RESPECT-21

Reorganising specialist cancer surgery for the 21st century: a mixed methods evaluation

Study overview

A research team, led by Professor Naomi Fulop (UCL Department of Applied Health Research), has been awarded £1.2 million by the National Institute for Health Research Health Services and Delivery Research Programme to study the centralisation of specialist cancer surgical services.

Focus: the study, which started in September 2015, focuses on centralisation of specialist surgical pathways for four cancers across two health care systems: London Cancer (a network of providers across North Central and North East London, and West Essex; population 3.2m) and Greater Manchester Cancer (covering Greater Manchester and East Cheshire; population 3.1m).

The team: The research team is formed of clinicians, patients, and academics from London and Greater Manchester (see study team).

Approach: the research (see study protocol) combines quantitative and qualitative methods to analyse how the centralisations were planned and implemented, and the impact of the changes on organisation and delivery of care, clinical outcomes, patient experience, and cost-effectiveness. The study also analyses patient, professional, and public preferences for changes of this kind (see our at a glance summary).

Contribution: in doing so, this evaluation addresses a number of important gaps in the evidence on centralising specialist cancer surgery, addressing key priorities highlighted in the Five Year Forward View. In addition, it builds on methods developed by the team in conducting high impact research on other forms of major system change.

Details

Funder: National Institute for Health Research Health Services and Delivery Research Programme (see NIHR project page)
Amount: £1,281,913
Duration: September 2015 – August 2019
Key Contacts: Angus Ramsay and Pei Li Ng (London), Catherine Perry (Manchester)

Study team

Chief Investigator: Professor Naomi Fulop (UCL)
Co-investigators: Professor Steve Morris, Professor Kathy Pritchard-Jones, Professor Ruth Boaden, Dr Angus Ramsay, Ms Rachael Hunter, Mr John Hines and Mr David Shackley
Patient collaborators: Veronica Brinton, Patrick Fahy and John Sandell
Clinical/organisational collaborators: Mr Ravi Barod, Professor Mark Emberton, James Leighton, Claire Levermore, Mr Satish Maddineni, Ms Caroline Moore, Professor Muntzer Mughal, Mr Dipankar Mukherjee, Mr David Shackley, Ms Maxine Tran and Mr Jonathan Vicker
Researchers: Dr Caroline Clarke, Dr Mariya Melnychuk, Dr Catherine Perry, Dr Cecilia Vindrola, Dr Victoria Wood and Dr Georgia Black

Publications (all free to download)

Full study report:

Fulop NJ et al. Centralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation. Health and Social Care Delivery Research 2023; 11(2).

Study protocol:

Fulop NJ et al. Reorganising specialist cancer surgery for the twenty-first century: a mixed methods evaluations (RESPECT-21). Implementation Science 2016; 11:155.

Research findings:

Clarke C S et al. Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis. Applied Health Economics and Health Policy 2022; 20
Black G B et al. Loss associated with subtractive health service change: The case of specialist cancer centralization in England. Journal of Health Services Research & Policy 2022; 27:4
Vindrola-Padros C et al. Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study. Journal of Health Services Research & Policy 2022; 27:3
Melnychuk M et al. Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals. BMC Cancer 2018; 18:226.
Vallejo-Torres L et al. Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. British Journal of Surgery 2018; 105:587.
Vindrola-Padros C et al. Implementing major system change in specialist cancer surgery: The role of provider networks. Journal of Health Services Research & Policy (2020); 0(0):1-8.
Clarke C et al. How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England. Applied Health Economics and Health Policy (2021), https://doi.org/10.1007/s40258-021-00660-6.

At a glance summary:

Newsletters

Further information

NIHR HS&DR project page

Key Contacts:

Angus Ramsay and Pei Li Ng (London)
Catherine Perry (Manchester)

News item:

Clarke, C. (2020). How to cost the implementation of major system change: case study using reconfigurations of specialist cancer surgery in part of London, UK. Health Services Research UK Conference 2020, 26 June 2020.
Wise J. (2015). Research team to look at the effect of major reorganisation of cancer surgery. BMJ 2015; 351:h3820

Remembering our colleague Neil Cameron

Sadly one of our patient collaborator colleagues, Mr Neil Cameron, died on 15 May 2017. Neil contributed a great deal to the study, from the development of the proposal, in particular providing essential feedback on our research questions in relation to patient experience, through to the work of the study to date. We will continue to acknowledge Neil’s contribution to our study in any outputs that we make.