• Report recommends reconfiguring children’s services in south London
  • Follows HSJ investigation revealing safety and experience problems with model
  • Commissioners have six months to decide on future of Royal Marsden services
  • Other London hospitals could host children’s services currently offered at trust’s Sutton site

Children’s cancer services in south London are to be reconfigured after a new review confirmed they represented an “inherent geographical risk to patient safety” — following HSJ revelations last year of how serious concerns had been “buried” by senior leaders.

Sir Mike Richards’ independent review was commissioned after HSJ revealed a 2015 report linking fragmented London services to poor quality care had not been addressed, and clinicians were facing pressure to soften recommendations which would have required them to change.

The review, published in conjunction with Thursday’s NHS England board meeting, recommended services at two sites should be redesigned as soon as possible to improve patient experience.

Regional commissioners have been asked to choose between three options for services currently split across the Royal Marsden Foundation Trust’s Sutton site, and St George’s University Hospital, by June.

Under the current model, deteriorating patients at the Royal Marsden’s Sutton site are shuttled eight miles away to St George’s University Hospital FT, if they need access to a paediatric intensive care unit — then, at the latter, they do not have proper access to their cancer specialists.

The two sites operate a joint principal treatment centre for children with cancer in Kent, Surrey and Sussex. The Royal Marsden site offers services including radiotherapy, but does not have its own emergency department, PICU or high dependency unit for children. 

The three new proposed options are:

  • A single site principal treatment centre at Evelina London Children’s Hospital, which is part of Guys’ and St Thomas’s FT. This site could host “Royal Marsden@” services;
  • Services remain at Royal Marsden in Sutton, only if a possible adjacent relocation of Epsom and St Helier district general hospital could viably host a children’s hospital. This option is considered “unlikely”; and
  • A single site principal treatment centre at St George’s, again possibly hosting Royal Marsden@ services.

The Royal Marsden site should receive a temporary derogation from colocation while the options are considered, the report said.

Sir Mike wrote in his new report: “I recognise that my recommendations have implications for some services and, in particular, for services provided at the Royal Marsden and St George’s.

“The services provided at the Royal Marsden site in Sutton are highly regarded, but the joint [principal treatment centre] arrangements, and crucially the lack of a colocated level 3 [paediatric intensive care unit] presents an inherent geographical risk to patient safety. This risk can only ever be partially mitigated.

“Separation of services impacts significantly adversely on patient experience and places an additional burden on staff as well as being inefficient and costly.”

Sir Mike added: “The main weight of clinical expertise and support is located at RMH, while the sickest patients are largely at St George’s.

“This means that oncologists who are in charge of a patient’s care are not always readily available when difficult decisions and conversations are needed.” The current configuration, he said, “should not continue longer than necessary”.

Sir Mike recommended making the colocation of children’s principal treatment centres with PICUs and other children’s services mandatory, except when treatments carry an extremely low risk of PICU admission. Services operated between Great Ormond Street Hospital FT and University College London Hospital FT, for example, could continue without colocation, the report said. Services at the sites, which are 1.3 miles apart, are configured with the risk of PICU admission in mind, it explained.

Royal Marsden medical director Nicholas van As said: “The Royal Marsden in Sutton ensures that children and young people with cancer receive the very best treatment and care, including access to clinical trials to improve survival, expertise in oncology, and modern, age-appropriate facilities. 

“If the NHS now wishes to commission and fund a different model of service for children and young people, it should demonstrate that any proposed changes will provide a better service for children with cancer and their families.

“We believe that a proposal which retains The Royal Marsden’s cancer expertise and life-saving research in Sutton will continue to provide the best clinical outcomes and patient experience.”

Concerns were raised in HSJ last year about the role of Marsden chief executive Cally Palmer, now Dame Cally, who is also NHSE’s national director for cancer, in influencing decision making to keep services in Sutton. NHSE said in June, after HSJ’s pieces, that she would not be involved in the decision making about the issue.