Agenda item

1.    To receive an update from North East London Commissioning Support Unit officers on the current review of proposals for services for prostate cancer (presentation attached).

2.    To discuss the open letter from clinicians concerning aspects of the proposals (attached with response letter from Sir David Nicholson, Chief Executive, NHS England).

The Committee received a presentation on the changes to Cancer and Cardiovascular services from a representative of the North East London Commissioning Support Unit who were overseeing the engagement process on behalf of NHS England. 

Neil Kennet-Brown (NKB) of the North East London Commissioning Unit advised members that local services were not organised in a way that gives patients the best care with specialists, technology and research spread across too many sites. In order to address this, clinicians had recommended the following:

·                    Specialist cardiovascular services at The London Chest, The Heart Hospital and St Bartholomew’s Hospital be consolidated to create an integrated cardiovascular centre at St Bartholomew’s

·                    For specialist cancer care, the proposal was to consolidate only some of the specialist elements of five cancers which equated to 1% of all Bart’s Health specialist cancer services and 2% of BHRUT specialist cancer services.

The Committee were asked to note that the majority of care would continue to be provided locally.

Formal support had been received from all Clinical Commissioning Groups bar one and the London Clinical Senate (LCS) was in the process of carrying out an independent clinical assurance exercise. The initial business case was expected to be published in April 2014.  There would be further planning for implementation and engagement until a final business case was agreed in June 2014.

NKB noted the interest around the prostate cancer services at BHRUT and advised that the LCS were currently holding an independent review led by Professor Chris Harrison.  Advice would be sought on the robustness of the clinical process to arrive at recommended options and depth of clinical involvement and support.  In addition, advice would be sought on the future model and locations of radical prostatectomies, specifically:

·                    A comparative analysis of current outcomes data

·                    Which outcome measures should be used to compare radical prostatectomy performance

·                     Implications of recently published NICE prostate guidance

In addition to the Prostate Review, LCS was also carrying out a clinical wide review of the proposed changes using independent experts from the medical profession and lay senate members.  Both the reports were to be concluded prior to April 2014 when the Senate reported to the NHSE.

A Commissioner Programme Board would have final approval of the initial business case. The Board will comprise NHS England representatives and six CCGs who are the majority commissioners for the proposed changes:

For specialist cardiovascular 59% of activity was CCG commissioned. Of this, 70% was commissioned by Haringey, City and Hackney, Enfield, Islington, Camden and Barnet CCGs

For specialised cancer care all the services were commissioned by NHS England, except acute myeloid leukaemia. This would particularly impact Enfield, Barnet, Haringey and Camden CCGs due to the proposed transfer of services to ULCH from other locations

Commissioners, clinicians, providers and the Trust Development Agencies would then commence planning for implementation.

With regards to Trauma Services a meeting was held on 16 December 2013 to identify and address issues.  A further full day clinically-led workshop was held on 16 January 2014. The current trauma service was recognised for its excellence and there was a clear commitment to maintain services by working collaboratively between Trusts and promoting training opportunities.

A programme of work had commenced between the Trusts, UCL Partners and Commissioners to mitigate risks. This work would form part of the wider planning for implementation with commissioner and provider assurance and oversight frameworks to be established and completed prior to implementation, if approved.

When the final decision had been approved in June 2014, there would follow an engagement process which would include:

·                    Approach discussed with patient advisory groups and meetings scheduled to discuss approach withLocal Healthwatch groups

·                    Engagement period commencing following approval of initial business case

·                    Plain English summary leaflet of proposals distributed to all stakeholders

·                    Information available online and cascaded via Trusts, CCGs and stakeholders

·                    Engagement events: 1x prostate discussion event in outer north east London

·                    3x stakeholder advisory group meetings covering travel, whole pathway integration, and service impacts

·                     Open offer to attend meetings

The Committee were asked to note that a number of meetings had been organised with various Healthwatch Committees over the coming two weeks. There were also plans to run Prostate Events and to organise advisory meetings with regards to travel impacts on patients and proposals.

The Chairman thanked the Commissioning Support Unit Team.

Dr Jackie Appleby (Hackney BMA Chairman) addressed the Committee and stated that she wanted the best care for her patients, however, she wanted to express her concerns regarding the effect these changes would have on local services.  Dr Appleby felt that there would be a knock-on effect for the specialist cancer services and did not feel that these concerns had been addressed.  If the specialist teams left then expertise and skills would be lost.  Services would drift from Whipps Cross, Newham and no evidence had been put forward to prove that there would be better outcomes for patients if the services were moved. She also enquired whether the workshops had fully addressed the risks of the proposals.  Dr Appleby also stated that at both BMA and public meetings, concerns had been expressed re the proposals and wanted to know how Barts Health could attract quality staff in the future.  Patients would also have to travel to two Trusts and then return to Barts for the remainder of their care. 

The Chairman invited Mary Burnett from the campaign group ‘We are Waltham Forest: Save our NHS’ to speak. Ms Burnett thought that the impacts on services were an unknown factor and that the potential risks to trauma care had not been fully investigated. Ms Burnet also expressed her concerns with regards to communications stating that Waltham Forest residents were only informed by letter.  Ms Burnet said that she had no confidence in the consultation process and that there was no building space at UCLH to house new cancer facilities.

NKB responded that the number of cancer procedures was very small in number and that BHRUT and UCLH had published their recommendations and the business case.  Brain surgery would move from its current three sites to be based at two sites. There was sufficient capacity at UCLH for the next three years with no additional building necessary however, the rehousing of the Cancer Centre at the site would require additional capacity and building at a later stage which had been planned.  Surgeons would spend 50% of their time at the centre and 50% back at their base hospital. 

Concerns were expressed about vital information moving with patients and the Committee were reassured that this was already happening and that a pilot scheme was testing communications between London Cancer and GPs.

A member of the Barts team did acknowledge that the concerns raised must be addressed, however the different sites must start working in a more joined up and unified way to make services more excellent.  If there were any risks involved in moving a service from one site to another, then clinicians would not allow this to proceed.

NKB stated that the consultation process had been thorough during his involvement with the Clinical Senate. The proposed changes have been widely publicised and consulted on and there was overall clinical support. 

A Committee member enquired about the loss of skilled staff particularly from the Trauma Centre. Barts Health acknowledged that this was an important issue. Meetings were being organised as it was necessary to speak to staff about working in different places 50% of the time however, the Royal London was not the only Trauma Centre.

A member requested that the Commissioning Unit provide further data for all five London Boroughs as outlined on page 3 of the presentation and was advised that locality breakdowns were available. 

The Committee noted the presentation and agreed to continue to support the proposals. The Chairman thanked all concerned in the presentation.  It was suggested that it would be a useful exercise for the Commissioning Unit to contact the Healthwatch groups to discuss holding Prostate Events.  It was also agreed any data on or outcomes from the Prostate Review would be sent to the Committee Clerk and be put on a future agenda for information.