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