So I think that question of the risk to the clinicians, I think there isn't, from what I read, and I can't, I didn't get to page 300 and something, but I did read quite a large amount of it.
There didn't seem to be any risk assessment of, I mean, there was sort of talk about mitigation and various things, but I didn't really think there was a good, what is the risk of this whole thing?
And I do think the one about the clinicians moving from the Georgia setup to the Evelina setup is a big risk.
And they really have to be very clear that that risk, that they assess that risk, that they talk to the staff, that they're convinced.
They just said, well, we'll just recruit some more people.
Well, you know, we all know that's not that easy.
I do think the transport issue has come up on the Northwest London, Josh, where they've centralized hip replacement.
It's completely different, but the thing of transport comes up because people have got to go to central Middlesex.
And so they've, so I think you can find solutions to that.
It might be that you just have Ubers or mini cabs or specialist drivers or whatever who collect families and bring them back, which is obviously a cost which would need to be costed.
But actually driving into Georges is no great joy.
And it wouldn't be a great joy to drive to the, you know, either way would be very stressful for a number of reasons.
So actually, I would have thought that one could be mitigated.
I think the point about the sort of political point about whether a new government is going to change the NHS England guidelines about whether you should have a pediatric.
I doubt that's in a way, you know, that's a clinical area.
But I do think there ought to be a risk assessment to say, well, actually, are the risks of doing this due to the things that people mentioned, that question should be answered.
Thank you.
And that was a particular point that when we responded to the consultation we made and so on, certainly a concern that St.
George's have made to us when we talk to them about that, for them, there's a risk that their staff will, some of their staff and so on who may not retain for some elements of their pediatric service as it is at the moment because they don't also have that caseload of very interesting and absorbing work that they do on very unwell pediatric cancer cases.
And so on that they might well go elsewhere for, but not necessarily want to go to Evelina for.
So I think you're right.
I don't think that risk has really, really, really been looked at.
I think it's relying on time, which is, you know, we know, you know, St. George's and Marsden have 25 years of experience and so on,
which may be very hard to put together.
The other point in terms of transport is the original business case was around actually having a single tenter that the children would have all their treatment for very specialist cancer care taken out.
The actual decision has been taken, the specialist radiology would now actually take place at UCL.
So there will be some, already some in this new, in the decision they've taken, they've already sort of agreed that one of the issues that came up in terms of unwell young people having to be transferred from Marsden.
Marsden and Sutton to St. George's was obviously they needed to be in a special ambulance with obviously clinical staff attending them if they needed ICU.
And of course there is a prospect now that they may well have to do that if they actually need specialist radiology treatment as part of their treatment whilst they may be under the care of Evelina.
So, you know, this is another aspect that's worrying and we don't think the risk necessarily has been fully considered.
Any other comments? Yes, Richard again. Thank you.
The two we've started picking on in terms of objections, which is the consultation process and the other one not in the best interest of the local health service,
it seems to me those look like they would be lost.
The first one is generally speaking public sector don't like being challenged that their consultation process wasn't perfect.
We don't like it ourselves actually.
So I don't suppose we'll make a lot of headway on that one.
The other one, of course, it does, you can argue that it's not in the best interest of the health service locally.
And they will say, well, yes, we agree that the current cohort going through won't get the full benefits.
We'll have some difficulties, but it's future generations that will benefit when we get this right.
So they can dismiss that one.
But the third one that's emerging and is emphasized by Jim and Stephen and Claire is one that will give them pause for thought,
which is the risks highlighting all the risks and issues associated with that transition because they won't have taken that fully into account.
And it will give them pause for thought.
And it may even make them think again about the decision.
I think that's the one we major on.
Thank you, Chair. So if I can just clarify, the new regulations set out the basis in which a referral request can be made to the Secretary of State.
And the first of those is that there are concerns with the process that's being followed by the NHS or commissioning body.
And that can include, for example, the way that the concentration itself or the way that it's been conducted.
It's not intended to be exhaustive, but it's the process that's been engaged.
And then the second criteria is where the decision and the concerns where a proposal isn't in the best interest of the health service in the area.
It's not intended to be restrictive.
So, for example, if the decision that has been reached and you consider looking at it in the round,
including whether or not the NHS England has properly evaluated the risks factors, that can still fall within that second category.
There isn't, I'm afraid, a third category.
So that's what we're looking at.
And my opening suggested that the request should fall under the category of the decision is not in the best interest of the health service for this area is only a suggestion.
You don't have to abide by it.
You may come to the conclusion that the referral should be on both grounds.
And that's an entirely appropriate consideration for you as members to make.
And we will take that away and produce a referral on that basis of your decision.
But it could be.
I wonder if it could be argued that actually the transition arrangements and so on may want to also be in the best interest and so on.
It's part of absolutely part of rather than trying to create a separate plan, which isn't in the regulations.
Thank you, Steve.
Thank you.
Yes.
So just a couple of follow up points there regarding the locality of the health service and also around the community impact.
I think when we were talking about whether it's in the best interests of the health service, obviously, we're talking specifically here about the barrel of Richmond.
But it's mindful that where the the job that unanimously supported the the approach to call this in is the whole of South West London ACB and Surrey Heartlands.
So there's quite a diverse, quite a diverse area here that is all opposed to that is all opposed to this approach.
And that's just a small part of the catchment area.
So it runs all the way from Surrey down to Kent.
And so therefore, that, as you can imagine, the transport element is hugely impactful.
And an associated part of that is that being a little bit selfish, perhaps it's not the end of the world for us to for patients in Richmond to be put in an Uber and popped over to Waterloo.
Whereas that's not that's not the case for Kent or Sussex and those sorts of areas.
And so in terms of the equity of care, I would imagine that they'll be making fairly similar representations from their side.
And Councillor Bennett raised a really important point about community impact that I had neglected to make, which is really important one. It's the fact that we're not just removing this relatively small number of patients from St.
George's and putting them into what Marsden St. George's put them into Avelina, but effectively we're using that, losing that centre of excellence around St. George's.
And St. George's have come very frankly and clearly to the JOST and they have said about the pernicious nature that they believe that this will have on their ability to deliver specialist paediatric oncologists.
So I would agree that in terms of the impact that this is going to have on the health system as a whole, the fact that we're increasing the centralisation of specialty in Avelina and potentially losing it from other places is an impact that should be considered.
Thank you. Does anyone else have a question or comment?
We have a recommendation before us and I hope you've all had a chance to actually look at the wording of this.
That we resolve to make a request as Secretary of State to call in the decision to NHS England on the reconfiguration of future location of very specialist cancer treatment services for children in South London and much of South East England and that we delegate authority to be Executive Director of Adult Social Care and Public Health to complete the referral form and submit the same to the Secretary of State for Health and Social Care.
So I wonder if I can take a vote if we're happy to back those recommendations.
Agreed.
Good. In which case I'd be happy that that's a clear recommendation from the committee that we proceed in that manner.
So thank you all very much for your attendance tonight and obviously we'll keep you informed as to how that progresses and obviously because we're in just about to come up to a pre-election period we may let the Secretary of State know that we're choosing, we have reached, we have, we are calling it in but we may actually delay the actual call and referral to actually a new Secretary of State is in after the Fourth of July.
So thank you all very much for attending.
Thank you.