Children’s Cancer Care: South-East

Stephen Hammond Excerpts

Wednesday 13th March 2024 Westminster Hall

[Munira Wilson]

To pick up where we left off, before we look at the evidence and arguments for keeping this precious service at St George’s, I want to raise the serious questions that have been highlighted around the decision-making process that has brought us to this point. NHS England first publicly expressed its preference for the Evelina proposal at the start of last year, long before it had even launched its public consultation. This has raised concerns that NHS England has created a process in which the views of patients, clinicians and patients’ families have not been seriously listened to and taken into account.

[Stephen Hammond (Wimbledon) (Con)]

The hon. Lady is quite right. I congratulate her on this debate. I have spoken to the Department and NHS England about the process, as there have been real concerns about the scoring and whether that has been based on evidence or preference. There is also real concern that clinical outcomes are not being given quite the highest priority they should be, which will be key if we are looking at the cancer survival rates for young children.

[Munira Wilson]

Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.

In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?

Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.

Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.

Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”

Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?

The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:

“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”

The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.

Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.

I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.

--- Later in debate ---

[Elliot Colburn (Carshalton and Wallington) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing this debate. As a constituency MP and chair of the all-party parliamentary group on cancer, I am particularly pleased to take part in today’s debate, and I absolutely agree with what has been said so far. Like the hon. Members for Twickenham and for Richmond Park (Sarah Olney) and the right hon. Member for Kingston and Surbiton (Ed Davey), my hon. Friend the Member for Sutton and Cheam (Paul Scully) and I have also written to the Secretary of State requesting that this decision be called in.

I do not want to repeat much of what has already been said, as many other hon. Members wish to speak, but I want to emphasise a few points, particularly the fact that paediatric cancer is incredibly rare and that treating it is a highly specialised service that the NHS provides. I understand that the NHS is concerned about co-locating the deliverables of that care on one site, but as has already been pointed out, and as St George’s keeps saying, that hospital is standing ready to be able to do that. St George’s is investing a lot into its campus, as is the University of London. St George’s stands ready to provide what parents are asking for, and it has 25 years of specialist experience, alongside the Royal Marsden, to do so. Therefore, it would be a mistake to take the decision to move the children’s cancer service to the Evelina.

Like the hon. Member for Twickenham, I am confident that the Evelina is a fantastic hospital with amazing staff and that it does amazing work, but this is about clinical deliverables.

[Stephen Hammond]

My hon. Friend is right: the Evelina is a great hospital. The other point about St George’s is that it not only has a specialism in paediatric cancer; it also has a wider specialism in neonatal and paediatric services. There is a concern that those would be lost if the co-location was based at the Evelina.

[Elliot Colburn]

My hon. Friend is absolutely right. That is a key concern, which is precisely why we want to avoid that happening.

It is also worth stating that St George’s does not just have 25 years of experience. The data really does speak for itself. It has been rated outstanding by the Care Quality Commission for delivering cancer services for children. St George’s proposal is to consolidate the primary treatment centre on to the St George’s site in a new state-of-the-art children’s cancer wing, delivering outstanding facilities to match the outstanding care already provided. The services that matter most for children with cancer are already available at St George’s. For some 80% of children with cancer, St George’s campus can already provide or is poised to provide key treatments that the Evelina will have to take time to develop.

Through its experience and expertise, St George’s can already deliver what parents say they want. The hospital is reliant on that experience and incredibly rare expertise. Only about 20 paediatric oncology surgeons with that uncommon skill are registered in the UK, and three of them are already at St George’s. Parents have consistently said they would prefer the children’s cancer centre to be outside the city centre, with better parking provision; again, that is something that St George’s is already able to provide. We do not need to wax lyrical about how awful the traffic is in central London—we say that every day anyway as we try to get into work.

Consolidating the children’s cancer services at St George’s will be easier and less costly for the NHS to deliver. A large part of the service is already there and the existing non-clinical space can, at relative speed, be transformed into a new state-of-the-art cancer centre. But beyond the financial impact of the individual institution we are talking about, there will be wider costs to the NHS as a whole if it is relocated. St George’s has estimated those costs to be around £2.5 million in the first year alone if the service is moved. That could have an impact on other children’s services, and indeed wider services, that are at St George’s at the moment.

Children’s cancer is distressing, but it is also, from a clinical perspective, not neat or stand-alone and addressing it requires incredible skill. The expert staff supporting these children could end up leaving St George’s Hospital and that would weaken the multidisciplinary teams who are there.

Now, with the increasing investment in the campus—with City, University of London, and St George’s, University of London, having agreed to merge and develop ambitious plans for the campus—the opportunities are stronger still. That is not to mention the expansion of the Institute of Cancer Research in the London Borough of Sutton, which we are so excited to see, and the development of a new acute facility. We have the ability to turn south-west London into a world-leading hub for cancer services, beating the United States in a sense. This is incredible news; we need to be grasping this opportunity, so taking the service away would be a huge mistake.

Given all this, I fail to see a compelling reason why the Evelina would provide better care for children in my constituency of Carshalton and Wallington and further afield. Accordingly, I request that the Secretary of State consider using her call-in powers to review the decision on a reconfiguration if that is the decision taken tomorrow.