Agenda item

Details of a consultation on cancer services across London.

Presentation by representative from UCL

The Board received a report entitled Improving Specialist Cancer and Cardiovascular Services in North and East London and West Essex produced by the North and East London Commissioning Support Unit. The report was presented by Professor Kathy Pritchard-Jones, Chief Medical Officer, London Cancer Academic Health Science Network. Neil Kennett-Brown, London Cancer and the Programme Director, NHS England was also in attendance to offer additional comments.

This report was presented as part of a wide consultation about configuration of cancer services and members of the Board were asked to note the following:

North and East London have expert cancer and cardiovascular doctors but these specialist services were not organised in a way that gave patients the best outcomes with specialists, technology and research being spread across too many hospitals. Evidence gathered by the London Cancer Academic Health Science Network suggested that focused specialist centres would lead to better outcomes. With 15 different pathways in London, a London wide review was underway. Formal engagement, if appropriate, would commence at the beginning of 2014 with NHS England and the CCGs to make decisions by mid-2014.

Cancer

Clinicians had reviewed specialist services for five rare or complex types of cancer:

Brain cancer

Head and neck cancer

Urological cancer (bladder, prostate and kidney)

Blood cancer (treatment of acute myeloid leukaemia and stem cell transplants)

Oesophago-Gastric cancer (stomach or gullet cancer)

The proposal was to create an integrated system of care. It was outlined that there would be a small amount of change within BHRUT as Queens Hospital had provided a range of cancer services for some years, however, it was envisaged that there would be a 3% decrease in Upper Gastro-Intestinal Bladder and Prostrate and Renal activities.

Professor Pritchard-Jones advised Board members that London cancer patients did not always report good experiences with their care and that specialist teams were fragmented and unable to provide a 7 day service. Specialist centres would work with local hospitals and GPs to improve the patient journey and follow up care and would also attract innovation and investment for research as well as attracting the best trainees.  Patients would have a better chance of survival, quicker recovery and better quality of life, support from specialist care teams, joined up sustainable 24/7 care and more access to clinical trials with access to the latest treatments. Local services would be more robust and resilient as part of a system,  with access to 24/7 specialist teams, better support to introduce innovation and clinical trials, better training opportunities and more precise outcomes, measurement and benchmarking.

Cardiovascular

A similar review was underway for Cardiovascular services due to patients waiting too long for treatment, surgery cancellations and hospitals unable to deliver 24/7 care by specialist teams.

It was proposed to create a world class integrated Cardiovascular Centre and develop a joined up network of care covering prevention and earlier diagnosis through to treatment of which a majority would be provided closer to people’s homes. Patients would have improved experience and outcomes, prompt access to treatment and state of the art equipment, specialist 24/7 care as well as shorter waiting times.

A period of engagement with the public to discuss the above proposals was currently underway.  A number of public meetings had been arranged within the inner and greater London areas to obtain feedback and further engagement with Public Health authorities was planned.

Members of the Board raised concerns about the following:

·                At times it was not clear that the exercise was actually a consultation and not the presentation of a decision that had already been made.

·                The demographic changes within the borough in terms of overall population size and the aging population should be considered in future planning of services. The centralisation of services to London did not make good sense when looking at future population growth across London. 

·                Survival rates were presented and the proposals aimed at improving survival rates. As survival rates reflect both quality of care and early diagnosis, the need to address lower survival rates without working out how much those rates relate to late diagnosis was not a robust argument.

·                The impact of patients having to travel into London to UCL should be assessed as this could have an effect on overall outcomes. This would also have an impact on the elderly, the poor and those who need family support.

·                Quality of care is a key factor in decision making about what services configuration is likely to be best and this was not brought out fully in the report. Some of the relevant units in BHRUT have higher quality indicators on a range of measurements than the same units in UCL. It was noted though that there was no standardisation of quality indicators so it was difficult to draw conclusions on quality.

·                Why were cancers with the minimum number of cases being centralised?

·                It was not clear to what extent consultants agreed with these the proposals.

·                Overall there appeared to be a lack of ambition for outer London with specialism being concentrated in inner London hospitals. This has been the pattern for many years and could become a self-fulfilling prophecy.

Professor Pritchard-Jones thanked the Board for their comments and said that their concerns would be noted.

The Chairman thanked both Professor Pritchard-Jones and Neil Kennett-Brown for a frank and open discussion.