Consultation on Future of very specialist Children’s Cancer services in South London and part of SE England

1. This is the response from Merton Liberal Democrats to the Consultation from NHS England on the future of very specialist children cancer services currently provided by the Royal Marsden Hospital and St George’s Hospital.

2. The consultation has come about after a Report from NHS England by Professor Sir Mike Richards that specialist children cancer services should only be offered on sites which also have a paediatric intensive care unit. This means that services have to move away from the Royal Marsden and two groups have proposed to take over the services:

• Evelina London Children’s Hospital in Lambeth, South East London, run by Guy’s and St Thomas’ NHS Foundation Trust
• St George’s Hospital, in Tooting, South West London, run by St George’s University Hospitals NHS Foundation Trust.

The NHS is recommending that the service be transferred to the Evelina but the decision is up for consultation.  It is important that there is no scare mongering in such an important area: either option will give Merton’s children a good, safe, local service. 

3. Our approach has been to place a very high importance on the views of the independent experts who have made these recommendations while coming to our own conclusions. Cllr Gould and Cllr McGrath have visited both hospitals and we are grateful to their staff and those of NHS England who gave up their time to talk to us.  We have also attended the consultation meetings and of course read the extensive documents which have been produced.   

4. While we think that both hospitals have put forward excellent and persuasive cases, we believe that the case from St George’s is stronger and that the marking scheme for NHS England does not give enough weight to the challenges of change. The comparison is between what might happen at the Evelina with what does (to some extent) happen at St George’s. An example of this is the evaluation factor for “Transition: supporting children to make the move to teenage and young adult cancer services when they are ready.” The Evelina scores highly for this as their proposals exceeded the service specification while St George’s met the specification. But St George’s currently do actually carry out (in connection with the Royal Marsden) this activity. The Royal Marsden is set to continue to provide cancer care for those aged 16 and above whichever hospital is chosen. The evaluation does not weigh for the fact that this is a service already being conducted, compared to a theoretical provision.

5. Whichever hospital is chosen, the move from the Royal Marsden will involve very substantial change. It is not clear how many of the 170 staff involved in this area at the Royal Marsden will relocate: either option will mean that many staff who currently travel to work by car will need to use public transport and there is a risk that a significant number will not wish to do so.  NHS England have rightly said that cost should not be a factor in making the decision but one advantage of the St George's bid is that it is cheaper - releasing more money to be spent elsewhere on patient care. We also note that one of the key points made by parents is that many children travel to their hospital appointments by car (as they are often  immuno-suppressed) and it is easier from most of the catchment area to get to St George's. There are also a large number of research projects underway at the Royal Marsden which need to be able to continue which would appear to be easier at St George’s.   

6.  We believe that any change of this magnitude will involve a substantial degree of risk, particularly in the initial stages. Given that the scoring differences between the two options are fairly low we believe that the option that reduces the amount of this risk should be chosen, and given the close relationship already between the Royal Marsden and St George’s we believe that to be St George’s.  We were very struck when we visited St George’s by the strength of their partnership with the Royal Marsden and  their work with children with cancer. For example, the paediatric ICU at St George’s has more cancer cases than any other hospital in England apart from Cambridge: we cannot see that the case for the Evelina is strong enough to overrule factors like this. We also have significant concerns as we understand that Evelina does not provide cancer neurosurgery and would rely on surgeons from St George’s travelling to the Evelina hospital to conduct these services

7. Both proposals have strong points and we would urge that whichever hospital is selected they work with the other to ensure that the best ideas are shared and the final result is a service which builds on the strengths of both proposals.