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MACN CRITERIA FOR A UROLOGY CANCER CENTRE
Introduction
Improving Outcomes in Urological Cancers (IOG) is a 141 page manual. IOG and
the then unpublished Urology Standards were used as templates for our MACN
Urology Cancer Centre bid. Cross-referencing between MACN bid criteria, IOG
criteria, External Review Team (ERT) opinions and the Joint Bid itself is difficult.
We apologise if the Joint Bid from Colchester and Chelmsford is not overly clear in
this respect, but hope that the enclosed briefing pack will provide the necessary
references and, in addition, provide explanatory notes on the IOG criteria
themselves.
CONFORMING WITH IOG
The key IOG criteria are:
1
2
3
4
5
The network and MDT
Diagnosis and Assessment
Patient-centred care
Palliative care
Treatment of the five urological cancers (3.2.7 pp 30):
Where not covered by 1 to 4:
5.1
5.2
5.3
5.4
5.5
Weight 10
Access to treatments
Availability of treatments
Markers of quality
Numbers treated
Outcome data
MACN Criterion a “CONFORMING WITH IOG” - MACN RANKING: 1
ERT states that both bids comply, but in the overview state: “The ERT
were not convinced that ERHT (Essex Rivers, ie, Joint Bid) had fully
considered the implications of the standards-based requirements of a
specialist cancer surgery centre … The review team considered that
the proposal from ERHT did not address the requirements of a centre in
sufficient detail for the team to be confident that their proposals would
deliver effective high quality specialist surgical treatment for urological
cancer.
To demonstrate a track record of conformity with IOG standards-based
requirements, 5.3, 5.4, 5.5, the Joint Bid provided outcome data for
bladder and prostate cancer surgery in Colchester, pp 14. Radical
prostatectomy outcomes from Chelmsford were given in the
presentation to the ERT.
The Joint Bid already complies with IOG rather than expressing an
aspiration for the future.
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Regarding the IOG pathology standard, “Markers of quality of radical
surgery, including the proportion of excised specimens with clear
margins and blood transfusion requirements.” The Joint Bid surgeons
and specialist pathologists have, in compliance with IOG, provided
MACN with this data, collected over ten years, rather than expressing
an aspiration for the future.
IOG Standard 1, the Network and MDT
The ERT state “No allowance was made in the proposal for additional
oncology input from Ipswich to the Network MDT”.
This is wrong. The Joint Bid states, page 24: the Specialist Urology
MDT will include surgeons, clinical and medical oncologists,
radiologists and pathologists from all MACN hospitals.
ERT state: “The sessional commitment of members of the MDT is not
clearly defined in Section 3.2 or Appendix 1 etc.”
The Joint Bid states: p23:
The Colchester MDT is comprised of all key staff enumerated in IOG pp
26-27 and who undertake all the roles designated therein … and our
proposals for linkage of the local MDTs to an MACN Cancer Centre
Specialist Urology MDT reflect IOG pp 31-39.
The Joint Bid states: p24:
The Centre Urology MDT will meet weekly and its nominated core
personnel will attend the requisite percentage of meetings required.
(Core personnel are all urology standard and are nominated in the Joint
Bid, Appendix 1.2, pp5-6)
Attempting to estimate costs/finance to the MDT would be entirely
speculative and current video conferencing facilities in Colchester will
eliminate travel. For instance, the East Anglian Testicular Tumour
Group MDT is entirely teleconferenced (see also Finance).
IOG Standard 2, Diagnosis and Assessment
Colchester’s Primary Care based access to specialist assessment and
diagnostic facilities has been recommended for implementation
throughout the network (ERT, p10).
IOG Standard 3, Patient-centred Care
Commended by the ERT (p1).
IOG Standard 4, Palliative Care
Fully provided – p30.
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IOG Standard 5, Treatment for Specific Cancers
1
2
3
4
5
Access to treatments
Availability of treatments
Markers of quality of treatments
Numbers treated
Outcome data
We believe the Joint Bid fully satisfies all these criteria indeed for items
3, 4 and 5 the Joint Bid provides data on the experience and quality of
service already provided by the Joint Bid Surgeons, p14, and in
subsequent reports to MACN.
Weight 10
MACN Criterion d: “ACCESS FOR PATIENTS” – MACN Ranking: 1
Road, rail and public transport:
Joint Bid:
1
P16: Central location favours majority population of MACN,
particularly for isolated peninsula communities in the east and
south of MACN. A12 1.5miles, A120 2 miles. New A12 link
proposal: ½ mile.
Rail links: ½ mile from Colchester station. P32,33: Ambulance
etc: shorter journey times to central location.
2
P16,32: Access to new hotel-style relative accommodation.
3
P38: Access to Primary based diagnostic services.
4
P16: Access to Treatment via cross-boundary Patient Pathways.
5
P18-21, Access via compliance with 2/52 target and cancer
waiting targets.
6
Access to cancer follow-up Patient-focused Pathways.
(i)
Primary care based oncology clinics close to patient’s
homes.
(ii)
Primary care based flexible cystoscopy bladder
cancer/follow-up
(iii)
Stable prostate cancer telephone follow-up
P32/33(iv)
Admission and discharge are co-ordinated by admissions
officer and ward-based admissions nurse in a
preadmission clinic and a ward-based discharge nurse.
Weight 7
MACN Criterion h: “KEY STAFF” – MACN Ranking 3
Joint Bid:
P17
Listing of key staff
“The Specialist Team”
The ERT state “The two options suggested by IHT to address the
surgical workload issues were considered to represent a robust and
flexible approach to ‘Centre’ working.”
Joint Bid, 3.2.4, P17: Both these options are provided:
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Option 1: 2 surgeons from Colchester plus 2 visiting surgeons who
have agreed to work in Colchester.
a
b
Mr Lewi from Chelmsford who supports the Joint Bid in
preference to Ipswich.
Mr Donaldson from Ipswich who agreed in a TSSG meeting to
travel to Colchester.
Option 2, P18: “Further sub-speciality of consultants will now occur and
appointment of a fourth urologist is planned in …. 2004.”
The fourth consultant (a cancer specialist) is now in post.
The Joint Bid therefore similarly envisages participation by Chelmsford
and Ipswich surgeons, but it is not dependent on this to manage the
workload as in Ipswich’s “Option B”.
The ERT state: “The review team considered that the clinical nurse
specialist time required for a specialist cancer surgery centre is likely to
have been underestimated.”
The Joint Bid indicates that much uro-oncology work is already
provided by Primary Care-based specialist nurses.
It also clearly states a second uro-oncology nurse will be appointed by
Essex Rivers. This appointment is now in process and the post is
funded outside the bid.
Both uro-oncology nurse specialists will provide cross-boundary
services.
Weight 7
MACN Criterion g: “WAITING TIME TARGETS” MACN Ranking 3
Is there evidence of a link to performance against waiting time targets?
ERT:
Weight 7
Colchester – “Yes”
Ipswich – “Yes”
MACN Criterion k: “SUPPORT FROM USERS” MACN Ranking 3
ERT: “The ERHT (“Joint Bid”) urological service is strongly patient
focused and is obviously extremely well supported by its users”.
Supporting Groups:
Colchester Prostate Cancer Support Group
Tendring Urology Support Group
Colchester Mens Health Action Group
Urology Research in North Essex (charity)
CHAPS – Colchester has active Prostate Cancer Support Group
(charity).
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Weight 3
MACN Criterion i: “RISKS” MACN Ranking 6
ERT: “The main issues are lack of capacity (beds and staff). It is not
certain how effective ring fencing will be in the absence of additional
capacity for medical outliers. The organisation of the network MDT was
also considered by the review team to be a risk to completion in the
sense that without an effective sessional commitment to the MDT it is
unlikely to achieve the required objectives.
Beds and Staff
(i) There is a strategic commitment by Essex Rivers to ringfence
urology beds and this has already proved effective.
(ii) Staff: see above. There are now 4 appointed consultants in
Colchester, 3 of whom are cancer specialists and the fourth is
developing laparascopic cancer surgery (Joint Bid p18).
(iii) MDT: see above.
If a weekly cancer centre MDT proves in practice to require a whole
session of consultant time, given the facility of teleconferencing to avoid
travel, we accept that this is a risk.
Given the number of cases that will require discussion, we cannot
envisage a whole session of time will be required. Our experience of
running local urology MDTs to IOG criteria and the teleconferenced
Anglian Testicular MDT support this view.
Weight 3
MACN Criterion c: “ESTIMATED COSTS” MACN Ranking 7
Weight 2
MACN Criterion m: “ACADEMIC LINKS” MACN Ranking 8
Joint Bid 2.9, P18
These are very strong. In addition to para 2.9, 1 consultant (C M
Booth) is now a Visiting Professor at Essex University.
URINE employs one research nurse. The Department of Oncology
employs a research nurse who attends Urology MDT meetings and
remits urology patients into NCR trials.
Appendix 7, pp90-99 demonstrates a massive and sustained
commitment to research, including clinical research that has
established national standards of care in both benign and malignant
disease.
URINE has provided £1/2 million to the Department to fund research
and education.
Weight 1
MACN Criterion e, “TIMETABLE” MACN Ranking 9
Joint Bid, PP35-36
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The Joint Bid Steering Group are confident clinical services and cancer
admissions can be commenced “within a minimum of time of 3 months
– but a more realistic time of 6 months from the date of confirmation.
Booked Admissions, patient choice and pathway co-ordination are fully
covered by the Joint Bid.
Weight 1
MACN Criterion l: “NON-MALIGNANT WORK” MACN Criterion 10
Joint Bid 3.12.1, P38-40
The Bid provides a full description of detailed achievements and
planning in providing improvements across the network for benign
disease management, for which Colchester is a recognised national
leader, now participating n its third national pilot study and with two
members of the team (1 urologist, 1 user) on national steering groups.
This expertise was endorsed by the ERT with a recommendation for
network-wide adoption.
If the Bid is successful, Colchester will actively support the
establishment of a “Stone Centre” in Chelmsford with a remit to joint
working and provision of this valuable facility for the whole network.
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