Episode 122: Acute Oncology services in the future with Dr Caroline Wilson

Join us as we complete our discussion on all things Acute Oncology Services with the superb Dr Caroline Wilson PhD FRCP from the The Christie NHS Foundation Trust.

🎙️We look at what future directions AOS will move into and what the challenges may be.
🎙️What are the BIG 5 AOS presentations?
🎙️Caroline stakes a claim for the need to change how we view the role of who manages acute oncology toxicities.

Enjoy 

Transcript

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Hello, and we welcome back the excellent Dr. Caroline Wilson from the Christie Hospital in Greater Manchester for our second part in acute oncology, where it sits with our cancer patients, where we should be moving it and steps that we can all take, Mike.
 to kind of move acute oncology forwards. Caroline, welcome back.

 WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   55:39
 Thank you. Thank you for having me back.In our last episode we talked about why acute oncology services have been set up and what an ideal service would look like. Now lets look at some of the challenges involved.

 ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   29:17
 Mhm.
 Now Caroline, I'm going to ask some harder questions here because that the whole the whole service sounds really great. And I think, you know, ultimately what we want to do is the right thing for the patient. We often know as clinicians what the right thing for the patient is. It's not going through sitting in a corridor in ED for 16 hours where no one's making a decision, waiting for an oncology.
 you know, acute oncology opinion to come through at some point the next day. But all of this calls, all of this is going to cost money, isn't it? It's where is the money coming from? And so what would you say, particularly when thinking about the consultant, because a lot of the nursing workforce is there, it's the consultant workforce I think that is often lacking.
 What would your response be or how would you approach where you say, well, actually, we don't have enough consultants to even run the outpatient setting, let alone thinking about the inpatient setting. Why, how am we going to justify employing these consultants to do acute oncology and not our outpatient work?
 What would be your response to that question?
 Mmh.

 WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   30:39
 But actually, if you develop services without your emergency cancer care, you're just going to cause a load of inequity across your region and unacceptable quality of care, as in we're reversing things 15 years ago to NCPOD. So we've always had a problem in AO of proving how we save money or how we generate income.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   30:52
 Mhm.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   30:59
 There is loads of data now and we've again looked across Greater Manchester to show that we can save bed days at a regional level by having this acute oncology MDT. But bed days don't save money because someone else just fills the bed. So, you know, we can release capacity, we can create safety,
 We can create equity in terms of those emergency pathways, but it is very hard to ever prove that AO will save a trust money. What I would say in terms of how you can get around that argument of we can't staff our outpatients is actually
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   31:28
 Mm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   31:37
 Just let oncologists that want to do outpatient.
 predominant work, let them do it. Not everybody wants to do acute. Not everybody wants to do emergency. Don't make them. Why make them? You know, if you're a, if you're a geriatrician, you probably aren't an acute medic. You know, so, and we're the same in oncology. So actually what you need is a workforce that deals with your emergencies.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   31:51
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   32:03
 and your inpatients and a workforce that does your elective oncology.
 What we're looking at Christie at the moment as well is trying to make sure that our inpatients in the Christie Cancer Centre are looked after also by acute oncology. So that then reduces the need for a site specific oncologist to have to trudge up to the ward to do a ward round on a patient to try and support the junior doctors when actually they could be doing more of their elective work in clinic and actually just providing a
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   32:24
 Mhm.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   32:32
 kind of a virtual decision with the acute oncologist.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   32:33
 I'm hearing this. I'm loving this. John McCrane is literally trembling. Yeah, we can get this in because like, you know, you've got ward drying slots put in, but like you might only have one or two patients on the ward. So you go up, you see one or two people, you come back, then you can, oh, where was I was meant to be doing planning or prescribing chemo.
 And then it just, you know, whereas if somebody's there all the time doing efficiently going through at volume, it just makes such it makes such sense. Like rather than having dribs and drabs of consultants turning up on a ward, grabbing juniors, pulling them each in a different direction. But Caroline, do you think
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   33:02
 Yeah, and, and I think...
 Yeah.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   33:12
 there is an appetite within the registrar workforce for this kind of work. That's my question as well.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   33:19
 So I think there is, I mean, if I look at if I look at what's happened with us at the Christie recently, so as we're moving to this model of trying to get acute oncologists on our on our inpatient wards, we haven't had much resistance. So a lot of our new jobs have been 50% AO, 50% site specific and people, you know, we still get applicants. Now you could argue that maybe that's because it's the
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   33:21
 Mhm.
 Mhm.
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   33:44
 Christie Brandon, it might be harder for a smaller cancer unit to do that. But again, I come back to training. If we don't make acute oncology part of our registrar's training and make it look good and make them enjoy it and show them how great it is, then we're not going to get the acute oncology workforce of the future. I teach every year at the RCR management course at Royal College of Radiologist management course on acute oncology.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   33:44
 Okay.
 Mhm.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   34:09
 and I get them all to put their hand up and say, how many of you loved doing acute medicine as an SHO? And that there will be some that will never put their hand up because they hated it. Now they are your academic oncologists, off you go, be happy, that will be fine and have a very much, you know, an academic or an elective practise.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   34:19
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   34:27
 but don't delve into emergencies. But those that put their hands up and say they loved acute medicine, I then say to them, how many of you want AO in your jobs? And loads of them will put their hands down. And that's the problem, is you've got people who used to love working on the wards, love their acute medicine. I was one, I should have been an acute medic and would love to do acute oncology, but I don't think we're nurturing them and we're not showing them the possibility. They're just seeing acute
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   34:50
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   34:52
 to oncology as just, you know, on call or making decisions that get overturned by a site-specific oncologist when they come to the ward. And it's got to change. It's got to be about recognising it as an entity, as a sub-speciality and giving it the respect it deserves from all of the site-specific oncologists as well.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   34:54
 Yeah.
 I.
 And so, and I completely agree. Yes, I think it is the culture change there behind it and moving it away from all this, the drudgery of on call. What could you do? Because a lot of units won't have an AO consultant, they won't have it, it'll be very nurse led. It's kind of like the chicken and the egg. You need, you need one to make the other better.
 Is there a way in those nurse-led units that you could look at incorporating AO more into registrar training without that consultant oversight? How does that work without that first consultant being there? Do you see what I mean? I need, you need to like... Just to be clear, Mike, the egg came before the chicken. It's physically not possible for the reverse.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   35:44
 Yeah.
 Yeah.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   35:52
 Thank you, John. That's answered that. That's answered an age-old question. Oh my goodness.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   35:53
 So, I, I don't know.
 And I'm not sure here whether the consultant's the egg or the nurse is the egg, but anyway, so I think again, this is about, again, it's that shift, it's that analogue to digital shift that we're all talking about. I'm not at all advocating that we have acute oncology consultants in every acute trust. I think that's impossible with our current staffing issues. You know, we know, we see the RCR reports every year of the workforce shortage in oncology.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   36:02
 Bye.
 Yeah.
 Yeah.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   36:21
 So I'm going to really annoy you now by saying I think we do have to work smarter. I'm going to get that word in there.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   36:26
 Oh, yeah. It was going so well. I hate that phrase. I hate it, Caroline. No, John, you can work harder. Everyone else will work smarter. OK, fine. That's fine. It just assumes that you're being an idiot.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   36:28
 I.
 I'm sorry.
 So...
 No, no, no, so, so...
 So this is about, no, this is about using digital smarter. So I don't, I often, and I argued this when I was in South Yorkshire across that patch and saying, I don't see the point of an acute oncologist driving an hour from cancer centre to DGH to do a ward round to drive an hour back because that wastes 2 hours of my time.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   36:38
 Yeah.
 THE.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   36:58
 Whereas actually what you can do is if you have me in an MDT capacity and I'm mobile on an iPad, I can do by the bed consultations with patients and I can do more in that time than I can if I was spending 2 hours in a car. And that's very much where I think I would advise people to start thinking differently. Don't think that you've got to get
 a timetable of acute oncologists into your DGH to provide a five day service. You don't. You just need a few acute oncologists at your cancer centre who will digitally link in and are comfortable doing virtual consultations over an iPad with patients. And I've done that. I've consented to urgent sacked with patients sat in inpatient beds when I'm on an iPad. It's about
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   37:31
 THE.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   37:40
 stretching the workforce we have a little bit thinner and accepting that we don't physically have to be present to still give a good quality consultation. You know, for these consultations, the AO nurse is always physically by the bedside of the patient. So yes, if the patient gets upset and there's very difficult decisions, which there often are in acute oncology if patients aren't fit,
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   37:46
 Mhm.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   37:59
 whilst I'm delivering it with empathy over an iPad, there is someone sat by the side of the patient to support them. You know, I don't advocate entirely virtual where there's no one physical to support the patient. But it's worked really well and I think that's probably the model I would suggest to people to start thinking about first because you don't need an enormous workforce.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   38:03
 Mhm.
 And that, and that, you know, those doors were kicked in by COVID. You know, lots of things that we were told cannot happen happened overnight with COVID. I was carried into a room on a laptop whenever I had COVID. I carried on and like my head was floating in space.
 But, you know, the show goes on and you're absolutely right. Physically driving as hub and spoke, where you physically have to manifest from the hub down each of the spokes, doesn't make sense. Then you're a driver who does a little bit of advising, whereas actually in a virtual setting,
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   38:49
 Yeah.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   38:55
 It's the decision making, it's the access to your ability to make decisions that people want. That can be done, Teams, you know, iPad, you know, it can be done digitally in simple terms.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   39:06
 Yeah, yeah, yeah, exactly.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   39:09
 So you've, so we didn't mention this at the start, but you're very heavily involved with a multitude of societies related to acute oncology, including the Acute Oncology Society. Is there being generated some sort of magical workbook that we can take to our trust managers and executives and say, look, I know this doesn't save you money,
 but it's better for the patients and it probably does save money because they're not coming in. It saves said space. Is there is there a workbook that we can slap there first and then we could say we are a level 3 size hospital. So this is what would be recommended for a hospital of this size. And these are the benefits for your hospital.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   39:48
 Yeah, so hopefully it's on its way. So you will have read the CANCER plan and there was a very clear kind of notion in there.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   39:56
 I'm going to stop you there, Caroline. I read the summary. Because that's too long. You did well, John. I know. I read the summary. Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   39:59
 Okay, that's fine.
 So you read the page. So there was very much references in there to kind of acute and supportive oncology. And so what NHS England have asked various national members to do and UK AOS is at the table for that is to kind of define
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   40:13
 Yeah, mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   40:24
 What does it what is a good AO and support? What's in a good acute oncology and supportive oncology service? What does it require? What does it look like? What would a good patient journey look like with those with those services in place? So that's currently being written and will hopefully come out. We're not sure if it will be part of these cancer manuals that come out. You know, so each tumour site is being asked to write the cancer manuals to support the cancer plan or whether it will be sort of an addendum. We're not quite sure.
 So that's being written at the moment, but in the meantime, what the UK Acute Oncology Society has, and I would encourage it, you don't have to be a member to get on the website, you could, there's a big information hub. What's on there is we've done some cancer alliance spotlights, so people have got spotlights done, there's about 3 cancer alliances on there.
 telling you how they've done AO at a regional level. So it started kind of at the top and then there's various descriptions of services at a local level as well. So if you want it just per trust and then you can extrapolate, can't you, in terms of the size of your service compared to what's on there. So I would definitely recommend going on that as a repository for information.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   41:10
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   41:29
 and a repository for kind of service delivery. I think if you're going to make changes.
 I think it's really hard to do it at an individual trust level when it's cancer, because most of our services are hub and spoke, aren't they? There's going to be very few where it's just oncology and one acute hospital. So actually looking at some of the cancer alliance level work and kind of that regional perspective of how you make things better,
 may help some of those conversations. So, you know, if you have no acute oncologists in an entire region, then that needs conversation across multiple different trusts. And you might then find that there's a way to talk about service level agreements to get things funded where each is taking a little bit of the cost pressure. So I think probably think about it more at regional level.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   42:16
 Caroline, I want to tease into a little bit more this virtual aspect that we were talking about a moment ago that kind of leads into this like, you know, hub and spoke description.
 You're talking about getting people earlier, like not waiting till they're sat in a hospital bed. The CHRISTIE have had a kind of a virtual, like a digital traffic light system for people reporting issues, I believe. I've seen it presented.
 conference where people were like, but problems essentially, where like E-PROMs and where that then links in, is that the next step if we want to find these problems early in the community so that we can then step in? Of course, everyone will then turn around and say,
 We don't have the resource for that, but the people are coming anyway. It's about finding out the size of the problem so that you can then resource it.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   43:09
 Yes, yeah.
 Yeah, yeah.
 So the way Christie are currently using EPROMs is EPROMs go out and yes, patients get RAG rated and they get an automatic reply according to that, but it's linked to a clinic episode. So for example, when I do breast clinic, my EPROMs all go out 24 hours before so that the patients will know that I will read their EPROMs
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   43:28
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   43:36
 on the day of clinic when they're in that clinic slot. The patients get an auto reply. So if they upload an EPROMs 24 hours before my clinic and it says you are in major danger, it will say, you know, this is a, you put in something critical, you need to contact, you need a medical review urgently, that's either A&E or GP, etc.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   43:52
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   43:55
 So the EPROMs are at the moment working in that way. What we're trying to do and what we've already piloted is how do you do emergency EPROMs? So how do you take an acutely unwell patient and use EPROMs? And I think that fits into how HOSPITALS work. So at the moment, the only option people have if they're unwell
 and they're under a cancer pathway is to phone the cancer hotline. But actually you can use EPROMs to try and do some of this digitally. And again, you can very easily redirect some of these problems to a bit of self-management. So, you know, if a patient has nausea because they're not taking the metoclopramide, some of that can just be self-management and some of that can be automated a bit to reduce the volume of
 calls to hotlines. But I think you can then use the digital EPROMs to try and support those amber and red calls as well, so that patients can upload an EPROMs and they get a call back in a suitable time, whether they're an amber or a red. So I think you can use it that way. What you referenced as well was the permanently on.
 EPROMs. Now I do not know and don't believe in our current NHS we would have any ability at all to do it that way. So I've seen, there was really good data at ASCO this year from one of the American hospitals who had done that. They had turned on EPROMs and they needed an entire team of nurses
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   44:56
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   45:14
 to continually be monitoring these EPROMs that were coming in 24-7. I'm not sure we have that ability at the current time. I think what we can do is make the interaction when a patient knows they're unwell easier with the use of emergency EPROMs. I don't think we can monitor them continually because I don't think there's the staff there.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   45:19
 Mm.
 Yes, and I, and I, I'm going to put the word yes in. And I was going to say, and are you talking about something like an AI driven agent? Is that what you're talking about in terms of sort of people reporting things and triaging through sort of an agent agentic corner of things? Say, yes, this is something you can self-manage to have no, this needs to be escalated.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   45:52
 Yep.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   45:56
 Three problems is that what?
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   45:56
 Yeah, absolutely. Absolutely. So, you know, all of our cancer hotlines work on the UK Oncology Nursing Society triage tool, which is a RAG rated principle. There is no reason why if people are using emergency EPROMs that we couldn't have some kind of AI bot that would give them advice based on their green.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   46:02
 Mhm.
 Mhm.
 Mhm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   46:16
 solutions, but probably an amber or a red is going to need some form of nursing interaction and advice. So I think there are ways we can streamline. There are companies out there that provide third party providers of IT systems that actually already do some of this. So you can buy them off the shelf. But I think each cancer hotline is going to have to have a think about how they do that in house, whether they try and do that themselves or
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   46:20
 Human interaction. Yeah, yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   46:41
 Is something that does it for them.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   46:43
 And it's about keeping it going and keeping it funded. A lot of these things are pilot projects that then stop as soon as the pilot funding stops. Although there has been data like Ethan Bash at ASCO about seven years ago showed like a survival advantage equivalent to, you know, some of our targeted therapies.
 by early intervention with that. Now, if you were thinking about quality improvement projects or ways of changing an AOS service, what kind of things would you be saying to your AOS teams out there or across the UK, you know, to be doing to try and, I suppose, build that business case
 And improve their service.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   47:24
 The first thing I would say is get your data. You know, it's actually astonishing how little emergency cancer care data you can get your hands on and how fractured it is. You know, our SACS databases don't talk to our emergency care data sets. They don't talk to our SUS data sets. So you've got this
 problem where it's almost a bit invisible and you have to end up pulling from multiple different databases to get anything. So we've, Cheshire and Merseyside have managed to do it. We've managed to do it across Greater Manchester and Cheshire to try and get some sort of regional acute oncology dashboard so that you can see the size of the problem.
 There is absolutely no point trying to say to your medical SDECs, will you ambulate some of our cancer patients? And because they'll just look at you and say, well, why should we? And why aren't you? And it's because you're not describing the entire problem. You know, we can see already from national data that around 5% of A&E's workload is cancer.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   48:17
 Mm.
 Mm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   48:24
 So you leave with that and you say, I can help with potentially 5% of your workload. Very few people can say that to A&E because it's just so busy. But if you can take a proportion of that and make them ambulatory, so move them into an S-DEC, whether that's oncology run or medical S-DEC and protocolise it and support the decision making,
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   48:30
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   48:45
 That's an enormous win. So I think it's about getting hands on your data, but unfortunately, I'm afraid to say it's not, I can't give you a very easy go and look at this data set because it is all very disparate. I would talk to your BI teams at your cancer alliances about what they have already, because quite a few of them have been linking data sets already.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   48:55
 Yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   49:06
 And if you just ask them to switch it with the emergency lens, which is what the Greater Manchester and Cheshire Cancer Alliance did for me, all of a sudden we had a wealth of data. So it's about asking for that work to be done.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   49:17
 And you're saying 5% of like emergency department work is acute oncology. Do you have a figure for like, you know, that medical take or acute medical unit? Like what percentage of that? Because I'm sure that gets distilled a bit.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   49:29
 Yeah, so it's...
 It does. So your acute medical take about 7.5% is cancer related.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   49:38
 Which is interesting because I'm sure a lot of A&E consultants and AMU consultants will have done no oncology. They'll all have done cardiology and respiratory and general medicine, but they will have done 0 oncology.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   49:52
 Yeah, what's really enthusiastic, what's enthused me is the acute medicine nursing training competency portfolio has just been rewritten and it's been written with the support of UK Acute Oncology Society. So our acute medic nurses are going to have some core competencies that link to our acute oncology passport
 competencies, which are the national framework for how you train in acute oncology. What's also happened is the registrars that are doing the acute medicine training can do a speciality module in oncology. And again, it comes back if you've not got the AO workforce to infuse your registrars, be it oncology registrars or acute medic registrars in your region to come and do acute oncology.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   50:26
 Mm.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   50:37
 with you. You're not going to create the workforce of the future. And I think the workforce of the future for oncology isn't just going to be acute oncologists. It might be acute medics who've done acute oncology and who really, you know, have embraced it and enjoy it. But you've got to have, this is chicken and egg, isn't it? You've got to have the teachers and the mentors.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   50:48
 Mhm.
 We've covered it, egg comes first, and that makes the chicken. See?
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   51:00
 Okay.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   51:06
 Caroline, this has been amazing. I would say acute oncology is probably something I might be an elective oncologist. So yeah, I treat prostate cancer and that's my thing. And you I tend to bring a lot of acute oncology into my clinic. So if I hear somebody sick, I'll bring them in and we'll try and do that. But
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   51:15
 Yeah, but that's fine. That's fine.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   51:25
 I suppose from who you're describing, I'm probably an elective oncologist. But if you were to give us three takeaway points for acute oncology, and you could just in whatever form you like, what would they be?
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   51:40
 Yeah, so I think knowing the current landscape, my 3 takeaways are try and align your acute oncology services with what the NHS and the cancer plan is doing. So have your analogue to digital hat on and think about how you can have an efficient workforce and have your hospital to community. It's not going to be good enough any longer just to see acute oncology's inpatient beds.
 So that's my first one is align it to what's out there already because these changes are coming and oncology need to get on board. We might not like it. We might be frightened of it because we've never done it, but we're going to have to do it. So start thinking about it. My second point is start thinking about when I talked about what acute oncology conditions can be led by acute medics and supported by oncologists or what really should be led by acute oncologists and supported by medics.
 And I think it's quite, it's becoming easier to strip those out. You know, some of your common stuff like Febronia neutropenia, cord compressions, a lot of that can be medic-led supported by oncology, whereas your ADC toxicities, your IO complex toxicities is probably the way around. And my final point is, please stop putting cancer patients in inpatient beds.
 we lose their fitness, we lose their ability to be fit enough for any more treatment. The key has got to be ambulating these patients, keeping them at home as much as we can. So start thinking about how you link into what's out there in the community. How would we do this? How would we prevent admission rather than the default for waiting to admission and trying to rush them out of hospital?
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   53:12
 Mhm.
 Brilliant. Fantastic. And is there, are there any acute, I'm going to really show myself up here. And are there any acute oncology conferences or meetings that people can attend?
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   53:13
 Those are my three points.
 Yeah, absolutely. So the UK Acute Oncology Society has a national conference every year. It's in May next year again, just go to the website and you can see that. Society of Acute Medicine have really helpful podcasts that I often listen to keep myself up to date. ImmunoBuddies have their podcasts. So there's lots and lots of CPD.
 that an acute oncologist can do. Obviously your lovely podcast, so educationally, obviously.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   53:45
 Obviously. Literally holding my breath there. Oh.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   53:51
 So all of these, all of these aspects are giving us knowledge and competency. So when it comes to your appraisal, you can prove that you genuinely are an acute oncologist. And so there is so much out there that we can do. But yeah, I would encourage anyone who's interested in acute oncology
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   53:54
 Yeah.
 If.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   54:08
 to link into the Acute Oncology Society. Like I said, it's free and there's a national conference and the wealth of information on there is really helpful for anyone trying to set up services or improve them.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   54:20
 Brilliant. Caroline, thank you so much for your time. So enthusing. I think, you know, AOS is the future. It's been forgotten, I think, amidst all the things that have changed. It's not been forgotten by Caroline. But no, well, no. But I think I think I think that flag very much needs to be flown. And I think, you know, from a patient journey point of view, it's the right thing for them.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   54:31
 No, but there's a few of us.
 Yeah.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   54:39
 We can't just focus on outpatient care. Emergency care is key. And actually that's when patients often feel they need help the most, yeah, because they're at their sickest. Yeah, yeah.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   54:46
 Yeah. And get TPDs, don't forget. So infuse the trainees because we won't have the workforce if we don't infuse our trainees.
ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST)   54:54
 A bit of a moot point me inspiring trainees, but anyway, Caroline, thank you so much.
WILSON, Caroline (THE CHRISTIE NHS FOUNDATION TRUST)   55:01
 No problems. Take care, both of you. Bye.

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