Children’s Cancer Care: South-East

Debate between Christopher Chope and Ed Davey

Wednesday 13th March 2024 Westminster Hall

[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.