A Model for Breast Services in North Wales Grace Lewis-Parry 11th March 2009

Context Designed for North Wales Holcombe & Raynor Report 2007 Ministerial Direction 2008 North Wales Cancer Network requested to take work forward

3-Stages Rapid review of current breast care services Development of an agreed model of care Option appraisal of how the model can be delivered in North Wales

Recommendation The expert group were all agreed that; Wherever the service is delivered, all elements i.e. screening, diagnostics and surgery should be co-located Fragmenting these elements was not seen as the optimum service model

Recommendations Phase 1 (up to 3 years) Management of a North Wales breast cancer service LLGH as the administrative centre Service managed as a unified symptomatic team with formally designated management and clinical leadership Symptomatic service and BTW will work together to develop joint operational management at LLGH and Wrexham

Recommendations Phase 1 (up to 3 years) Screening and symptomatic diagnostic services A new health centre for breast services on the LLGH site Wrexham will fulfil the same role Mammography and ultrasound will continue at YGC and YG for patients unable to travel to Llandudno or Wrexham

Recommendations Phase 1 (up to 3 years) 2 x MDT meetings per week to consider both screening and symptomatic patients, one in Wrexham, one in LLGH In this phase surgery would continue at the four hospital sites, however, further expansion of surgical services on LLGH could be planned to take account of day surgery and new low impact technologies

Recommendations Phase 1 (up to 3 years) Sentinel Node Biopsy (SNB) SNB will be made available at LLGH using the blue dye / radio isotope / gamma detection probe approach and cases audited for efficacy Reconstruction Breast surgeons will access additional training

Recommendation Phase 2 (3-5 years) Will reflect progress of Phase 1 Will reflect technology, manpower, clinical standards, advances in non-complex surgery