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Briefing on changes to oncology services

20/01/2020

Briefing on changes to oncology services – Scarborough Hospital, Bridlington Hospital, Scunthorpe General and Diana, Princess of Wales Hospital

The purpose of this document is to outline the approach to communicating proposed changes to the delivery of oncology services affecting patients on the East Coast served by Scarborough and Bridlington hospitals, part of York Teaching Hospital NHS Foundation Trust and the South bank of the Humber served by Diana Princess of Wales Hospital, Grimsby and Scunthorpe General Hospital, part of the Northern Lincolnshire and Goole NHS Foundation Trust.

This is initially a temporary change made on a basis of patient safety, a further review will take place after three months.

A joint approach will be taken by the following organisations:

• York Teaching Hospital NHS Foundation Trust
• Hull University Teaching Hospitals NHS Trust
• Northern Lincolnshire and Goole NHS Foundation Trust
• NHS Scarborough and Ryedale CCG
• NHS East Riding of Yorkshire CCG
• NHS North East Lincolnshire CCG
• NHS North Lincolnshire CCG
• Humber, Coast and Vale Health and Care Partnership
• Humber, Coast and Vale Cancer Alliance System Board

What is oncology?

Oncology is the treatment and management of patients with cancer using treatments such as radiotherapy and chemotherapy.

The part of the service that is changing is the location of oncology outpatient appointments at Scarborough, Bridlington and Scunthorpe hospitals, and inpatient oncology at Scunthorpe. At these outpatient appointments, patients will discuss their diagnosis, test results, and treatment options with the oncologist. Patients may undergo an examination, have blood tests, and be referred for further investigation and treatment. For the majority of patients, the provision of chemotherapy will not be affected by this change and will continue to be provided in its current locations.

Patients will usually attend multiple oncology appointments, the number will vary dependent on the nature of their disease and their treatment plan.

Background:

Hull University Teaching Hospitals NHS Trust (HUTH) provides a range of high quality oncology services at the Queen’s Centre, Castle Hill Hospital in Cottingham for patients from Hull, East Riding and surrounding areas.

Under an arrangement with York Teaching Hospital NHS Foundation Trust (YFT), HUTH provides medical oncology outreach services at Scarborough Hospital (four days per week) and some at Bridlington Hospital (one morning every alternate week). This is provided by HUTH with one substantive consultant, one specialty doctor in a locum consultant role and one specialty doctor. Chemotherapy is delivered through the well-established, nurse-led service in Scarborough Hospital and Bridlington Hospital (through the mobile chemotherapy unit).

Under an arrangement with Northern Lincolnshire and Goole NHS Foundation Trust (NLAG), HUTH provides medical oncology outreach services at Diana Princess of Wales (DPoW) Hospital in Grimsby (five days per week) and Scunthorpe General Hospital (five days per week). This is provided by HUTH with 10 substantive consultants, one speciality doctor in a local consultant role and two speciality doctors. Chemotherapy is delivered through the well-established, nurse-led service in Scunthorpe General Hospital and at DPoW, Grimsby.

All radiotherapy treatment is undertaken within the Queen’s Centre, Castle Hill Hospital.

Why is the change necessary?

Oncology services have been provided at Scarborough, Bridlington, Diana Princess of Wales and Scunthorpe General hospitals by HUTH for a number of years. The provision of this service has been under increasing pressure for many years due to workforce pressures and recruitment difficulties. Despite every effort to maintain the current mode of consultant-led care, the situation is worsening and now requires an alternative model to be urgently implemented in conjunction with all stakeholders.

The Hull oncology team is currently facing significant challenges.

• Vacancies
One of the main contributing factors is the significant lack of oncologists (both locum and substantive) nationally to employ. HUTH has advertised on numerous occasions over the past 18 months, for both substantive and locum staff, with limited success. A previous workforce strategy concluded that an additional 5.5 wte consultants are required, simply to cover the existing levels of current activity and complexity and to be in line with national guidance.

There are currently 4 substantive oncology Consultant vacancies in Hull University Teaching Hospitals. This is a significant proportion of the 21 oncology consultant posts in total at Hull.

• Staff Health and Wellbeing
There is a higher than average level of sickness absence within the substantive consultant oncology workforce and it is important to ensure that staff health and wellbeing is protected.

• National Shortage of Oncologists
There is a national shortage of oncologists and also oncology trainees. The service has advertised numerous times over the past 18 months to recruit both substantive and locum staff with little success.

As a result of these workforce challenges, it is no longer possible for Hull University Teaching Hospitals NHS Trust to maintain a high quality, safe oncology service in all locations that is both consultant-led and delivered.

In order to maintain services with the current numbers of consultants it is necessary to consolidate the majority of consultant time within the Queen’s Centre at Castle Hill Hospital in Cottingham. This will reduce the time spent travelling by consultants and ensure that the maximum amount of patient care is obtained from the limited consultant resource.

What is changing?

Given the current levels of referral and the reduction in available resources, a number of options were considered as to how to deliver oncology services in order to deliver a safe and quality service to patients.

Based on patient safety, a temporary change is being made to service provision which will see the following:

All first outpatient appointments for new patients will be provided in the Queen’s Centre at Castle Hill Hospital, Cottingham or Diana Princess of Wales Hospital, Grimsby by the relevant oncology team specific to the type of cancer. This will facilitate consultant-led oversight of care and ensure that there is equality of service provision for patients across the wider region.

Scarborough and Bridlington:

Consultant Oncologist presence within Scarborough Hospital will continue for one day per month in order to provide clinical assurance, managerial oversight and support to service development. This will allow the majority of follow up care to continue to be provided in Scarborough by specialty doctors, according to clinical need. The medical oncology service provided at Bridlington one day per fortnight will be withdrawn.

Oncology in-patient services are currently delivered at Scarborough Hospital by local physicians – this will not change and support will continue to be provided from visiting consultants and specialist doctors. All patients requiring more intensive support are already transferred to Castle Hill Hospital and this will continue.

Patients in follow up who require significant treatment decisions will either receive a further face to face review with the team at the Queens’ Centre, Castle Hill Hospital or, if clinically appropriate, their case will be reviewed through a virtual clinic link up between clinicians in Scarborough and Castle Hill Hospital. This will maintain consultant oversight at all critical phases of the patients’ journey as well as enabling some treatment change follow up appointments to continue in Scarborough.

All chemotherapy that can be safely delivered at Scarborough Hospital will continue to be delivered locally under the supervision of the local nursing team and visiting speciality doctors. The mobile chemotherapy service at Bridlington Hospital will also continue.

Patients with Gynaecological or Renal cancers will have all face to face outpatient appointments at Castle Hill Hospital.

Chemotherapy sessions for these patients will take place at Castle Hill Hospital and will not be able to continue at Scarborough and Bridlington.

It has always been the case that patients requiring particularly specialist or complex therapy have received it at Castle Hill Hospital, and this is currently the case for all cancer pathways.

Due to the small numbers of patients with gynaecological or renal cancers, and the complexity and potential complications of their therapy, specialist supervision is required to ensure safe delivery of their treatment.

Northern Lincolnshire and Goole NHS Foundation Trust:

To ensure patient safety and the highest levels of patient care, every oncology patient must receive a consultant-led plan with adequate supervision provided for non-consultant grade staff. The only way to facilitate this at this current time is to consolidate onto one site within Northern Lincolnshire and Goole Trust. Whilst the consolidation is being considered in the longer term as part of the Humber, Acute Services Review, it now has to be brought forward on a temporary basis due the need to maintain a safe service.

The Diana Princess of Wales Hospital, Grimsby has been temporarily chosen over Scunthorpe General Hospital. This decision has been made because Grimsby has a specialist cancer ward and department and moving there is less disruptive to other services. Where patients’ preference is to have their appointments at the Queen’s Centre, Castle Hill Hospital, Cottingham, then patients may do that.

Clinic provision at DPoW, following these proposed changes, will be restructured into ‘disease-site specific’ days. These multi-doctor clinics will substantially increase service resilience and allow speciality doctors to work within a consultant-led environment, improving service equality to match services at HUTH and Scarborough.

Patients with Gynaecological or Renal cancers will have their Consultant face to face outpatient appointments at Castle Hill Hospital. This is because it is the only place they will be able to see the highly skilled specialist they need as they work at this hospital. Chemotherapy sessions for these patients will continue at both Scunthorpe and Grimsby.

With the proposal that all clinically led oncology care will be delivered at DPoW, it has been decided that all acute inpatient care will also be delivered on the same site. This is to ensure that the clinical team is consultant-led and can facilitate acute inpatient reviews and ward rounds. The longer term plan for the location of all clinically-led oncology care will form part of the Humber Acute Services Review. Further changes to the management of inpatients may be required to ensure adequate service capacity and quality.

Who will be affected?

Centralising consultant-led outpatient services to DPoW Hospital, Grimsby and Castle Hill Hospital will affect patients from the following CCG areas:

• NHS Scarborough and Ryedale CCG
• NHS East Riding of Yorkshire CCG
• NHS North Lincolnshire CCG
• NHS North East Lincolnshire CCG

Number of patients impacted

• The impact on the Scarborough population relates to 317 patients over a 12 month period – this is the number of patients accessing their first appointment. The majority of these patients will be able to receive follow up appointments at Scarborough Hospital. This figure includes 47 patients with Gynaecological or Renal cancers who will be required to attend Castle Hill Hospital for all appointments, including chemotherapy.
• The impact on the Bridlington population relates to 149 patients over a 12 month period. This figure includes 15 patients with Gynaecological or Renal cancers who will be required to attend Castle Hill Hospital for all appointments, including chemotherapy.
• The impact on the Goole population relates to approximately 36 patients per month.
• The impact on the Northern Lincolnshire population relates to approximately 267 patients per month.
• The impact on North East Lincolnshire population relates to approximately 8 patients per month – this is the number of patients with Gynaecological or Renal cancers only, as all other services will remain at DPoW Hospital.

When will these changes happen?

These changes will be made on a temporary basis due to patient safety on 27 January 2020; letters will be sent to patients affected to inform them of these changes.

Patients already in the system with an imminent appointment will be contacted by letter, by their respective hospital trust, either York Teaching Hospital NHS Foundation Trust or Northern Lincolnshire and Goole NHS Foundation Trust. Patients will be told that their oncologist will no longer be providing clinics in Scarborough, Bridlington or Scunthorpe respectively.

NLaG patients with an appointment between Monday 27 January 2020 and Friday 14 February 2020 will be contacted by telephone to rearrange it. NLaG patients with an appointment on or after Monday 17 February 2020 will receive a second letter with a date and time for their next appointment. York Trust patients who have an appointment in the next few weeks will also be contacted by telephone to inform them of the change to the location of their appointment. Further letters will also be sent to confirm the date and time for their next appointment.

For inpatients, at Scarborough Hospital, there is no change to the provision of care. For acute oncology inpatients, patients will no longer be admitted to Scunthorpe General Hospital. Instead, patients will be admitted to Diana Princess of Wales Hospital, Grimsby.

Hull based Oncologists will continue to provide telephone advice to Scarborough clinicians. They are able to access scans and blood results electronically and, based on the number of referrals and type of referrals seen, they are assured that this would be a safe and workable solution

What are the next steps?

The priority is to ensure that patients who need to be seen by a highly skilled specialist can do so as quickly as possible, and the only way to do this within the current resources is to centralise the service to the Queen’s Centre, Castle Hill Hospital, for patients currently served by Scarborough Hospital and Bridlington Hospital. For patients currently served by Scunthorpe General Hospital this would mean centralising services at Diana Princess of Wales Hospital, Grimsby.

This is a short term measure which is necessary to continue to deliver quality and safe services across Northern Lincolnshire, Goole and the East coast. A review will take place three months after these changes, which will be led by the Humber Cancer Board.

We are aware that a key impact of this change is likely to be around transport. We are working very hard to minimise the impact on this by helping patients with alternative arrangements for those who need them.

Patients who are not eligible for Patient Transport Services, and who have difficulty in getting to the new location for their appointment, will be assessed for transport support. This support is for patients who do not have access to private transport, either their own or through friends/relatives. In these cases the patient may be able to access taxi services between hospital sites. This is detailed in the letter we are sending to them.

A long term strategy for the future provision of oncology services is currently underway as part of the Humber Acute Services Review, led by the Humber, Coast and Vale Health and Care Partnership.

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