Transforming specialist cancer surgery services for Gynaecological, Oesophago-Gastric and Urological cancers.

Celebrating success with the launch of one of the biggest cancer surgical centres in Europe at Salford Royal

Oesophago-gastric (OG) surgical services across Greater Manchester are now being delivered by Salford Royal, integrating services from Wythenshawe Hospital and the Manchester Royal Infirmary, making it the biggest single OG surgical centre in the UK.

The OG cancer single service is part of Greater Manchester Health and Social Care Partnership’s devolution plan to achieve the fastest improvements in health and wellbeing, experience and outcomes for the region.

This service is now fully compliant with NICE’s Improving Outcomes Guidance. Patients from across Greater Manchester and Eastern Cheshire with OG cancer will still be seen at their local hospital for initial diagnosis and for follow-up outpatient appointments but those who will have cancer or complex benign conditions who need operations will undergo highly-specialised surgery at the centre in Salford. This fits well with one of the ambitions in the NHS Long Term Plan to  “… redesign healthcare so that people get the right care at the right time in the optimal care setting”.

“Throughout the process I’ve been given options as to where I’d like to be seen for clinics for instance, which is handy for patients who aren’t very well because they get a choice of convenience to them, which I find really helpful …. The actual care I received at Salford Royal was exemplary, it was absolutely first-rate, from the surgeons, down to the staff and the guys who were teaching me to walk again afterwards basically, especially the staff in CCU and the high dependency wards that I was on, the staff and nursing there was more than I could have expected and it really helped with my recovery,”- patient who received care using the new surgical centre.

We were delighted to be able to support all the phases, right from the beginning in terms of mobilising the project, during the redesign stage, supporting the new way of governance and decision making and finally supporting and facilitating the launch.

Outcomes for patients are significantly improved when we gather all the resources together in one place so that’s been one of the main driving forces,”- Jonathan Vickers, Consultant Oesophago-gastric Surgeon at Salford Royal and Chairman of the GM Oesophago-gastric Cancer Pathway Board​.

Sharing the learning from our OG work with Gynaecological and Urological cancer services

On the same day as the launch we ran a Lessons Learned event where everyone involved was able to share knowledge and learning from the process of operationalising the new service. The OG programme has been part of the Respect 21 Research programme funded by the NIHR[1] following GM and London transformation activity to evaluate change management in practice. Professor Ruth Boaden and Dr Catherine Perry from Alliance Manchester Business School, University of Manchester, presented findings gleaned from research interviews with local service planners, managers and providers. This stimulated a lot of discussion and reflection from everyone present. It was clear that there were important areas that need careful consideration: history is important; effective engagement needs to start early and involve a wide range of people including patients; feedback and governance frameworks with effective distributed leadership supports effective integration.

One of the common features of the three cancer services has been establishing single service multi-disciplinary teams (MDTs). An MDT is a team made up of cancer experts. These are people who understand what cancer cells look like and how they behave and people who can carry out tests, decide what the type of cancer is, and which drugs are most effective in treating it. Everyone in the MDT plays a part in supporting the patient and their family through the care pathway, including decisions about any surgery they may need.

A systematic review of MDTs in cancer services found that all studies reported improved outcomes. These included increased rates of survival, improved patient satisfaction and better treatment planning [2]. However, whilst MDT working is considered the gold standard for cancer patient management[3] it’s recognised that MDTs are facing challenges and there’s a need for further MDT reform. We’re working closely with the Greater Manchester Cancer team and have secured agreement for the Gynaecological programme to pilot the national MDT reforms. This is a fantastic opportunity to shape national developments and we’ll be using what we’ve learned already to develop these effectively.

Improving patient outcomes through colorectal MDTs

Royal Oldham Hospital and North Manchester General were the first hospitals in GM to set up a joint Colorectal MDTs to treat patients with bowel cancer and their MDTs have now been running for 2 years.  One of the benefits they’ve seen is that they’re now able to treat patients earlier using ‘first available slot’ between the sites.

The teams of health professionals from both hospitals work together on all cases of bowel cancer. They bring a mix of knowledge and skills together to decide the best course of treatment to continuously improve the quality of hospital bowel cancer care.

“The MDT as a concept has helped to bring together a range of experts involved with colorectal cancer. It has encouraged collaborative discussions that help clinicians to make patient specific decisions related to that individual patient’s diagnosis and treatment. By working together on all bowel cancer cases, it has helped our teams and clinicians to work more closely to decide the best course of treatment for individual patients and look at ways to continuously improve the quality of hospital bowel cancer care.

“Bringing together the colorectal MDTs for patients in Oldham and North Manchester has helped to remove the geographical boundaries between hospitals and that benefits our patients by giving them the opportunity to access diagnostic services and treatment more quickly.”   Dr Zahirul Huq, Clinical Director for General and Colorectal Surgery, North Manchester General Hospital and Fairfield General Hospital

At the TU we’re supporting colleagues at other hospitals to set up effective joint Colorectal MDTs and in January this year a new MDT between Tameside and Stepping Hill Hospitals was launched. Manchester Royal Infirmary and Wythenshawe Hospital are initially trialling their MDTs with a small number of patients with complex cases, as are Wigan, Bolton and Salford Hospitals.

We’ll be running a facilitated event to enable hospital colleagues to share their learning across Colorectal and OG cancer services in February.

[1] http://www.research.mbs.ac.uk/hsrc/respect-21

[2] Prades, J., Remue, E., Van Hoof, E. and Borras, J.M. (2015) ‘Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes’, Health Policy, vol 119, no 4, pp 464–474.

[3] Independent Cancer Taskforce. 2015. Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020. London: Independent Cancer Taskforce.

Photo credit: Union for International Cancer Control 2019