Agenda item

·         Cancer Screening and Diagnostics

·         Service Review at Mount Vernon Cancer Centre

Cancer Screening and Diagnosis

Dr Kathie Binysh, Head of Screening at NHS England (NHSE) and NHS Improvement (NHSI), advised that there were currently three cancer screening programmes running: bowel, breast and cervical.  Concern was expressed that, nationally, there had been a reduction in the number of women participating in cervical screening which was reflected in the local uptake.  In a move to provide improvements to the service and more reliable results, a single laboratory on Euston Road was being established which would provide the new primary HPV screening test for all cervical screening samples in London by March 2020.  100% of GPs in the Borough had signed up for the text service to remind patients to have a cervical smear. 

With regard to breast screening, Hillingdon had performed second worst in the country 25 years ago.  Significant improvements had been made in the interim.

Bowel cancer screening had been introduced in 2015.  A new test (the FIT test) had been introduced from June 2019 which meant that there was no longer any need for three samples to be taken and a 7% increase in coverage was expected as a result.  Hillingdon’s performance with regard to bowel cancer screening was lower than the England average and lower than other outer London boroughs.  There had been historical concerns that the test kits had not been arriving in Hillingdon but this had been addressed when the service transferred to a new provider last year.  It was suggested that consideration be given to enabling patients to order their own tests online for bowel cancer screening.  NHSE was now looking to set ambitious bowel cancer screening targets. 

GPs in Hillingdon would be meeting soon to look at improvements to colorectal (bowel) cancer screening.  Mr Joe Nguyen, Deputy Managing Director at Hillingdon Clinical Commissioning Group (HCCG), advised that a lot of work had already been undertaken with GPs and a patient engagement event in relation to cervical screening had been undertaken with Somali women. 

Hillingdon had been performing well in comparison to the rest of North West London but was below the national average.  Whilst Members acknowledged that the Borough’s performance was adequate, it was clear that there was still more work to do.  Dr Binysh advised that consideration was being given to adopting the text reminder system across the whole of London and national campaigns were being developed to raise awareness.  Thought was also being given to how practices with a low uptake could be targeted and well as how to target those with learning difficulties (LD) or severe mental illness.  A lot of work had already been undertaken to get the message through to those with LD and these would need to be replicated for mental health services.  He noted that HCCG would also be able to help NHSE with ways to increase reach to those with LD.  Consideration could also be given to using Hillingdon Care Partners to help increase uptake.

Dr Stephen Vaughan-Smith, Cancer Lead at Hillingdon Clinical Commissioning Group (HCCG), suggested that the recent increase in the uptake of health checks should help to increase the uptake of the screening programmes.  Ethnic difference would also have an impact on uptake. 

It was noted that sexual health screening had moved to an online model.  This had shown that a proportionate number of older people were using the service. 

Dr Vaughan-Smith advised that Hillingdon Hospital had today issued a press release stating that Hillingdon had been deemed the best in London (and nationally) for the treatment and diagnosis of cancer.  There was, however, still a significant need for improvements. 

Members were advised that there was currently no screening programme for prostate cancer.  Whilst previous tests had produced unreliable results, a new MRI test was thought to be potentially very good but more work was still needed.  Kits were used initially to screen for cancer.  If the kits gave a positive result, or if the individual was symptomatic, they were invited for an endoscopy. 

Mount Vernon Cancer Centre (MVCC) Review

Ms Caroline Blair, Programme Director Renal and Cancer at NHSE, advised that a letter had been sent out from NHSE and NHSI - East of England to stakeholders in April 2019.  A meeting was being held on 13 June 2019 to look at the options available for the site and it was noted that reviews had been undertaken at the Mount Vernon site at various times.  East and North Hertfordshire NHS Trust (ENH), which provided the cancer services at Mount Vernon Hospital, had effectively requested the review of cancer services provided at the site. 

The concerns raised by ENH had been in relation to the estate and facilities on the site.  In addition, there was no ITU / HDU facility on site.  Dr Vaughan-Smith advised that immunotherapy was an expanding area of treatment which meant that there was a growing need to have access to an ITU.  However, repairs had been made when issues had been reported.  It was noted that there had been a growth in referrals and attendance at MVCC. 

Ms Jessamy Kinghorn, Head of Communications and Engagement at NHSE Specialised Services, advised that NHSE had been approached by ENH at the end of March/early April and the review was currently at the data gathering stage.  An external review had been commissioned, a site visit would be undertaken the following week and telephone interviews would be undertaken.  NHSE would be able to report back on these findings in July 2019.  Four patient engagement events/workshops had also been scheduled in North Hertfordshire, West Hertfordshire, Hillingdon and North West London.  Focus groups would then be set up to fill any gaps in the feedback.  Data was being gathered from other sources such as the national patient survey, a Healthwatch Hillingdon report from last year and the Macmillan Advisory Group.  The patient/public voice was being considered alongside the clinical voice. 

Members were advised that fifteen hospitals fed into MVCC with 13.09% of the patients coming from Hillingdon.  Consideration would be given to the deliverability of various options.  It was anticipated that the review would result in a more sustainable service.  If options looked like changes would be needed to the patient pathway, an options appraisal/plan would need to be undertaken. 

Concerns had previously been raised by Members regarding ENH’s ability to be a fit and proper provider.  There had been a particularly difficult issue whereby ENH had refused to provide a service unless enormous capital investment was undertaken.  It was thought suspicious that ENH had tried to relinquish hospice services and was now looking at its involvement in cancer services.  It was unclear how the services at Mount Vernon could remain stable when these issues had already prompted a number of staff to resign. 

It was important to provide the best possible service to the best of the providers’ ability in the circumstances available.  Ms Kinghorn advised that clinicians were currently working up options and she would need to come back to a future meeting to talk through these options once determined. 

Member queried who would be responsible for any expenditure that would be needed on the building as a result of the MVCC review.  Ms Kinghorn advised that she would need to investigate this matter further and would provide the Democratic Services Manager with a definitive response for circulation to the Committee as soon as possible.  It was suggested that, if The Hillingdon Hospitals NHS Foundation Trust (THH) was responsible, it would be worth liaising with the Trust so that they could identify where the money might come from as they already had a £26m deficit.  Ms Kinghorn advised that THH was part of the Programme Board so she would be able to ask the question at their next meeting. 

Mr Nguyen advised that the majority of patients in North West London were from Hillingdon.  He noted that there was an immediacy needed with regard to engagement with staff.  It was also suggested that a relocation to Lister Hospital would not be good for Hillingdon residents.  However, it was thought that, if a decision was made to move the service to Stevenage, it was likely that Hillingdon patients would go to a London hospital such as the Royal Marsden.  Mr Nguyen advised that a request had been made to include Hillingdon’s Clinical Lead on the Programme Board. 

RESOLVED:  That:

1.    Ms Kinghorn attend a future meeting to talk through options for the MVCC;

2.    Ms Kinghorn provide the Democratic Services Manager with a definitive answer to which organisation would be responsible for paying for repairs to the MVCC estate; and

3.    the discussion be noted.