10 June 2016

Improving specialist cardiovascular and cancer services

Supporting partnership working to improve the lives of people with cancer and heart disease.

The challenge

Cancer and cardiovascular disease account for two thirds of all premature deaths before the age of 75 in London. To help address this, proposals were developed by clinical teams across the partnership, and supported by UCLPartners, building on work originating from models of care produced by NHS commissioners in 2010. These models of care concluded that whilst Londoners had access to some excellent clinical care, there was a high variation in patient outcomes across the region, and that lives could be saved for people with specific types of cancer and heart disease by reconfiguring specialist services in dedicated centres.

Aim

UCLPartners has supported clinical teams across north and central London (and in west Essex for cancer) to help revolutionise care for patients with cancer and heart disease. By linking local hospitals and GPs with specialist ‘centres of excellence’, the aim is to save over 1,000 lives each year in the region each year by giving patients world-class care at every stage – from disease prevention, earlier diagnosis through to and treatment and beyond. In addition, the proposed new approach to organising care aims to deliver savings to the NHS and to benefit the UK economy through the development of globally competitive research into cancer and heart disease.

Addressing the challenge

Evidence shows that dedicated specialist centres, treating a high volume of patients, staffed by expert teams and equipped with the latest technology and research capability save lives and reduce complications. This has been the result of the creation of specialist stroke centres in London four years ago, which have saved more than 400 lives and driven improvements in outcomes and care. Based on a case for change put forward by heart disease and cancer doctors and nurses, new centres at St Bartholomew’s Hospital and UCLH act as ‘hubs’ within a comprehensive network of care including local hospitals, GPs and other community services. This integrated system focuses on the needs of patients, providing the safest care and a more highly skilled workforce available 24/7, whilst ensuring people are still able to receive the majority of their care locally – all aimed at giving patients the best outcomes and a better experience of their care. It also ensures that services are sustainable for the future.

Under the new system, Barts Heart Centre opened as the centre for specialist treatment of heart disease, including the largest cardiovascular surgery centre in England in 2015. The new centre combines the services and staff from the London Chest Hospital in Bethnal Green and The Heart Hospital in the West End, along with those that were already running at St Bartholomew’s hospital. UCLH, working within a system of hospitals including The Royal London, St Bartholomew’s, The Royal Free and Queen’s in Romford, has become a centre for the specialist treatment of five types of cancer – brain, prostate and bladder, head and neck, oesophago-gastric and blood cancers. The Royal Free Hospital has become a centre for the specialist treatment of kidney cancer. The vast majority of other cancer services, including radiotherapy and chemotherapy for these and other cancers, are still available in local hospitals.

With care now delivered within an integrated, comprehensive network it ensures the latest treatments, research and medical innovation are available to people at the right time in a setting that most suits their needs.

Outcomes

The changes have created world-class centres of excellence that specialise in providing care of the highest standards for people needing the most complex treatment, while enabling other services to focus on enhancing the quality of rehabilitation and care beyond hospital treatment.

Almost one year on from opening the new dedicated specialist centre at Barts the results speak for themselves: the standardised hospital mortality index at Barts is 0.535 (equivalent to 340 lives saved every year); faster inter-hospital transfers (target now exceeded by one day); full seven-day emergency and specialist cover for patients with serious acute heart conditions; cancellations reduced by half; and savings worth over £45m to the NHS over five years.

For people with cancer, more are now able to have surgery that spares their kidneys (20% more than the national average); and over half of patients with small mass kidney/urological cancers avoid the need for any surgery at all. This makes a huge difference to the experience and the long-term outcomes for patients.

These achievements have only been possible through the commitment and collaboration of the clinical teams in the region who saw solutions over the long-term and made this happen.

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