Urological cancer surgical services update
Background • • • A 2010 pan‐London review of cancer services (published by London Health Programmes) found that while progress had been made, more needed to be done to improve patient outcomes and patient experience of cancer services. Public engagement on the pan. London case for change and model of care was undertaken in 2010. As a recommendation of the pan-London review, two integrated cancer systems were established in London – London Cancer covering North East London, North Central London and West Essex and London Cancer Alliance covering other parts of London. Since the publication of the pan-London case for change and model of care for cancer, clinicians from across London Cancer have been working together with GPs and patient representatives to consider how we could deliver the best possible urological cancer care for our patients, specifically bladder and prostate cancer and kidney cancer. London Cancer is leading this review. Clinicians believe that the way in which urological specialist services are currently arranged does not maximise the delivery of the highest quality of care, research and training that we are capable of. Clinicians believe that centralising complex surgery for bladder, prostate and kidney cancer would lead to better patient outcomes. We also need to diagnose urological cancers earlier, whilst also improving the care and support of people who have finished their treatment and are either living with their cancer, in remission or recovery. Specialist treatment is only a small part of a urological cancer patient’s care. The vast majority of patient care would always take place at local hospital units and GP surgeries.
Urological cancers • Prostate and bladder cancers are common, but very complex surgery is not necessary for all patients. Of around 1, 500 cases of prostate cancer diagnosed in London Cancer every year, and 400 cases of bladder cancer, only 350 of these 1, 900 patients require complex surgery. This is just under 1 in 5 of all patients. • Kidney cancer is relatively rare. There are relatively few treatment choices for kidney cancer and treatment is most often surgical. Some surgical operations for kidney cancer are simple whereas others are very complex. All are becoming increasingly reliant on emerging technologies, such as keyhole (laparoscopic) surgery and robotically-assisted surgery.
Current services • Prostate and bladder cancer: In 2010/11, four hospitals across NEL, NCL and West Essex carried out between 54 and 89 complex operations each – a total of 296. These were: University College London Hospital, King George, Whipps Cross and Chase Farm. This total was made up of 220 operations for prostate cancer and 76 operations for bladder cancer. Since 2010 a substantial number of Whipps Cross cases have taken place at UCH and since October 2012, by clinical agreement, Chase Farm cases have been undertaken at UCH. • Kidney cancer: In 2010/11, nine hospitals across NEL, NCL and West Essex each did between 10 and 72 complex kidney operations – a total of 292 operations. These were: Chase Farm, King George, Royal London, UCH, Whipps Cross, Royal Free, Newham, Princess Alexandra, Homerton.
Why we need to change Clinicians are finalising a case for change which outlines why clinicians believe that services need to change. In summary: • Across North East and North Central London and West Essex around two people a day require complex surgery to treat kidney, bladder or prostate cancer. These patients require highly specialist, once‐in‐a‐lifetime surgery to give them the best chance of controlling their cancer and reducing the risk of long‐term side effects such as incontinence. • We have a highly-skilled and experienced workforce, passionate and committed to delivering the best care to the populations that we serve. However, the way in which services are currently arranged does not maximise the delivery of the highest quality of care, research and training that we are capable of. • National and international evidence demonstrates a clear link between higher surgical volumes and better patient outcomes. Specialist centres which have frequently practising specialist teams and full facilities, with high patient throughput, generally have better patient outcomes.
Indicative engagement process To ensure we understand a wide range of views, we will discuss London Cancer’s recommendations with local patients and the public, clinicians and other representatives prior to finalising clinical recommendations. Discuss clinical case for change and recommendations with patients and the public, LINks, councils and other representatives Six week engagement January and February • • • Formally discuss the recommendations with Clinical Commissioning Groups to understand their views Discussions with CCGs during March Formally discuss the recommendations / requirements for further engagement with Joint Health Overview and Scrutiny Committees Discussions with JHOSCs during March and April Decision making by NHS Commissioning Board taking account views received during engagement Following engagement and development of final clinical recommendations, decisions made by NHS CB The principles of reconfiguration recommended by the pan-London model of care for cancer were also subject to a public engagement process in 2010. We will engage on the proposed local model of care with groups in north central London, north east London, west Essex and south Hertfordshire. The proposed reconfiguration will be subject to the four tests for reconfiguration – support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and consistency with current and prospective patient choice.
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