• NHS England says national cancer director will ‘play no part’ in decisions on new child cancer standards
  • Sir Vince Cable criticises “culture of secrecy” that meant concerns were not discussed openly
  • Doctor who oversaw transfers between Marsden and London hospitals says model “illogical and dangerous”

NHS England has said Cally Palmer, national cancer director and chief executive of the Royal Marsden Foundation Trust, will “play no part” in decisions on new child cancer standards.

The national body made the commitment following revelations by HSJ yesterday that concerns about the Marsden’s south London model of care were “buried” by NHS England, and that Cally Palmer was conflicted because of her dual roles.

NHS England’s former medical director for London Andy Mitchell told HSJ there was a “pervasive influence” at the top of NHS England and he accused Ms Palmer and/or Simon Stevens of being responsible for the blocking of a major 2015 report into the issues.

Sir Vince Cable, leader of the Liberal Democrats, who spoke at the NHS Confederation dinner last night, described the HSJ revelations as “really shocking” and said they exposed “a culture of secrecy which should have no place in a modern healthcare system”.

“The really outrageous aspect of it is that the families who have been left devastated as a result of losing a child are treated with utter contempt,” he said. “Surely, they have a right to know that this service has been heavily criticised several times and that proposals for reform have been ignored. Vested interest and conflict of interest has got in the way of good patient care.”

He called for stronger legal protections for people to be able to speak out about unsafe practice.

Earlier this month, new standards for child cancer services were published for consultation by NHS England. The Children’s Cancer and Leukaemia Group, a professional association for child cancer clinicians, said the proposals had been “softened” during drafting following “feedback from the national cancer team”.

A reference to services needing to be co-located with intensive care - which the Marsden cannot meet - was changed from a “must” requirement to “should”.

The CCLG said the rationale for the change had not been made clear “and needs to be challenged”, adding it “belies the body of evidence that has recognised the clinical importance of co-location of such services”.

In her first personal statement on the revelations, Ms Palmer told HSJ she had not been involved “in the committee” which discussed the 2015 report by Mike Stevens which is central to the concerns, nor made the decision not to publish it. She said she was not on the circulation list for the report, adding: “It is factually incorrect to imply or suggest that I was.”

She said the recent draft specifications for child cancer services were considered by the national cancer team which she leads to ensure they met the 2015 recommendations made by NHSE’s cancer taskforce, but added: “The decision on the specifications was taken by the expert clinical reference group and not by the national cancer team.”

Referring to the Royal Marsden services, she said: ”These have been assessed as safe and of high quality by the CQC and other regulators.”

An NHS England spokesman said: “Clinical opinion is clearly divided on this question and that is why we have launched this consultation.

“While it is right that as national cancer director and chief executive of the Royal Marsden, Cally Palmer’s national team comments on these specifications, she will play no part in decision-making at the conclusion of the consultation.”

‘Illogical and dangerous’

One clinician who worked for retrieval teams handling the transfer of children between the Royal Marsden’s Sutton site and other south London hospitals told HSJ the model of transferring children for intensive care was ”illogical and dangerous”.

The doctor, who contacted HSJ yesterday, said they were “genuinely surprised” by the model and, speaking on condition of anonymity, added: “Patients that would be managed to a high dependency level in other centres required transfer to St George’s.

“They are an isolated site. There is no support from critical care on site and this requires moving the patient which is in itself an inherent risk. They could deteriorate en route and also it’s at the behest of a transport service that may be out on other jobs.”

The doctor added: “There are children at the Marsden who were moved to SGH who I am certain would not have been admitted to critical care in other children’s centres. This was because there is no back up [at the Marsden Sutton site]… No ability to escalate care. There are also children who become critically ill as a result of their treatment.

“The set-up of an offsite, stand-alone oncology centre raises many eyebrows in the ICU world. It is an inherent risk that requires some transfers of children that would never be undertaken in other centres as well as moving critically ill children with a high mortality in the back of an ambulance to another hospital. To me, it is both illogical and dangerous.”