Professor Mark R Baker
Dec 18, 2015
Professor Mark R Baker
Strategic context Service organisation in England The research agenda Drivers for the review Main findings Options and preferences Politics and pragmatism Interim improvements
20 years of neglect EUROCARE, 1993 Expert Advisory Group, 1993-95 Improving Outcomes Guidance, 1996-2005 Cancer Peer Review Creation of NICE, 1999 NHS Cancer Plan, 2000 National Radiotherapy Advisory Group,
2007 Cancer Reform Strategy, 2007
Calman/Hine iteration 1995◦ Centres and Units
Improving Outcomes Guidance◦ Centre teams and Unit teams
Peer review 2004◦ Specialist teams and Local teams
Centralised the complex and rare; localise everything else
Basic principles of team working, specialisation, centralisation required for specialisation
1999 review of NHS R&D Top priority (only one funded) was to establish
an infrastructure in the NHS for the conduct of cancer clinical trials
NCRN created in 2001◦ Local networks built on service networks as rest of
NHS was in chaos NCRI – national partnership of (non-commercial)
funders Goal of improving research quality, speeding up
and increasing recruitment, building research capacity and spin-off benefits for patient care
No academic oncology in Liverpool (by far the largest centre without)
CRUK looking to accredit 15 cancer research centres in UK incl. Liverpool
Isolation of oncology centre seen as obstacle to developing academic oncology
Service is isolated and misplaced◦ Over-centralised and self-indulgent◦ Surgical fragmentation and oncology isolation
make for messy pathways and lack of synergy
Commitment to expand RT through use of satellite units
CRN has hit a glass ceiling Perceived opportunity to invest in the short
term (misplaced as it happens) by commissioners
Service needs are more important than research needs in driving change
Physical isolation of oncology centre inhibits treatment development and ambition
Fragmentation of specialist services restricts team building and strength
Commitment to satellite radiotherapy provides the opportunity to think radically about location, synergy and building strength
Can’t do cancer without research and can’t do research without academic oncology
Move the main inpatient base to Central Liverpool, teaching hospital campus
Align specialist oncology with specialist onco-surgery
Deliver radiotherapy on three sites Devolve chemotherapy much more Resistance of oncologists to supporting two
inpatient units is an obstacle Inadequate corporate infrastructure, paranoia
and status of oncology centre is major block
If major relocation scheme is not short-term:◦ Proceed with satellite RT Units◦ Retain opportunity to develop one (at Aintree)
into a linked centre with IP beds◦ Develop academic oncology at the RLH campus
under university auspices – relationship with oncology centre to be determined
If financial opportunities improve:◦ Have a scheme to centralise oncology at RLH
ready to pounce