There is one week remaining for the public to have their say about the future location of very specialist cancer treatment services for children living in south London and much of south east England.

NHS England (London and South East regions) is urging parents, patients, professionals and the public: “Don’t delay – have your say,” ahead of the planned closure of its consultation at midnight on Monday 18 December 2023.

The current Children’s Cancer Centre (covering Brighton and Hove, East Sussex, Kent and Medway, south London and most of Surrey; which also cares for some patients from other areas) is provided in partnership between The Royal Marsden NHS Foundation Trust at its site in Sutton and St George’s University Hospitals NHS Foundation Trust at St George’s Hospital in Tooting. It treats about 1,400 children at any one time, most aged one to 15.

Currently children with cancer have most of their care at The Royal Marsden. Intensive care, most surgery for children with cancer, and some other specialist services are provided at St George’s Hospital, eight miles away.  Some services which are not part of this consultation are also provided at other specialist centres.

NHS England’s proposals will see the very specialist cancer treatment services for children provided by The Royal Marsden move to a site which has a children’s intensive care unit that can give life support, and other specialist services for children.

There are two options proposed for the future centre:

• Evelina London Children’s Hospital in Lambeth, south east London, run by Guy’s and St Thomas’ NHS Foundation Trust, with conventional radiotherapy at University College Hospital in central London

or at

• St George’s Hospital, in Tooting, south west London, run by St George’s University Hospitals NHS Foundation Trust, with conventional radiotherapy at University College Hospital in central London.

The consultation will help NHS England decide where it should be.

Dr Chris Streather, Medical Director, NHS England (London) said:

“Everyone cares very deeply about children’s cancer care. Children with cancer who have been looked after at The Royal Marsden have received high quality care and it’s natural that people will be loyal to the NHS service that’s been there for them in such difficult times.

“However, cancer specialists across the country are clear about the advantages for children with cancer of being on the same site as an intensive care unit and children’s cancer surgery and other specialist services.

“Currently, there are no intensive care specialists on site at The Royal Marsden and surgeons are there once a week. At the proposed future centre, these services will be on the same site and very near to the children’s cancer ward. Intensive care specialists will be able to pop along to see children who need their expert review and give face-to-face advice in a way that just isn’t possible over the phone.

“What’s more, innovative cancer treatments can be very hard on the body. Being on the same site as an intensive care unit which can offer life support is important now and will become more so in future, as new treatments are developed for cancers.

“To provide the very best care for children with cancer, things have to change. Our ambition is clear: the future centre, wherever it is located, will build on the strengths of the current service and be able to deliver best quality care and world-class outcomes for patients.

“No decision on the future location will be made until we have reviewed all the feedback. To help inform our decision, we would like to hear from as many people as possible.  We would therefore encourage people to consider our proposals and give us their views before the consultation closes.”

Why the service needs to move

In 2021, a new national service specification set out that very specialist cancer treatment services for children – like those at The Royal Marsden – must be on the same site as a level 3 children’s intensive care unit which can give life support, if needed. The specification was shaped by feedback from patients, parents and professionals.

As a specialist cancer hospital, The Royal Marsden does not have a children’s intensive care unit.  These units are always on sites used by tens of thousands of children every year because intensive care teams need to see high volumes of very sick children to maintain their specialist skills and expertise.  This wouldn’t be possible at The Royal Marsden due to the small number of children who need treatment there.   The Royal Marsden acknowledges it cannot deliver the national service specification and is committed to working with NHS England, Guy’s and St Thomas’ NHS Foundation Trust and St George’s University Hospitals NHS Foundation Trust to arrive at the best outcome for children.

At present, a small number of very sick children with cancer who need or might need intensive care are transferred from The Royal Marsden to St George’s Hospital every year. This is a journey of eight miles and is currently managed safely by ambulance with an expert team on board. However, urgent transfers of very sick children to another hospital add potential risks to patients in what is already a very difficult and stressful situation for children and their families.

Why the future centre needs to be located on the same site as an intensive care unit

Huge advances in cancer treatment have been made in recent years, bringing hope to children and families. The current Principal Treatment Centre offers a wide range of innovative treatments but is excluded from giving a specific type of new treatment (CAR-T treatment) and may be unable to provide others expected in the future.

This is because some innovative cancer treatments have a greater risk of complications – such as too big a response from a child’s immune system – that could require urgent support from an onsite intensive care team. As a result, they can only be given at children’s cancer centres on the same site as a children’s intensive care unit. By moving the centre, it will have the same opportunity to provide future ground breaking treatments as other major centres worldwide that are located on the same site as intensive care units.

Building on current strengths for the future

The future centre, wherever it is located, will build on the strengths of the existing service – high quality care by expert staff, good access to clinical trials, a family friendly centre for children and young people, and ground-breaking research working closely with the Institute of Cancer Research. The vision for the centre is that it will give best quality care and achieve world-class outcomes for children with cancer for decades to come.

The options for the future location of the centre

The shortlisted options being consulted on are the result of more than three years’ work involving clinicians, independent expert advisors, cancer specialists, families, patients and stakeholders.

Evaluation criteria used to assess the viability of the sites included:

• clinical services – aspects of the services the two hospitals provide that would be important for the future centre
• patient and carer experience – how the two hospitals would support children with cancer and their families
• non clinical factors – everything the future centre would need to work smoothly. This included looking at the impact on staff
• research – what the hospitals, the trusts that run them, do now for research and what they would offer the future centre

Both options scored highly in the pre-consultation evaluation but Evelina London Children’s Hospital scored higher.

Ashley Ball-Gamble, Chief Executive of children’s cancer charity, Children’s Cancer and Leukemia Group commented:

“Having a child with cancer brings worry and upheaval for the whole family, and it is important we do all that we can to make their experience of cancer care as smooth as possible. Whichever location is chosen, the changes proposed will provide all services that a Principal Treatment Centre must have on site in one location, resulting in more seamless care for children and a high-quality experience for their families.”

How the two options would meet the national specification

Both options for the future location deliver children’s services which are rated outstanding by the Care Quality Commission. Both could deliver a future Principal Treatment Centre that meets the national requirements.

Whether the future Principal Treatment Centre was at Evelina, London, or St George’s, it would:

• end hospital transfers from the specialist centre of very sick children with cancer who need or might need intensive care, eliminating the added risks and stress these transfers bring. If children did need an intensive care bed, the bed would be very close by on the same site
• enable more children to get their care on the specialist cancer ward and minimise the number of children admitted to intensive care, which can be stressful for children and families

With intensive care specialists on site

• children would never be transferred as a precaution in case they might go on to need intensive care
• specialist input from intensive care teams could help some children avoid intensive care. Cancer specialists say cancer services in children’s hospitals with intensive care units on site have fewer intensive care admissions for this reason.
• have more services on the same site than now, improving the experiences of children and their families
• meet the national requirements of having an intensive care unit on site supporting different future treatments
• make it easier for different specialist teams treating the same child to work closely together, improving care for children and supporting new kinds of research
• make it easier for cancer and non-cancer specialists to learn from each other and share learning. As well as being good for children’s care this would be likely to help the future centre keep and attract new staff.

Transport to and from the future centre

Parents and carers have raised concerns about getting to either of the proposed options for the future Children’s Cancer Centre site, including the cost of transport and parking.

NHS England is working with parents, charities, and others to make recommendations on how best to support parents.

Both hospitals are committed to help, for example: Evelina London and St George’s would offer dedicated parking spaces for children with cancer if they became the future Principal Treatment Centre.

They and University College Hospital, which would provide all radiotherapy for these children under the proposal (rather than some, as now), would also support parents taking children to their appointment to access reimbursement for ULEZ (Ultra Low Emission Zone) and congestion zone charges (where applicable).

Families on low income or benefits may also be able to reclaim public transport costs under the Healthcare Travel Costs Scheme.

Where patients are unable to use public transport and their family does not have access to a car, they will be eligible for NHS-provided patient transport.

Getting involved

The public consultation closes at midnight on Monday 18 December 2023. The consultation document with full details of the proposals and how to provide feedback is available here www.transformationpartners.nhs.uk/childrenscancercentre

No decision will be made until the public consultation has concluded, feedback has been reviewed and all relevant information taken into consideration. Services are not expected to move before 2026.