LEAKED: Clinical Letter to Ministers

posted in: Uncategorized | 1

We have received the contents of a letter sent by clinicians to Welsh Ministers, Senedd Members, and Councillors in South East Wales. This highlights the major concerns regarding a stand alone Cancer Centre. Yet Members largely chose to ignore these at the Plenary debate on Wednesday 3rd of March, despite having it sitting in their inbox. Instead, they used platitudes regarding their constituents, failing to acknowledge the evidence that this cancer centre will not be fit for purpose, or even try to hold the Executive team who have wasted public money and time to account.

We are publishing the letter as we feel Members are violating their duty to act in the public interest, and secure the best, safest cancer care for their constituents. Read the shocking issues with the model below.

Dear Members of the Senedd,

I apologise for writing to you uninvited, but I believe that the information contained in this email is of paramount importance, and as such it must be shared widely with all stakeholders and interested parties.
At the latest meeting of the petitions committee it was recommended that a submission calling for an independent clinical review of the proposed new Velindre Cancer Centre (VCC) be put forward for open debate in the Senedd.

Open debate requires those engaged to have access to all the information.

This email was originally sent  to the Health Minister as there was significant concern that the decision making process regarding the siting of the New Velindre Cancer Centre may have been adversely affected by misinformation and as such it is now fatally flawed. 

I am sending to you today an updated version with inclusion of two additional documents (Appendices Nineteen and Twenty).

  The following observations are not made lightly, and each one is referenced with supporting evidence. 

  • The Non existent Barrett Report.
  • Misrepresentation of the number of patients transferred urgently.
  • Misrepresentation of the role of EMRTS (Emergency Medical Retrieval and Transfer Service).
  • Falsely stating EMRTS had attended a patient who sadly died.
  • Misrepresenting the time taken for ambulance transfer for escalation of care.
  • Misrepresentation/Suppression of the Level of concern within Velindre NHS trust.
  • Failure to fully and meaningfully engage stakeholder Health Boards in the planning process.
  • A recent letter signed by 163 Senior clinicians, expressing concern at the current  plans for a stand alone new Velindre Cancer Centre.

  The above points are explained in detail below, with 20 appended documents to confirm the veracity of each point raised.

   I. The Barrett report: 

In the document produced by the Velindre NHS Trust “Why not build a new Velindre Cancer Centre on another hospital site?”  (Appendix One) the following statement is made:

 “The clinical lead in an external review of the project, carried out in 2017, was Dr Jane Barrett OBE, an eminent UK clinical oncologist and past President of the Royal College of Radiologists.”

This statement is clearly refuted in an email from Dr Barrett herself (Appendix Two), wherein it is stated:

“You are correct that I was involved in the review into the siting of satellite centres in South Wales. However it was not a review into the redevelopment of Velindre.”

The existence of an independent clinical review of the proposed stand alone model has frequently  been alluded to by the Velindre NHS trust, when the reality is that no such report was ever written by Dr Barrett.

To date NO external clinical review of the project has been undertaken. The Nuffield Trust did not undertake a clinical review, as clearly stated on page 10 of their report (Appendix Seven) 

“First, this is not and has never claimed to be a wholescale independent review of the project. The scope of this report is tightly defined and relates specifically to the clinical management of the planned network model for non-surgical tertiary cancer services and new cancer centre.”  

  2.  Misrepresentation of Patient numbers transferred for urgent escalation of care unavailable at the current Velindre site:

The concern here is that the current figures as quoted by the Velindre NHS trust are incorrect, misleading and falsely reassuring to the general public. More worrying is the intention to replicate this current model of care at the proposed New Velindre Cancer Centre on the Northern Meadows.

 In the same document  “Why not build a new Velindre Cancer Centre on another hospital site?”  (Appendix One) the following statement is made:

“fewer than thirty patients a year on average need an unplanned emergency transfer.”

A Freedom of Information enquiry was submitted to WAST (Welsh Ambulance Service Trust) (Appendix Three)  and in their response they have provided the raw data on ambulance transfers (Appendix Four). 

What this clearly shows is that on average around 100 patients are transferred each year using the 999 Ambulance system. These are urgent transfers for escalation of care that is not available at the Velindre Hospital.

The same request was made of Velindre NHS trust in respect of acute patient transfers, and their response is included as Appendix Five.

In the response by Velindre NHS Trust , the following statement is made:

“Due to the nature of these clinical pathways, and the number of clinical systems, the organisation does not hold one overall system that collates all patient interventions and transfers

“In our duty to advise and assist we can confirm patients are transferred to other acute hospitals for a range of interventions and the details are accessible by clinical staff in the individual patient record.”

Essentially the Velindre NHS trust have no idea how many patients are transferred each year, nor indeed why they are transferred. To be certain of the exact figure, every set of patient notes held by the Velindre Hospital would have to be scrutinised.

The previous statement “Fewer than 30 patients a year”  could, for all we know, be a random number chosen to offer a false sense of security to the public.

A detailed analysis of the responses to both FOI enquiries submitted to WAST and Velindre NHS Trust is included as Appendix 6. It must also be noted that this misrepresentation continued as recently as November 2020, with the publication of a letter in the South Wales Echo, from the Chair of Velindre NHS Trust (Appendix sixteen).

Whilst this letter suggests that most transfers were non urgent, the Nuffield Trust report 2020 (Appendix Seven) states on page 32:

“In addition to the 999 calls detailed above, there were a very small number of other non-urgent transfers

3. Misrepresentation of the role of EMRTS (Emergency Medical Retrieval and Transfer Service):

 In the same document “Why not build a new Velindre Cancer Centre on another hospital site?”  (Appendix One) the following statement is made:

“have access to the Emergency Medical Retrieval and Transfer Service (EMRTs) who can assess and transfer these unwell patients to the University Hospital of Wales (UHW)” 

A similar statement is made in the document  “Transforming Cancer Services In South East Wales – Clinical Service Model – January 2016  (Appendix Eighteen) wherein it is stated on page 11:

   “Patients rapidly deteriorating will have access to Emergency Medical Retrieval and Transfer Services, who will come to Velindre Cancer Centre, stabilise the patient and arrange transfer to the most appropriate Local Health Board” 

  To the general public, the belief that the helicopter doctors are on hand is hugely reassuring.

 In the last five years EMRTS have attended twice, and they did not attend at all in 2019. This is stated on page 32 of the Nuffield Trust Report 2020 (Appendix Seven). 

The statement as made by the Velindre NHS trust is falsely reassuring and misleading.

Whilst EMRTS are available to any critically unwell patient, the practicalities of their attending a hospital site over 50 miles from their helicopter base in Llanelli, yet 3 miles from UHW, translates to the reality of having attended only twice in five years.

4. Misrepresentation of the role of EMRTS in attending the fatal collapse at Velindre NHS Trust:

More concerning is the fact that Velindre NHS Trust have stated in the response to two separate Freedom of information requests,  that EMRTS attended in 2019 to treat the patient who collapsed and died.

This patient had suffered an anaphylactic reaction to chemotherapy. 

The public would have been reassured to believe that the specialist helicopter doctors attended this resuscitation. 

Velindre NHS Trust stated that EMRTS did attend. (Page 4, Appendix 5). 

They did not: (Appendix 8, Appendix 9).

Perhaps of equal concern is the statement made by the Velindre NHS trust regarding this unexpected death. (Appendix Five)

“The case was not reported as a serious incident as it did not meet the threshold for reporting.”

5. Misrepresentation of the transfer times for patients requiring urgent escalation of care:

In the same document “Why not build a new Velindre Cancer Centre on another hospital site?”  (Appendix One) the following statement is made:

“UHW is less than three miles away and can be reached within minutes.”

As previously stated, the Velindre NHS trust do not collect  and collate this data, and as such the statement is presumably a guess based on geographical proximity. The statement as it reads is very reassuring, the reality, less so.

A freedom of information request was submitted to the Welsh Ambulance Service Trust (WAST) requesting information on transfer times.

The response (Appendix Ten) and the raw data provided in the form of an Excel Spreadsheet (Appendix Eleven)  is Analysed and summarised in Appendix 12 .

      a)    The average wait for an ambulance was:

    AMBER ONE calls   =      59 minutes 59 seconds

     RED calls              =       8 minutes 18 seconds

b)    The Longest wait for an Ambulance was 

  AMBER ONE Call      =    3 hours 27 minutes 52 seconds

RED Call                =     24 minutes

    c)    Average wait for handover at hospital 

  AMBER ONE calls     =     44 minutes 54 seconds

RED Calls               =     30 minutes 28 seconds 

   d)    The longest wait for Handover at Hospital

  AMBER ONE Call     =      4 Hours 12 minutes 25 seconds

RED Call                =      51 minutes 21 Seconds

  e) Average Transfer Time for RED calls to UHW      = 6 minutes 36 seconds

      Average transfer Time for AMBER ONE calls to UHW   = 8 Minutes and 10 seconds.

The suggestion that UHW (University Hospital of Wales) can be reached in minutes, belies the stark truth. 

Reassuring the public that UHW can be reached in minutes is a disingenuous representation of the actual time these transfers take.

These patients are already ill, they deteriorate, and then on average for AMBER ONE CALLS have to wait nearly two hours until admitted to UHW.

This fact is also  discussed in the Nuffield report (Page 31 – 32).

  6. Misrepresentation/Suppression of the level of concern within the Velindre NHS Trust:

In the same document “Why not build a new Velindre Cancer Centre on another hospital site?”  (Appendix One) the following statement is made:

“Our plans for providing specialist, non-surgical cancer services for people across south east Wales have the support of health board clinicians, our staff and patients”

Both TCS (Transforming Cancer Services) and the Velindre NHS Trust will have been aware of the level of concern expressed by a significant number of its senior doctors and nurses.

A letter was written to this effect on 24 July 2020, but appeared to progress no further than the Chief executive (Appendix Thirteen), and it was not until external help and reassurance was provided by the British Medical Association, that the letter was sent to the Health Minister and other members of the Health, Social Care and Sports committee. 

 I requested, under the Freedom of Information act,  a copy of the letter written by the British Medical association to the Velindre NHS trust. After 57 working days (The expectation is that a response will be provided within 20 working days) The Velindre NHS Trust wrote to me advising that they would not release the letters as requested.

They stated that it was in the public interest to withhold this information.

I have now obtained a copy of the letter from the BMA to the Velindre NHS Trust, which is attached as Appendix Nineteen. The letter itself confirms the belief that there was suppression of internal dissent, including the line:
“members are still not prepared to speak up because of fear of reprisals”

7.  Failure to fully engage the other stakeholder Local Health Boards in the planning process:

This is discussed in both the Nuffield report and the minutes of the Health Social care and Sports Committee meeting held on 30/09/2020   [https://record.assembly.wales/Committee/6443]

On Page 18 of the Nuffield Trust report (Appendix Seven) the following points are made with reference to the Transforming cancer care Programme

  • A strong emphasis on care closer to home and the design of care around the patient’s need.
  • Enhanced care within the Local Health Boards (LHB).
  • Three or more Velindre@ specialist units supported by VCC, providing a range of ambulatory cancer services within LHB sites and working closely with local services.
  • A VCC satellite radiotherapy unit at Abergavenny.
  • A new VCC including acute care and providing the Velindre@ for the Cardiff & Vale LHB.

 The detailed components of some of this have not been developed. This planning process culminated in the approval in 2017–18 by all LHBs of an outline business case for a new VCC to be built on the Northern Meadows, 

It beggars belief that despite the fact that  “The detailed components of some of this have not been developed”  approval was gained for the outline business plan.

This may in part be explained by comments from the Chief Medical Officer, Dr Frank Atherton,  at the Health Social care and Sports Committee meeting held on 30/09/2020, at 09:42:50 Dr Atherton states:

“I think perhaps, with the benefit of hindsight, having made the decision by the health boards to go ahead with the construction of the new Velindre cancer centre back in 2018, perhaps that clinical engagement should have continued, and that’s perhaps allowed—that perhaps didn’t happen as much as it needed to.

At 09:50:21 the following statement is made, again by Dr Atherton:

“ Talking to Tom Crosby, in particular, he spent a huge amount of time travelling around all the health boards, talking with all interested parties from a clinical perspective, up to the decision by the health boards in 2018 to proceed with the development of the new Velindre cancer centre. Of course, since then, time has moved on, and, with the benefit of hindsight, I think it would have been better if that clinical engagement perhaps had continued. It probably paused because a decision had been made; it was assumed that everybody was comfortable”

It is quite clear that the engagement process has been incomplete and flawed.

Assuming everyone was comfortable is not the same as unanimous support, and surely not the ringing endorsement to signal the green light for a £200 million project.

It is known that the cancer lead from Cardiff and Vale expressed significant concerns as far back as 2017, regarding the proposal to build a stand alone model.

It is also clear that when engaging with other Health boards, there was no discussion around the findings of the Beatson enquiry into the West of Scotland Cancer Centre, despite this having been undertaken in 2015 (Appendix 14).

More recently there have been further significant examples of Velindre NHS trust failing to engage with other Health Boards in respect of the care of acutely unwell patients.

Velindre NHS trust have undertaken a pilot project to significantly restrict the number and type of patient admitted to their beds.

This is outlined on page 33 of the Nuffield report:

“During the course of our work, the Trust proposed a new set of admission criteria that would further reduce the risks associated with sick patients out of hours” 

One must ask why now?

TCS have been in place for 6 years, and have spent £20 Million, yet at no point prior to this did they consider reviewing the admissions criteria for the current hospital. Understanding which patients require what treatment would obviously impact on plans for the New Cancer Centre.

If you do not know what is needed in the present time, how can you plan for the future?

This new admissions protocol has been commenced in the middle of a significantly escalating pandemic, without consulting the other Health Boards who will now have to admit those patients deemed unsuitable for Velindre.

The date for implementation of phase one of this new admission protocol was set at 14/12/2020, (Appendix Fifteen) without discussions having taken place with other Health Boards who may be significantly impacted. 

The Nuffield Report essentially states that NO patients should be admitted to Velindre. On page 45 of the report:

“The new model should not admit who are at risk of major escalation, to inpatient beds on the VCC. 

These patients should be sent to district general hospital sites if admission is required, to avoid a later transfer”

In reality, this encompasses all patients. If you have cancer, and require admission to hospital, there is inherent in this the risk of deterioration. 

Trying to predict which patients will deteriorate and those who will not is unsafe. 

 8. Letter signed by 163 Senior Clinicians.

This letter is attached as appendix Twenty. The letter questions the wisdom of building a stand alone cancer centre and draws on the Nuffield Trust Advice document to highlight specific issues.

The names of all signatories have been removed as anonymity was in many cases requested. This reflects the significant issues raised above in the letter from the BMA. 

The names, role within cancer care and the seniority of all signatories are known to the Health Minister, who can confirm the legitimacy of this letter.

In summary

It is clear that TCS and the Velindre NHS Trust have been lacking a level of precision that one might expect from a statutory body, when outlining the facts and figure they have used to reassure the public and politicians regarding the safety of the proposed New Velindre Cancer centre on the Northern Meadows. 

The reasons for the persistent inexactitude need to be determined before this project is allowed to proceed any further.

Despite the manner in which the Nuffield Trust engagement was announced (this being at 08:59 on the day the WAG Petitions committee were due to consider a petition calling for an independent clinical review) and the very rigid terms of reference, the Nuffield Trust report makes clear that co-location at UHW would be the option that best serves the needs of the next generation of cancer patients.

There exists the opportunity to use the new Covid-19 Surge unit as a base for co-location, with this unit providing ample space for inpatient beds and research on the UHW campus.

There is no need for a conference centre, and the belief that such a facility might generate significant income now appears questionable, as the Covid-19 pandemic has significantly changed the whole landscape of clinical conferences.

What is left can now be safely and expeditiously built on the current Velindre/Grange site if immediate and full co-location proves challenging. 

Spending up to £30 million on access roads to the northern meadows, to build a much smaller unit which may only be used for 10 years may be considered fiscally inappropriate.

One final question which must be asked is why there has been no progress on the satellite radiotherapy unit at Abergavenny.

This unit has the agreement of all invested parties. The report was published in 2017 (Appendix Seventeen)  yet 3 years later a business plan has yet to be submitted.

This delay needs to be explored and explained.

As politicians, doctors, nurses and clinicians, our service to the public is but transient.

It is incumbent on us to do the right thing, for the right reasons at the right time.

We owe this to the future generations.

Yours Respectfully

  1. T Gardiner

    All involved in the decision making progress concerning VCC should be ashamed of themselves and remember their speciality is not hospital location and construction. Just get on with the job at Velindre/Grange and acknowledge the clinical experts.

Leave a Reply

Your email address will not be published. Required fields are marked *