NHS Trust ‘over-egged’ think tank’s support for new cancer centre

Campaigners claim that advocates for a controversial new cancer centre over-egged comments made by a think tank in order to win approval for the project.

Opponents of a new standalone £700m+ Velindre Hospital in Cardiff say that a crucial document submitted to the NHS Infrastructure Investment Board (IIB) in 2020 that has recently surfaced should not have included the sentence: ‘Nuffield [the independent Nuffield Health think tank] had confirmed that the Velindre model of a stand-alone non-acute cancer hospital rather than co-location on an acute hospital site was an appropriate clinical model.”

A spokesperson for the campaign group Colocate Velindre – which argues that instead of the planned standalone centre it should be colocated with a general hospital – said: “The words ‘rather than co-location’ grab the reader. The testimony is found from Velindre only in this one, pivotal IIB document, and runs counter to what even Velindre itself has often recited elsewhere.

“And, to the contrary, the Nuffield Advice (2020) actually ‘confirmed’ colocation as the usual and preferable UK-wide NHS model, but noted that a lengthy timetable for any new Heath Hospital (UHW2) impeded ‘full colocation’ in south east Wales.

“We can safely say the words of the claim appear nowhere in the Advice. What’s more, many find it unthinkable, anyway, that the Nuffield panel’s expert members would downgrade the dominant model of colocation in favour of one long since abandoned and discredited. That would be to put themselves out of step with a UK-wide and growing global norm.

“The IIB paper is also clear on the financial consequences of December 2020: ‘this decision-point effectively commits the Welsh Government to the scheme, its enabling works, and associated capital equipment etc.’ In other words this unevidenced bid for money resting on one claim commits the government at once to the whole construction debt, currently declared at £725m, ‘unless there is a major change in the process’.

“For critics then, a misleading statement pitching for huge sums looks a gravely serious issue. They want Velindre’s managers to show what page of Nuffield gives this generalised ‘confirmation’ of the standalone model over colocation. The claim also seems at odds with Nuffield’s panel being excluded from re-scrutinising the embedded standalone model. Its terms stipulated advice only on management of the whole cancer network.”

Funding

The spokesperson added: “The IIB’s briefing paper also shows why the Nuffield panel could never have confirmed the standalone as an appropriate model rather than colocation: there are only two standalone cancer centres in the UK, the Royal Marsden and the Christie.

“But they are surgical and very large, thanks to exceptional funding. They also arose in the middle of the last century. Nuffield could not possibly have recommended what cancer care has not done for decades.

“The IIB papers also report that “the standalone model hinders [Velindre’s] ability to keep pace with the evolution of cancer therapies.” They recognise that: ‘the proposed model could hinder the Trust’s aspiration to be seen as a leading cancer centre in the UK.’

“Though aligned to Nuffield, the IIB does not challenge the sober predictions that a standalone centre will fall behind the leading cancer treatments. Hence critics also deny that the standalone will be a ‘catalyst’ for transformation as TCS also claimed to the IIB.

“If Velindre should be deemed to have misled, how may we safely sign up to its forthcoming Full Business Case, proposing a multi-million financial spend?

“The claim about Nuffield seemingly passed unquestioned. The IIB’s endorsement on December 162020 helped to embed several Nuffield myths among public and politicians. That has stifled open, political scrutiny of the project, and enabled prejudice against NHS and international experts. Campaigners have experienced both online and street abuse.”

Legal advice

In a letter to Mark Isherwood, Chair of the Public Accounts and Public Administration Committee, Drs Penny Owen and Roy Kearsley of Colocate Velindre said: “As a result of legal advice, Colocate Velindre has found itself in a position to scrutinise the IIB minutes for meetings in December 2020.

“The IIB’s advice in favour [of the project] to the government has since helped to entrench [Velindre’s] point of view with politicians and public, against contrary evidence from eminent clinicians and wider consensus. But now the IIB’s redacted Minutes and accompanying Policy Paper can be laid bare to analysis and evaluation. As a result, disconcerting anomalies emerge.”

In their letter to Mr Isherwood, Drs Owen and Kearsley draw attention to their view that the Nuffield Advice has been misinterpreted.

They go on to state: “New Velindre and the Welsh Government have still continued to suggest that under the regional network proposals the standalone model is equal in value to a colocated one. There are many reasons why this cannot be so. The policy paper ends this way: ‘Some of the benefits of co-location can be achieved through the development of Velindre hubs at acute sites but the £[redacted] million investment in a new build, networked cancer hospital, does not achieve the following important features:

* The most robust arrangements for the management of deteriorating inpatients.

* The most integrated clinical model; including onsite access to diagnostics, surgery, multi-specialty management, as well specific co-location with paediatric oncology and haemo-oncology and genomic medicine.

* The most future proofed model of care; specifically developments in cell and genome therapy and more intense immunotherapy and immediate access to onsite PET-CT [scans].

* The capability to deliver all phase one clinical trials.

* Capacity to meet projected demand for external beam radiotherapy and SACT [Systemic Anti-Cancer Therapy] – this is delivered as part of separate business cases.

* A consistent clinical model within Wales for tertiary non-surgical cancer care.

Just before Easter, on March 28, Velindre University NHS Trust, which insists the decision to press ahead with a standalone new cancer centre is in line with the Nuffield Advice, confirmed it had reached an agreement with the Acorn consortium for it to design, build and maintain the new Velindre Cancer Centre.

Construction will start in the coming weeks, with the opening scheduled for 2027.