NHS England has finally ordered a major shake-up of paediatric cancer services in London after a long-running battle which saw national cancer director Cally Palmer accused of being ‘hugely conflicted’ because of her dual role as the chief executive of the trust at the centre of the storm.
The national commissioner today issued its response to a review of children’s cancer services in London by Sir Mike Richards, and said the existing arrangements were not sufficient.
Sir Mike’s review, delivered just before the pandemic hit last year, recommended all children’s cancer principal treatment centres should be co-located with paediatric intensive care units. NHS England today confirmed this would be mandated, with “no exceptions or special arrangements permitted”.
The move means NHS England London will now have to lead, consult on and implement significant changes to the way these highly specialised services are run.
In a letter to Sir Mike, the national head of specialised services for NHSE John Stewart said: “Neither University College London Hospital (a joint principal treatment centre with Great Ormond Street Hospital) or the Royal Marsden Hospital (a joint PTC with St George’s Hospital) have co-located level three paediatric critical care”. This means that acutely ill patients sometime have to be transferred to other hospitals.
An earlier review into children’s cancer care in the capital by Professor Mike Stevens took place in 2015 after a spate of child deaths and a warning from coroners over the arrangements for paediatric cancer patients looked after the Royal Marsden and other south west London providers.
It too highlighted shortcomings in children’s cancer services for south London and south east England, which centre on the Royal Marsden Foundation Trust’s Sutton hospital.
However, NHS England London’s former medical director Andy Mitchell told HSJ two years ago that the report was subjected to a “process of bureaucratic burial”.
He claimed he was prevented from reforming paediatric cancer services in the capital because of a “pervasive influence from the top of NHS England”, and that Dame Cally Palmer’s dual role as national cancer director at NHSE and as chief executive of the Royal Marsden meant she was “hugely conflicted”.
Eventually Dr Mitchell was told the issues would be taken forward by NHSE’s national cancer taskforce, but after more than three years key elements of the model which were criticised remain largely unchanged.
At the time of Dr Mitchell’s revelations, a spokesperson for the Royal Marsden said the trust had “robust data to demonstrate that [its] clinical outcomes [for children] are equal to or better than the national average”.
Howver, the Royal Marsden has now finally agreed to re-design its service and admitted that the changes would effectively mean the end of its children’s centre at Sutton.
A spokesperson for the FT said: “The Royal Marsden is incredibly proud of the outstanding and safe treatment and care we provide for children with cancer and their families, and our practice-changing research we undertake with the Institute of Cancer Research, London, to improve the outcomes for children with cancer globally.
“We recognise that NHS England’s new specifications are designed to pave the way for a new, future-facing service when there will be greater emphasis on having paediatric intensive care on site. Unfortunately it is not viable for us or the NHS to build and commission a paediatric intensive care unit at The Royal Marsden.
“Our priority now is our professional duty to share our expertise for the benefit of children with cancer and their families by helping ensure the new service is of the highest possible quality and ensuring a smooth and timely transition for our staff and patients.”
The trust did not rule out re-locating services to St George’s University Hospital, which does have a level three paediatric intensive care unit.
Paediatricians at St George’s told Sir Mike in his review that they believed co-locating the PICU and children’s cancer services was the right thing to do even if that meant their trust no longer provided the services.
The service could also be re-located to Evelina Children’s Hospital, part of Guy’s and St Thomas’ Foundation Trust.
HSJ understands both units would want to run the service, with a GSTT bid also including King’s College Hospital because the Evelina does not have paediatric neurosurgery services. St George’s is understood to lack the tertiary cardiology services but does have all the other paediatric specialties, but on a smaller scale than its northern neighbour.
In north London the situation is less clear with PICUs at St Mary’s, part of Imperial College Healthcare Trust, The Royal Brompton, now part of GSTT, The Royal London, part of Barts Health Trust, and Great Ormond Street Hospital.
The latter had previously wanted to provide an all-London service but some sources in the capital said it would not have the room to do this for children’s cancer.
NHS England London said a final decision on service change could come in late 2022 or early 2023, with an “aim to have a clear proposal” by April or May” next year. No date was given on when changes would be implemented, which will be at least 14 years after the first incident.
UCLH, St George’s and Great Ormond Street have been approached for comment.
A spokesman fot GSTT said: ”We welcome the publication of these new national specifications which seek to ensure that future generations of children can continue to access world-leading cancer treatment, building on the excellent services we already have in London.
”NHS organisations in south London already work very closely together to ensure that children receive the best possible care, with the right level of specialist support, and we look forward to continuing to work collaboratively with our partners as we develop this new model.”
NHS England London medical director Vin Diwakar said: ”As a paediatrician myself, I know that when a child is ill with cancer it’s an unimaginably stressful time - we will be working closely with families and clinicians across London to make sure we implement any changes together, taking their views into account.”
A St George’s spokesperson said: “St George’s is proud of the comprehensive and outstanding care for children with cancer it has delivered with the Royal Marsden for over 20 years.
“With significant advances in NHS cancer treatments, we welcome this new national standard and we will continue to work with our partners to develop a model that will provide the best possible outcomes for children with cancer.”
This story was updated at 9.47am on Friday November 12th after NHS England London provided a comment and timetable for when changes would be consulted on
It was updated to include St George’s comment on Monday November 15th at 12.17pm.
- BARTS HEALTH TRUST
- Board Talk/governance/assurance
- Dame Cally Palmer
- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
- GUY'S AND ST THOMAS' NHS FOUNDATION TRUST
- IMPERIAL COLLEGE HEALTHCARE NHS TRUST
- Patient safety
- St George’s University Hospitals NHS Foundation Trust
- THE ROYAL MARSDEN NHS FOUNDATION TRUST
- UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST