Agenda item

To receive an update from Neil Kennett-Brown, Programme Director, Transformational Change, North and East London Commissioning Support Unit on proposals for changes to cancer and cardiovascular services.

Note: A draft response letter from the Joint Committee is attached for discussion and agreement by Members.  

NHS officers explained that the prostate surgery proposals were now being reviewed externally by the London Clinical Senate. A hybrid option was being considered where bladder cancer surgery would take place at UCLH with radical non-robotic prostatectomies carried out at BHRUT. Findings of the review would be communicated to the Committee. The outcomes of the review were expected to be known by the end of February and it was AGREED that these should be scrutinised at a special meeting of the Committee.

A two-site option for stomach and gullet cancer involving BHRUT and UCLH had been recommended for the medium term. Any move to a single site would be subject to a separate review in 3-5 years. There would also be a to clarify the future of the smaller centre undertaking operations of this kind in Chelmsford.

There had been five public drop-in sessions for people to discuss the proposals and the sessions had been run in a similar way to those for other major consultations such as Crossrail or the HS2 rail link. Patients had been involved in an options appraisal workshop and videos and Twitter had also been used as part of the engagement.

Health officers had met with the Chairmen of the three Joint Overview and Scrutiny Committees in December 2013 and felt it would be useful if the Committee could scrutinise planning for the implementation of the proposals such as for example travel issues. Officers were also happy to attend future meetings as required.

A recent issue that had been raised was the impact of the changes on the ocular oncology service but officers felt there was still sufficient capacity for the service at Barts Hospital.

In the new structure, renal surgeons from, for example, BHRUT would also be able to carry out operations at the Royal Free Hospital, thus reaching a sufficient of operations per surgeon to improve skills.

A Member felt that the consultation events had been held in the wrong place and had been too London-centric. Officers pointed out that events had been held at different times of the day. The Commissioning Support Unit officers would have been happy to present in for example Loughton but had not been asked too. The proposals had also been advertised in local newspapers covering Harlow, Epping Forest and surrounding areas.

There were 79 radical prostatectomies that took place in the sector last year and this was less than 20% of all prostate work. This was also less than 3% of cancer in-patient activity. It was emphasised that there were no plans to move any other prostate treatments from BHRUT.

A representative of a local prostate patients support group felt that not enough weight had been given to patients’ views during the options appraisal. They also felt that the consultation outside London had been inadequate and that the proposals should be subject to formal s. 244 consultation. Officers responded that the weighting given to patient experience had increased from 20 % to 25% at the expense of clinical outcomes.

It was confirmed that BHRUT would remain a neurology service and continue to offer services for leukaemia and oesophago-gastric cancer. Only partial nephrectomy for renal cancer (approximately 60 patients per year) and prostate cancer surgery (around 80 patients per year) would move from BHRUT.

The Committee considered whether formal s. 244 consultation was required but noted that to do so, a Joint Committee would need to be formed from the three existing Joint OSCs. Members would be free to scrutinise the issues further in the future, even if formal consultation was not invoked. Members felt that it was essential that further engagement took place on the proposals as they were developed, even if formal consultation was not considered necessary. Members also felt that the proposals would improve services overall, even if they did constitute a substantial variation.

The Committee AGREED that the draft response letter concerning the cancer and cardiac proposals should be sent to the appropriate health officer, subject to the addition that further engagement and consultation on the proposals should take place. The Committee further AGREED that formal consultation under section 244 of the National Health Service Act 2006 was not required on this occasion.