Children’s Cancer Care: South-East
(9 months, 1 week ago)
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Munira Wilson (Twickenham) (LD)
I beg to move,
That this House has considered children’s cancer care in the South East.
It is an honour to serve under your chairmanship, Sir Christopher. In 2020, Jackson’s parents received some of the worst news a parent possibly can: Jackson had been diagnosed with leukaemia, at just two years old. He soon began treatment at St George’s Hospital in Tooting; and after three years, in April 2023, he finally rang the bell that signified the end of his treatment. It was a very difficult experience for Jackson, but his family are extremely grateful for the treatment they received at St George’s Hospital. Reflecting on the experience, Jackson’s mum, Samantha, said:
“Thank you St George’s for being such a great hospital and to everyone who works there, you have made our journey so much easier to deal with because you’re the best team.”
Tomorrow, NHS England will make a decision about where to place a new children’s cancer centre, which will serve south-west London and the surrounding areas, such as Surrey, Sussex, Medway and Kent. NHS England will decide between two proposals: one submitted by St George’s Hospital, and the other by the Evelina London Children’s Hospital in Lambeth. After listening to staff, patients and others affected, I am here, with colleagues from both sides of the House, to make the case that children’s cancer care must remain with St George’s.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
I thank the hon. Member for making a powerful speech and for referring to Jackson. Does she agree that the independence of NHS England is important, that any decision it makes tomorrow has to be based on the clinical knowledge of medical experts, that the decision must be free from any political interference and that the world-class facilities at Evelina, which the hon. Lady has seen at first hand, should be considered alongside the other hospital? Does she agree that we must ensure that the decision is independent, and that we do not undermine the public reputation of NHS England or put undue pressure on it?
Munira Wilson
This is not about political interference; it is about ensuring that there has been a fair, balanced and transparent process. I will talk about the process in a moment, but that is the concern. The hon. Lady talks about clinical input. The consultation, albeit that it was run in a very flawed way, had 2,500 responses—some were from clinical experts, and many were from patients and their parents—and it provides very strong evidence that St George’s is best placed and that the Evelina has been predetermined. I have nothing against the Evelina, and in fact I was just about to sing its praises, because I have had personal experience.
To make myself clear, the Evelina is a brilliant hospital that does incredibly important work in treating children. My own daughter, who is nine, is currently undergoing treatment at the Evelina and has received outstanding care. This is not about pitting hospital against hospital; it is about looking at the process and the evidence before us. As the hon. Member for Vauxhall (Florence Eshalomi) has alluded to, I would like to personally thank the medical director at the Evelina, who showed me around its excellent facilities on Monday. However, as I have mentioned, the evidence overwhelmingly demonstrates that, in this case, St George’s is best placed to deliver for this highly specialist cancer service.
Before I come to that evidence, I want to raise serious questions about the decision-making process to date. [Interruption.]
Sir Christopher Chope (in the Chair)
Order. There is a Division in the House. I do not know whether there will be just one Division. If there is only one, we will come back in 15 minutes; if there are two, we will come back in 25 minutes.
Munira Wilson
To pick up where we left off, before we look at the evidence and arguments for keeping this precious service at St George’s, I want to raise the serious questions that have been highlighted around the decision-making process that has brought us to this point. NHS England first publicly expressed its preference for the Evelina proposal at the start of last year, long before it had even launched its public consultation. This has raised concerns that NHS England has created a process in which the views of patients, clinicians and patients’ families have not been seriously listened to and taken into account.
Stephen Hammond (Wimbledon) (Con)
The hon. Lady is quite right. I congratulate her on this debate. I have spoken to the Department and NHS England about the process, as there have been real concerns about the scoring and whether that has been based on evidence or preference. There is also real concern that clinical outcomes are not being given quite the highest priority they should be, which will be key if we are looking at the cancer survival rates for young children.
Munira Wilson
Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.
In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?
Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.
Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.
Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”
Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?
The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:
“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”
The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.
Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.
I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.
Sir Christopher Chope (in the Chair)
Back Bench speeches in this debate will have to finish by 5.38 pm.
Elliot Colburn (Carshalton and Wallington) (Con)
It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing this debate. As a constituency MP and chair of the all-party parliamentary group on cancer, I am particularly pleased to take part in today’s debate, and I absolutely agree with what has been said so far. Like the hon. Members for Twickenham and for Richmond Park (Sarah Olney) and the right hon. Member for Kingston and Surbiton (Ed Davey), my hon. Friend the Member for Sutton and Cheam (Paul Scully) and I have also written to the Secretary of State requesting that this decision be called in.
I do not want to repeat much of what has already been said, as many other hon. Members wish to speak, but I want to emphasise a few points, particularly the fact that paediatric cancer is incredibly rare and that treating it is a highly specialised service that the NHS provides. I understand that the NHS is concerned about co-locating the deliverables of that care on one site, but as has already been pointed out, and as St George’s keeps saying, that hospital is standing ready to be able to do that. St George’s is investing a lot into its campus, as is the University of London. St George’s stands ready to provide what parents are asking for, and it has 25 years of specialist experience, alongside the Royal Marsden, to do so. Therefore, it would be a mistake to take the decision to move the children’s cancer service to the Evelina.
Like the hon. Member for Twickenham, I am confident that the Evelina is a fantastic hospital with amazing staff and that it does amazing work, but this is about clinical deliverables.
Stephen Hammond
My hon. Friend is right: the Evelina is a great hospital. The other point about St George’s is that it not only has a specialism in paediatric cancer; it also has a wider specialism in neonatal and paediatric services. There is a concern that those would be lost if the co-location was based at the Evelina.
Elliot Colburn
My hon. Friend is absolutely right. That is a key concern, which is precisely why we want to avoid that happening.
It is also worth stating that St George’s does not just have 25 years of experience. The data really does speak for itself. It has been rated outstanding by the Care Quality Commission for delivering cancer services for children. St George’s proposal is to consolidate the primary treatment centre on to the St George’s site in a new state-of-the-art children’s cancer wing, delivering outstanding facilities to match the outstanding care already provided. The services that matter most for children with cancer are already available at St George’s. For some 80% of children with cancer, St George’s campus can already provide or is poised to provide key treatments that the Evelina will have to take time to develop.
Through its experience and expertise, St George’s can already deliver what parents say they want. The hospital is reliant on that experience and incredibly rare expertise. Only about 20 paediatric oncology surgeons with that uncommon skill are registered in the UK, and three of them are already at St George’s. Parents have consistently said they would prefer the children’s cancer centre to be outside the city centre, with better parking provision; again, that is something that St George’s is already able to provide. We do not need to wax lyrical about how awful the traffic is in central London—we say that every day anyway as we try to get into work.
Consolidating the children’s cancer services at St George’s will be easier and less costly for the NHS to deliver. A large part of the service is already there and the existing non-clinical space can, at relative speed, be transformed into a new state-of-the-art cancer centre. But beyond the financial impact of the individual institution we are talking about, there will be wider costs to the NHS as a whole if it is relocated. St George’s has estimated those costs to be around £2.5 million in the first year alone if the service is moved. That could have an impact on other children’s services, and indeed wider services, that are at St George’s at the moment.
Children’s cancer is distressing, but it is also, from a clinical perspective, not neat or stand-alone and addressing it requires incredible skill. The expert staff supporting these children could end up leaving St George’s Hospital and that would weaken the multidisciplinary teams who are there.
Now, with the increasing investment in the campus—with City, University of London, and St George’s, University of London, having agreed to merge and develop ambitious plans for the campus—the opportunities are stronger still. That is not to mention the expansion of the Institute of Cancer Research in the London Borough of Sutton, which we are so excited to see, and the development of a new acute facility. We have the ability to turn south-west London into a world-leading hub for cancer services, beating the United States in a sense. This is incredible news; we need to be grasping this opportunity, so taking the service away would be a huge mistake.
Given all this, I fail to see a compelling reason why the Evelina would provide better care for children in my constituency of Carshalton and Wallington and further afield. Accordingly, I request that the Secretary of State consider using her call-in powers to review the decision on a reconfiguration if that is the decision taken tomorrow.
Dame Siobhain McDonagh (Mitcham and Morden) (Lab)
I do not want to take up too much time—I know that lots of people want to say things in this debate—but I would like to speak on behalf of some of the parents and children who have been involved in the consultation. They have made it clear that they want the cancer services to remain at St George’s Hospital—as we would imagine—for practical reasons and particularly transport and parking.
It is St George’s that offers dedicated parking spaces and a drop-off zone directly outside the entrance of the proposed new state-of-the-art children’s cancer centre. We can just look at Angela’s case to see how critical that is. A children’s nurse at St George’s, she has cared for hundreds of kids during her decades-long career, but her worst fears were realised when her own teenage daughter was diagnosed with cancer. Angela has been staunchly opposed to plans to move the services. She said:
“I can’t imagine travelling to Central London for cancer care with a vulnerable child is in anyone’s…interest.
Luckily we were able to drive to St George’s when Meg was here, and for our family it was invaluable. We were able to keep some semblance of normality.”
This is not just about Megan and Angela. Philip has a 10-year-old son, Daniel, who has just finished cancer treatment and spent countless days and nights at St George’s. Philip said:
“You can’t use public transport when your child is immuno-suppressed, and I can’t imagine having to drive into central London every time Daniel needed urgent care.”
Little Jackson Hall was diagnosed with leukaemia in February 2020 after a rash appeared on his skin and would not go away. He was treated by an “amazing team” at St George’s. His dad, Shaun, said:
“If we had to transfer to Evelina it would be added stress and worry and take away what we can give to Jackson.
When we come here there’s a network and protocols in place and it takes the weight off us knowing that we have that here.
If he has a temperature the protocol is to get Jackson to St George’s or the…Marsden within an hour so being forced to go further into central London means there’ll be traffic and nowhere to park and we might not make it in an hour.”
Shaun summed up my thoughts when he said:
“Why change something that’s not broken?”
The services are excellent. They provide a service more cheaply than the proposed changes would. Leave things alone. Let children’s cancer care stay at St George’s.
Sir Paul Beresford (Mole Valley) (Con)
I congratulate the hon. Member for Twickenham (Munira Wilson) on obtaining this debate. It is a little interesting that we are having it before we have got the report. We cannot really add to or comment on the report, because we do not have it, but one thing that we will all agree on is that there is no doubt that a centre is required, so, like everybody here, I am waiting for the report with considerable interest.
I listened to the story from the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) about Jackson. It is always a delight to hear these stories—cancer treated by St George’s, with a delightful story to follow it. Equally, however, every hospital that I know of that treats cancer and children’s cancer has similar stories, and St George’s has more than just the few that she has given.
I am a huge supporter of St George’s Hospital. As Members will know, I spent a considerable number of years on its health board when St George’s was being rationalised, reorganised and rebuilt. St George’s is world-class in many respects, although not all, right across the spectrum of medical treatment. The rebuilding that taken place at St George’s has centred on making the buildings as welcoming as is feasible for adults and children and for medical and surgical care. I know St George’s well; it is a delightful, functioning national health service hospital that gives much to our community and that will, if the hon. Member for Twickenham has her way, give much to the whole south-east.
However, access to St George’s is by tube and then by foot or by bus. If someone goes by car, they then have to hope they can park. Hon. Members have said that parking spaces are easily available, but I can remember sitting for ages in the car park at St George’s, especially in the morning, and not being able to park. Some of the consultants I know at St George’s drive in hours early just to get a space for their car in the consultants’ car park. So parking at St George’s is not as simple as has been said.
Public transport to St George’s from many areas of the south-east would be a nightmare. Those coming from the coast would have difficulty; they would not even know where Tooting is, let alone St George’s in Tooting.
Sir Paul Beresford
I apologise to the hon. Lady. I will write to people who say they do not know where Tooting is to explain, and I will give them a picture of her.
I have also got to know the Evelina hospital, which is an absolutely amazing place. It is not designed and built for adults; it is designed and built for children. When you walk in the front door, it strikes you that it is a children’s hospital. You immediately go into a tall, spacious atrium, which goes right up, floor after floor after floor—I hope the hon. Member for Twickenham went up and looked down into it when she visited. It is a magnificent building, and one whole floor has been left, waiting for building, in case the report comes forward and says that the Evelina is the choice for the cancer centre. The Evelina also sits next to St Thomas’ Hospital and has access to it. There are specialist carers, along the lines people have been talking about, from St Thomas’ Hospital if required.
It is correct that anyone travelling to the Evelina has to come into central London. Driving in is a problem but, as I understand it, the hospital is prepared to provide specific parking. The hon. Member for Mitcham and Morden mentioned specific parking at St George’s, so the two hospitals are doing the same thing. For special cases, the Evelina will provide special cars for individual patients.
We await the report. It will put the cases together, and we will see what the experts say. I am the nearest thing to an expert here, which is a great big smile, but I have treated children, and treating children, especially east end children, is an art. That is why I would like us to look very strongly at the Evelina if it comes through as the choice. It would be best for kids, and kids are who we are looking at now—kids with cancer and the accumulated diseases and conditions that go with cancer. I am sorry to disagree with just about everyone here at the moment—I emphasise “at the moment”—but, as far as I am concerned, the Evelina is the choice, and I await the report.
Ed Davey (Kingston and Surbiton) (LD)
I congratulate my hon. Friend the Member for Twickenham (Munira Wilson) on securing the debate. I should declare an interest of sorts, because my disabled son, John, has been treated at both these hospitals. A few years ago, he had a very successful operation at St George’s, and for most of the last two years he has been attending a weekly clinic at the Evelina. My wife and I are grateful to both hospitals; they are both excellent hospitals, and we regard them very highly. So the fact that I strongly believe that NHS England should choose St George’s is no reflection on the Evelina—not in the slightest.
I have approached this issue from the start by looking at the facts, talking to clinical experts and listening to both sides. I have also looked at the risks of each of the options, because that is what we really look at when we take big decisions: which is the least risky option to make sure we have the quality of services? I have looked at the facts and the evidence, and talked to clinical experts, and they suggest to me that St George’s is easily the less risky option for locating these specialist children’s cancer services—for my constituents and for people across south London, Surrey, Sussex and beyond.
I want to take everyone through some individual cancers and how risks lay for those. I will start with neurosurgery. Twenty-five per cent of children with cancer have a brain or spinal tumour, and many of those will need neurosurgery. St George’s currently delivers that; the Evelina does not. The Children’s Cancer and Leukaemia Group, which is the UK’s professional association for those involved in the treatment of children with cancers, said in response to the public consultation that if the Evelina was the option chosen, it
“would be the only Principal Treatment Centre in the UK where neurosurgery is not carried out on site”—
the only one—and that there is
“evidence that suggests that Principal Treatment Centres for childhood cancers should be co-located with neurosurgery.”
In other words, with respect to neurosurgery, the Evelina option is the most risky. The Evelina’s solution to that—to use King’s—defeats the purpose of uniting children’s cancer services.
Let us move to oncology surgery. Another 15% of children with cancer will have a neuroblastoma, renal tumour or germ cell tumour. Those children often require major surgery by a paediatric oncology surgeon to remove or reduce the tumour. That expertise is rare. There are around 20 such surgeons in the country, three of whom are at St George’s. The Evelina does not have that expertise at all and will need either to rely on surgeons from St George’s going to work at the Evelina or to build a new surgical team from scratch.
If St George’s surgeons were to travel to the Evelina to operate on children with cancer, there would remain the question of the wider, non-surgical expertise required to manage those children, including the specific anaesthetic skills. Furthermore, it would be much more challenging to manage post-operative complications. In other words, for oncology surgery, as for neurosurgery, the Evelina option is the most risky.
Let us go on to bone marrow transplants. Another 42% of children with cancer will have leukaemias, other blood cancers or lymphoma. For those children, bone marrow transplants and, increasingly, chimeric antigen receptor T-cell treatment, where a patient’s cells are modified to help fight cancer, are key treatments for any new primary treatment centres to be able to deliver. Those treatments are complex, high risk, heavily regulated and difficult to set up without experience. Indeed, the process to do that probably takes years, not months. St George’s has a bone marrow transplant programme for adults and is accredited to provide CAR-T for adults, so it is well placed to extend that offer to children. The Evelina partnership, including Guy’s and St Thomas’ Hospitals, does not currently have a bone marrow transplant programme and is not accredited to deliver CAR-T. Developing such a programme there and delivering it with the required quality, without the adult service, will cost much, much more and be much, much more challenging.
I could go on with other examples of specific cancer treatments for children, but I will end by focusing on some wider issues where, once again, it is clear that the Evelina option is just more risky. Which of the hospitals has the most experience with paediatric cancer? As my hon. Friend the Member for Twickenham said, St George’s has 25 years’ experience of caring for children with cancer. The Evelina does not have the experience of caring for children with cancer—nothing like the experience of St George’s.
On staff, where are the specialist cancer staff currently working, and what would they do if there was a change? There are 432 staff at St George’s who are involved in caring for children with cancer. They are from a wide range of specialities and professions. The vast majority of those staff and the expertise they have built up in caring for children with cancer over the years will not move to the Evelina if the primary treatment centre is moved there. Why? Because most spend only a proportion of their time caring for children with cancer and the majority of their time caring for children with other conditions. St George’s estimates that only four whole-time equivalents, out of 432 staff, would be likely to transfer under TUPE regulations. Not only would the skills be lost, therefore, but they would need to be redeveloped in another group of staff. At a time when the NHS is facing one of its most substantial staffing and skill shortages ever, is that really a risk that NHS England wants to run? That type of basic medical risk analysis points clearly to St George’s being the solution.
But let us look at the financial risk too. NHS England itself has assessed the St George’s proposal as involving lower capital costs—£13.5 million lower—representing better value for money and having a better revenue impact. By 2030-31, the St George’s option would be breaking even, whereas the Evelina option would be running a £2 million-a-year deficit. Even taking into account the charity funding envisaged for the Evelina option, it would cost the NHS £3.5 million more in capital funding than the St George’s option, and the charity funding could presumably be used elsewhere. If the PTC were moved to the Evelina, St George’s would lose the income but would not be able to lose the associated staff. The trust estimates that that would leave a £2.5 million financial gap to close in the first year. Given that NHS finances are under real strain, why take the capital and revenue risk of opting for the most expensive option?
I have listened to the counter-arguments brought forward by the Evelina, some experts and NHS England. A big focus of those arguments is on research into developing new treatments into the future, so let us look at that. Cellular treatments such as CAR-T are likely to be central to the future treatment of children’s cancer. St George’s is accredited and commissioned to provide CAR-T, whereas the Evelina is not. Research into using vaccines to treat cancer is at an early stage, but St George’s, University of London, co-located with St George’s, is an international leader in research into vaccines, infection studies and clinical trials, with the long-term potential for vaccine technology to be developed to support the treatment of cancer. The hon. Member for Carshalton and Wallington (Elliot Colburn) was right to point to the Institute of Cancer Research and the Royal Marsden being in close proximity to St George’s. Again, they are part of the research offer that only St George’s can provide.
To conclude, I think this is a no-brainer. I am staggered that anyone has any doubt about which is the right option. I listened to the hon. Member for Mole Valley (Sir Paul Beresford), and I take him very seriously. He is a great professional in dentistry—he offered my wife some treatment in a previous debate, and I was grateful for that. He is right that we are all looking in expectation to see what happens with tomorrow’s decision. However, having listened to the experts and spent a lot of time looking at the issue, I just do not think there is any doubt: yes, the Evelina is a fantastic children’s hospital, and my son goes there every week, but it is not an expert in cancer services or in children’s cancer services, which is the point of this decision. St George’s can offer those specialities and the expertise, and it can do it more cheaply and in a more accessible way. It is by far the less risky option. I am grateful to the Prime Minister for saying that I can meet the Health Secretary to discuss this issue, and I look forward to that. I hope that tomorrow, given the arguments set out in this debate and elsewhere, NHS England will decide for St George’s.
Sir Christopher Chope (in the Chair)
I let the right hon. Gentleman finish his speech, but I am told that there are now going to be two Divisions, which means the sitting is suspended for 25 minutes.
Sir Christopher Chope (in the Chair)
In the absence of the Minister, but with the consent of the hon. Lady about to speak, I call Sarah Olney.
Sarah Olney (Richmond Park) (LD)
It is a pleasure to serve under your chairmanship, Sir Christopher. Thank you very much for giving me time to speak; I will not detain hon. Members long.
I congratulate my constituency neighbour and hon. Friend the Member for Twickenham (Munira Wilson) on securing this important and extremely timely debate. As she has already highlighted, the Evelina is an excellent facility and I commend the incredible work its doctors do every day. I do, however, share her view that the weight of evidence shows that St George’s Hospital would be a better home for paediatric cancer care in south London and the surrounding counties. I had an excellent experience of in-patient paediatric care there when my daughter was in the Frederick Hewitt Ward for a short period last year. I can confirm that the paediatric care there is excellent, and I would like to say to the hon. Member for Mole Valley (Sir Paul Beresford) that I had no problems with parking any of the times I visited my daughter.
One of the less well-known but most dangerous side effects of cancer treatment is the extreme increase in patients’ susceptibility to bacterial and viral infections. While most children with cancer are able to overcome minor infections, the mortality rate from infection is three times higher in cancer patients than in the general public. Because of that risk, many children living with cancer cannot take public transport or even smaller private hire vehicles. In the most extreme cases, visitors and carers are expected to shield so that they do not bring a risk of infection. Travelling by car is the only option available to many of these young people and their families. As such, any plan to bring paediatric cancer treatment in south London and the surrounding counties under one roof must ensure that certain patients can access the hospital safely.
The point was driven home to me when one of my constituents contacted my office after her daughter was diagnosed with Hodgkin’s lymphoma. During the six months that her daughter received chemotherapy and radiotherapy at University College Hospital, they had to travel from Richmond to the hospital in Euston several times a week for her to receive treatment. Due to the very limited parking at the hospital, and the need to avoid public transport because of the risk of infection, the family were forced to hire taxis to make the journey. Each round trip cost the family close to £100. That is not a unique situation.
On average, the families of children with cancer have to spend £250 and travel 350 miles each month to get their specialist treatment. Three in four struggle to meet those costs, and one in 10 miss or delay their treatment because of the expense. St George’s Hospital has two visitor car parks, and it has presented a plan to create a series of dedicated parking spaces and drop-off zones for the families of children with cancer. [Interruption.]
Sir Christopher Chope (in the Chair)
Order. We now have another Division in the House. I put on the record the fact that the Minister has profusely apologised for her absence; she was misled on whether there was going to be a gap between the Divisions. There was a gap, and although we have exploited it as much as we could, it is now time to suspend the sitting again. I am told that there will be two more Divisions, so it will be suspended for another 25 minutes. That means we will start again at 6.27 pm.
Sir Christopher Chope (in the Chair)
I call Sarah Olney, a few minutes early.
Sarah Olney
Thank you, Sir Christopher. I was on the verge of taking an intervention.
Paul Scully
The hon. Lady was talking about transport. Yes, the Evelina has amazing facilities, and parents can stay in Ronald McDonald House just opposite. However, the point is that it is easier to get to Tooting by car none the less, especially for people coming from outside London. Patient transport to the Evelina from Brighton takes more time to get into London from the outskirts than from Brighton to the outskirts of London in the first place.
Sir Paul Beresford
I suggest that my hon. Friend the Member for Sutton and Cheam (Paul Scully) gets a new “A to Z”; the journey is not that much more difficult.
Sarah Olney
I am grateful to the hon. Gentleman, but my personal experience is that it is a lot easier to get from anywhere in the surrounding counties to the outskirts of London than from the outskirts of London to central London.
As I was saying, the Evelina’s parking facilities are, in the hospital’s own words, “very limited”. Patients are advised that there is often a queue for parking, which of course can only add to the stress of parents trying to get their children into hospital for urgent treatment. Given that the Evelina sits in central London just over the river from here, I am concerned about its ability to significantly expand parking provision.
The Evelina also sits within the congestion charge zone, meaning that any family member who wishes to visit an in-patient will be charged between £15 and £17.50 every time they come to the hospital. I acknowledge that TfL will reimburse the cost to patients with compromised immune systems, for families visiting on a regular basis who are not covered by the exemption, the expense could become significant; there is also a significant additional administrative burden for those families.
Admission to hospital can be a terrifying prospect for a young person. Parents often take shifts, keeping their child company during an unimaginably difficult time. If each day they drive to and from the ward, they could end up paying more than £100 a week in congestion charges alone. The NHS was founded on the principle that everybody should have easy access to life-saving medical treatment, regardless of their economic circumstances. I believe that St George’s meets that criterion in a way that the Evelina simply cannot. Both are world-class hospitals and both teams provide an excellent standard of care, but St George’s offers both parents and children a solution that truly meets their needs.
Sir Christopher Chope (in the Chair)
Before I call Karin Smyth, I should say that this debate has to end by 6.54 pm according to our new timetable. That includes a maximum of two minutes for a response to the debate.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Sir Christopher—it has been severely tested this afternoon, but you have done remarkably well in getting us all to the end of this important debate, particularly for local people, on the issue of children’s cancer. I commend the hon. Member for Twickenham (Munira Wilson) on securing it. The hon. Members for Carshalton and Wallington (Elliot Colburn), for Richmond Park (Sarah Olney) and for Mole Valley (Sir Paul Beresford), my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the right hon. Member for Kingston and Surbiton (Ed Davey) all spoke on behalf of their constituents with the diligence that we would expect.
Receiving a cancer diagnosis is always distressing and deeply worrying for anyone; for a child and their family it can be particularly devastating. Watching a child go through that is a difficulty that most parents, fortunately, do not have to face, but my thoughts are with the many who do, who are being talked about today—particularly those who have lost a child to cancer. I pay tribute to the many families campaigning for good cancer care for children and young people.
Every year, 4,000 children and young people are diagnosed with cancer in the UK; sadly, it is still the biggest killer by disease of children and young people in our country. As we have heard this afternoon, the needs of children and young people with cancer are very different from those of adults. They can face real challenges in cancer care. It is crucial that they get the right treatment and family support. Often that treatment takes place in dedicated specialist treatment centres far from home: children can travel on average 350 miles to get their cancer treatment.
According to research by Young Lives vs Cancer, distressed and vulnerable children often travel across the country to receive care. As we have heard, the location of the centres is important for local people seeking the best care for their children. My city, Bristol, is home to the paediatric haematology/oncology programme, which serves the whole south-west region, working with shared care centres from Gloucestershire to Cornwall to ensure that children receive care as close to home as possible.
What should that care look like? We know that children receive the best care with early diagnosis and access to treatment from well-supported and trained staff, based on the latest research. Sadly, under this Conservative Government swathes of targets have not been met, and children are left waiting for a diagnosis when every second is vital. Those missed targets include the faster diagnosis standard, with three in every 10 patients waiting longer than 28 days for a diagnosis or to have cancer ruled out in 2022-23. Waiting lists have risen to a record high, with over 400,000 children awaiting consultant-led treatment. Prolonged waits have a detrimental impact not only on children’s health, but on their education and overall wellbeing. Although I welcome the children and young people cancer taskforce announced last month, without a properly functioning wider health system, children with cancer will continue to be vulnerable to those missed targets and delays in care.
The root of the crisis is the failure to provide the NHS with the staff it needs to treat patients on time. Indeed, the Royal College of Radiologists, which represents specialist paediatric radiologists, has said that after years of underinvestment, the workforce is stretched, causing backlogs and delay. That is why Labour is committed to providing the staff, the modern technology and the reform that are crucially needed to bring down those waits to safe levels. We will provide 2 million more appointments a year for planned surgery, diagnostics and out-patient care, and double the number of CT and MRI scanners, speeding up diagnosis and access to treatment for children.
We know and we have heard in the debate how important it is for people, and particularly for their families, to be confident that they will receive the right care in the right place. The guidelines produced by NHS England are very clear about the processes to be followed and the clinical case to be made for major service change. Indeed, that was much discussed in the Bill Committee for the Health and Care Act 2022, on which I sat. I look forward to hearing from the Minister—I will give her plenty of time—about any assurances that she can give to local people on the decision, and to the Members of Parliament who have spoken today on both the process and the substance of decision making in the NHS.
The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
Thank you, Sir Christopher. It is a pleasure to serve under your chairmanship in what has been quite a drawn-out debate on such an important topic. The hon. Member for Twickenham (Munira Wilson) has raised an incredibly important issue. I hope she and all hon. Members accept that clinical assessment and knowledge are crucial to making vital decisions that affect children’s health at such a difficult time for them and their families.
I am responding to this debate on behalf of my right hon. Friend the Member for Pendle (Andrew Stephenson), but I will endeavour to respond to each colleague and commit to writing where necessary. The debate has understandably stirred some strong emotions, because every colleague has had direct or indirect exposure to some of the questions it has raised. I am therefore grateful to all hon. Members for their contributions, which demonstrate the huge importance to us all of getting the right outcome.
Each of us has helped a parent who has called our constituency offices seeking help at an incredibly difficult time. I want to assure everyone that each person in the Government, from the Prime Minister down, knows the importance of getting this right. That is why cancer services for children are an absolute priority. From my own work in the Start for Life programme, and in the few months I have been in my current role, I have seen a collective determination to ensure that children right across the country receive the highest possible standards of care. Children with cancer are the key priority.
The Royal Marsden Hospital and St George’s Hospital currently care for most of the children with cancer in south London and the south-east. I pay tribute to the work of those dedicated doctors and nurses who do everything they can to look after the children entrusted to their care, and I want to be clear that NHS England’s proposed changes do not reflect on the stellar service that those staff members have given and continue to give. Rather, the proposals follow advice from Professor Sir Mike Richards’ review, which made it a clinical requirement for cancer services to be placed in the same location as an intensive care unit in order to give critical life support to the most unwell children.
Sir Mike’s reasoning was simple. First, we need to end transfers between hospitals for very sick children, which add risks and stress for them, not to mention their families, during what is already an unimaginably difficult time. Secondly, while we will not compromise on safety, we need to ensure quality of care. As every Member will agree, children deserve to benefit from the very latest technology available. Thirdly, we need to ensure a seamless, joined-up approach.
NHS England has listened to patients, parents and clinical experts to hear how we might best improve their care. The NHS England process has been rigorous, and it has been immensely important for all those patients, parents and specialists to put forward their own significant insights. Last year, NHS England carried out a 12-week public consultation on two options for the future location of the principal treatment centre for south London and much of the south-east: Evelina London Children’s Hospital and St George’s Hospital. Under both options, all radiotherapy for children with cancer would be at University College Hospital.
Both Evelina London and St George’s deliver outstanding-rated children’s healthcare. They also provide outstanding-rated education in their hospital schools. Both are capable of delivering a future principal treatment centre that meets our high standards. They are also both adept at listening to children, young people and their families to improve on the care they deliver.
The experience and expertise of specialists working side-by-side with intensive care and surgical teams will make a real difference: enabling children to get care where they need it, when they need it, on a specialist cancer ward; bringing down the number of children admitted to intensive care; making it easier for different specialist teams treating the same child to work closely together; improving care for children; upskilling the workforce and supporting new kinds of research. Importantly, it will also mean that the future cancer centre will be capable of offering the most innovative and cutting-edge treatments, which may bring precious new hope for children and their families.
The centre will build on the strengths of the existing service, including high-quality care by expert staff and access to clinical trials. It will be a family-friendly centre for children and young people, at the forefront of groundbreaking research and continuing the close relationship with the Institute of Cancer Research.
Munira Wilson
The Minister said a moment ago that the new centre will build on the service and the experience. The point that I and many Members have made is that St George’s has that experience. While the Evelina is brilliant in many paediatric specialisms, it does not have children’s cancer experience, so what will it build on? On the point about process, it was already predetermined, as I pointed out. It has been made clear in meetings we have had that a lot of the responses will not be taken into account unless there is new evidence. The views of children, their parents and clinicians are not being listened to in the consultation.
Dame Andrea Leadsom
I am afraid I fundamentally disagree with the hon. Lady on that point. The consultation has been open, with an open mind and following the best principles of open consultation. I think she is taking quite a liberty to suggest it is a foregone conclusion. I do not think she is correct in her belief. It is essential that clinicians can take all the inputs from those consultations to come to the right decision.
Several hon. Members rose—
Dame Andrea Leadsom
I will give way first to my hon. Friend the Member for Mole Valley (Sir Paul Beresford).
Sir Paul Beresford
Knowing quite a number of consultants at St George’s, if they heard that they were at a standstill position and not building on what they have now, they would be insulted.
Dame Andrea Leadsom
I will also take the intervention from my hon. Friend the Member for Woking (Mr Lord).
Mr Jonathan Lord (Woking) (Con)
Like several colleagues, I thank the existing hospitals for the amazing care that they have given over the years, but I agree with my hon. Friend the Member for Mole Valley: I do not think this decision is necessarily a no-brainer. We need to look at the final decision and report, and weigh up what is good and what is bad. Who knows what the final decision and its reasoning will be? I agree with the Minister that it has been a proper process. We should allow it to come to its conclusion very shortly, look at the evidence, and look at the decision in that light and with an open mind.
Dame Andrea Leadsom
I absolutely agree with my hon. Friends that the consultation is critical, that it has been an open consultation and that all views are being taken into account. I am grateful to them for supporting the process. As Members of Parliament and constituency representatives, we all want the best for our constituents, but in the case of clinical care, it is vital that those with specialist knowledge and understanding should be able to make such important decisions that will affect life and death outcomes for children.
The new centre will be a family-friendly centre forusb children and young people at the forefront of groundbreaking research, continuing a close relationship with the Institute of Cancer Research. The centre will lead joined-up working between different children’s cancer services so that children get proper access to care, wherever they live. Importantly, it will have many more services on site, reducing the need for some families to travel, which will be particularly helpful for children with complex needs and families that struggle to speak English.
I assure colleagues, and anyone who might be watching at home, that once the decision has been taken, there will be no sudden changes to how patients receive care. Of course, some families will naturally be worried about what the change might mean for their children. That is entirely normal, and NHS England will carefully involve every clinical team currently providing care, keeping parents and families closely updated at every stage. NHS England will encourage experienced staff to move to the future centre so that they can continue to provide a friendly and familiar face to the children they serve. No one from among the clinical staff will be made redundant in any future changes resulting directly from this decision. NHS England has met staff to listen to their views, and they assure me that that will continue.
The consultation heard from children, their carers, and families who have received the worst news. They have talked about their own experiences selflessly to try to help others. The consultation closed in December last year, and an independent research organisation published its findings in January. NHS England has taken into account every word of feedback and every inch of evidence to inform the decision-making process. NHS England leaders are meeting tomorrow to decide the future location of the centre. The meeting will be livestreamed so that everyone who is interested can hear the discussion and the decision.
In conclusion, wherever the future centre is placed, I am confident that tomorrow’s decision will offer the right outcome for our children and take all views into account.
Dame Andrea Leadsom
No, the hon. Lady will have her chance in a moment. Throughout this process, the guiding principle has always been safety, quality of care and the best outcomes for children with cancer, now and for the long term. The children and their families deserve nothing less.
Munira Wilson
I am sorry that the Minister would not give way again; I wanted to ask her a direct question, but I do not believe that she has the opportunity now to come back to me.
I start by thanking all the right hon. and hon. Members who have participated in this rather drawn-out debate. I particularly thank my right hon. Friend the Member for Kingston and Surbiton (Ed Davey). I thought the clinical case that he made was forensic; he went into great detail in making the compelling case of why this service should be placed at St George’s, where it already exists and is being built upon. I did not quite understand the intervention of the hon. Member for Mole Valley (Sir Paul Beresford), in which he suggested that I was insulting clinicians; I was merely explaining that it is already there and it is being built on.
The hon. Member for Mole Valley and the hon Member for Carshalton and Wallington (Elliot Colburn), who is no longer in his place, laid out the huge research opportunity we have. The Minister talked about innovative therapies. My right hon. Friend the Member for Kingston and Surbiton talked about CAR-T and all the other innovative therapies that they are already working on at St George’s. He also highlighted staffing concerns, and both he and the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) talked about the cost implications of moving the service.
I thank my hon. Friend the Member for Richmond Park (Sarah Olney) and the hon. Member for Sutton and Cheam (Paul Scully) for highlighting the travel issues. I strongly agree with what they said, which came through very clearly. I want to repeat this again, because I think some Members have suggested that we are knocking the Evelina: everyone agrees that it is an outstanding children’s hospital. The point is that St George’s also has paediatric services that are recognised by the CQC as outstanding. The royal college of paediatric surgeons also recognises it as having some amazing specialities.
There is deep concern—not just from Members of Parliament and politicians, but from professional groups and local Healthwatch groups, as I mentioned in my opening remarks—that this consultation has not been transparent and fair and that the process has not been fair. I ask the Minister again: if the decision is made tomorrow by NHS England to move the service to the Evelina, will she urge the Secretary of State for Health and Social Care to call this in and have it looked at once again by Ministers so that all the very compelling arguments we have heard today on the clinical case and, most importantly, the risk to children’s cancer care and other services are taken into account? The voices of children, parents, clinicians and patient groups must be heard, and I do not believe that they are being heard at the moment.
Question put and agreed to.
Resolved,
That this House has considered children’s cancer care in the South East.