Agenda item - Reconfiguration of Specialist Children's Cancer Services

Report of the Executive Director, Governance, People & Resources (copy attached).

6.1       This item was introduced by Dr Chris Streather, Regional Medical Director, NHSE London;  Ailsa Willens, Programme Director, Children’s Cancer Principal Treatment Centre, NHSE London; and Catherine Croucher, Consultant in Public Health, NHSE London. Also on the meeting call were Dr Christopher Tibbs, Medical Director, Specialised Commissioning NHSE South East; Sabahat Hassan, Head of Partnerships & Engagement, NHSE South East Commissioning Directorate; Fiona Gaylor, Transforming Partners for Healthcare; and Dr Dinesh Sinha, NHS Sussex Chief Medical Officer.

6.2       The NHSE representatives described current services, the rationale for change, and consultation plans to the committee:

·         There are 13 Principal Treatment Centres (PTC) for children’s cancer across England. The formal catchment areas for the PTC which this service change is about covers south London, Kent, Medway, most of Surrey, East Sussex and Brighton & Hove.  Patients from areas such as West Sussex (which is part of the catchment area for the Southampton PTC) may also choose to receive their care from the PTC.

·         PTCs operate shared care arrangements with local Paediatric Oncology Shared Care Units (POSCU) (e.g. the Royal Alexandra Children’s Hospital, Brighton) ensuring that as much care as possible is delivered locally, but that care is delivered from the regional hub when necessary.

·         Our PTC is jointly operated by The Royal Marsden from its Sutton site alongside, St George’s Hospital, Tooting who provides the Paediatric Intensive Care Unit for patients alongside other services, such as surgery.

·         However, there are risks inherent in having separate PTC and PICU, and there is now a requirement for all PTCs and PICU to be on a single site to remove the need to transfer patients who need PICU. It would not be feasible to create a PICU on the Royal Marsden’s Sutton site, so a new location for the PTC must be found.

·         NHSE have considered potential providers and have narrowed this down to a shortlist of two: St George’s Hospital, Tooting; and the Evelina Children’s Hospital (part of Guy’s & St Thomas’s).

·         Both potential providers have been evaluated by NHSE against four domains (clinical/patient & carer experience/enabling/research); the Evelina currently scores higher than St George’s, but both bids score well and both are viable providers.  NHSE will consult on both options.

·         NHSE will conduct a 12 week consultation with current and former patients and carers, stakeholders and the public. This will include a mid-period review of the consultation process to seek to ensure NHSE hear from as many stakeholders as possible. A final decision on the provider will be made in early 2024.

·         There has been extensive clinical input to date and will be more as the consultation progresses.

·         It will take around 2 and a half years from contract award to the full launch of the new service, in part because capital works would be required at either of the future PTC providers.

·         A full Equality & Health Inequalities Impact Assessment (EHIA) has been conducted. This includes a focus on travel. Both options will, on average, have shorter journey times by public transport for most patients, but longer journey times by car, particularly the Evelina (Westminster).

·         A range of mitigations have been identified including helping families to plan their travel arrangements: helping families access national NHS reimbursement schemes for travel costs (including  for the congestion charge and ULEZ), or provision of hospital transport. Additional mitigations include remote consultations (where appropriate) and shared care closer to home.

·         The consultation will include patients, carers, staff, community & voluntary sector groups (CVS), stakeholder groups etc.

·         There is a high percentage of families in the area covered by the PTC for whom English is not a first language, and much thought has been given to developing accessible consultation materials.

6.3       Dr Dinesh Sinha told the committee that NHS Sussex (Sussex Integrated Care Board) is fully supportive of the PTC consultation process.

6.4       Cllr Evans asked whether the incidence of children’s cancer is higher in certain communities. Dr Streather responded that, unlike adult cancers, the incidence of children’s cancer does not particularly vary according to  deprivation status or ethnicity.

6.4       Cllr Evans asked a question about the involvement of local CVS organisations. Ms Willens responded that NHSE are linking with the local CVS to help target the consultation. Materials will be available in a variety of languages (most commonly spoken) and there will be scope to do translation on demand also.

6.5       Cllr Lyons asked whether it was true that 23% of the communities being consulted do not have English as their first language. Dr Streather replied that this is accurate, according to a recent survey carried out with families whose children are currently receiving specialist cancer treatment.

6.6       Cllr Evans asked about the relative scores of the Evelina and St George’s. Dr Streather responded that he did not have the precise figures to hand, but that there was approximately 4-5% difference overall, in favour of the Evelina London, with around 2% difference on the clinical domain (in favour of Evelina London); and a 1.5% difference on the patient & carer experience domain (in favour of St George’s).

6.7       Cllr Evans questioned whether modelling of public transport to the potential sites was all that relevant, given that families were likely to drive if they had the option. Dr Streather replied that the current 75/25 split (in survey data gathered so far) between cars/public transport may reflect the fact that The Royal Marsden in Sutton site has poor public transport links for anyone not living locally, and there could be an upswing in public transport use for either of the new sites. Some communities have expressed strong views about access to one or another of the sites. These views are valid, but they have to be balanced against the access needs of everyone in the catchment area. Ultimately, the decision on the site needs to be principally informed by clinical outcomes; and other factors alongside consideration to the convenience of travel.

6.7       Geoffrey Bowden asked a question about overnight accommodation. Ms Croucher responded that this is part of the mitigation measures that will be put in place. Both sites have the facility for parents to stay on wards, and both have some nearby accommodation for families (e.g. Ronald McDonald House). There may also be opportunities for the providers to partner with local hotels. Another issue that will need to be addressed is how to ensure that all families are made aware of the support on offer.

6.8       In answer to questions from Mr Bowden on problems people might have with having travel costs reimbursed if they are unable to meet up-front costs, and on childcare costs for other children in the family, Ms Croucher responded that both providers have indicated their willingness to explore schemes that provides up-front funding for travel costs. There is potential learning from Surrey Heartlands who have also explored this type of scheme. There is nothing specific available (through the NHS) in terms of childcare costs, but supporting for families to access benefits, charitable help etc. is a key recommendation for mitigation of adverse impacts.

6.9       Cllr Robins asked what ages the service covers. Ms Willens responded that the service is 1-15. Young babies (under the age of 1) receive services at Great Ormond Street Hospital; and there is a teenager & young adult service at The Royal Marsden. There is some flexibility around transition from the children’s service to this service.

6.10    In response to a question from Cllr Robins on why West Sussex residents are not part of this service, Dr Streather responded that West Sussex residents have the option to use either the Southampton or the South London PTC.  They formally sit in the catchment area to the Southampton PTC.

6.11    In response to a question from Cllr Robins on the most common types of childhood cancer, Dr Streather replied that these tended to be blood cancers and also brain cancer.

6.12    Cllr Nann asked a question about what potential there was to change elements of planning in response to information from the consultation. Dr Streather replied that NHSE has an open mind about the choice of future provider, so the consultation could definitely affect this. There is also a long run-in time before any new service will be operational and this will allow for learning from the consultation to be fed into mobilisation plans by the future provider, particularly in terms of patient experience and access considerations.

6.13    Cllr Hill asked about the research scores for the two sites. Dr Streather replied that St George’s has a partnership with the University of London, and the Evelina with King’s College, London. The latter is a larger provider offering more research opportunities, so if St George’s became the future provider work would be needed to grow research opportunities there. The Evelina scored 3.8% higher than St George’s in this domain.

6.14    Cllr Hill asked a question about work that could be done to improve the Evelina’s score in terms of patient & carer experience. Differences between the two providers in this domain relate to: quality of facilities (specifically patient privacy and dignity), patient travel times (particularly by road). Dr Streather responded that some of the difference in scoring between the Evelina and St George’s may be due to St George’s being part of the current service. However, there is also time for learning to be embedded in the new model. Members of the South West London & Surrey Joint HOSC have been invited to visit the Evelina to explore what is being done to improve patient experience.

6.15    RESOLVED - That Committee has reviewed the plans described here to reconfigure specialist children’s cancer services and has  determined that it does not wish to make specific comments or require additional responses, as it considers that on balance the changes mooted will not be detrimental to the health of city residents; and

That Committee formally agrees that it does not wish to undertake further formal scrutiny of these plans, but asks officers to indicate to NHSE its desire to be kept informed of their progress.

6.16    The Chair thanked guests from NHSE and from NHS Sussex for attending the meeting and for providing such a wealth of information on plans to improve children’s cancer services.