The South East London Joint Health Overview and Scrutiny Committee met to discuss the proposed reconfiguration of the Children's Cancer Principal Treatment Centre, an update on Management Cost Reduction within the South East London Integrated Care Board, and urgent and emergency care and discharge performance. The committee also reviewed its work programme.

Reconfiguration of Children's Cancer Principal Treatment Centre

The committee was scheduled to consider proposals for the future location of the Children's Cancer Principal Treatment Centre (PTC). NHS England is responsible for commissioning specialised services, including the PTC, which provides diagnosis, treatment, and coordination of highly specialised care for children aged 1 to 15 years with cancer. The current PTC operates across two sites: The Royal Marsden NHS Foundation Trust in Sutton and St George's University Hospitals NHS Foundation Trust in Tooting.

New requirements from NHS England necessitate that PTCs be located on the same site as a Level 3 children's intensive care unit, children's surgery, and other specialist children's services. This is to ensure that children requiring intensive care do not have to be transferred between specialist centres, reducing risks and stress.

Two options have been consulted on for the relocation of the PTC:

• Evelina London Children's Hospital, run by Guy's and St Thomas' NHS Foundation Trust.
• St George's Hospital, run by St George's University Hospitals NHS Foundation Trust.

Under both options, conventional radiotherapy services are proposed to move to University College Hospital in central London. The report pack detailed the public consultation process, which ran from 26 September to 18 December 2023, and highlighted key themes that emerged, including travel and parking arrangements, workforce concerns, local support, and the delivery timeline. The committee was asked to consider and agree key points and recommendations for its formal response to NHS England.

Management Cost Reduction (MCR) Update

The committee received an update on the implementation of management cost reductions required of all Integrated Care Boards (ICBs) nationally. The South East London Integrated Care Board (SEL ICB) was informed in March 2023 of a requirement to deliver a 30% reduction in its Running Cost Allowance (RCA) in real terms by 2025/26, with at least 20% to be delivered in 2024/25.

The report outlined the process undertaken by the SEL ICB, which included a line-by-line review of non-pay running costs, a vacancy freeze, and restructuring to ensure the delivery of core and statutory functions. The process involved staff consultation, with key concerns raised relating to capacity, workload, and the interface between different parts of the ICB. The update included figures on overall savings secured (£15.2m) and the net reduction in full-time equivalent (WTE) posts.

Urgent & Emergency Care and Discharge

This agenda item focused on the performance of urgent and emergency care (UEC) and discharge processes across the South East London Integrated Care System (ICS). The report detailed commitments made in the 2023/24 operational plans, including targets for Emergency Department (ED) performance, aiming for 76% of patients to be seen, treated, and discharged or admitted within 4 hours by March 2024.

Key supporting actions for UEC improvement included working with the London Ambulance Service (LAS) to sustain and improve hospital handover times, implementing a discharge improvement plan to focus on in-hospital flow and length of stay, and optimising community alternatives such as virtual wards. The report also highlighted ongoing pressures in mental health services.

Performance data for UEC showed a deterioration in 4-hour performance, with December 2023 at 62% compared to a peak of 71% in June. Ambulance handover delays increased in December, though longer delays of over an hour reduced. Discharge performance indicated that in Q3 2023/24, 53.6% of patients identified as not meeting the 'criteria to reside' were discharged. An average of 242 patients per day remained in hospital beds despite no longer meeting these criteria. The SEL Discharge Improvement Plan, co-designed following a summit in March 2023, aims to improve transfer of care standards, secure safe and personalised pathways, meet complex patient needs, and avoid unnecessary admissions.

SEL JHOSC Work Programme

The committee discussed potential items for its future work programme. Members suggested topics such as hospital capacity planning for the Queen Elizabeth Hospital, NHS workforce recruitment and retention, vaccine uptake, medicine shortages, follow-up on ICB structures, A&E pressures, and managing the '8am rush' at GPs. It was also discussed that 'winter arrangements' could form an agenda item. The committee was invited to identify and recommend additional items, ensuring they were appropriate for system-level scrutiny and did not duplicate work undertaken by individual authorities.

The report also summarised discussions from an informal meeting held on 21 November 2023 with NHS England regarding the reconfiguration of Children's Cancer Treatment Services, where feedback from the public consultation was discussed.