Agenda item

The Chairman welcomed those present to the meeting.  Ms Jessamy Kinghorn, Head of Partnerships and Engagement at NHS England (NHSE) and NHS Improvement (NHSI) – East of England, advised that she had continued to work on plans following the independent clinical review of cancer services at Mount Vernon Cancer Centre (MVCC) that had been undertaken in 2019.

The MVCC review programme had been paused in 2020 to enable clinical and operational teams to focus on responding to the pandemic.  Following this pause, several key pieces of work had been undertaken with a medium to long term focus. 

It was noted that patients attending MVCC came from a wide geographical area which included: Herts Valley CCG (28%), East and North Herts CCG (16%), Hillingdon CCG (14%), Harrow CCG (9%), Bedfordshire CCG (6%), Buckinghamshire CCG (6%), Luton CCG (5%), Brent CCG (4%), East Berkshire CCG (3%), Ealing CCG (3%) and Barnet CCG (2%).  Given the large area covered, it would be important to find a solution that everyone could support.  Over the next couple of months, it would be important to identify the source of any capital funding that would be needed to implement any resultant recommendations before any consultation could be undertaken.  This would mean that consultation would only be undertaken if the funding was in place to deliver an outcome. 

If capital funding was not forthcoming from the NHS, Members queried whether private financing would be sought.  Members also asked if consideration had been given to building the cancer centre into the new Hillingdon Hospital redevelopment if full funding was not secured.  Ms Derrett advised that alternative potential sources of funding had not yet been investigated.  NHSE/I had been working closely with health colleagues (including Hillingdon Hospital) but no conversations had yet been held in relation to what would happen if full funding was not secured.  The Committee would be updated as progress was made. 

Ms Kinghorn noted that the review was not just looking at the buildings but also at the lack of acute services on the site and the inability to respond to new developments and treatments.  Staff had continued to do a good job in providing high quality treatment and ensuring patient safety, despite these conditions. 

Members were advised that two options that had been considered were: full reprovision; and reprovision with ambulatory hub.  Fewer patients were currently going to MVCC.  This had proved somewhat frustrating at times for clinicians who were having to care for patients remotely, but had also meant that there had been fewer emergency transfers to acute facilities. 

The Programme Board had met in December 2020 to consider the views and feedback already received and to discuss areas of concern around cancer outcomes and health inequalities.  As only one of the sites considered met the criteria that had been set in full, the Board recommended that work be undertaken to develop proposals for a full relocation of MVCC to the Watford Hospital site, with enhanced local access to services where possible.  For example, it would be important for patients to be able to have blood tests undertaken close to their home but this would require compatibility between the different IT systems used by different parts of the system.  When looking at the feedback received on each of the site options, Watford had been considered by most to the best option, or at least the best compromise.  It was noted that, should the MVCC services relocate to Watford, Ms Kinghorn would be keen to discuss the possibility of chemotherapy services being included in the new Hillingdon Hospital redevelopment project.  Consideration would also need to be given to shortening some patient journeys (particularly for those further North in Bedfordshire) by creating a new radiotherapy service at either Luton or Stevenage. 

The impact of the suggested move to Watford on travelling and access times for patients from Hillingdon had been raised as a concern by Members.  It was noted that patients from Hillingdon would be able to choose whether to receive treatment at Hammersmith Hospital instead of Watford Hospital.  Ms Kinghorn noted that there had been a lot of travel analysis undertaken to determine the impact on patients from different parts of the area served.  She would look at the breakdown of this information by the different services access (as well as travel times for Hillingdon residents to Hammersmith Hospital) and get back to the Committee. 

In terms of engagement, Ms Kinghorn advised that online focus groups had been held to look at estates and preferred options.  Surveys had been undertaken and would continue to be used as a way to maintain engagement.  Over the last six months, Hillingdon residents had made up over 14% of those who had been involved in engagement activities.  These residents had been generally supportive of the option to move cancer services further North but had raised concerns about public transport from Hillingdon to Watford.  As such, consideration would need to be given to establishing a more direct bus route. 

Ms Ruth Derrett, Programme Director for the MVCC Review at NHSE/NHSI, advised that she would be happy to provide the Committee with the travel information that was available.  Consideration was being given to improving non-emergency patient transport times and Ms Derrett would be happy to share this information too. 

The Committee was advised that there had been a lower uptake on radiotherapy services during the pandemic than health partners would have liked as it involved daily travel for treatment over a number of weeks.  Currently, a large number of patients travelled over 45 minutes each way for this treatment. 

Concern was expressed that it was likely that some residents’ cancer had remained undiagnosed during the pandemic and that a surge in presentations now that the situation was easing might put pressure on MVCC from September 2021.  Ms Susan Sinclair, Managing Director of RM Partners – West London Cancer Alliance, advised that the identification of any new cancer patients would be welcomed.  Any surge in numbers would be managed as the alliance liaised with providers on a weekly basis to review referrals and waiting lists.  It would be important to ensure that capacity was available at MVCC, Hillingdon Hospital and elsewhere to cope with any increase in demand over the next few months. 

In terms of measuring outcomes, work was already ongoing to assess current outcomes for patients.  These outcomes would need to be measured for 1-5 years to be able to confidently identify the impact of any action taken. 

Concern was expressed as to whether the uncertain situation at MVCC had led to the loss of specialist staff.  Ms Derrett advised that the overall vacancy rate at MVCC in March 2021 had been 6%.  This level was not unusual and had not really changed over the last two years.  Ms Derrett would need to check on the vacancy rate for specialists. 

A number of engagement events had taken place to solicit feedback from staff and it was thought that this had contributed to the stability in the number of vacancies.  The workforce at MVCC were thought to be loyal and, although they needed certainty, they were hopeful for the future. 

RESOLVED:  That:

1.    Ms Kinghorn provide a breakdown of the travel analysis undertaken to determine the impact on patients from different parts of Hillingdon based on the services that they accessed (as well as travel times for Hillingdon residents to Hammersmith Hospital);

2.    Ms Derrett provide the vacancy rate for specialist staff at Mount Vernon Cancer Centre; and

3.    the presentation and discussion be noted.