Agenda item
Improving specialist cancer and cardiovascular services in north and east London and west Essex - Consultation on case for change
Minutes:
8.1 The Chair welcomed the following senior officers to the meeting:
Neil Kennett-Brown, NHS England
John Hines, London Cancer
David Fish, UCL Partners
Muntzer Mughal, UCL Hospitals/London Cancer
Ben O’Brien, Barts Health/UCL Partners
Hilary Ross, UCL Partners
8.2 Mr Kennett-Brown thanked the Chairman, and informed the JHOSC that early engagement to gather feedback on the proposals for improvements to specialist services showed strong support. A leaflet and public events campaign had begun on 28 October and would conclude on 4 December.
8.3 Mr Mughal, from UCL Hospitals and London Cancer, outlined the vision for a world class cancer service with an advanced computer system and the latest treatments. He informed Members that survival rates and patient experience was poor in this part of London, which was a major driver to change and strengthen services. Five centres were proposed for five rare types of cancer: brain, head and neck, urological (bladder, prostate and kidney), acute myeloid leukaemia and oesophago-gastric (upper GI). Focus would be on giving patients access to the best specialist care and to the latest treatments and clinical trials, improving patient experience and holistic care, and utilising the research opportunities.
8.4 Mr O’Brien, from Barts Health and UCL Partners, spoke about the cardiovascular proposals. Although the new building was an enabling factor, the high a number of deaths from cardiovascular illnesses was the real driver for change. Recent innovations in treatment were now being offered, but there was still a high number of cancellations due to organisational issues.
8.5 The proposal would see specialist cardiovascular services currently offered by both University College London Hospital (UCLH) NHS Foundation Trust and Barts Health NHS Trust come together in a single centre for excellence at St Bartholomew’s Hospital in late 2014. Services provided at the London Chest Hospital and The Heart Hospital would join the new site, but care would extend beyond the three centres to create an integrated system felt in the community. Academic forces would be linked to ultimately create one centre of excellence that could compete with the world’s academic power houses.
8.6 In closing, Mr Kennett-Brown returned to the feedback from the on-going engagement exercise. Support had been received from Clinical Commissioning Groups (CCGs), although the Outer North East London Joint Health and Scrutiny Overview Committee had voiced concerns regarding prostate cancer and the future of oesophago-gastric cancer moving from two to one centre. Travel and access were also important issues, with patients prepared to travel further for better outcomes and the UCLH committing to specific access arrangements (i.e. requesting additional disabled parking bays).
8.7 Wendy Mead opened the questioning by asking officers why UCLH had been selected over Barts to provide specialist treatment for head and neck cancer, despite the latter treating more patients in 2012/13?
8.8 Mr Fish, from UCL Partners, responded that the lead for head and neck cancer was an employee from Barts who supported the selection of UCLH. The hospital could offer strong infrastructural support, including the UCLA Ear, Nose and Throat hospital and Postgrad Dental Institute. In addition this was a nationally funded site to develop proton beam therapy, and a support was available from neuro-surgery and neuro-oncology surgery.
8.9 Wendy Mead queried the robustness of communications planned between the various hospitals and sites?
8.10 Mr Fish agreed that communications throughout the NHS were inadequate, but advised that having fewer specialist sites would reduce communication difficulty as the complexity of interaction would also be reduced. He assured Members that investment in informatics could link providers of care across the partnership; although the current baseline for communications was low, it was a priority for improvement.
8.11 Wendy Mead followed up her question, querying how reducing the number of sites would improve patient experience outside of their home territory, which was largely where problems arose?
8.12 Mr O’Brien replied that wider networking between colleagues would be facilitated to enable better working relationships and improve communication. Patient pathways would be integrated the entire way, to ensure patient experience was consistent and staff communication was continuous.
8.13 Mr Hines, from London Cancer, advised Members that Officers were familiar with the difficulties in moving patients around the system and that it would be easier with fewer places. Doctors and specialists would split their time between the centre and peripheral hospitals to improve communication and patient care, and investments into informatics would ensure GPs were updated at every step of a patient’s treatment.
8.14 With particular reference to prostate cancer, the Chairman asked whether it was wise to proceed with the one centre approach when there were concerns over travelling for treatment.
8.15 Mr Kennet-Brown advised that all proposals were being evaluated, including single and multi-site options. There was no evidence to show that the current urology service at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRT) was poor, but the aspiration was to become world class, which was why a review was being carried out. Mr Kennet-Brown informed Members that he would be sharing the outcomes of this review with the ONEL JHOSC.
8.16 Mr Hines added to this, stating that statistics showed surgeons who performed complex surgeries on a regular basis achieved better survival outcomes and the complication rate for robotic surgery was halved. Cancer survival statistics for UCLH were comparable to large American centres (which were consistently successful), and it was therefore justifiable from a clinical standpoint that operations should be held centrally with high level surgeons and high level technology. Mr Hines pointed out that patients in North East London have been travelling to the centre for treatment since 2005, though patients coming from outer London would need more consideration.
8.17 Councillor Munn asked whether follow up care for cardiovascular treatments would be carried out locally.
8.18 Mr O’Brien responded that there was a wide spectrum of cardiovascular diseases; lesser illnesses would be followed up locally, whilst more complex ones would be treated at the centre. Ms Ross, from UCL Partners, added that staff would be rotated between the centre and peripheral hospitals to ensure a cross site approach for the patient and to establish a robust relationship with outlying hospitals for discharges.
8.19 With regards to consultation on patient experience, Councillor Paul asked how softer issues would be addressed in the future.
8.20 Mr Kennet-Brown replied that listening to people was an evaluation criterion, and would be measured through the changes made as a result of feedback received. The ‘hub and spokes’ model for the centre allowed for an exchange of ideas and information to ensure all hospitals benefitted.
8.21 Councillor Saunders congratulated officers on their aspiration to create a world class centre for excellence, and queried whether this would mean an increase in private practise and smaller waiting lists?
8.22 In response Mr Kennet-Brown reported that an increase in private patients would not be detrimental as the income from their treatments would be used to improve the site. He advised Members that the aim was to attract more people in to using the centre through achieving an encouraging reputation.
8.23 Councillor Edgar asked what the long term implications were.
8.24 Mr Fish stated that the centre would be held to account permanently by the treatment outcome in the wider population rather than just the results from inside the hospital. Ms Ross advised Members that the current cardiovascular provision was rated excellent, and that twelve Transformation Leaders had been appointed to bring teams together in order to understand what is needed from the new service provision.
8.25 The Chairman allowed a question from the floor: Mr Michael Vidal (Board Member, HealthWatch Hackney) asked whether there had been discussions about the proposals with Monitor?
8.26 Mr Fish responded that there had been discussions with the relevant agencies and this included Monitor.
8.27 The Chairman thanked the officers for their report, and it was agreed that discussions would continue regarding Members’ concerns over the proposals. Mr Kennet-Brown advised the JHOSC that he planned to meet with the Chairmen of the 3 JHOSCs to share and discuss outcomes after 29 November 2013.
Supporting documents:
- 8_covers_sheet_-_cancer_and_cardio_item, item 8. PDF 41 KB
- 8a__NHSE_NCE_London_briefing_on_cancer_and_cardiac_proposals, item 8. PDF 220 KB
- 8b Cancer and cardiovascular services slides, item 8. PDF 597 KB
- 8c_Cancer_and_Cardio_JHOSC_request_from_NHSE_to_Cllr_Vaughan_25_Oct_2013, item 8. PDF 99 KB
- 8d_Cancer_and_Cardio_Case_for_Change_Doc_Oct_2013, item 8. PDF 4 MB