Non Surgical Oncology

Non-surgical oncology – or NSO for short - is the name given to services that provide treatment and care for cancer patients without surgery – mainly chemotherapy and radiotherapy.

NSO services in our region are organised in a unique way that was agreed more than 20 years ago.

The delivery of NSO services has become increasingly challenging over recent years. With more people living with cancer and receiving treatment for longer, demand has grown at a faster rate than the numbers of health professionals working in this particular specialism of cancer care.

The Cancer Alliance was asked by West Yorkshire Association of Acute Trusts to review  the way in which the chemotherapy and acute oncology aspects of the non-surgical oncology services are delivered across West Yorkshire and Harrogate, with recommendations for improvement.

There is a separate piece of work just starting with colleagues in Leeds to look at future radiotherapy service expansion. We will work to bring these two pieces of work together where appropriate.

Here is where you can learn more about non-surgical oncology, the improvements being developed and why the changes are needed. Read more below.

Why are we looking to make changes to non surgical oncology services?

West Yorkshire is different to the rest of the country in the way its NSO services were delivered. Here, each Cancer Unit employed its own specialist teams to deliver local non-surgical oncology drug treatments for the common cancers (breast, bowel, prostate and lung), with specialist care provided at the Cancer Centre in Leeds. Elsewhere in England, local services are usually provided as a visiting service from the Cancer Centre.

Over recent times, it has proved difficult to recruit the required number of specialist doctors (oncologists) particularly in some parts of West Yorkshire, and as a result, other hospitals in our area were required to provide mutual aid and support. The uncertainties that this created, along with the need for staff to undertake different ways of working on different sites, and the high levels of temporary cover,  created additional challenges.

The national job market for these specialist areas has also become more challenging and there is also a shortage of qualified Advanced Care Practitioners (ACPs). Acute oncology, care for cancer patients who become unwell during treatment or because their disease had progressed is also under pressure.

In developing proposals for more robust services for the future, we have spoken to people affected by cancer (patients and carers) and people with an interest in cancer (staff) about what is important to them.

This includes:

• our Cancer Alliance community/patient panel
• medical and nursing staff in the hospitals where non-surgical cancer care is provided
• independent experts from outside our region

They have helped us to develop some fundamental principles and we have worked alongside them to develop plans for the future. The most important of these principles was that care should be available as close to patients' homes as is practicable.

In 2023/24 we sought the views of a broad range of people in local communities. Healthwatch Wakefield were asked to facilitate a series of sessions so that people could come along to learn more about the proposals for non-surgical cancer care across West Yorkshire and Harrogate; give their views on how those proposals might be improved and ask questions about what matters to them.

Engagement sessions and surveys were undertaken in more than 20 cities, towns and villages across the region including Almondsbury, Birstall, Bradford, Brighouse, Featherstone, Harrogate, Leeds, Oakes, Pontefract, Skipton and Wakefield. Two online sessions, via Zoom, were also held.

To ensure that all our communities had been offered the chance to comment on the proposals we held extra sessions  with voluntary sector groups who work with people at higher risks of health inequality or those who might have been underrepresented at earlier events. We heard views from a diverse range of individuals on what was important to them and how we could improve the plans.

We also commissioned a company to undertake over 1100 surveys in community locations across West Yorkshire and Harrogate

Feedback on the proposals was positive, , with over 90% of those consulted supporting treatment closer to home and over 80% positive about the changes proposed for outpatient services that included remote and self monitoring as well as skill mix changes.

However, not all feedback was positive. Transport emerged as a key theme as did the need to ensure that hospitals were mindful that not everyone is comfortable using technology when rolling out new ways for patients to access services. We shared this feedback with hospitals and agreed changes designed to increase the range of services available closer to patients' homes; to reduce the average number of times that patients are required to attend a hospital, and to support patient access to, and training in the use of, devices such as smartphones and laptops.

A summary of our engagement work and findings is available here

Drug Therapies

• All hospitals in West Yorkshire and Harrogate currently offering anti-cancer drug treatments will continue to do so.
• Patients will be allowed to choose to receive chemotherapy and other anti-cancer drugs outside of hospital settings, for example on mobile services or in your home supported by district nursing, where it is safe to do so.
• Patients with rarer cancers who have to travel to Leeds Cancer Centre for outpatient appointments will be offered the opportunity to have their drug treatments (like chemotherapy) from their local hospital where safe and possible to do so ie for simple treatments.

Radiation Therapies

• Patients should not experience any significant change in radiotherapy services.
• Treatments will continue to be delivered from Leeds St James’ Hospital and doctors specialising in radiotherapy will continue to travel to local hospitals to deliver outpatient clinics for common cancers. There is a separate piece of work starting with colleagues in Leeds looking at expansion of radiotherapy services in the future.

Outpatient Clinics

• Services will be re-organised into two geographies, North and South. This merges some services and creates larger clinical teams which will be more resilient and offer a more equitable level of service.
• Outpatient clinics for the most common cancers will continue to be provided from each of the six hospital trusts. The most common cancers are lung, breast, colorectal (bowel) and prostate cancer.
• Outpatient clinics for rarer cancers will continue to be delivered from the Leeds Cancer Centre only (as is the case now).
• Outpatient clinics will be delivered in a more standard and equitable way using a combination of doctors and other cancer specialists such as senior nurses and pharmacists.
• Wherever appropriate, hospitals will give patients the option to have their outpatient clinic or monitoring remotely. This could be by telephone, video conference or use of electronic monitoring tools.

Inpatient Care

• All hospitals in West Yorkshire and Harrogate with an A&E department will continue to admit and treat patients who become unwell due to side effects of treatment or their cancer becoming more advanced.
• We will consolidate our specialist beds. Specialist inpatient beds will continue to be provided at Leeds St James' and Huddersfield Royal Infirmary.
• Most patients will be seen by at their local hospital by either the A&E medical team, a specialist acute oncology nursing team or another medical specialty – for example a cancer patient with a bowel obstruction would be seen by a surgical team.
• Bradford Hospital will continue to provide care for most complications of cancer but patients requiring specialist inpatient care will be transferred to Leeds Cancer Centre. This change will be phased in once our programme funding and implementation plans are agreed (currently aiming for end of 2027)
• Wakefield Pinderfields and Dewsbury Hospitals will provide care for most complications of cancer but patients requiring specialist inpatient care will now be transferred to Huddersfield Royal Infirmary instead of to Leeds St James'. This provides for better continuity of care as it is oncologists from Huddersfield that will be responsible for the outpatient care of these patients.
• Where required, investment will be made to increase the size of acute oncology nursing teams to support patients to stay out of hospital/ have care as close to home as possible.

The consolidation of specialist inpatient care for people with cancer will free up doctors’ time for other clinical work such as outpatient clinics and to support chemotherapy

The NSO programme presented its review with recommendations for service improvements to the West Yorkshire Association of Acute Trusts (WYAAT) in Summer 2025.

WYAAT agreed that the Cancer Alliance had identified a future model for non-surgical oncology which had significant engagement support. However, in July 2025 the government published its 10 Year Health Plan for England : Fit for the future, and local NHS leaders wanted to ensure that the model was consistent with that plan.

Additional work was requested, to review the model against the 10 year plan and also to complete a capacity and demand assessment of other areas of cancer care including diagnostics, surgery, radiotherapy and inpatient care.