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 ratified its informal response to an independent consultation report, expressing a unanimous preference for St George's Hospital over Evelina London Children's Hospital.

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

The committee considered the findings of the South West London and Surrey Joint Health Overview and Scrutiny Sub-Committee regarding proposals for the future location of very specialist cancer treatment services for children in south London and much of south east England. The independent consultation summary report had not swayed the Sub-Committee's view, which reiterated strong feelings from patients, families, and clinicians against a move to the Evelina.

The Joint Health Overview and Scrutiny Committee (JHOSC) wished to ensure that NHS England (NHSE) had carefully considered the consultation findings and that all stakeholders' voices had been heard.

The JHOSC's preferred option, should a service move be required, is St George's Hospital¹. Key reasons for this preference include:

• More accessible location: St George's is considered more accessible, particularly for families travelling from Surrey, Kent, and Medway, compared to the central London location of Evelina.
• Experience with paediatric oncology: St George's has extensive experience in paediatric oncology, including specialised tumour surgery, and a long-standing working relationship with The Royal Marsden².
• Established working relationships: The close working relationship between St George's and The Royal Marsden is seen as critical for establishing and maintaining specialist services.
• Family accommodation: St George's has the potential to offer dedicated family suites, allowing parents to stay alongside their child, which is a significant advantage over the off-site and shared accommodation proposed for Evelina.
• Staff retention: There is a concern that a move to Evelina could negatively impact staff training and retention at St George's, potentially jeopardising the long-term viability of specialised services.

Conversely, the JHOSC identified several concerns regarding a potential move to Evelina London Children's Hospital³:

• Accessibility and travel: The central London location of Evelina presents significant challenges for patients and families in terms of travel time, cost, and the need for multiple modes of transport. This is particularly concerning for those from more rural areas or with lower incomes.
• Lack of experience: Evelina is perceived to have less experience in paediatric oncology compared to St George's, and would require significant investment to build a comparable team.
• Staffing and retention: There are concerns about the ability to recruit and retain experienced staff in a central London location, which could impact the quality and continuity of care.
• Accommodation: While Evelina offers nearby accommodation, it is off-site and shared, which may not be ideal for families of very sick children.

The committee also discussed the proposal for conventional radiotherapy services to move to University College Hospital⁴. While acknowledging the potential benefits of centralising radiotherapy expertise, concerns were raised about increased journey times for some families and the loss of resilience with a single radiotherapy site.

The JHOSC recommended that NHSE consider a risk-adapted model whereby key services, such as radiotherapy, could be retained at The Royal Marsden, with St George's named as the Principal Treatment Centre (PTC). This model, if clinically safe, could help minimise transfer risks and address concerns from various stakeholders.

The committee formally agreed with the Sub-Committee's report and will use it as a basis for drafting their final response to NHS England. The decision on the future location of the services is expected to be made by NHS England leaders in Spring 2024.