Agenda item
UROLOGICAL CANCER SERVICES
Minutes:
Cllr Vaughan asked the officers from London Cancer to offer the Committee a
brief presentation before the Committee offers its questions.
The key points of the presentation given by John Hines were:
· Currently, outcomes for patients are poor when compared with other
European countries and the centralised model proposed will improve
this.
· The new centralised centres will provide care for the most complex
surgery.
· It is recommended that UCLH hosts the bladder and prostate centre
and the Royal Free London to host the renal centre
Kathy Pritchard-Jones (KPJ) followed on from Mr Hines by explaining that a
memorandum of understanding had been in place for two years that outlined
the partnership working that the organisations would commit to and it was
emphasised that a great deal of work had gone into the planning of the
changes.
Two bids had been received for the renal centre, with the unsuccessful bid
coming from Barts Health Trust (BHT). Both bids were very strong and careful
weighing up of the bids drew the conclusion of the Royal Free offering a
marginally better bid.
Neil Kennett-Brown (NKB) added that the main issues to the proposals related
to:
1. Travel
2. Patient choice
In regards to travel, it was explained that plans are being made to mitigate the
impact of travelling further and there would be support. In regards to patient
choice it was stressed that the new centres would only be for short stays and
the bulk of the treatment would still take place in local centres.
Cllr Vaughan thanked the officers for their presentations and asked members
to offer their questions.
Q What changes will occur in regards to the Homerton site?
A The Homerton will remain a site for local treatment but no specialist
treatment is planned there.
Q The statistical information in the reports pack only goes back as far as
2009, is there information on trends of patient numbers that can inform
usage going beyond this date?
A (KPJ) This data is available but largely the numbers show only small
variations and remain similar.
Q In regards to accessibility, why was the Royal Free site chosen when it is
much more inconvenient to reach than Barts?
A (KPJ) Two expressions of interest were submitted (Royal Free and Barts)
and these bids were carefully analysed and the Royal Free was slightly
stronger. In regards to the pelvic centre there was only one bid and this
was from UCLH.
Q Will a significant amount of investment be required at the Royal Free,
particularly in light of large investment already being given to BHT to
develop cancer services?
A (KPJ) Yes, a significant amount of investment will be needed but this
would be the case at any successful centre. Gillian Smith (GS) added that
investment at Royal Free will indeed be needed and plans to mitigate
travel issues will be put in place. KPJ concluded that the decision was
clinically led and although Barts had a strong bid it was the right choice to
go with the Royal Free option. Steve Ryan (SR) explained that BHT was
disappointed with the decision but explained that BHT is fully supportive
of the decision and will work in collaboration to make sure that the issues
such as transportation are got right.
Q Can the officers explain what the differences actually were in the bids and
why as previously mentioned that Barts Health Trust was not successful?
A (KPJ) It was more a case of being in favour of the Royal Free than rejecting
Barts. In each of the seven domains that are outlined in the reports, the
Royal Free was stronger and the board all agreed on this. GS added that
the Royal Free is already working closely with BHT on the clinical aspects
and looking at more bespoke options for the transportation issues. It is
important to add that the proposals relate to a small amount of patients (1-
2 patients per day) and this means that more creative options can be
sought. GS closed by explaining that the Royal Free was in the process of
tendering for the renal transport services.
Q I understand that UCLH has funded two new clinical specialists to support
their bid. Did this in any way sway the process and can the role of the
specialists be explained?
A (KPJ) No, the clinical experts were in complete agreement at the start
and remain in agreement that wherever the sites are that they are
committed to working at the new centres. Specialists will work half of their
time in local sites and the remainder in the new centres. This will mean
that the volume of patients will increase and so will success rates. It is
important to remember that specialists use their time in a variety of ways
and no surgeon would ever operate five days a week.
(JH) Normally surgeons operate for two days per week and do preoperation
work, teach and undertake research. Surgery is very much
based around a team of skilled clinicians.
Q The issue of transport to the Royal Free is a major issue because it is very
difficult to get to. If this is not resolved how will patients and the public
“buy in to” the new centres?
Follow-up
A (GS) Bespoke options are needed for the Royal Free site and this may
involve taxi services.
Q Taxis may be viable for the patient going to the Royal Free but if family
members are coming from different areas how will it be possible to have
taxis for them too? It is much easier to get to the Barts site.
A In regards to the bids, what weighting was given to patient experience?
Q (KPJ) Patient experience is very important in the bid and both bids were
strong in this area. Leadership of service and patient transport were the
weaker areas in the bids. As stated creative thinking will be needed to
solve the transportation issue and this may involve patients in some
instances using iPads or Skype technology to contact family and friends.
Follow-up
A The bids seem the same therefore does this mean that BHT is weaker in
terms of management?
Q (KPJ) The bids were not the same and BHT is fully committed to the
project.
Questions from the public
Q In the view of officers has sufficient public engagement been given to this
change as there is a view that this change is being undertaken through
the backdoor?
A (KPJ) The process has been led by providers with clinicians being
essential to this process. The public have been involved throughout the
process and since 2011 over one thousand patients have been consulted.
(NKB) Overview and Scrutiny Committees have been consulted and they
will continue to be updated. In both Barking and Dagenham and
Redbridge the Committees were supportive of the proposals. However,
the transport issue must be got right. The Barts site does not have a large
enough population to be a stand alone centre (700,000) as at least a 2m
population is required.
With no more questions, Cllr Vaughan summed up by stating that
transportation remained the main area of concern for the Committee and that
it is a challenge for London Cancer that must be taken seriously. Cllr Vaughan
asked the officers to send information about how this proposed change in
urological cancers will fit in with other changes to cancer services and asked
that to assist the Committee’s forward work programme that any other
changes are sent to the officers in good time to allow adequate planning.
In conclusion, Cllr Vaughan proposed a motion to the Committee whether
it supported the proposal. Cllrs Akehurst, Munn, Jones, Saunders and Pavitt
voted in favour. Cllrs Paul and Sparrowhawk and Common Councilman
Littlechild voted against and the Chair abstained. The vote to accept the
proposal was carried.
Cllr Vaughan closed by thanking members and officers for their attendance
and contribution.
Supporting documents:
- 4. Urological cover_sheet, item 4. PDF 47 KB
- 4a. Urological cancers services, item 4. PDF 252 KB
- 4b. recommendation_making_process, item 4. PDF 558 KB
- 4c. London_Cancer_why_we_need_change_doc_on_urological_cancer, item 4. PDF 804 KB
- 4d. specialist_urological_cancer_centres_the_clinical_evidence, item 4. PDF 497 KB