Your comment on our proposals to relocate upper gastrointestinal cancer surgical services to improve clinical outcomes was very perceptive in setting out the challenges we face.

Two leading upper gastrointestinal surgeons travelled to Cornwall to set out the case for change as the best way of improving clinical outcomes. The proposals have been informed by the national and international evidence, and reinforced by the improvements achieved since centralisation of this surgery in other locations, promoted by the Healthcare Commission and the Royal College of Surgeons.

Advice has also been provided by the national clinical director for centralisation and the national cancer action team. The clinical evidence is unequivocal.

The PCT responded to the very real concerns raised during an engagement process, agreed by the overview and scrutiny committee, with a set of recommendations to ensure patients have clear and effective clinical pathways and their families are supported. The PCT has now been asked by the committee to undertake a further consultation, having dismissed the recommendations from the initial engagement process without debate, and having agreed on two separate occasions that the proposals did not represent a substantial change.

Lack of support

It is disappointing that the committee was unwilling to support the proposals on the basis of the strong clinical case placed before it. We will however now work with the committee to plan further consultation as quickly as possible, recognising that in the meantime patients are being denied the opportunity of the best possible chance of survival and cure.

The PCT strongly believes that the residents of Cornwall and Isles of Scilly have a right to expect the greatest chance of surviving upper gastrointestinal surgery despite the practical factors of living in a rural county and isles where there are significant issues of deprivation and transport challenges. We support this move, recognising that it will mean greater travelling distances for people.

However, we believe the benefit of more people surviving the surgery and living longer is the best we can do for the people we serve.

Ann James, chief executive, Cornwall and Isles of Scilly primary care trust