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Cancer uptick

Amid the difficulties of accident and emergency and the ticking timebomb of avoidable patient harm from deprioritised elective procedures, London has quite a good story to tell on cancer.

Two years ago, the capital’s clinical commissioning groups were among the worst performing in the country on the 62 day cancer target.

Of the 20 worst performing, six were in London – twice as many as you would expect. All but one of the six were in the north central and north east London patch overseen by London Cancer (one of the cancer alliances). The areas in question were a mix of deprived inner east London, poor GP access outer east London and no obvious excuse outer north central London.

Skip two years ahead to quarter two 2017-18 and none of those CCGs are in the bottom 20.

All saw big improvements in performance in the latest data (they’re all still missing it but often only just, against a national picture that has worsened considerably).

UCLH Cancer Collaborative (successor to London Cancer) said the improvements in Barking and Dagenham and Havering CCGs were the result of sustained work, and this is often about getting providers to work better with one another on referrals.

It is a cancer performance truism that for years the referral process has operated poorly, with disagreements on which organisation will bear responsibility for the patient with a missed 62 day target. In the capital, this often manifests as a dispute between the outer London district general hospital swamped with work and late referrals from primary care, or the inner London specialist swamped with complex cases and late referrals from outer London DGHs.

The argument over who was to blame seemed to obscure the question of how to make sure the breach didn’t happen at all.

So, credit to the providers concerned and the managers that made the improvement happen in north and east London.

It is not clear what has happened to Lewisham CCG’s performance over this period though, with performance declining steadily to 67 per cent over the past 10 quarters, earning it a place in the bottom 20 nationally. Only it and Bexley represent the capital in this group, and Bexley’s decline was not as steep as Lewisham’s.

Certainly, Lewisham’s position is not expected to improve in 2017-18 as Guy’s and St Thomas’ Foundation Trust, the specialist centre, isn’t planning on doing the work to hit the performance target.

Fundamentally, Lewisham and Greenwich Trust lacks diagnostic capacity and the CCG is looking at buying this direct from the private sector.

While we’re talking about cancer and London, one of the intractable configuration issues in another part of the capital could be a step closer to being solved.

The planned, single, replacement for Epsom Hospital and St Helier Hospital in south west London is a bigger issue than just cancer.

But there is a small possibility that if it gets approved (public consultation could happen this year, after 15 years of effort) and built in Sutton, the St George’s/Royal Marsden head and neck cancer conundrum might get solved.

At the moment, the same team of oncologists for south west and north west London is served by specialist surgeons at both hospitals. Managers would prefer to see those centres combined in one place – it would be safer, and head and neck cancer surgery is one of the more dramatic surgeries.

But there is, of course, no consensus on where that one centre should be.

Perhaps the rebuilt Epsom and St Helier site could, working with the Marsden’s existing base in the borough, combine all the surgeons?

Estates update

There should soon be news on the new, hopefully improved case for redevelopment in north west London.

Readers will remember the Shaping a Healthier Future plan for the sector being knocked back by NHS Improvement last year after its projections for the amount of work that could be carried out in the community were deemed unrealistic.

NWL was due to have come up with some updated figures this week and while these are not yet known it seems a couple of options are possible.

  1. NWL provides evidence their original plan will do what they said it would do;
  2. NWL lowers the benefits estimate and this lowered ambition is nonetheless considered a worthwhile investment; or
  3. NWL lowers the benefits estimate and this lowered ambition is no longer considered a worthwhile investment.

If option three were to happen, the SaHF plan would be left in a sort of limbo. Its supporters could point to some successes in downgrading Central Middlesex Hospital’s emergency department but the plan to turn Ealing Hospital from a proper DGH into a far less acute health campus would be left high and dry.

There is a lot brewing on the London NHS property scene over the next year and it’s not impossible that plans to develop sites at Lewisham and King’s take precedence instead.

A large part of central capital funding depends on the local NHS earning some money itself from capital receipts.

So, disruption to STP plans from NHS Property Services limiting selloff possibilities and uncertainty around Project Oriel (moving Moorfields to St Pancras) could see less in the pot for London overall.