Agenda item

Dr Chris Streather (Joint SRO, NHS England- London region) and Ailsa Willens (Programme Director and Joint SRO, NHS England- London region) presented this item, followed by questions from the Committee. The following key points were noted:

5.1The aim of the consultation that would be carried out by NHS England was to engage with as many people as possible within the geography affected by this service change and to hear their views on the proposals for the future location of the children’s cancer principal treatment centre.

5.2The consultation would aim to understand the impact of implementing either proposal and try to identify any mitigations that could be put in place.

5.3The consultation document was currently being refined based on the feedback that NHS England had received through the pre-consultation period.

5.4NHS England officers informed the Committee that their support in helping NHS England engage with the population in South-East London during the consultation phase would be really valued.

5.5A committee member raised concerns about Evelina London Children’s Hospital scoring lower in patient and carer experience and sought clarification on the reasons behind the lower score, the extent of the difference in scores and whether steps would be taken to improve the situation if it became the new site for the Principal Treatment Centre (PTC). In response, the officers acknowledged that both proposals scored highly, but they did exhibit variations in certain areas. The most significant divergence was found in the research domain and the clinical domain, where Evelina scored slightly higher. In the patient and carer experience category, the difference between the two was around 2%, reflecting the fact that St George’s scored more highly in two areas – patient travel times; and quality of facilities, specifically privacy and dignity.

5.6Officers emphasised that they valued and would consider the feedback from current service users, however, most of these individuals would have completed their treatment by the time this change was implemented. Therefore, it was important to take the voices and needs of future patients into account in the decision-making process too.

5.7A Committee member enquired about the transportation methods used by patients accessing the PTCs, specifically whether they relied on public transport or private vehicles. Concerns were expressed about the limited parking space available at Evelina. Officers cited the Great Ormond Street Hospital as a model which managed with no on-site parking whilst facilitating access to services, sometimes with hospital provided transport. The Committee was informed that the Programme Board for this service change had the Chief Executive from Great Ormond Street Hospital as well as an independent advisor, Michelle McLoughlin (who used to be the Chief Nurse at Birmingham Women’s and Children’s Hospital) who had experience in hospital schemes and planning around travel.

5.8In response to the question around transportation methods, officers reported that there was no systematic data collection exercise to gather data on travel methods (as this was not routinely collected by the hospitals) but one of their teams was visiting children and families in the wards to survey patients/their carers about how they travelled to the PTC. At the Royal Marsden site, the survey data (collected to date) showed that around 75% of the people who were asked the question travelled by car and 25% travelled by public transport. It was important to note that not all the people travelling by road/ car were traveling in ‘private’ cars as some of it was hospital-provided transport. One of the recommendations within the Equality and Health Inequality Impact Assessment (EHIA) around mitigations was how the chosen PTC site could develop their directly provided transport scheme to make it as accessible as possible. Officers added that before the consultation, they wanted to work with both the potential PTC site providers to look at the issue of travel and transport though a working group to seek further assurance on the potential mitigations.

5.9The parking capacity at the Royal Marsden site consisted of around 12 parking spaces for parents or carers travelling to the PTC. Both St. George’s Hospital and Evelina London Children’s Hospital were giving serious consideration to parking capacity as part of their proposals. St. George’s proposal provided 20 dedicated parking spaces and Evelina was looking at options as well.

5.10  It was discussed that paediatric cancer services required highly specialised care, and fortunately, the number of children in need of these services was relatively low. While this limited demand was positive, it posed challenges for establishing satellite or local sites, as the lower numbers might result in underutilised facilities. Moreover, providing the safest and highest quality care for seriously ill children would be difficult at local centres. The Paediatric Oncology Shared Care Units (POSCUs) played a vital role in delivering responsive care to local communities, delivering care closer to home where it was clinically appropriate to do so.

5.11  The Committee noted that the presentation highlighted many children with cancer also received care in their homes. This could be from staff or 'outreach' services from the PTC, POSCU or staff from children's community nursing teams. The Committee appreciated this and recognised its importance in improving the lives of these young patients.

5.12  It was discussed that regardless of which site was chosen to be the future PTC, there would be significant implications for the staff currently based at Royal Marsden Hospital. A member of the Committee enquired how the impact on staff would be mitigated and the plan for recruitment and retention at the new site. Officers acknowledged that workforce issues would be one of the more challenging aspects of the decision-making process. It was also noted that the largest staff group being impacted by the decision would be nurses. Proactive steps were being taken to gain a better understanding of the workforce issues and explore ways to effectively mitigate any potential challenges that may arise.

5.13  A Committee member enquired whether both site providers were adequately prepared to meet the 2.5-year implementation timeline of this service change and what would happen if this timeline was not met. It was reported that the level of preparedness was the same for both providers. However, to date, the reconfiguration process, including the work to involve all parties and listen to their input had taken more time than anticipated. Furthermore, unforeseen events like general elections and mayoral elections could also introduce additional time constraints. Both site providers would also need to refurbish space in existing buildings. Therefore, although there was every intention to meet the 2.5-year timeline, it could not be promised. Officers recognised the urgency to meet this timeline as it would enhance the current service for children and avoid staff uncertainty.

RESOLVED:

·  That the presentation be noted, and NHS England be invited to come back to a subsequent committee meeting to provide an update once the public consultation concludes.