefit from being next door to a main hospital with all the necessary clinical support, and linked by a physical bridge to make access easy when it is needed. Watford General Hospital has been identified as the most appropriate hospital site as it improves access for those with the longest journeys and does not significantly worsen access for those with shorter journeys.

Because we would be moving the service further from the current area it is in (the Hillingdon Clinical Commissioning Group area), we are proposing to develop a new Chemotherapy Unit at Hillingdon Hospital. Hillingdon patients currently attend Mount Vernon Cancer Centre for Chemotherapy. Patients from most other areas can already have Chemotherapy at their local hospital. The most complex Chemotherapy patients would still need to be treated in the new cancer centre.

This proposal forms our basic re-provision option.

As part of our patient engagement, we have heard a lot of feedback from patients and carers and have worked with patient groups to establish what doesn't work well at the moment. We are using this feedback and their ideas to develop our preferred option, which goes beyond a basic re-provision to meet the needs of patients.

Patients have told us:

• Staff are exceptionally well-rated and patients would like to see the staff team remain together and be strengthened
• Most patients feel they receive excellent care, although the buildings are thought to be poor
• The majority of people thought parking availability was good.
• Disabled access to and around the site is poor with many clinic and waiting rooms too small for modern wheelchairs.
• There are long journey times to MVCC for many patients for simple / quick procedures that could be done elsewhere (local hospital / GP practice / hospice):
  • Blood tests
  • Swabs (Covid)
  • PICC line cleaning
  • Dressing changes
• Some patients are required to travel to MVCC to collect prescriptions that could be available at other hospitals
• Long journey times for some patients to participate in Lynda Jackson Centre activities (pre-Covid)
• Duplication of tests because different hospitals / practices can’t access results
• Patient notes not always available at the right place
• Long daily journey times for radiotherapy from East and North Hertfordshire, Bedfordshire and parts of East Berkshire
• Longer journey times for chemotherapy for Hillingdon patients if MVCC moves to Watford
• Haematology patients from Hertfordshire and Bedfordshire needing to be treated in London, including for minor procedures like blood tests would like to see more accessible services. The cost and logistics of travelling to London is difficult for most.
• Increase in ‘virtual’ appointments works for some patients (saves time and travel), but not for others, video conference is preferred to telephone as patient can see consultant and vice versa
• There used to be a very good “invaluable” District Nurse service where District Nurses visited patient homes to attend to drains and dressings. This would be very helpful to avoid need for people to come into hospital
• Patients report not often having choice of appointment time, and are nervous about trying to change an appointment they are given for fear of losing it. The time of day can make a significant difference to how a patient feels about travelling to MVCC

There has been a lot of feedback from patients since the review of services began, with patients and carers taking part in more than 100 focus groups, surveys, interviews and engaging via this website. More detail on what patients have told us can be found on the Engagement pages on this website.

Selection of Patient Stories

	Rachel is 43 and lives in Kings Langley. She lives with her husband and teenage children. She was diagnosed with lymphoma after struggling to breathe and having pains on the right side of her arm. Tests were done and a mass found. Rachel was admitted UCLH for 5 weeks. Her husband juggled work, caring for the children and visiting Rachel, taking her clean clothes each week. The journey was 90 minutes each way. Rachel’s treatment involves several periods of spending 4-5 weeks in hospital. She also has to attend for blood tests. If her appointment is 10.30, she has to leave before 8.30, in peak traffic. Travelling to UCLH requires pre-booking parking and paying the congestion charge. It is very expensive. The journey is quicker by train but Rachel was advised to avoid public transport as she was having chemotherapy.
	Sonia is 34 and lives alone in Stevenage. She does not have a car and had been fit and healthy before her diagnosis. She now relies on her parents to take her into London for treatment that is not available at Mount Vernon Cancer Centre. Her parents live in a different part of Hertfordshire. Sonia values her independence and would prefer not to rely on them. Sonia is now in remission so travels into London for treatment less frequently, but still needs bone marrow biopsies every three months. When Sonia tried having blood tests and PIC line dressings locally, she would often find they needed to be re-done at UCLH. On occasions, she would be dropped off by her dad at UCLH for inpatient treatment but find the platelets weren’t high enough for her to have her treatment and her dad would return home after a 3-hour round trip to a message asking him to return to collect her. There was nowhere to park up and wait. Traffic into London was bad, London has the “faff of getting the congestion charge exemption” and there was nowhere to park unless you’d found a car park to book in advance.
	Christine is 62 and from Bushey. Her GP initially told her she had nothing to worry about, but as her symptoms quickly worsened, she dialled 111 and was sent to an Out of Hours GP service at Watford General Hospital where she was sent to A&E for blood tests and then transferred to UCLH where she spent a month as an inpatient. Christine’s husband Alan said that the impact on the partner of the service being so far away was great and needed to be considered as well as the patient. He did more travelling – driving Christine to each outpatient appointment and visiting when she was an inpatient. Each journey was a three hour round trip, even if it was for a five-minute blood test or to have a quick cup of tea with Christine. Alan still has at least another year of doing this at least two days each week.
	Emma is 33 and lives in Stevenage. She does not drive. She takes patient transport to UCLH. She has tests twice a week. She has to be ready three hours before her appointment and often has to wait for others to be collected as well. Her whole day is often consumed for a 5-minute procedure. She finds the travelling and waiting extremely tiring. On one occasion transport arrived late and she was too late to have her transfusion as there wasn’t enough time left to prepare and transfuse the blood she needed.
	Bill is from Luton. His wife passed away in December. They had been going back and forth to Mount Vernon Cancer Centre for Covid tests, blood tests with one trip a week before chemotherapy treatment and another two days before. Bill says his wife was “diminishing in health” and feels “awful” for making her do that journey. Getting to Mount Vernon Cancer Centre would take 90 minutes. For parts of her treatment, his wife was able to have chemotherapy at Luton and Dunstable hospital which was more convenient and she was more comfortable.
	Robert is from Harrow. He is prescribed a medication which can only be prescribed and collected at Mount Vernon Cancer Centre. Whilst the service is very efficient, he thinks it would be helpful if he could collect it at Northwick Park which is easier for him to get to.
	Hayley is from the East of Hertfordshire. Her husband is having immunotherapy at Mount Vernon Cancer Centre, 50 miles away. As well as immunotherapy treatment, they also have to make the 100 mile round trip for blood tests and Covid swabs on different days. Having both arranged at Lister Hospital for the same appointment means a 12 mile round trip.

Our proposals

In response to patient feedback, the new Mount Vernon Cancer Centre would include all the services it currently provides (the basic option), and be designed in new, modern facilities with good disabled access. The preferred option would also include:

• Haematology services would be available at the new MVCC at Watford – these were once provided at MVCC but can no longer be provided on the site because of the lack of access to critical care services. This change to the basic proposal would mean people in Hertfordshire and Bedfordshire would no longer need to travel into London
• Patients wanted to be able to have a full brachytherapy service at the cancer centre and did not like being wheeled across the car park or taken to another hospital for brachytherapy surgery. We are proposing a new Brachytherapy Theatre so more brachytherapy could be done at the new MVCC instead of other centres
• In response to patient concerns about access to radiology (particularly from Hertfordshire), and feedback from clinical teams, we propose new Interventional Radiology enabling more patients to be treated at their most local specialist cancer centre
• Patients have told us they would like to maintain the phlebotomy improvements that have been developed through Covid at the new centre (i.e. dedicated cancer centre phlebotomists) to compliment local blood test options. This is something we will aim to do.

In response to patient feedback, particularly about lengthy journey times for some treatments, we are proposing a range of developments or enhancements to local services:

• Enhanced Chemotherapy services at Northwick Park and Luton and Dunstable Hospitals
• New Chemotherapy services at Hillingdon Hospitals
• Possible additional Acute Oncology at Luton and Dunstable Hospital, and consideration of other enhancements at the L&D.
• New Radiotherapy services at EITHER Lister Hospital or Luton and Dunstable Hospital.
• Additional Radiotherapy provision at Hammersmith Hospital
• Local blood tests and other minor procedures available at local hospitals, or preferably GP practices, care homes, hospices etc. This depends on effective IT and communications systems.
• Network of support services for people living with, and beyond cancer, including face to face offers in local areas and online / virtual support and activities.
• Improved patient transport, particularly from Bedfordshire and East Berkshire
• Build on the success of virtual appointments by providing both face to face and virtual appointments in future.
• Do some more work to look at diagnostics and how the Cancer Centre interacts with new Rapid Diagnostic Centres
• Changes to patient record systems (introduction of EPIC care records system - use of EPIC has been highly encouraged by patients with experience of it)

What would change for patients?

Some examples below are based on real patient stories, others based on information provided by patients but with elements changed for illustrative purposes: