The South West London and Surrey Joint Health Overview and Scrutiny Committee met on Thursday 7 March 2024 to discuss proposals for the future location of very specialist cancer treatment services for children. The committee formally ratified its response to an independent consultation report, expressing a unanimous preference for St George's Hospital as the preferred location for these services.

Proposals for the Future Location of Very Specialist Cancer Treatment Services for Children

The committee's primary focus was to consider the findings of an independent consultation report regarding the future location of very specialist cancer treatment services for children in south London and much of south east England. The committee noted the findings of the South West London and Surrey Joint Health Overview and Scrutiny Sub-Committee and ratified the informal response of the South West London and Surrey Joint Health Overview and Scrutiny Committee (JHOSC).

The JHOSC's response indicated a unanimous preference for St George's Hospital¹ as the preferred location for these specialist services, should a move be necessary. This preference was based on several factors, including its more accessible location, established experience in paediatric oncology and specialised tumour surgery, and a close working relationship with The Royal Marsden² NHS Foundation Trust, which provides access to radiotherapy services. The JHOSC also highlighted the potential for St George's to utilise family suites for parents to stay alongside their children and the prospect of investment in a new children's cancer facility.

Conversely, the committee expressed significant concerns regarding Evelina London Children's Hospital³ as a potential location. Key challenges identified included its central London location, which was deemed difficult for families to access by car and potentially costly due to charges like the Ultra Low Emission Zone (ULEZ)⁴ and congestion charges. Concerns were also raised about Evelina's perceived lack of experience in paediatric cancer care, the potential for staff recruitment and retention issues in a central London setting, and the availability and proximity of family accommodation. The JHOSC noted that while Evelina has strong links with King's College London and Great Ormond Street Hospital, the existing working relationship between The Royal Marsden and St George's was considered more easily replicable.

The committee also discussed the proposal for conventional radiotherapy services to be moved to University College Hospital⁵ under both Evelina and St George's options. While acknowledging the potential benefits of consolidating radiotherapy expertise, concerns were raised about the increased travel for very sick children into central London and the potential loss of resilience with a single radiotherapy site.

A key suggestion that emerged from the consultation and was supported by the JHOSC was the evaluation of a risk-adapted model. This model would involve retaining the Principal Treatment Centre (PTC) at The Royal Marsden and St George's, with patients most at risk of requiring intensive care being treated at St George's, and potentially retaining key services like radiotherapy at The Royal Marsden. The JHOSC recommended that NHS England⁶ (NHSE) explore this hybrid option further as part of the Final Decision Making Business Case (DMBC).

The committee was informed that the final decision on the future location of these services would be taken by NHS England leaders for the London and South East regions in Spring 2024. NHS England stated that they would consider all available evidence, including the public consultation feedback, to ensure the best quality care for children with cancer. The committee was assured that efforts would be made to ensure a smooth transition, with services not expected to move until at least 2026.