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					                 SOUTH ESSEX CANCER NETWORK

  Designation of Surgical Centres for Complex Surgery in
Gynaecological, Upper GI, Urological Cancers in South Essex

                                Briefing Paper
                                September 2003

Introduction
The following briefing paper details the decisions made by the South Essex
Cancer Network Board at their meeting on Friday 16 th May 2003 on the
designated centres for complex surgery in the above intermediate range
cancer groups. The decisions made are in principal, pending public
consultation and formal approval from Essex StHA.

The decisions are as follows:

   Upper Gastro-intestinal (Oesphageal and Gastric) Cancer Surgery will be
    centralised at Basildon and Thurrock University Hospitals NHS Trust
   Gynaecology Cancer Surgery (complex) will be centralised at Southend
    Hospital NHS Trust
   Urology Cancer Surgery (Radical Prostate and Bladder) will be centralised
    at Southend Hospital NHS Trust

Background

Following the visit by Prof Mike Richards (the National Cancer Director), the
Essex Strategic Health Authority (ESHA) agreed (11th December 2002) that
the network should provide surgical services within South Essex for upper
gastrointestinal (g-o), gynaecological and urological cancers despite our
population shortfall, as long as we can demonstrate good outcomes. This
was great news for our patients in that we can continue to provide high quality
services close to the patients’ home.

Timescale for Designation

The ESHA required that the network designate where complex specialist
surgery for these intermediate-range cancers be centralised by May 2003.
Each tumour type would only have one surgical centre in the network for the
complex resections.

The Network Board agreed and approved the designated centres for each
cancer type on 16th May 2003. It is recognised that the centralisation itself will
have to be planned and implemented over a realistic timescale.




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The Designation Process

Colleagues will recall that the respective tumour boards were tasked to make
recommendations on designations. Unfortunately, they were unable to reach
mutual agreement. It was vital therefore that the decision-making process be
reviewed with input from acute trust chief executives and medical directors.

A dedicated assessment group was established and tasked to make
recommendations on designation to the Cancer Network Board. Membership
of this group consisted of: the consultant in public health and Commissioning
Director representation from all five Cancer Network PCTs; one external
Network Lead Clinician; one external PCT Commissioning Director, and two
senior network CHC representatives (observers).

This group met on the following dates: 9th May 2003 - to receive the
submissions and agree the scoring and weighting criteria to be used; 14 th May
2003 to review and score the submissions collectively, and; 16th May 2003 to
receive the presentations and present their recommendations to the Network
Board.

Decisions Reached & Key Defining Factors

It was extremely difficult process for the assessment group who had to review
six substantial submissions and hear six excellent presentations from both
trusts. Submissions were reviewed and scored against agreed criteria on
Weds 14th May. These scores were then reviewed post presentations and
amended accordingly on Fri 16th May. The assessment group were in
agreement with the final scores and made their recommendations to the
board identifying the key defining factors for each cancer site.

Upper GI

It was recommended and approved by the Network Board that Upper Gastro-
intestinal (Oesphageal and Gastric) Cancer Surgery be centralised at
Basildon and Thurrock University Hospitals NHS Trust.

Key defining factors were:

   (a) The high risks for Southend Hospital associated with the departure of
       their Upper GI surgeon in July 2003, and
   (b) The network-wide service model proposed by Basildon Hospitals.

Gynaecology

It was recommended and approved by the Network Board that Gynaecology
Cancer Surgery (complex) be centralised at Southend Hospital NHS Trust.

Key defining factors were:


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    (a) Improving Outcomes Guidance very clear in recommendations that
        should centralise in Cancer Centre.
    (b) Two previous external reports both recommend Southend (author of
        first being Prof Kitchener).
    (c) Southend presented very patient-centred model.

Urology

It was recommended and approved by the Network Board that Urology
Cancer Surgery (Radical Prostate and Bladder) be centralised at Southend
Hospital NHS Trust.

Key defining factors were:

    (a) Improving Outcomes Guidance recommendation that centralise in
        Cancer Centre
    (b) Paper and presentation made by Southend provided strong response
        to key criteria.

Patient Numbers Effected

Gynaecological cancers

Estimates suggest that about 170 women in South Essex will present with
gynaecological cancer in any one year. Just over one-fifth will require complex
surgery at the centre

The designated centre will need to accommodate:

   Total of approximately 36 cases per annum subdivided into:

    -   16 –18 complex ovarian procedures
    -   10 – 12 Complex vulva procedures
    -   6 Complex cervical procedures (numbers decreasing due to success
        of screening)

Therefore, approximately 18 patients will to travel from west of network
to Southend Hospital

Gastro-oesphageal cancers

Estimates suggest that about 160-180 new cancers in South Essex will
present in any one year.

   Approximately 50-70 of these cancers will be suitable for resection
    subdivided into:
    - 20 Oesophageal procedures (require ITU post-op)
    - 30 Gastric procedures (require HDU post-op)



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Therefore, approximately 25 patients will to travel from east of network
to Basildon Hospital

Urological cancers

A population of one million should expect to undertake 50 radical
prostatectomies/cystectomies per year.

   For the South Essex population this should equate to 36-40 per year.

Therefore, approximately 18-20 patients will to travel from west of
network to Southend Hospital

Way Forward/Next Steps

Key Action           Outcome                                         Timescale
Local                Meeting between Acute trust chief               By Fri 6th
Executive            executives, medical directors, cancer lead      June 03
Meeting              clinicians and network board chair to
                     discuss decisions and in particular, agree
                     way forward on the key issues emerging
                     from each decision (see above).
Public               Undertake period of public consultation         Sept – Dec
Consultation         under leadership and direction of Wendy         2003
                     Smith, Communications lead at Essex
                     StHA       and    involvement     of    local
                     communication leads across the network.
Essex    StHA        Post public consultation receive formal         Dec 2003
approval             approval from Essex StHA (who will liase
                     with Prof Mike Richards and National
                     Cancer Team, Dept of Health).
Develop Action       Respective Tumour Boards will be tasked         Aug -      Oct
Plan        for      to develop Action Plans identifying             2003
Implementation       explicitly the separate steps in building the
                     respective network with date identified for
                     each
Approve              Network Board to review and agree Action        Dec 2003
Action  Plans        Plans prior to submission to StHA and the
for                  National Cancer Action Team, Dept of
Implementation       Health

                                                                      Kevin McKenny
                                                                     September 2003




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