Peninsula Cancer Network (North, East & West Devon, South Devon & Torbay, Cornwall, Taunton & Somerset) Network Site Specific Group for Head and Neck
Constitution
Approval Date:
Review Date:
1Peninsula Cancer Network Head & Neck Constitution 2015 VERSION CONTROL THIS IS A CONTROLLED DOCUMENT - PLEASE ARCHIVE ALL PREVIOUS VERSIONS ON RECEIPT OF THE CURRENT VERSION.
Please check the website for the latest version available: www.swscn.org.uk
VERSION DATE ISSUED SUMMARY OF CHANGE OWNER 0.1 v2 June 2015 2nd draft PCN Head & Neck SSG 0.1 v3 October 2015 Outcome of NSSG Mtng PCN Head & Neck SSG
Agreement cover sheet This constitution of the Peninsula Cancer Network Head and Neck Group has been prepared by:
Andrew McLennan – Chair of the Peninsula Cancer Network Head & Neck SSG, Consultant Oral & Maxillofacial Surgeon, Royal Devon & Exeter Hospital NHS Foundation Trust.
Liz Boylan – Peninsula Cancer Network SSG Manager
This constitution has been agreed by:
Na Position Organisation Date m agreed Andrew Husbande Consultant Oral & Maxillofacial Surgeon Royal Devon & Exeter NHS Foundation Trust David Courtney Consultant Maxillofacial Surgeon Plymouth Hospitals NHS Trust Steven Adcock Consultant Surgeon Royal Cornwall Hospitals NHS Trust David Cunliffe Oral & Maxillofacial Surgeon South Devon NHS Foundation Trust Petra Jankowska Consultant Medical Oncologist Taunton & Somerset NHS Foundation Trust
2Peninsula Cancer Network Head & Neck Constitution 2015 Contents
3Peninsula Cancer Network Head & Neck Constitution 2015 1. Statement of Purpose
The Peninsula Cancer Network exists to secure equal access to high quality care for all cancer patients; strive for better clinical outcomes and improve the experience of patients, their carers and families throughout screening, diagnosis, treatment, aftercare and survival.
The Network has an increasing role in the prevention of cancer and reducing health inequalities. To achieve these goals it collaborates with all healthcare providers, commissioners, patients and their carers throughout Devon, Somerset, Cornwall and the Isles of Scilly.
The Peninsula Cancer Network serves a population of approximately 2.2 million people and is comprised of the following organisations:
Clinical Commissioning Groups Northern, Eastern & Western Devon CCG South Devon & Torbay CCG NHS Kernow CCG Somerset CCG
Acute Hospitals Northern Devon Healthcare NHS Trust Plymouth Hospitals NHS Trust Royal Cornwall Hospitals NHS Trust Royal Devon & Exeter NHS Foundation Trust South Devon Healthcare NHS Foundation Trust Taunton and Somerset NHS Foundation Trust Yeovil District Hospital NHS Trust
Hospices Hospiscare, Exeter Mount Edgcumbe Hospice, Cornwall North Devon Hospice Rowcroft Hospice, Torquay St Julia’s Hospice, Cornwall St Luke’s Hospice, Plymouth St Margaret’s Hospice, Yeovil
The following document outlines the constitution, roles and responsibilities of the Group.
2. Terms of Reference for the Group 14-1C-101i
In response to the publication of the Manual for Cancer Services (2004) a number of clinical sub-groups were established to address services for specific types of cancer.
4Peninsula Cancer Network Head & Neck Constitution 2015 Network Site Specific Groups have collective responsibility for the coordination and consistency across the Network for cancer policy, practice guidelines, audit, research and service improvement for each type of cancer.
Network site specific groups are multidisciplinary with representation from professionals across the patient care pathway as well as involvement and representation from patient and their carers.
3. Structure and Function
3.1 Role and Function of the Group
Network Site Specific Groups have been established to: Act as the Network Executive Board’s primary source of tumour site specific clinical opinion for the network; Advise and consult on service planning to ensure services are in line with national guidance in order to promote high quality care and reduce inequalities in service delivery; Ensure Network decisions become integrated into local practice; Monitor progress on meeting National Cancer Standards and ensure action plans agreed following Peer Review are implemented; Promote links between teams and other relevant Network Groups.
The key objectives of Network Site Specific Groups will be to:
Establish common referral and clinical guidelines for the Network; Agree a tumour site specific minimum data set and support consistent data collection across the Network; Engage in service improvement by using appropriate redesign tools and techniques via process mapping, capacity and demand measurement and redesign; Agree and support an annual audit programme both at regional and local level; Agree a common approach to research & development working with the Network Research Team, participating in nationally recognised studies whenever possible; Consult with cross-cutting groups on issues involving chemotherapy, cancer imaging, histopathology, laboratory investigation and specialist palliative care; Identify emerging new cancer drug treatments and technologies which require appraisal by commissioners through the Peninsula Health Technology Appraisal process; Support the development of education and training programmes for teams; Support effective patient and carer involvement in service planning and delivery; Produce an annual work plan.
3.2 Network Configuration of MDTs 14-1C-101i
The Head and Neck Group is the Upper Airway Tract cancer group for the Network. The Network has a separate Thyroid cancer group. For information regarding Thyroid Cancer Care in the Peninsula please go to the Thyroid NSSG page on CQUINS on: http://www.swscn.org.uk/networks/cancer/site-specific- groups/
5Peninsula Cancer Network Head & Neck Constitution 2015 Currently head and neck cancers from North Devon are sent for surgery to the Royal Devon and Exeter Hospital, and major head and neck cases from South Devon are operated on by Torbay surgeons at the Royal Devon and Exeter Hospital. Patients from Taunton are generally operated on in Exeter although some agreed surgery is undertaken in Taunton, in particular where this avoids cancer wait time breaches. Skull base patients are referred to either Plymouth or outside of the Peninsula Cancer Network. At the moment some patients from Cornwall are operated on in Plymouth Derriford Hospital. Derriford Hospital surgeons operate on and fully treat all patients from the Plymouth health care community.
The National Cancer Action Team has agreed to two centres for Devon and Cornwall.
The team in the East has agreed referral criteria for those cases which travel to the RD&E for their surgery. Torbay patients have been treated at Exeter since April 2008, in accordance with the implementation plan agreed in 2007. Taunton patients requiring microvascular surgery and major reconstruction have also been operated on jointly by the Exeter and Taunton surgeons since 2004.
In the West there is agreement regarding transfer of cases between Derriford and Cornwall with microvascular surgery and skull base surgery being carried out in Derriford and Photodynamic Therapy carried out in Cornwall.
Diagnosis and Assessment MDT MDT dealing with any of the following: Salivary Gland, Skull base,Thyroid,Thyroid and Endocrine (state which) Northern Devon Healthcare NHS Trust (no MDT All patients are discussed at RD&E MDT via video at NDDH - pathway of care agreed with RD & E) Conferencing. Deals with all Plymouth Hospitals NHS Trust Weekly MDT which deals with all
Royal Cornwall Hospitals NHS Trust Weekly MDT patients for major surgery discussed with PHNT Royal Devon & Exeter NHS Foundation Trust Weekly MDT to discuss RD&E, North Devon and South Devon patients via video link. Deals with all South Devon Healthcare NHS Foundation Trust All patients are discussed at RD&E MDT via video conferencing Taunton and Somerset NHS Foundation Trust All patients discussed at weekly Peninsula MDT, via video link
3.3 Named Designated Hospitals for Head and Neck Cancer 14-1C-102i, 14-1C-103i
The diagnosis and assessment of patients with head, neck and thyroid symptoms takes place only within designated hospitals fulfilling the following criteria: They have the specialist facilities for investigation of head and neck patients; They have contracted direct patient care sessions with at least two designated clinicians for head and neck diagnosis and assessment; They are the only hospitals for which there are contact points specified in the primary care referral guidelines for head and neck cancer; Most thyroid cancers are treated within local hospitals however more complex cases are discussed at network level where clinical complexity requires other specialty services such as cardiovascular or neuro-spinal.
3.4 Local Support Teams 6Peninsula Cancer Network Head & Neck Constitution 2015 The local support teams for the Peninsula Cancer Network are the Acute Trust MDTs for Head and Neck Cancer including Thyroid.
Distribution and Role of Local Support Teams 14-1C-103i
Diagnosis Neck Lump Clinic Curative Surgical Locality Referring CCG and Centre Population Assessment NortMheDrnT Devon Neck lumps go to RD&E, Royal Devon 164,997 NHS NEW Devon Healthcare NHS Head and Neck Clinic at & Exeter NHS CCG Trust North Devon with Foundation Northern Locality No Head Consultant from RD&E. Trust Eastern Locality and Neck Separate Thyroid Clinic Ward Plymouth Hospitals Yes with separate Plymouth 349,481 NHS NEW Devon NHS Trust Thyroid Clinic Hospitals NHS CCG H&N Ward: Trust Western Locality Lyhner Royal Cornwall Yes, joint Head & Neck and Royal 534,503 NHS Kernow Hospitals NHS Thyroid Clinic Cornwall CCG Trust Hospitals NHS H& N Neck Ward Trust Royal Devon & Separate Head and Neck Royal Devon 383,040 NHS NEW Devon Exeter NHS Clinic including neck & Exeter NHS CCG Foundation Trust lumps. Foundation Eastern Locality H&N Neck Separate Thyroid Clinic Trust Ward: Otter South Devon Head & Neck, neck lump and South Devon 286,000 NHS South Devon Healthcare NHS Thyroid Clinics Healthcare NHS & Torbay CCG Foundation Trust Foundation H&N Ward: Trust Forrest Taunton and Weekly H&N and neck lump Royal Devon 544,000 NHS Somerset Somerset Clinics & Exeter NHS CCG NHS Foundation Foundation Trust Trust Head and Neck Ward: Blake 2,262,021 Total
The NSSG agree that the local support team is the Acute Trust MDT who alongside the CNS also manage the aftercare and Rehabilitation of head and neck cancer patients by: Working according to protocols agreed by the MDT’s regarding which parts of the care pathway are delivered in locality settings M anage the aftercare and rehabilitation of head and neck cancer patients within the relevant locality Work closely with other teams who may have contact with Head and Neck patients on their cancer journey T ake responsibility for co-ordinating the provision from relevant local services for each individual. 7Peninsula Cancer Network Head & Neck Constitution 2015 Responsibilities
The Acute Trust MDT Provider should provide a written rehabilitation plan that is agreed prior to discharge. This must include ensuring patients and carers are aware of how to manage their on-going care, including communication and feeding, information about oral rehabilitation/ restorative dentistry services and altered airway management. As required, there should be links with the patient’s local Primary and Secondary Care Teams to ensure the patient has adequate local care provided once discharged. The Acute Trust MDT Provider should detail how they have integrated the Local Support Team with the relevant membership, as outlined in the IOG and detailed below.
Local Support Team Members may include:
C linical Nurse Specialist (CNS) Speech and Language Therapist (SLT) Dietician Senior Nurse with relevant experience (as outlined in IOG) Dental Hygienist Psychology/ Psychological Support Local patients providing ‘buddy’ support Physiotherapist Occupational Therapist Social Worker
The Acute Trust MDT Provider should outline how patients across the network will be able to access the Local Support Team members and the services they provide; this could be expanded to include services which provide support with smoking cessation and alcohol dependency. It must be clear how this team will operate across the network geography, with teams in different Trusts and at different locations offering their guidance and advice based on their specialist skills and experience of working with Head and Neck Cancer patients. This Acute Trust MDT should provide on-going support and act as a link on behalf of patients between the MDT, Primary Care and other support services.
Support must be available for patients for as long as required, whilst demonstrating that this contact has a benefit to the patient. The Provider should make clear how this work will be evaluated to ensure it meeting both needs of patients and deemed clinically effective.
3.5 Network Group Membership 14-1C-104i
Membership of the Group will be multi-disciplinary in nature with representation from professionals across the care pathway. All core and extended members of the relevant Acute Trust MDT(s) are invited to participate in group activities via group meetings, working parties and email communications as appropriate.
The Chair of the Group will be elected from within the membership of the Group. The term of office will be for three years.
8Peninsula Cancer Network Head & Neck Constitution 2015 The Group will work towards developing patient and carer involvement in to the Group. Patient and carer representatives will be appointed whenever possible.
A cancer research sub specialty lead will be identified from within the membership of the group and assume responsibility for recruitment to trials.
Patient engagement within the Network Site Specific Groups is a requirement of the Peer Review process. It is recommended that at least two user representatives sit on each group, however if this is not possible then it is necessary to ensure that there is an agreed mechanism by which user representative advice can be shared. Within the Peninsula Cancer Network this role is undertaken by the Patient Champion who is usually a Clinical Nurse Specialist within the group. This person will have specific responsibility for patient issues and providing information to assist in the integration of patient issues into the work of the group.
Named Membership of the Group
Group Members Group Chairperson Andrew McLennan Consultant Oral & Maxillo-Facial Surgeon RD&E/NDHT
Group Service Improvement Lead Julie Hewett Clinical Nurse Specialist SDHT Group Trial Recruitment Clinical Lead David Hwang Consultant Oncologist NDHT/RD&E Patient Champion & Information Lead Joanne Greedy Clinical Nurse Specialist TST Joanna Dauncy Clinical Nurse Specialist TST Patient and Carer Representatives
North Devon Healthcare NHS Trust
Andrew Husband Lead Clinician RD&E/NDHT Charlotte Overney Lead Nurse for Cancer Services Claire Barber Clinical Nurse Specialist RD&E/NDHT Claire Hakin Speech & Language Therapist David Hwang Consultant Oncologist RD&E/NDHT Emily Cruwys Advanced Specialist Dietician Taunton and Somerset NHS Foundation Trust - Blake Ward Graham Merrick Consultant Oral & Maxillofacial Surgeon Andrew Baker Consultant Maxillofacial Surgeon Andrew Drysdale Consultant ENT Surgeon Ed Chisholm Consultant ENT Surgeon Matthew Jerreat Consultant Restorative Dentist Joanne Greedy Specialist Cancer Nurse Joanna Dauncey Senior Cancer Staff Nurse Petra Jankowska Consultant Medical Oncologist Karen Dockings Speech & Language Therapist Lynsey Clode Macmillan Dietitian John Hunter Consultant Radiologist Gervaise Khan-Davis Directorate Manager
9Peninsula Cancer Network Head & Neck Constitution 2015 Royal Devon & Exeter NHS Foundation Trust - Otter Ward Andrew Husband Lead Clinician RD&E/NDHT Andrew McLennan Consultant Oral & Maxillofacial Surgeon Andrew Brightwell Consultant Otolaryngologist John Bowden Consultant Richard Garth Consultant Surgeon Katerina Anesti Consultant Plastic Surgeon Chris Wallace Consultant Plastic Surgeon Jim Gilbert Consultant in Palliative Care Rebecca Baines Consultant in Palliative Care Tina Grose Lead Cancer Nurse Claire Barber Clinical Nurse Specialist RD&E/NDHT Zoe Copp Clinical Nurse Specialist Head & Neck Susan Downer Cancer Nurse Specialist Lorraine Beddard TYA Clinical Liaison Nurse Dawn Edwards Research Nurse Joy Higgs Staff Nurse Andrew Goodman Consultant Oncologist David Hwang Consultant Oncologist RD&E/NDHT Chris Hamilton Consultant Oncologist Guy Mizon Clinical Psychologist Paul Farrand Clinical Psychologist Nicola Harding Head of Speech & Language Therapy Stefania Antonucci Speech & Language Therapist Claire Higgins Speech & Language Therapist Marianna Bos-Clark Speech & Language Therapist Marie-Claire Oliver Dietitian Ros Wade Head of Physiotherapy Simon Harries Consultant Radiologist Richard Thomas Consultant Radiologist Patrick Rogers Consultant Radiologist Sally Bell Senior Radiographer Alan Betts Radiographer South Devon NHS Foundation Trust - Forrest Ward David Cunliffe Oral & Maxillofacial Surgeon Daphne Carpenter Macmilllan Speech Therapist Ruth Carr Clinical Oncology Consultant Catherine Drysdale Consultant – Restorative Dentist Julie Hewett Clinical Nurse Specialist Deborah Howland Dietitian Fahida Rehman-Manby Clinical Nurse Specialist – Head & Neck Richard Perriss Consultant Philip Reece Consultant Simon Hickey Clinical Director / ENT Surgeon Jayne Newell MTO Plymouth Hospitals NHS Trust Wing Commander Andrew Hope Consultant ENT Surgeon Tass Malik Consultant ENT Surgeon David Courtney Consultant Maxillofacial Surgeon Paul McArdle Consultant Maxillofacial Surgeon Steph Murgatroyd Clinical Nurse Specialist Julia Pockett Speech & Language Therapist Sue Ramsay Macmillan H&N Oncology Specialist Dietician
10Peninsula Cancer Network Head & Neck Constitution 2015 Geoff Cogill Consultant Oncologist Amy Roy Consultant Oncologist Tim Bracey Consultant Histopathologist Abdul Gafoor Consultant Radiologist Rob Lavis Consultant Radiologist Royal Cornwall Hospitals NHS Trust Stephen Adcock Consultant Surgeon (MDT Lead) Phil Flanagan Consultant ENT Surgeon Zarina Shaikh Consultant Thaung Naing Specialty Doctor Evette Grobbelaar Surgeon Venkat Reddy Surgeon Adam Wilde Consultant ENT surgeon to be added Rashid Mamun Specialty Registrar Kel Anyanwu Staff Grade Surgeon Jacqui Williams Clinical Nurse Specialist Karen Yelland Clinical Nurse Specialist Vanessa Hitchman Nurse Matthew Collinson Oncologist Rob Jenkins Histopathologist Hugh Jones Histopathologist Philip Cook Radiologist Nick Hollings Radiologist Benjamin Rock Radiologist Thomas Sulkin Radiologist Sumaira Ilyas Radiology Registrar Sharleen Olley Senior Paediatric Hearing Screener Emma Mitchell Specialist Speech and Language Therapist Susan Ogilvie Specialist Oncology Dietician Jane Mitchell Speech & Language Therapist
3.6 Network Group Meetings 14-1C-105i
Meetings will be held at least twice per annum. The group agrees to operate under the Terms of Reference (Appendix 1). All members will be informed of meeting dates and location and be included in distribution of the Agenda and Minutes. Minutes, actions and notes of the group meetings will be circulated to all members, trust management teams and other interested parties. They will also be published on the SWSCN website: http://www.swscn.org.uk/networks/cancer/site-specific- groups/peninsula-site-specific-groups/head-neck-ssg
Records of attendance will be maintained and shared with the Cancer Unit Managers in order to inform them of their trust’s representation at network level. Liz Boylan, Peninsular Cancer Network Manager, and the Network Administrative Assistant will provide managerial and administrative support at group meetings.
3.7 Work Programme and Annual Report 14-1C-106i
The group will produce an Annual Report and Work Programme for Peer Review purposes
3.8 Named Surgeons Authorised to Perform Lymph Node Resections 14-1C-107i
11Peninsula Cancer Network Head & Neck Constitution 2015 All Thyroid surgeons within the Network are able to perform level six (central compartment) neck dissections. Nominated surgeons from each trust will assist in lateral neck dissections.
Named surgeons in the network authorised to perform lymph node resections on thyroid cancer patients.
Hospital Named Surgeon Lateral Central Compartment Compartment Plymouth Hospitals Mr Peter Cant Yes Yes NHS Trust Mr Tass Malik Yes Yes Royal Devon & Exeter Miss Julie Dunn No Yes NHS Foundation Trust Mr Richard Garth Yes Yes Mr Douglas Ferguson No Yes Royal Cornwall Ms Evette Grobbelaar Yes Yes Hospitals NHS Trust Mr Adam Wilde Yes Yes South Devon Mr David Cunliffe Yes Yes Healthcare NHS Mr Simon Hickey Yes Yes Foundation Trust Taunton and Somerset Mr Edward Chisholm Yes Yes NHS Foundation Trust Mr Sarwat Sadek
4. Coordination of Care/Patient Pathway
4.1 Clinical Guidelines – UAT Cancer 14-1C-108i
The Head and Neck NSSG has agreed to continue to follow the Head and Neck Cancer Multidisciplinary Management Guidelines (ENT UK, 2011) clinical guidelines which include guidelines for skull base imaging. They have also agreed to adopt RCR recommendations for cross-sectional imaging in cancer management (2006). The Head and Neck Specialist Nurses have agreed to follow the SIGN guidelines with regard to the nursing elements of the patient pathways.
Click link to Royal College of Radiologists guidelines ht t p : / / w w w . r c r . a c .u k /d o c s /o n c o lo g y /p d f/ C ros s _ S e c tio n al _ Im a ging _ 1 2 .p d f
Click below for link to ENTUK guidelines
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Click below for link to SIGN guidelines
ht t p : / / w w w . s ig n .a c .u k / p d f/ s ig n 9 0 .p d f
4.2 Clinical Guidelines – Thyroid Cancer 14-1C-109i The group has agreed to follow the Head and Neck Cancer Multidisciplinary Management Guidelines 2011 (ENTUK) which include imaging guidelines and the British Thyroid Association Guidelines 2007. They have also agreed to adopt RCR recommendations for cross-sectional imaging in cancer management 2006.
4.3 Chemotherapy Treatment Algorithms 14-1C-110i
12Peninsula Cancer Network Head & Neck Constitution 2015 The NSSG, in consultation with the Network Chemotherapy Group (NCG) have agreed a list of acceptable chemotherapy treatment algorithms which will be updated bi-annually.
C lick h e re for C h e mot h era p y T reatme n t A lg o r i thms
4.4 Patient Pathways – UAT Cancer 14-1C-111i
TBA
4.5 Network Referral Proforma 14-1C-113i
Primary Care practitioners will refer all patients defined by the “urgent, suspicious of cancer” guidelines for Head and Neck cancer to the contact point of a single local Head and Neck team. Referring clinicians should ensure that all relevant information is provided to facilitate the continuity of care and avoid unnecessary delays.
There are two separate Referral Proformas relating to Head and Neck and Thyroid. Referrals can be made directly by dentists or via the general practitioner. Referral proformas are available on the PCN website. Click link for access to documents. http://www.swscn.org.uk/networks/cancer/site-specific-groups/
The Peninsula Tertiary Referral Form (TRF01) should be used when referring patients to another Acute Trust for specialist investigation or treatment and sent within one working day of the referral being made. C lick h e re for T R 01 fo r m
5. Patient Experience 14-1C-114i TBA
6. Clinical Outcomes/Indicators 6.1 Clinical Outcomes Indicators and Audits TBA
6.2 Discussion of Clinical Trials 14-1C-116i TBA
6.3 Network Guidelines
Patients with synchronous cancers at Head and Neck and other site
Such patients will be discussed in the Head and Neck MDT. Lead responsibility will be shared with the other site-specific MDT until it becomes clear which MDT would be best to lead in each individual case.
Distribution Process for Internal Referral Guidelines
Named Clinicians are as per the MDT list above.
The internal referral guidelines, once localised will be distributed to the Cancer Managers within each hospital for distribution to the following clinicians: Designated consultant clinicians
13Peninsula Cancer Network Head & Neck Constitution 2015 Non-designated consultant clinicians (ENT surgeons, endocrine surgeons, OMF surgeons, oral medicine specialists) Endocrinologists.
The distribution process may be via the following routes: Email Hard copy Trust intranet.
The guidelines will also be distributed to the following: Head & Neck NSSG members Head and Neck/ Thyroid MDT members
Pathology guidelines
The Group has adopted the guidelines of the Peninsula Cancer Network Pathology Group; both are available on the Head and Neck page of the PCN website.
Pathology Network Reporting Guidelines and Pathology Network External Referral Policy Click link below for Head and Neck pathology policy and external referral guidelines
ht t p : / / w w w . p e n in s ula c a n c e rne t w ork. o rg.u k /p r ofes s io n a l/s s g s / H e a d / P a g e s /d e fa u l t. a s p x
Network guidelines will be reviewed at least every three years or on the publication of new guidance.
It is the responsibility of the Chair of the Group to ensure that all Network guidelines are up to date and reflect current practice.
7. Data Collection
Network-wide Minimum Data Set
All Trusts have previously confirmed their compliance with data collection requirements for cancer waiting times and the Cancer Registry.
Together these constitute the MDS for the Head and Neck Group
Network Policy for Collection of MDS
Responsibility for Data The Acute Trust first seeing a patient for a particular month or quarter is responsible for ensuring that the mandated data fields are complete on the database by the national deadline.
The Acute Trust first treating or giving subsequent treatment to a patient in a particular month or quarter is responsible for ensuring that the mandated data fields regarding that patient are complete on the database by the national deadline.
The multidisciplinary team responsible for the care of the patient should ensure that information is made available to allow it to be recorded prospectively and electronically.
Cancer Services teams in each Acute Trust should ensure that the information is transferred within the timescales specified and should establish robust lines of communication with their colleagues in other Acute Trusts.
14Peninsula Cancer Network Head & Neck Constitution 2015 Go to link below for MDS
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15Peninsula Cancer Network Head & Neck Constitution 2015