Mount Vernon Hospital is a very complex place. The site is owned by The Hillingdon Hospital NHS Trust, which provides elective surgery in the Mount Vernon Treatment Centre. It also provides some of the other acute services on the site, including the Minor Injuries Unit and a number of out-patient services.
However, Mount Vernon Cancer Centre - the biggest Cancer Centre in the south of England - is the responsibility of East & North Herts NHS Trust, and the Northwood & Pinner Unit is the responsibility of Central & North West London Foundation Trust.
Several charities are housed on the site – The Paul Strickland Scanner Centre, The Lynda Jackson Macmillan Centre, The Restoration of Appearance and Function Trust (RAFT). The site also houses commercial interests – Bishopswood Hospital; a private sector dental service; Baxters providing Scanner Centre pharmaceuticals.
There is also the Mountwood GP Surgery, the Michael Sobell Hospice, staff accommodation and Chart Lodge - a patients’ hostel. Some buildings have historic importance and are listed. Some buildings are empty, awaiting demolition. If we had the resources, we could devote a whole website to this remarkable place – as it is, we have only this page for news from anywhere on the site.
Inpatient Wards, 10 and 11, have 47 beds between them, including 2 high dependency beds.
Radiotherapy treatment is provided by nine linear accelerators, including CyberKnife and TrueBeam
The Cancer Centre is supported on site by:
- The Paul Strickland Scanner Centre
- The Lynda Jackson Macmillan Centre
- The Michael Sobell House palliative care unit
The new Unit is beautifully laid out and now affords a more luxurious environment than the previous unit in the old Mount Vernon Hospital. There is a 4-bedded ward where patients requiring a gastroscopy or colonoscopy investigation can now be accommodated for their treatment throughout their visit, whereas previously they had to retire to a separate sitting room before being discharged, which allows a more relaxed experience.
The Endoscopy machine is a "State of the Art" piece of equipment. Much of its cost was contributed by the Voluntary Comfort Fund. It is situated adjacent to the ward and the nearby theatres. The Unit is open from Monday to Friday, with sessions in the morning, afternoon and at weekends. Procedures are always conducted by a consultant. The Unit carries out more procedures than other hospitals in the area.
The staff are very proud of the new unit and enjoy working in it - although there are a few regrets about moving from the 'old place'!
This year the founder of the Scanner Centre, Dr Paul Strickland, sadly died at the age of 92. He launched the Scanner Appeal in 1983 aiming to raise £1,250,000 in three years, but in two years he had raised £1,700,000 - enough to fund a CT scanner, an MRI scanner and a building to house them. He established the Centre in 1985 and for 26 years played a significant personal role.
The Scanner Centre is a charity, providing a local but more specialist scanning service than local hospitals. Since its opening, it has scanned just over 225,000 patients. It has three buildings and 5 scanners on its site at Mt. Vernon Hospital, where it has very close connections with the Mt. Vernon Cancer Centre and with Siemens, which produces its radioactive tracers in an on-site cyclotron.
To provide its services and engage in research, it has 45 employees - radiologists, radiographers, physicists, IT people, fundraisers and administrative staff. It also has many volunteers and its Friends Committee, which helps its fundraising team and also runs events in its social programme.
The Scanner Centre’s latest PET/CT scanner, installed in October 2013, at a total cost of £1.4m offers many advantages over earlier machines – faster, clearer images, a lower dose of radiation, and a larger bore so it is less claustrophobic for patients. Positron emission tomography (PET) uses radio-tracers to show the extent of disease and the response to treatment. Computerised tomography (CT) shows the anatomy, using x-rays to distinguish hard and soft tissue.
Magnetic resonance imaging (MRI) based on water content in different tissues, uses radio signals in a strong magnetic field – useful for brain, spine, joints, cardiac, lung and colorectal cancer, prostate and whole body oncology. The Centre has the greatest experience in whole body MRI in the UK.
Success is measured in many ways - by patients’ responses in questionnaires, by the volume of complaints and compliments, by its quantity of work, by the time between receiving referrals, providing scans, and delivering reports. Financial success includes the size of donations, legacies, and fund raising activities, which determine the ability to reinvest in new high technology equipment. Research success includes the number and citations of papers produced by the Centre’s staff in refereed journals. A final measure of success is the level of training provided for clinicians.
Every scan is different, providing both early diagnosis of disease, and monitoring of treatment.
The Scanner Centre’s research contributes to the field of medical imaging, covering the whole body, including prostate, chemo/radiotherapy effects on head and neck, pancreatic cancer management, breast cancer, lymphoma, and the technical quality and information of images.
Although the health care system from April 2013 is complex, the Scanner Centre plans to work with the NHS in this new structure, both to build on its current success and to develop new services.
Mrs. Sullivan then answered a wide range of questions, which raised many interesting points, including:
- Some of the Centre’s NHS work comes from GPs in Hertfordshire. Unfortunately Harrow and Hillingdon NHS patients may now only be referred via Hillingdon Hospital. Harrow and Hillingdon Clinical Commissioning Groups do not allow GPs direct access to PSSC as it is does not have access to “Choose and Book”. This would require a costly IT project for the Scanner Centre.
- The Centre carries out some scans to diagnose dementia. Nationally, new scans are being developed to assist in diagnosing dementia as part of the toolkit for doctors. The Centre is well placed to assist.
- The NHS purchases scans from the Scanner Centre at its own tariff rates. There is no charge for the Scanner Centre’s training services.
The speaker was thanked on behalf of the audience by Donald Edwards, which was endorsed by loud applause from all those present. The audience had been warned that a video of the address was being made and that anyone present who preferred not to be shown on the video should make this known by the end of the meeting.
The Mount Vernon 2015 project is making progress:
A strategy has been developed to define a site to be transferred from the Mount Vernon Hospital landlord, the Hillingdon Hospitals NHS Trust, to East & North Herts. NHS Trust, which administers the Mount Vernon Cancer Centre.
The strategy includes the Cancer Centre vacating the original Mount Vernon Hospital building, which is now a listed building and impossible to modify to meet the current needs of cancer patients. The plan is to develop the Cancer Centre elsewhere on the site, where it can provide for its long term future and build modern wards for its patients.
NB: This is not a summary. Only issues of relevance to the Mount Vernon Cancer Centre are noted, plus a few more general points
Awards for Mount Vernon Cancer Centre by the National Institute for Health Research:
The Mount Vernon Cancer Centre Supportive Oncology Team was the winner of the outstanding achievement award in the “Annual Best Practice in Research Achievement Awards’ for Hertfordshire and Essex “.
In addition the Renal and Melanoma Research Team, Mount Vernon Cancer Centre, and Lisa Clark, Study Co-ordinator in that team, were commended for an outstanding achievement by an individual or a team.
Impact on Mount Vernon Cancer Centre of the NHS structural changes on 1st April 2013:
In comparison with last year there will be one additional NHS body to deal with this year for Hertfordshire, Bedfordshire and Essex - due to two CCGs replacing NHS Hertfordshire – but all activity for those areas will be through a single commissioning support unit, NHS Central Eastern CSU. In contrast, in London there will be 16 organisations to deal with instead of 12 last year.
However, the majority of Mount Vernon activity will now be paid for by the Special Commissioning Unit of NHS England, so the contract values for the CCG contracts will be much lower than last year.
The Board’s papers noted that it has had one case of MRSA – no indication of where in the Trust this case occurred. It is noted here to draw attention to the absurdities of the system. The Trust’s current target is no MRSA cases, so this single case breaches the Trust’s target and it will remain red rated for the rest of 2013-14 in consequence!
These staff members liaise with other organisations such as social services or intermediate care to identify alternative places of care if acute admission is not needed. Their introduction has made a significant contribution to reducing admissions and readmissions.
Friends and Family test:
This Trust reports continued difficulty in achieving the required response rate of 15% for adult inpatients and particularly for patients discharged from A&E. The Trust is addressing these issues – as are other Trusts that we monitor.
Liverpool Care Pathway:
A comprehensive report on the use of this pathway, following work on this issue in February 2013, included evidence from a number of audits. This led to the Trust being satisfied that appropriate controls and safeguards are in place and it therefore agreed to support the continued use of the pathway within the Trust.
On 4th March 2013, Dr Catherine Lemon, Divisional Chair for Cancer Services, East & North Herts NHS Trust was guest speaker at the meeting of The Community Voice - of which we are a member. The notes below summarise her address.
Dr. Lemon has been in post at Mount Vernon since April 2012. She was pleased to report that the Mount Vernon Cancer Centre (MVCC) is thriving. It has 26 consultants and many new developments. Her talk was divided into sections – Radiotherapy / Chemotherapy / Patient Experience / Research / Plans for the Mount Vernon site / The new NHS.
- Radiotherapy: MVCC now has eight standard radiotherapy treatment machines, plus cyberknife.
- It has two new state-of-the-art True Beam Treatment Machines, which use new faster delivery techniques and rapid-arc treatment, with the machine moving around the patient. Treatment which used to take 15 minutes now takes 2 minutes – a big improvement for patients. The machines also offer future opportunities to compensate for movement due to breathing during treatment. As MVCC is one of the few centres with two machines, it is to be featured in a TV programme on 18th March.
- Seven of the treatment machines allow Intensity Modulated Radiotherapy (IMRT) which offers very focused treatment so that tumours receive high dosage of radiotherapy to improve rates of cure but normal tissues are spared, which reduces side effects.
- Image Guided Radiotherapy (IGRT) takes an image of the patient daily and compensates for small changes that arise between treatments on different days, such as the patient’s position or fullness of the bladder.
- The National Radiotherapy Innovation Fund distributed £15m to improve access to IMRT and IGRT. Of this, MVCC received £750,000 this will allow an additional machine to offer IGRT, plus software to help replan patients who may have lost weight during a course of radiotherapy or to compensate for movement during breathing for lung patients, and for planning from remote hospitals.
- Cyberknife treated 109 patients last year. MVCC is collecting evidence of its benefits for particular cancers such as prostate cancer. It is becoming the standard treatment for lung and brain patients.
- During replacement of aging machines MVCC extended its day from 8m to around 8pm. This proved very helpful for some patients and so this pattern of work has now become standard.
- A new storage system for scans is to be installed and MVCC hopes to get a new gamma camera which shows the position of radioactive substances in the patient, useful in iodine treatment and bone scans.
- Chemotherapy: This has seen major changes too. Marie Curie Ward, with 18 patients’ chairs, is now a day-care ward. Electronic prescribing has been introduced and the advice line has been expanded to include advice for all cancer patients and professionals 24 hours a day including weekends.
- Patient experience: There has been much effort to improve the experience of patients within MVCC. There have been various questionnaires and surveys. Patient Information Prescriptions (PIPS) have been introduced. HOPE (Helping Overcome Problems Effectively) has been set up to assist the carers of cancer patients. WiFi is used to help patients access online information. The Lynda Jackson Centre has led the way in providing information for patients and their families.
- Research: MVCC and Royal Marsden Hospital are academic partners. There is a strong emphasis on research and patients are entered into trials when these are available and appropriate.
- NHS changes have replaced cancer networks with Academic Health Science Networks. MVCC is on the edge of two such networks and so is a member of both East of England and Imperial (London).
- Plans for the Mount Vernon site: Joint working between the Hillingdon Hospital Trust and East and North Herts Trust led to formation of the Mount Vernon Programme Board. The vision for the site is being developed under the title “Project 2015”. This aims to improve the facilities on the Mount Vernon site especially the cancer wards and the cancer outpatients department. There is also planned building work to extend the Lynda Jackson Centre.
- The new NHS: Primary Care Trusts and Cancer Networks will be abolished on 1st April 2013, to be replaced by Clinical Commissioning Groups and Academic Health Science Networks. London has developed two Cancer groups. One is the London Cancer Alliance, of which MVCC is a full member, which includes the Royal Marsden Hospital, Charing Cross Hospital and Guys and St Thomas Hospitals – serving most Harrow and Hillingdon patients. The second is called London Cancer, of which MVCC is an Associate Member, which includes Barts Health, The Royal Free Hospital, University College Hospital and West Middlesex Hospital.
- The future holds many challenges including payment by results and national tariffs, for which all treatments will be coded. Clinical Commissioning Groups will commission and pay for many cancer treatments, but Specialist Commissioning Groups will be responsible for radiotherapy commissioning and payment. Strategic Networks will devise standard treatment pathways.
- The vision for MVCC: The aim is to be a state-of-the-art cancer centre, delivering best radiotherapy and chemotherapy, with high levels of patient satisfaction and key partnerships supporting continued development of MVCC within the Mount Vernon site.
Dr Lemon then answered wide ranging questions. She acknowledged that MVCC hopes to expand the lymphoedema services. She also noted that new commissioning patterns will help to address the problems of postcode lottery for cancer services.
Dr Lemon was thanked on behalf of the audience by James Kincaid, Vice Chairman of the Community Voice. This was followed by extensive applause as she left the hall.