DH intervention forces cancer rethink

National cancer director Mike Richards "strongly advised" that Cornwall and Isles of Scilly PCT should undertake an urgent review of the upper gastrointestinal service at Royal Cornwall Hospitals trust, to inform its reconfiguration plans.

The PCT wants to centralise the service at Derriford Hospital in Plymouth, in line with the DH's guidance on improving outcomes commissioning.

The guidance recommends centres cover catchment areas of 1-2 million to ensure staff skills and good patient outcomes are maintained. The minimum acceptable population size for sparsely populated areas is 500,000. The Royal Cornwall serves a population of fewer than 400,000.

Patient outcomes

Patient groups argue that the service should not be moved because it would mean long distances for patients to travel and it has good outcomes - 84 per cent survival at one year.

Cornwall and Isles of Scilly PCT chief executive Ann James and Royal Cornwall Hospitals trust chief executive John Watkinson confirmed in a joint statement that Professor Richards had advised the review should take place. The cancer czar's intervention appeared to open the way for the PCT to diverge from the guidance. However, the review by two leading gastrointestinal surgeons, published this week, has concluded that the service at the Royal Cornwall was not sustainable and supported the centralisation.

Ms James said the review would "clarify" what had already been said by the PCT, she said. "We've always recognised the lower volume meant [the Royal Cornwall] would never get the outcomes that are expected now."

Ms James said Professor Richards had made the request because of the delay in completing the centralisation, which was planned for 2007. "Peer review is not unusual but this has clearly been triggered by concern that this has not been implemented."

She said the PCT now planned for similar reviews to be carried out of services at Derriford and at the Royal Devon and Exeter Hospital.

Knock-on effects

Rose Woodward, chair of Cornwall and Isles of Scilly cancer patient group, said loss of upper gastrointestinal cancer surgery from Cornwall would have a knock-on effect for other patient groups because of the skill set of the surgeons.

"Any operation that would involve opening up the chest cavity couldn't be carried out in our own county any more," she said. "Cornwall has specific problems of rurality and deprivation. These are recognised by every other government department except health."

The DH said the final decision on the services was the PCT's. A spokesperson said: "It is our policy that the local NHS decides the priorities for the provision of local health services."