Frequently Asked Questions about the Strategic Outline Programme to Transform Cancer Services in South East Wales. Q. Is this just about a new cancer hospital? A. No, it’s much more than a building. We’re working with everyone concerned with cancer – patients and their families, the health boards which commission our services, our staff, the voluntary organizations, the cancer Networks and other partners - to improve the quality and outcome of cancer services. This means better prevention, detection, diagnosis and support,and education and research which will deliver continuous improvements in patient experience and outcomes. This new service will need to be delivered in enhanced facilities throughout South East Wales. As well as a new cancer centre we need to redesign services to be delivered around the patient. So more often, services should be provided in the home or the community, or in primary and secondary care settings. It is true however, that our current cancer centre, at Velindre, which has served us well for sixty years, will need to be replaced over the next ten years. The design of this must take into account which services will need to be delivered ‘centrally’ and which can be delivered locally. Q. Is it true that the site of the new cancer centre has already been decided? A. No, this decision has not been made yet. We have been invited to collaborate on developing our Strategic Outline Programme (SOP) with all those who help us to provide cancer services and with those who have received it. We are now doing that, and building an detailed business case which will be submitted to Welsh Government early in 2016. This will describe the form of a cancer centre and possibly a satellite radiotherapy unit that we think is suitable to meet the needs of patients for the coming decades. It will also propose improvements to the entire cancer journey. We have, however, been thinking about this a great deal. We have been asked to undertake this Programme because of our reputation for delivering excellent care and high quality research and service improvements. This reputation is based upon reported patient experience and published outcomes for the treatments we are directly responsible for delivering. Our role, as Velindre Cancer Centre, will be to provide non surgical tertiary care services to patients across South East Wales, and some specialist radiotherapy services for all of South Wales. We believe we know and deliver this tertiary service really well. We understand that our service needs to be integrated with each of the Health Boards for whose resident populations we provide care. There will always be a need for a Cancer Centre, to provide the majority of the radiotherapy, specialist care and research for the whole of South East Wales. This will require specialist inpatient and outpatient facilities. Essentially, we need to work out which services need to be delivered at the specialist centre, and which can be delivered more locally. The way we support the delivery of cancer care in local hospitals also needs to change. This will be in all cancer units. We want to redesign secondary care services, putting the patient at the centre of the picture. This will be a much better defined model of care,whereVelindre, haemato-oncology and acute secondary care teams combine to provide fast, effective, equitable and excellent care in designated hospital units. Q.. Why can’t we stay at Velindre? A. There are several reasons. The most important is that more people are getting cancer, needing treatment and needing it for longer because they’re living with cancer for longer. In five years, if we do nothing, patient demand for care will outstrip our capacity to deliver. We are not only seeing increased demand for services because of a higher incidence of cancer. We are also seeing patients needing more complex care. The current patient environment doesn’t allow us to provide the highest quality experience for patients, their families and carers. It does not support us sufficiently to improve their outcomes, such as survival and quality of life, which we believe are high priorities. Q. Will the new hospital be the same as the current Velindre? A. The challenge will be to take all the things that make Velindre so special, the expertise, the patient friendly environment and culture and the shared purpose of the staff to deliver care, quality and excellence but to deliver this in a facility fit for next 50 years. It is important also we adapt to the complex needs of patients now and in the future. We believe a better integration of the care delivered by Velindre with our Health Board partners will ensure treatment and support is given a more timely, effective and convenient setting. So we believe some patients that currently have to travel to Velindre should be able to receive the same excellent care in cancer units closer to home and we believe some patients currently receiving care in those units could actually be better managed in community and primary care setting. It is likely that this service model will continue to evolve over the next 10 years and we believe Velindre could have a lead role in shaping this. Q. What is the scope of this Programme? Will this just be for patients in South East Wales? Velindre Cancer Centre provides specialist non surgical care for patients in South East Wales. We also provide some specialist services for patients beyond these boundaries, eg specialist radiotherapy services and early phase clinical trials. We know this service well and deliver excellent care and lead high quality research. We are also aware however, that whilst patients who experience this care rate it very highly and just continuing to do this alone will not improve overall patient outcomes so that they are similar to those of the best performing comparable countries. It is also clear to us that, as we develop our service model with our partners in South East Wales, which we hope will ‘pull’ services toward the patient, it is very likely that the benefits of this model could be enjoyed by patients beyond South East Wales. For example if we develop better support for GP clusters in the form of better access for diagnosis, advice and support, there is no reason to think that this shouldn’t benefit patients across all of Wales. We will lead and deliver this learning through existing structures such as the Framework for cancer in Primary care and the Cancer Networks, soon to have an all Wales remit. Another example might be in the commissioning radiotherapy equipment (coordinating the buying of new and replacement linear accelerators). This is likely to be more strategic, efficient and cost effective, for example by having a single maintenance contract for all machines in Wales. We have excellent relationships with Singleton Cancer Centre in Swansea. We have a single training programme for medical staff and wherever possible share thoughts, service developments and research ideas. We need to explore how this collaboration can be made even stronger for patients throughout South Wales. Q. How much will this cost? A. We are still at an early stage of investigating feasibility. We will be able to give more details on costs once the outline business case is submitted in early 2016. Q. Can you give more detail on how the new service model will affect other hospitals and centres in the region? A. Cancer prevention, detection, diagnosis, treatment and support has always happened within many different NHS Wales locations and organisations. There are many bodies with a responsibility for delivering services in this area, and this will not change. For example cancer surgery has always been carried out at local hospitals and this is likely to continue. Whatever the service model for the future, this will need to adapt to the increasing demand, complex needs of patients and specialist treatments. We believe it is better to plan for this service strategically as this will be more likely to deliver prudent and affordable health care for all. We know that prevention is preferable and more cost effective than treatments. We also know that the costs of preventable, unscheduled care are high and that early diagnosis can reduce the costs of expensive treatments and palliative care. Ultimately, the service of the future will have to be delivered within available and finite resources available to NHS Wales. We believe we will get more equitable and higher quality care with good forward planning. Q. Some patients prefer to travel to a specialist cancer centre so that they can be assured they are getting the best possible treatment. Are you saying that option won’t be available in future? A. No. Where clinically appropriate, patients will continue to come to Velindre. We have some equipment, for instance for radiation, which is so specialist and expensive, that it makes much more sense to continue with a central location. For other services there is evidence that concentrating expertise can improve patient outcomes and in our experience patients are willing to travel for this better care. But there are many treatments which can, and should be delivered locally, either in local hospitals, community and primary care settings or at home. We describe this as a pull of specialist services towards the patients. Wherever possible and desirable, our services will come to patients, not the other way around.