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77-513: The Clatterbridge Cancer Centre is an NHS Foundation Trust , which specialises in the treatment of cancer . The centre is one of several specialist hospitals located within Merseyside ; alongside Liverpool Heart and Chest Hospital , Alder Hey Children's Hospital , Liverpool Women's Hospital , and the Walton Centre . Currently headquartered at Clatterbridge Health Park , Bebington , Wirral ,

154-511: A blade. Like other forms of radiation therapy (also called radiotherapy), it is usually used to treat cancer . Radiosurgery was originally defined by the Swedish neurosurgeon Lars Leksell as "a single high dose fraction of radiation, stereotactically directed to an intracranial region of interest". In stereotactic radiosurgery ( SRS ), the word " stereotactic " refers to a three-dimensional coordinate system that enables accurate correlation of

231-402: A cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. The Health and Social Care Act 2012 abolished

308-549: A dedicated radiosurgery Linac is the CyberKnife , a compact Linac mounted onto a robotic arm that moves around the patient and irradiates the tumor from a large set of fixed positions, thereby mimicking the Gamma Knife concept. The fundamental principle of radiosurgery is that of selective ionization of tissue, by means of high-energy beams of radiation. Ionization is the production of ions and free radicals which are damaging to

385-512: A distinct neurosurgical discipline that utilizes externally generated ionizing radiation to inactivate or eradicate defined targets, typically in the head or spine, without the need for a surgical incision. Irrespective of the similarities between the concepts of stereotactic radiosurgery and fractionated radiotherapy the mechanism to achieve treatment is subtly different, although both treatment modalities are reported to have identical outcomes for certain indications. Stereotactic radiosurgery has

462-457: A greater emphasis on delivering precise, high doses to small areas, to destroy target tissue while preserving adjacent normal tissue. The same principle is followed in conventional radiotherapy although lower dose rates spread over larger areas are more likely to be used (for example as in VMAT treatments). Fractionated radiotherapy relies more heavily on the different radiosensitivity of the target and

539-637: A hemispheric array in a heavily shielded assembly. The device aims gamma radiation through a target point in the patient's brain. The patient wears a specialized helmet that is surgically fixed to the skull, so that the brain tumor remains stationary at the target point of the gamma rays. An ablative dose of radiation is thereby sent through the tumor in one treatment session, while surrounding brain tissues are relatively spared. Gamma Knife therapy, like all radiosurgery, uses doses of radiation to kill cancer cells and shrink tumors, delivered precisely to avoid damaging healthy brain tissue. Gamma Knife radiosurgery

616-408: A lethal cumulative dose of radiation there, while limiting the dose to the adjacent healthy tissue. Ten years later significant progress had been made, due in considerable measure to the contribution of the physicists Kurt Liden and Börje Larsson. At this time, stereotactic proton beams had replaced the x-rays. The heavy particle beam presented as an excellent replacement for the surgical knife, but

693-487: A link between the community and the board of directors. The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation. These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers. Some trusts are more committed to co-operative principles and have even written

770-417: A medical synchrotron or cyclotron , and accelerated in successive transits through a circular, evacuated conduit or cavity, using powerful magnets to shape their path, until they reach the energy required to just traverse a human body, usually about 200 MeV. They are then released toward the region to be treated in the patient's body, the irradiation target. In some machines, which deliver protons of only

847-819: A new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status. The Health and Social Care Bill 2011 , overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014. The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to

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924-716: A radiotherapy satellite centre. At a cost of £17 million, the unit was partly funded by The Marina Dalglish Appeal. The Aintree facility provides Stereotactic Radiosurgery services in partnership with The Walton Centre. In 2008 a review was published into the provision of non-surgical oncology services within the Merseyside and Cheshire Cancer Network. [1] In this review; its authors, Professor Mark Baker and Mr Roger Cannon, recommended that an inpatient cancer treatment facility be built in Liverpool . The Clatterbridge Cancer Centre Foundation Trust announced in 2011 that this recommendation

1001-476: A recent systematic review found no difference in the affects on overall survival or deaths due to brain metastases when comparing SRS treatment alone to SRS plus WBRT treatment or WBRT alone. Expansion of stereotactic radiotherapy to other lesions is increasing, and includes liver cancer, lung cancer, pancreatic cancer, etc. The New York Times reported in December 2010 that radiation overdoses had occurred with

1078-584: A satellite hospital on the Aintree University Hospital campus to provide more convenient radiotherapy services to Liverpool. On 1 April 2012 the trust changed its name from Clatterbridge Centre for Oncology NHS Foundation Trust (CCO) to The Clatterbirdge Cancer Centre NHS Foundation Trust (CCC). In 2016 the Trust established a subsidiary company, Clatterbridge PropCare Services Ltd, to which 13 estates and facilities staff were transferred. The intention

1155-570: A shared services solution". By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with

1232-495: A specific energy, a custom mask made of plastic is interposed between the beam source and the patient to adjust the beam energy to provide the appropriate degree of penetration. The phenomenon of the Bragg peak of ejected protons gives proton therapy advantages over other forms of radiation, since most of the proton's energy is deposited within a limited distance, so tissue beyond this range (and to some extent also tissue inside this range)

1309-767: A variety of tests, which have changed over time. In 2003 only trusts with three stars from the Commission for Health Improvement were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts. Formerly referred to as foundation trust equivalent (FTe) instead of Equivalent Foundation Trusts , this designation applies only to trusts providing high secure psychiatric services, of which there are three: Nottinghamshire Healthcare NHS Trust , West London Mental Health NHS Trust and Mersey Care NHS Trust . These trusts abide by

1386-417: A virtual target seen in the patient's diagnostic images with the actual target position in the patient. Stereotactic radiosurgery may also be called stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) when used outside the central nervous system (CNS). Stereotactic radiosurgery was first developed in 1949 by the Swedish neurosurgeon Lars Leksell to treat small targets in

1463-432: Is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area. In addition, there are governors appointed by bodies with whom the trust works in partnership. So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations. Governors are intended to act as

1540-532: Is able to accurately focus many beams of gamma radiation on one or more tumors. Each individual beam is of relatively low intensity, so the radiation has little effect on intervening brain tissue and is concentrated only at the tumor itself. Gamma Knife radiosurgery has proven effective for patients with benign or malignant brain tumors up to 4 cm (1.6 in) in size, vascular malformations such as an arteriovenous malformation (AVM), pain, and other functional problems. For treatment of trigeminal neuralgia

1617-611: Is also on the Aintree Hospitals campus, it is in a separate building to the Clatterbridge Cancer Centre Liverpool, which was built at a later date. Following a £1.3 million renovation, the centre runs a nurse-led chemotherapy delivery service from Southport Hospital 's Medical Day Unit, for bowel, breast and lung cancer patients. The Trust provides chemotherapy and oncology services in St Helen's Hospital. It

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1694-569: Is described in Schedule 7 of the National Health Service Act 2006 , with the formal corporate form being called a "public benefit corporation". Each foundation trust has a council of governors. This is made up of elected governors and appointed governors. Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public. The elections are usually held in separate constituencies. Typically there

1771-657: Is located in a converted, former nursing college at the Royal Liverpool University Hospital. It provides services for patients with bowel and breast cancers. The trust opened a unit dedicated to chemotherapy for gynaecological cancers at the Liverpool Women's Hospital, in February 2011. Treating breast, bowel, urology and lung cancers, The Marina Dalglish Centre was opened in 2007, having been converted from an old special care baby unit . Although this centre

1848-406: Is mechanically rotated around the patient in a full or partial circle. The table where the patient is lying, the "couch", can also be moved in small linear or angular steps. The combination of the movements of the gantry and of the couch allow the computerized planning of the volume of tissue that is going to be irradiated. Devices with a high energy of 6 MeV are commonly used for the treatment of

1925-572: Is spared from the effects of radiation. This property of protons, which has been called the " depth charge effect" by analogy to the explosive weapons used in anti-submarine warfare, allows for conformal dose distributions to be created around even very irregularly shaped targets, and for higher doses to targets surrounded or backstopped by radiation-sensitive structures such as the optic chiasm or brainstem. The development of "intensity modulated" techniques allowed similar conformities to be attained using linear accelerator radiosurgery. As of 2013 there

2002-843: The Hospital Universitario Fundación Alcorcón in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the Spanish National Health System , but its operational management is contracted out to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups. Foundation trusts were announced by Health Secretary Alan Milburn in 2002, and

2079-664: The Rochdale Principles into their constitution; they aspire to work closely and in partnership with other mutual and local organisations. At first, foundation trusts were authorised and regulated by Monitor , a non-executive body under the Department of Health. Monitor was merged into NHS Improvement in 2016. The trade body for foundation trusts is NHS Providers , formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. A 2014 report by

2156-546: The Royal Liverpool University Hospital and University of Liverpool . The Trust operates three sites across Merseyside, with a number of outpatient clinics hosted in other Trusts in the area. The main base of the trust is located on the Wirral near Bebington. It provides a range of radiotherapy and chemotherapy services along with inpatient wards. The site hosts the only low energy proton therapy unit in

2233-541: The Socialist Health Association said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation". The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital , a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust . NHS Improvement were said to have effectively ordered

2310-496: The cells . These ions and radicals, which may be formed from the water in the cell or biological materials, can produce irreparable damage to DNA, proteins, and lipids, resulting in the cell's death. Thus, biological inactivation is carried out in a volume of tissue to be treated, with a precise destructive effect. The radiation dose is usually measured in grays (one gray (Gy) is the absorption of one joule of energy per kilogram of mass). A unit that attempts to take into account both

2387-471: The synchrocyclotron was too clumsy. Leksell proceeded to develop a practical, compact, precise and simple tool which could be handled by the surgeon himself. In 1968 this resulted in the Gamma Knife, which was installed at the Karolinska Institute and consisted of several cobalt-60 radioactive sources placed in a kind of helmet with central channels for irradiation with gamma rays. This prototype

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2464-675: The 1980s all with 201 cobalt-60 sources. In parallel to these developments, a similar approach was designed for a linear particle accelerator or Linac. Installation of the first 4  MeV clinical linear accelerator began in June 1952 in the Medical Research Council (MRC) Radiotherapeutic Research Unit at the Hammersmith Hospital , London. The system was handed over for physics and other testing in February 1953 and began to treat patients on 7 September that year. Meanwhile, work at

2541-574: The 21st century. The localization accuracy and precision that are implicit in the word "stereotactic" remain of utmost importance for radiosurgical interventions and are significantly improved via image-guidance technologies such as the N-localizer and Sturm-Pastyr localizer that were originally developed for stereotactic surgery . In the 21st century the original concept of radiosurgery expanded to include treatments comprising up to five fractions , and stereotactic radiosurgery has been redefined as

2618-551: The Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act , and have been judged to pose a grave and immediate danger to the public. Unlike full foundation trusts, governors have no statutory role, and

2695-410: The Department of Health was promoting "A new type of NHS hospital". In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked. It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and

2772-479: The Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of

2849-458: The FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted". By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement . The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined

2926-489: The Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income. In order to achieve foundation trust status, NHS trusts have to pass

3003-604: The Gamma Knife is dedicated to radiosurgery, many Linacs are built for conventional fractionated radiotherapy and require additional technology and expertise to become dedicated radiosurgery tools. There is not a clear difference in efficacy between these different approaches. The major manufacturers, Varian and Elekta offer dedicated radiosurgery Linacs as well as machines designed for conventional treatment with radiosurgery capabilities. Systems designed to complement conventional Linacs with beam-shaping technology, treatment planning, and image-guidance tools to provide. An example of

3080-597: The Gamma Knife unit and the Cyberknife unit. The highly precise irradiation of targets within the brain and spine is planned using information from medical images that are obtained via computed tomography , magnetic resonance imaging , and angiography . Radiosurgery is indicated primarily for the therapy of tumors, vascular lesions and functional disorders. Significant clinical judgment must be used with this technique and considerations must include lesion type, pathology if available, size, location and age and general health of

3157-697: The Leksell Gamma Knife) is used to treat brain tumors by administering high-intensity gamma radiation therapy in a manner that concentrates the radiation over a small volume. The device was invented in 1967 at the Karolinska Institute in Stockholm , Sweden, by Lars Leksell , Romanian-born neurosurgeon Ladislau Steiner, and radiobiologist Börje Larsson from Uppsala University , Sweden. A Gamma Knife typically contains 201 cobalt-60 sources of approximately 30  curies each (1.1  TBq ), placed in

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3234-573: The NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?". In January 2022 Sajid Javid , writing in The Times said he was planning a “revolution” that would allow “well-run hospitals more freedom”. Foundation trusts had

3311-593: The Stanford Microwave Laboratory led to the development of a 6 MeV accelerator, which was installed at Stanford University Hospital, California, in 1956. Linac units quickly became favored devices for conventional fractionated radiotherapy but it lasted until the 1980s before dedicated Linac radiosurgery became a reality. In 1982, the Spanish neurosurgeon J. Barcia-Salorio began to evaluate the role of cobalt-generated and then Linac-based photon radiosurgery for

3388-612: The Trust operates an extensive network of services across Cheshire and Merseyside which includes their three sites in Liverpool, Wirral and Aintree, as well as clinics in hospitals across the region, and its team of specialist nurses who treat patients while they're at home or work. In 1862 the Liverpool Hospital for Cancer and Diseases of the Skin was established. This hospital moved to a new site and became The Radium Institute and by 1901

3465-525: The United Kingdom, which provides proton beam therapy for eye tumours. One of the first NHS England funded community diagnostic centres in England is Clatterbridge Diagnostics, on the Wirral site, which offers tests for Phlebotomy, Ultrasound, MRI, CT, ECHO, ECG and Sleep Studies. In June 2013, as part of a joint venture between the trust and Ireland's Mater Private Hospital , a private radiotherapy clinic

3542-490: The board of directors have no statutory duty towards the governors. The governors cannot, without the board of directors' permission, have any control over the direction of the trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors. Radiosurgery Radiosurgery is surgery using radiation , that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with

3619-425: The brain that were not amenable to conventional surgery. The initial stereotactic instrument he conceived used probes and electrodes. The first attempt to supplant the electrodes with radiation was made in the early fifties, with x-rays . The principle of this instrument was to hit the intra-cranial target with narrow beams of radiation from multiple directions. The beam paths converge in the target volume, delivering

3696-426: The brain, due to the depth of the target. The diameter of the energy beam leaving the emission head can be adjusted to the size of the lesion by means of collimators . They may be interchangeable orifices with different diameters, typically varying from 5 to 40 mm in 5 mm steps, or multileaf collimators, which consist of a number of metal leaflets that can be moved dynamically during treatment in order to shape

3773-537: The council of governors to work towards a merger. A study undertaken in 2005 by the King's Fund of Homerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned. Another report in 2005, funded by the Nuffield Foundation , found that it was too easy to invite members to sit on sub-committees, where they quickly became bogged down in the minutiae of operational planning, whilst

3850-608: The different organs that are irradiated and the type of radiation is the sievert , a unit that describes both the amount of energy deposited and the biological effectiveness. When used outside the CNS it may be called stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR). Radiosurgery is performed by a multidisciplinary team of neurosurgeons , radiation oncologists and medical physicists to operate and maintain highly sophisticated, highly precise and complex instruments, including medical linear accelerators,

3927-406: The hospital was expanded to include outpatient departments, computerised radiotherapy planning facilities and medical records facilities. Between 1984 and 1987 the site was again expanded to include Computer Tomography, a gamma camera and The Douglas Cyclotron. In the 1990s these were followed by MRI facilities, a High Dose Rate afterloader and additional linear accelerators. In 2011 the Trust opened

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4004-529: The legislative basis was the Health and Social Care (Community Health and Standards) Act 2003 . The first ten NHS hospitals to become foundation trusts were announced in 2004. Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002. By 2012, the Monitor website listed 145 foundation trusts. Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009

4081-565: The linear accelerator method of radiosurgery, due in large part to inadequate safeguards in equipment retrofitted for stereotactic radiosurgery. In the U.S. the Food and Drug Administration (FDA) regulates these devices, whereas the Gamma Knife is regulated by the Nuclear Regulatory Commission . This is evidence that immunotherapy may be useful for treatment of radiation necrosis following stereotactic radiotherapy. The selection of

4158-509: The main decisions were taken at meetings that they only heard about after they took place. The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust scandal of the late 2000s ( Stafford Hospital Scandal ) and the ensuing Francis inquiry , published in 2013. At the outset, some critics claimed that foundation trusts went against

4235-428: The patient. General contraindications to radiosurgery include excessively large size of the target lesion, or lesions too numerous for practical treatment. Patients can be treated within one to five days as outpatients . By comparison, the average hospital stay for a craniotomy (conventional neurosurgery, requiring the opening of the skull) is about 15 days. The radiosurgery outcome may not be evident until months after

4312-533: The private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had its own cap, set at the level of its private activity when the first FTs were established in 2003/4. About three-quarters of all FTs had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from

4389-422: The procedure may be used repeatedly on patients. Acute complications following Gamma Knife radiosurgery are rare, and complications are related to the condition being treated. A linear accelerator (linac) produces x-rays from the impact of accelerated electrons striking a high z target, usually tungsten. The process is also referred to as "x-ray therapy" or "photon therapy." The emission head, or " gantry ",

4466-435: The proper kind of radiation and device depends on many factors including lesion type, size, and location in relation to critical structures. Data suggest that similar clinical outcomes are possible with all of the various techniques. More important than the device used are issues regarding indications for treatment, total dose delivered, fractionation schedule and conformity of the treatment plan. A Gamma Knife (also known as

4543-412: The public sector and less autonomous than was originally expected. By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts. They included acute trusts, mental health, community and ambulance trusts. By March 2019, the number of foundation trusts had shown a small increase to 151. The basic governance structure and form of foundation trusts

4620-447: The radiation beam to conform to the mass to be ablated. As of 2017 Linacs were capable of achieving extremely narrow beam geometries, such as 0.15 to 0.3 mm. Therefore, they can be used for several kinds of surgeries which hitherto had been carried out by open or endoscopic surgery, such as for trigeminal neuralgia. Long-term follow-up data has shown it to be as effective as radiofrequency ablation, but inferior to surgery in preventing

4697-432: The recurrence of pain. The first such systems were developed by John R. Adler , a Stanford University professor of neurosurgery and radiation oncology, and Russell and Peter Schonberg at Schonberg Research, and commercialized under the brand name CyberKnife. Protons may also be used in radiosurgery in a procedure called Proton Beam Therapy (PBT) or proton therapy . Protons are extracted from proton donor materials by

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4774-532: The service to more areas and treatments. The trust provides some nursing staff to the Countess of Chester Hospital , allowing breast, bowel, lung and prostate cancer patients to be given chemotherapy on Haematology & Oncology unit. In 2009 the centre opened a chemotherapy centre at Warrington and Halton Hospitals NHS Foundation Trust 's Halton General Hospital site to treat breast, bowel, lung, lymphoma, prostate and urological cancers. The Linda McCartney Centre

4851-545: The spinal metastasis is efficient in controlling pain in up to 90% of the cases and ensures stability of the tumours on imaging evaluation in 95% of the cases, and is more efficient for spinal metastasis involving one or two segments. Meanwhile, conventional external beam radiotherapy is more suitable for multiple spinal involvement. SRS may be administered alone or in combination with other therapies. For brain metastases, these treatment options include whole brain radiation therapy (WBRT), surgery, and systemic therapies. However,

4928-607: The spirit of the principles laid out by Aneurin Bevan , the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management. In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance. In June 2014, Bill Moyes, former Monitor executive chair, urged

5005-466: The supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached. Foundation trusts have some managerial and financial freedom when compared to NHS trusts . The introduction of foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided. At

5082-694: The surrounding normal tissue to the total accumulated radiation dose . Historically, the field of fractionated radiotherapy evolved from the original concept of stereotactic radiosurgery following discovery of the principles of radiobiology : repair, reassortment, repopulation, and reoxygenation. Today, both treatment techniques are complementary, as tumors that may be resistant to fractionated radiotherapy may respond well to radiosurgery, and tumors that are too large or too close to critical organs for safe radiosurgery may be suitable candidates for fractionated radiotherapy. Today, both Gamma Knife and Linac radiosurgery programs are commercially available worldwide. While

5159-542: The time of introduction, they were described "as a sort of halfway house between the public and private sectors". This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an internal market . The stated purpose is to devolve decision-making from a centralised NHS to local communities, in an effort to be more responsive to their needs and wishes. But after Gordon Brown prevented plans by Alan Milburn to make them financially autonomous they have been much more in

5236-732: The treatment of AVMs and epilepsy . In 1984, Betti and Derechinsky described a Linac-based radiosurgical system. Winston and Lutz further advanced Linac-based radiosurgical prototype technologies by incorporating an improved stereotactic positioning device and a method to measure the accuracy of various components. Using a modified Linac, the first patient in the United States was treated in Boston Brigham and Women's Hospital in February 1986. Technological improvements in medical imaging and computing have led to increased clinical adoption of stereotactic radiosurgery and have broadened its scope in

5313-433: The treatment. Since radiosurgery does not remove the tumor but inactivates it biologically, lack of growth of the lesion is normally considered to be treatment success. General indications for radiosurgery include many kinds of brain tumors, such as acoustic neuromas , germinomas , meningiomas , metastases , trigeminal neuralgia, arteriovenous malformations, and skull base tumors, among others. Stereotatic radiosurgery of

5390-534: Was announced that the planned hospital will have 11 floors, and also include blood cancer treatment facilities. The Transforming Cancer Care project was projected to cost £155 million in total. This includes both the building and equipping of the new hospital, and refurbishing the Trust's Wirral cancer centre. It opened to inpatients on Saturday 27 June 2020 and outpatients were welcomed from Monday 29 June 2020. It has 110 fully-single en-suite patient bedrooms and five radiotherapy Linac treatment suites. Laing O'Rourke

5467-406: Was being actioned, and would take advantage of separate, but concurrent, plans for the redevelopment of the Royal Liverpool University Hospital . Approval to move forward with the plan for the new cancer hospital on West Derby Street, Liverpool was given by the eight local authorities in December 2014. This followed a public consultation, which ran from July 2014 to October 2014. In October 2015, it

5544-491: Was designed to produce slit-like radiation lesions for functional neurosurgical procedures to treat pain, movement disorders, or behavioral disorders that did not respond to conventional treatment. The success of this first unit led to the construction of a second device, containing 179 cobalt-60 sources. This second Gamma Knife unit was designed to produce spherical lesions to treat brain tumors and intracranial arteriovenous malformations (AVMs). Additional units were installed in

5621-637: Was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. 92% of staff recommend it as a place for treatment and 73% recommended it as a place to work. In March 2023, it had 1,796 full-time equivalent staff and a sickness absence rate of 4.7% compared to 4.9% average across England. In 2019 the trust was rated as good by the Care Quality Commission dropping from an outstanding rating in 2017. NHS Foundation Trust Alan Milburn 's trip in 2001 to

5698-569: Was one of the two major radiotherapy centres in the North West of England . In 1950s the organisation was renamed The Liverpool Clinic and in March 1958 moved to a new site near Clatterbridge , Wirral. The hospital had three wards and by 1959 was treating up to 80 patients per day on a Mullard 4 MeV linear accelerator. In the 1960s superficial x-ray equipment was introduced, along with a second linear accelerator in 1966 and two Cobalt-60 units. In July 1972

5775-504: Was opened at the Clatterbridge Cancer Centre. The clinic provides chemotherapy, and radiotherapy treatments using a dedicated linear accelerator. In 2014 Maggie's Centres , a registered charity that provides support to anyone affected by cancer, opened Maggie's Merseyside centre. Located on the campus of Aintree University Hospital , adjacent to The Walton Centre . The Clatterbridge Cancer Centre Aintree opened in 2011, as

5852-834: Was the main contractor. To enable patients located to the north and east of the River Mersey to receive more convenient access to cancer treatment, the centre operates a number of satellite centres and clinics within the Liverpool City Region and North West. Since 2010, the centre has run a nurse-led, day case chemotherapy clinic from a dedicated unit at Broadgreen Hospital . The unit treats lung, prostate and urological cancers. The Trust provides some chemotherapy in patients' own homes. Specialist chemotherapy nurses from The Clatterbridge Cancer Centre currently visit patients at home in certain areas of Merseyside and Cheshire to deliver trastuzumab (Herceptin). The Trust plans to expand

5929-446: Was to achieve VAT benefits, as well as pay bill savings, by recruiting new staff on less expensive non-NHS contracts. VAT benefits arise because NHS trusts can only claim VAT back on a small subset of goods and services they buy. The Value Added Tax Act 1994 provides a mechanism through which NHS trusts can qualify for refunds on contracted out services. In June 2020 the Trust opened a new 11-storey hospital building in Liverpool next to

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