Agenda item

To consider a presentation on proposals for changes to non-surgical oncology services from representatives of NHS England and the Northern Cancer Alliance.

Consideration was given to proposals for changes to non-surgical oncology (Systemic Anti-Cancer Treatment (SACT) (chemotherapy-related) and radiotherapy) services across the North East. Supplemented by additional background context outlining challenges associated with the existing offer and the preferred model for future delivery, representatives of NHS England and the Northern Cancer Alliance gave a presentation which included the following:

Ø  Why non-surgical services need to change

Ø  Overview of oncology services and original outpatient appointment sites

Ø  Principles for strategic review and strategic model development

Ø  Options considered, decision-making, and preferred option

Ø  Example patient pathway and proposed hub locations

Ø  Benefits of a tumour-specific hub

Ø  Clinical model – peer review (September 2023) and outcomes

Ø  Engagement and communication

Ø  Impact assessments – health and travel (to date and for preferred option)

Ø  Next steps

The rationale for altering the existing service model was outlined, a key aspect of which was the nationally recognised shortage in oncologist workforce (identified as far back as 2020). Other factors included a regional variation in current provision and access, the anticipation of new drugs associated with this pathway causing increased demand, and the general increase in cancer incidences.

Mapping the present offer across the North East and North Cumbria Integrated Care System (NENC ICS) footprint, two specialist cancer centres at Newcastle (Freeman Hospital) and South Tees (James Cook) included radiotherapy treatment, with chemotherapy delivery units based at 19 sites (the proposals did not change the sites for these services). However, the historical model of outpatient provision was no longer fit for purpose, with inequity of access developing over time, a lack of resilience within the workforce, and an increase in referrals and complexity of cases contributing to delivery pressures.

The principles underpinning a strategic review of these services was noted, with key features including the need for patient-focused, clinically-led, care which was delivered as close to home as possible. Given the expected widening of the gap between supply and demand for the regional oncology workforce in the next five years, ensuring oncologist time was used for maximum efficiency was crucial, as was providing safe levels of specialist cover alongside opportunities to enhance resilience through peer support and learning.

Following various consultation and engagement with stakeholders (including the public), four future options were identified, one of which was to continue with the current model (already established as unviable). Two others involved either centralisation to the existing cancer centres or a decentralised model – however, these were both problematic due to travel / estate implications and lone-working / inequity of service development concerns respectively. The fourth option – clinical networks with tumour-specific hubs and treatments as close to home as possible – was therefore the preferred choice. Once the ongoing engagement and further development phase had concluded, it was intended that the agreed model would be signed off by March 2024.

The preferred option was explored in more detail, with example patient pathways, proposed hub locations, and the benefits of a tumour-specific hub demonstrated. Assurance was given that the original diagnostic pathways would not change, though an individual may need to travel further to see a non-surgical oncology doctor. The introduction of hub locations would create a more resilient workforce that provided better patient care, and only a small number of patients (around 15 per week) would need to receive their face-to-face appointments at an alternative site. It was felt that people were less concerned about travelling further if the service they receive was good.

Details of a 2023 peer review to check and challenge the proposed model were relayed – this was initiated to ensure safety, sustainability, co-dependencies, quality standards, workforce, equity, and access were appropriately considered. Review outcomes showed support in principle for the preferred option, though work required to mitigate the impact of these changes was identified around workforce levels, out-of-hours provision and access to acute oncology, technology adoption to enable remote access to care, and a programme of involvement / engagement.

Regarding this latter finding, extensive engagement and communication efforts were documented in order to seek the views of the public, patients, professionals and partners. Future consultation plans around the proposed new model were also listed – this included the involvement of those with lived experience of oncology services, and activity that engaged people with the greatest level of inequity of access / health inequalities. Health and travel impact assessments had also been undertaken for the preferred option – this was done to identify likely impacts of the proposed service change and provide further insight to reduce potential barriers / discrimination.

Concluding the presentation, the next steps around the development of these services were highlighted. Further to securing support for these proposals and the continuation of clinical pathway standardisation work and contract / commissioning conversations, it was hoped that change would start to be implemented from April 2024.

The Committee referenced its awareness of feedback on the value of familiarity in terms of contact with professionals and attendance at treatment locations. Officers confirmed that the proposals for the future model would indeed assist in this regard, with professionals to be based within the hubs who patients would be able to repeatedly access, and a co-ordinator to be available for individuals to contact in relation to their ongoing care. One issue that had proved challenging was when people become ill out-of-hours, and much consideration had gone into how best to manage these situations. Work around a regional outreach model was taking place to ensure a more robust out-of-hours structure – Members welcomed this and felt it may also assist in identifying other wraparound care requirements (e.g. the need for social care input).

Instances of waits for radiotherapy services were raised by the Committee. Officers agreed to follow this up after the meeting, though reiterated that if the workforce was limited and too far spread across a wide geographic area, there was little resilience within the system and delays would inevitably occur. The NENC ICB representative present noted the targeted lung health check work across the region and indicated the support of the ICB for the preferred option.

The key issue of transport links to services was discussed, with Members querying whether patient transport options would be available for the revised hub locations, and questioning if the criteria for accessing this was clear. Officers responded by expressing their desire to get input from all parties on the clinical model proposal, and that discussions were being held with voluntary transport providers. Criteria for its use was considered clear, and options were and would still be available. Whilst transport-related conversations needed to continue (and were reviewed on an annual basis anyway), the NENC ICB representative added that spending on transport assistance initiatives diverted funds away from clinical patient care. It was acknowledged, however, that it was important to ensure equitable transport provision across the five Local Authority areas.

AGREED that the non-surgical oncology outpatient transformation information be noted, and the preferred option (clinical networks with tumour-specific hubs and treatments as close to home as possible) be supported.