Leaked letter from cancer expert warns of impact Velindre plans could have on patient care and research
Alex Seabrook, local democracy reporter
A leaked letter from a top cancer expert has warned the plans to build a new cancer hospital in Cardiff could harm research and impact on patient care and recruitment.
A new Velindre Cancer Centre is proposed to be built in Whitchurch, near the existing hospital.
But the plans are controversial as some believe the new centre would be better off next to a larger hospital like the University Hospital of Wales (UHW) at the Heath.
Now a newly-leaked letter, written in November last year, warns the plans to build a standalone hospital could harm cancer research and staff recruitment.
A spokesperson for Velindre said the trust had a “strong track record of delivering research of international impact, working in partnership with our colleagues across the health, university and commercial sectors”.
Professor Neil Burnet, an expert in proton clinical oncology, sits on the external advisory board of Wales Cancer Research Centre. The letter, dated November 5, fed into the landmark Nuffield Trust inquiry into the Velindre proposals.
In the letter, obtained by campaigners Co-locate Velindre, Prof Burnet said: “The board was unanimous in our opinion: we feel this represents a huge potential missed opportunity.
“There is a clear trend for specialist cancer services to be moved to larger hospitals with a wide range of specialist services as they are redeveloped. Cancer units which have had general services withdrawn from their campuses have been badly disadvantaged, both for patient care and research.
“Velindre is very much out of step with the prevailing thinking about patient care, an issue which needs to be considered very carefully.”
One issue raised by the professor in the letter was a lack of an intensive care unit at the new Velindre Cancer Centre, which he claimed would prevent the hospital taking part in some trials for new experimental treatments. The nearest ICU would be at UHW.
Another potential issue is the impact on staffing, which could impact on the “prestige and brand” of Velindre and Cardiff in cancer research communities.
He said: “The decision to re-site Velindre separately will also have implications for staff recruitment at both junior and senior level. That in turn will have a knock-on effect on research. Physical separation of radiotherapy degrades the capability for successful collaboration between oncologists and other specialities.
“There will be loss of prestige and damage to the strong Velindre brand and to the standing of Cardiff and Wales in the wider cancer care and research communities. The next [five years] will be difficult should Velindre be rebuilt distantly, and that will restrict opportunities for patients to engage in, and benefit from, research.”
The letter was considered in the inquiry on the Velindre proposals conducted by the Nuffield Trust, a health think tank. The Nuffield report, published in December last year, explored concerns around building the new hospital on a stand-alone site, instead of next to an existing large general hospital like UHW.
The report said patients at risk of major escalation should not be admitted to the new Velindre Cancer Centre, and a cancer research hub should be developed at UHW. It added most patients at Velindre are outpatients, who arrive for treatment and leave on the same day, and many value the convenience of travelling to the hospital, just off the M4 motorway.
A spokesperson for Velindre said: “Velindre Cancer Centre already delivers multi-disciplinary, cutting edge cancer research with patient safety at its heart. Since the Nuffield Trust’s advice was published, Velindre University NHS Trust has worked closely with all relevant partners to deliver the recommendations on research and development.
“Specifically, work is underway in partnership with Cardiff and Vale UHB and Cardiff University to develop a Cardiff Cancer Research Hub at UHW—as per the Nuffield Trust recommendation—that will enable us to further develop our shared ambitions, including the successful delivery of complex early phase studies and advanced therapies for patients across south-east Wales.
“Velindre has also produced a research and development ambitions document outlining a 10-year commitment, and it continues to play its role in the development of a regional and national cancer research strategy for Wales. This was also a key recommendation by the Nuffield Trust.”
But campaigners claimed the letter was a “damning verdict” of the plans for the new cancer centre, and are calling for an “independent clinical review” of the stand-alone model.
A spokesman for Co-locate Velindre said: “This letter shows that a permanent stand-alone cancer centre in Cardiff will have serious consequences for patients and erode Wales’ reputation in the eyes of the world. Nuffield merely recommended a process towards co-location starting with the research hub at UHW.
“Velindre and the Welsh Government have defied the real intent of Nuffield’s advice and made a mere staging post the final destination. So the review board’s letter still roundly condemns what they’ve chosen and every word still applies to this approved stand-alone cancer centre.”
In an interview after the letter was leaked, Prof Burnet said he still held concerns about the standalone model, but added challenges could be overcome. He also said he sympathised with the fact that many people believe there is an urgent need for Velindre to build a new hospital rather than wait for the UHW to be rebuilt.
He said: “My view, based largely on experience of myself and others, is that cancer centres work much better if they’re co-located with a big general hospital.”
The professor, who started his consultant career at Velindre, said the lack of intensive care or surgical facilities was a concern when conducting intensive chemotherapy treatments or managing surgical complications.
He said: “I used to do quite intensive chemotherapy there. Most patients who have chemotherapy are absolutely fine, but sometimes there are complications with it. You need to be able to provide support for blood pressure, for example. If a collapse happens you need some quite intensive medical and nursing input, you need the patient to be in an intensive care unit. But in the back of my mind that was always a worry.”
Another concern was staffing, and how making contacts and attending meetings becomes harder when clinical services are split across multiple sites.
He said: “You have one group of doctors doing intensive treatments at UHW, and a different group of doctors doing intensive chemotherapy somewhere different. You start to get fragmentation. You can overcome those challenges. But you have to work much harder at it, and have higher levels of staffing to do it.”
A third issue was the lack of space at UHW to fit a potential co-located new Velindre hospital. The current site at the Heath has little available space, and while there are plans to replace the UHW with a new building, these are in the early design stages. Velindre already has planning permission for the Whitchurch site, and enabling works are set to begin soon.
Prof Burnet added: “I understand there would be huge problems fitting Velindre in at UHW, and I gather that Velindre needs to be rebuilt much sooner than my understanding of the time frame for the rebuild at UHW. But if you have a limited footprint you can also build up and down: in the USA it’s normal to have skyscraper hospitals.
“Saying there’s no space at UHW is important, but there are ways around a space issue. There are merits to both proposals, for sure. But that’s part of the problem. People can be polarised and get very angry about the opposition.”
A Velindre spokesperson said: “As noted by the Nuffield Trust in its report, south-east Wales can only deliver its cancer research ambitions by working in partnership, and Velindre will continue to focus on this.”
Similar concerns had previously been raised in a letter signed by 163 unnamed clinicians, who claimed it would be “safer for patients” to build the new cancer centre next to UHW.
Construction work for the new Velindre Cancer Centre is expected to start in March 2023, taking about two years, and is likely to open in summer 2025. Enabling works to prepare the site could begin this autumn. The Welsh Government signed off the outline business case in March earlier this year, and planning permission was granted by Cardiff council in 2017.