The South East London Joint Health Overview and Scrutiny Committee met on Thursday, 1 February 2024, to discuss the reconfiguration of the Children's Cancer Principal Treatment Centre, an update on Management Cost Reduction (MCR) within the South East London Integrated Care Board (SEL ICB), and performance in Urgent and Emergency Care and Discharge. The committee resolved to include specific comments on travel costs, workforce concerns, and local support offers in their formal response to NHS England regarding the children's cancer centre, recommending Evelina London Children's Hospital as the preferred future location.

Reconfiguration of Children's Cancer Principal Treatment Centre

The committee received an update on the public consultation regarding the reconfiguration of the Children's Cancer Principal Treatment Centre (PTC). The consultation, which ran from 26 September to 18 December 2023, sought views on two proposed options for the PTC's future location: Evelina London Children's Hospital and St George's Hospital. NHS England reiterated that the national service specification mandates that specialist children's cancer services must be co-located with a children's intensive care unit, which is the driver for this change.

A total of 2669 formal responses were received, including survey responses, face-to-face conversations, and organisational submissions. An active petition with over 10,000 signatures advocated for a model where some care remains at The Royal Marsden NHS Foundation Trust for lower-risk patients. NHS England confirmed that the consultation focused on the two presented options and that the national service specification was non-negotiable.

Feedback indicated a desire for specialist services to be located in a single site, with valued specialist knowledge, convenient locations, strong research facilities, and a child-friendly atmosphere.

Evelina London Children's Hospital was noted for its strengths as a purpose-built children's hospital with existing specialisms, a large children's intensive care unit, good public transport links, and proximity to University College Hospital for radiotherapy. However, concerns were raised about a perceived lack of experience in children's cancer care, no provision for neurosurgery on-site, limited research in paediatric cancer, potential recruitment issues, and difficulties with car access and family accommodation.

St George's Hospital was praised for its established PTC services, existing links with The Royal Marsden, some on-site neurosurgery, easy car access, and available private rooms and family accommodation. Challenges included feedback describing the current estate as outdated, perceived poor facilities, a lack of privacy on the ward, a weaker research proposition, and difficulties with car access and family accommodation.

The proposal to move conventional radiotherapy services to University College Hospital (UCH) was generally seen as beneficial for consolidating expertise, with existing knowledge at UCH and access to proton beam therapy. However, concerns were raised about the transport of sick children to central London, longer journey times for some families to UCH, and potential capacity and resourcing issues at UCH.

The committee discussed several key points for their formal response to NHS England:

• Travel and other incidental costs: Concerns were raised about the affordability of travel, including ULEZ, Congestion Charges, tolls for river crossings, and accommodation costs for families, particularly if existing family accommodation is unavailable or insufficient.
• Workforce Concerns: The committee expressed concerns about staff capacity, the willingness of staff to relocate, and the potential for competition with other central London hospitals for staff recruitment.
• Local Support Offer: The role and development of Paediatric Oncology Shared Care Units (POSCUs) were highlighted as important for providing care closer to home.

While acknowledging the excellent service currently provided at The Royal Marsden and St George's, and the existing links between them, the committee, by a significant majority, recommended Evelina London Children's Hospital as their preferred option for the future location of the Principal Treatment Centre, based on the evidence presented. They also requested to be updated by NHS England once a final decision has been made.

Management Cost Reduction (MCR) Update

Sarah Cottingham from the South East London Integrated Care Board (SEL ICB) provided an update on the implementation of Management Cost Reductions (MCR). The ICB is required to achieve a 30% reduction in running costs in real terms by 2025/26, with at least 20% to be delivered in 2024/25. The process involved a review of non-pay running costs and a vacancy freeze. The ICB has restructured to ensure core functions are delivered within the reduced allowance.

The MCR process involved six stages, and the ICB is now in the implementation phase. A staff consultation received 298 responses, with common concerns relating to capacity, workload management, and inter-departmental interfaces. Final structures were published in December, and a job matching process is underway. The overall saving secured is £15.2 million, representing a net reduction of 217.12 Whole Time Equivalent (WTE) posts. The recruitment process is expected to be completed by the end of March. While there is no guarantee that the £15.2m saving will be reinvested specifically within South East London, it will be reinvested into patient care. The reductions are not expected to affect staff in front-line services. The savings targets have been applied differentially across the ICB, with SEL teams having a larger savings target than borough-based teams to address historical differences in management resource.

The committee noted the report.

Urgent & Emergency Care and Discharge

Sarah Cottingham from the SEL ICB presented an update on Urgent and Emergency Care (UEC) performance and discharge. The national target for March 2024 is for 76% of patients attending A&E to be seen, treated, and discharged or admitted within 4 hours. Significant emphasis has been placed on improving hospital handover times with the London Ambulance Service (LAS), with a 45-minute handover protocol now in place.

Work has also focused on reducing overstays and improving discharge rates through investment in the Better Care Fund, and the development of community services, including virtual wards. The ICS is also expanding same-day emergency care pathways and exploring alternatives to hospital admission. Efforts are being made to improve the Mental Health crisis offer to reduce pressure on A&E, including the rollout of an NHS 111 service for mental health concerns and increased bed capacity.

Despite these efforts, the UEC system remains challenged, with performance in December 2023 at 62%, down from a peak of 71% in June. While there was an improvement in January 2024 compared to December, the system is still some way from its target. Industrial action has also impacted continuity of care.

Regarding discharge, a significant number of patients deemed medically fit for discharge remain in hospital beds. On average, only 50% of patients are discharged on the day they are medically fit, highlighting challenges with flow. A discharge summit agreed on objectives including investment in discharge processes and transfer of care hubs, as well as increased capacity in intermediate care and nursing home beds. Borough-specific initiatives are underway, with learning shared across the ICS and regionally.

The committee raised concerns about the affordability of discharge funding in boroughs, with some pathways having to be scaled back. They also expressed concern about wait times, repeat attendees (particularly those with mental health issues or SEND), and lost bed capacity for mental health patients. While regular attendees are tracked for ongoing support, challenges remain, though additional mental health beds are being commissioned. The need for earlier discharges during the day was highlighted to improve flow. Clarity was sought on how the NHS is working with on-site primary care facilities to capture patients who should be attending primary care rather than A&E.

The committee noted the report.

SEL JHOSC Work Programme

The committee noted the report on their work programme, which included previously proposed items for future discussion. It was suggested that the next meeting could be held in early summer, potentially hosted in Greenwich.

The committee resolved to note the suggestions for their work programme.