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,  Improving Outcomes Guidance,  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