Coventry & Warwickshire COVID-19 Portal

Re: Midlands Cancer Surgical Hub

Firstly, thank you for participating in the call on Friday regarding the Midlands response to management of essential cancer surgery during the coronavirus pandemic document and the principles therein.

We believe that capacity is not at a level to support current, and future activity over the next six months. We have proposed a single central administrative reference point within the Midlands (the Hub) for registration of cases where provider MDTs have agreed treatment plans and prioritisation status against the indicative list of conditions noted in the appendix. 

This will be aligned as close as possible to established operational reporting systems within providers to minimise administrative burden. With the identification of safe haven ring fenced operating facilities described in the clinical guide, this is intended to be a simple sign off process but will provide system assurance for equity together with real time intelligence to balance activity against variable available capacity. We are aware that a number of providers have already developed highly functioning processes and where possible we wish to build on these further. An example utilised by University Hospitals Birmingham and partners is provided for reference.

Where a treatment plan is agreed by an MDT but no local solution is available for a single or cohort groups of patients it is intended that the Hub will coordinate the mutual aide to achieve resolution which is intended to be local where achievable.

Fundamental to the principles of the guidance is the identification and consolidation of surgical activity through ‘clean’ surgical facilities. We urgently invite STP and NHS/IS collaborations to review current provision against the new recommendations and report whether with the introduction of testing they would fulfil all criteria and whether there is additional potential capacity availability by surgical specialty.

As colleagues are aware, the Midlands is without a non-acute tertiary referral cancer treatment centre. There are limited high dependency facilities within IS providers and we are trying to establish whether a clean surgical facility with ITU support following the principles once again within the document can be delivered within current established specialist tertiary providers. Where identified it may be used to consolidate site specific complex surgery activity. For a small number of cases where capacity restrictions may limit the ability to deliver specialist treatment a second clinically led prioritisation process may be required.   

We are working with representatives from University Hospitals of Leicester; Nottingham University Hospitals; University Hospitals Birmingham; University Hospitals Coventry and Warwickshire and University Hospitals North Midlands to ensure we are able to achieve the aims of the national document and in particular are aligned to our requirements for the Midlands. We are not seeking to destabilise current developments but also wish to consider capacity available at other tertiary cancer providers.

Thank you for your support and should you require any further information kindly contact Belinda Dooley bdooley@nhs.net 

Yours sincerely

          

Alison Tonge Rob Gornall

Regional Director Commissioning - Midlands Clinical Director