Joint Surrey and SWL Health Overview and Scrutiny Sub Committee - Wednesday 22 November 2023, 6:30pm

Joint Surrey and SWL Health Overview and Scrutiny Sub Committee
Wednesday, 22nd November 2023 at 6:30pm

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hi everyone, sorry, we're starting a little bit late, I think pretty much everyone has been stuck in traffic on the way here. Myself included, so sorry about that, welcome to the committee. My name is Councillor Forbes and I am the Chair of a south-west London and Surrey JOSC Sub-Committee Members of a Sub-Committee. I will now call your names in alphabetical order. Please switch on your microphones to confirm your attendance and once you have confirmed your attendance, please remember to switch your microphones off, so I'll go through in alphabetical order, Councillor Akyigyina

you just need to turn your test a microphone.

Councillor Hall person, Councillor Joyce,

Councillor R Day.

Councillor O'Shea present and Councillor Schaper is on her way, I know she's just running Les we've had apologies from her for that, are there any other apologies for absence this evening?

item number 2, we're going to cover declarations of interests, are there any declarations of pecuniary or other registrable or non registrable interests catalogue?

a interest to declare in our community representative for NHS Frimley, that's an unpaid position, and I'll also point out that the PCT for Frimley is something that will not be involved.

thank you anything else or anyone else.

great moving on to Item 3 and the main items of business, so we are onto the reconfiguration of children's cancer services, the consultation mid-point review.

one thing I just want to highlight on this this evening, unlike the last JOSC meeting and not the sub-committee we all heard this evening just to cover the mid-point review and the consultation process itself, so while there was broader discussion last time on the merits of the mood and the process as a whole, we are here as a sub-committee this evening purely looking at.

the consultation itself and how the consultation has been going so far and our way at the midpoint, so if everyone's comments, questions could be kept to to the consultation itself, I think.

the meeting will flow a little bit better.

and we will just need to make sure that if people all covering areas on

irrelevant to this evening, this can be something that can be picked up by the JOSC itself and not the Sub-Committee tonight.

please note as well that there have been two supplementary papers published St George's presentation and the briefing notes from the sub-committees site visits last week, and I'd like to thank both Trusts for putting on the visits last week, I think Members found it really really helpful and it's made the work of the sub-committee this evening I think a little bit smoother to have some of that context.

so it is not necessarily has to be covered in depth tonight because we want to make sure that we have a lot of time for Q and A so to crack on if we go move over to the NHS England presentation fog, which will be followed by the Q and A I'm gonna let the representatives from NHS England introduce themselves as they go along so if you introduce yourself,

and your role as you go include the presentation that will make it a little bit easier for members when they are addressing questions to you, so over to you for the presentation.

here, thanks thanks, very much Councillor Forbes on Chris Strother on the regional medical director for the NHS in London, sorry, I think.

someone's going to drive slides from remotely Colin, Chapman.

often high quality, but that involves some quite complex arrangements.

children, so the the specialist, particularly the medical oncology cancer services, are provided, principally in Sutton, but the children's intensive care unit and the vast majority of the surgery is delivered geographically separately at St George's. There are national requirements for principal treatment centres set by NHS England which are not part of this consultation that say very specialist children's cancer. Treatment like those at Marsden must be on the same site as a level 3, which is the most advanced form of intensive care unit and both St George's and Evelina have level 3 intensive care units. This is one non negotiable

piece of the pie exercise

and the other 12 principal treatment centres, and indeed some of the sort of European centres of excellence that we looked at as part of the background for this. The current services are is an extreme outlier in terms of the model of care, so the current treatment centre can't comply and doesn't comply and can't comply in the future, and the Marsden had acknowledged publicly that their current service doesn't meet the national service specification and and they're committed to working with NHS England and colleagues either at St George's or Evelina to arrive at the best outcome for children. The purpose of the current consultation is to understand both the impact of

of either option to move to the whole service, to St George's or the whole Service, to Evelina and and also the additional impacts of moving conventional radiotherapy from the Royal Marsden to University College hospital, which is a component of either option.

you've got the next line up already, thank you.

so there are five main reasons for this hospital transfers are very sick children to incentive care, add some risk to patients that they have to be put in an ambulance, with nurses and doctors, and and often their relatives and transferred at a time of potential danger, and that's stressful and risky we put a great deal of.

a sort of you know work around around that to keep people safe, but it's inherently risky the intensive care unit.

at St George's are also not able to provide face-to-face advice for children who are reaching a point of deterioration where they might need intensive care unit and intensive care, which would be normal practice in our children's children. A comprehensive children's department or children's hospital. There's a need to improve children's experience and when they require intensive care and another related especially children's services and, as I said already, the current principal treatment centre doesn't and can't meet its national requirements, and the Royal Marsden have accepted that point in public and although it does offer some inner indicative treatment a wide range of voters, the current principal treatment centre is excluded from giving a specific type of new treatment Kati cells, which is where immune cells are taken out of the body modified and put back in to fight cancer.

this only affects a small number of children, but it can't be done without the support of intensive care unit and there may be future developments in this line in the future.

Councillor carers has advanced quite a lot, I will certainly over the nearly 40 years of my career, and I would expect it to do over the next 10 to 15 years, and preparing for the future is part of this. So who would this affect? Around 400 children a year are treated by the principal treatment centre. Most people are in this this phase of their treatment for for around three years and for that's around 400 to 450 new patients every year, 84 of those had been in intensive care had intensive care

and around 35 children need transfer each year, a significant number 41 need conventional radiotherapy, but in the future, because of the advances in treatment and the availability of a proton and proton beam accelerator at UCL H one of only two in a country that is 41 children will waiting to receive their treatment at UCL H and as you can see from the map, children are pretty evenly distributed between story.

south-west, London, south-east London and Kent and Medway, and then there were slightly fewer patients from Brighton and Hove and in East Sussex because the West Sussex patients, most of whom go to

go to go to Southampton, which will already heard about from Councillor Hulk for some population's next slide, please.

so.

what while childhood cancer is is happily happily rare?

it's a, you know it, there's nothing more important for that child or all those families.

the rate of dies diagnosed in new EU cancers is around 160 cases per million population, which means around one child in 6,200 get cancer each year.

on average, that means that 45 children from this bit of London get cancer and 35 from the Surrey area that's represented, and in total this means of the 1,400 children a year that are treated around 259 18% come from south-west London and 233 or 17% come from Surrey, so this is a significant proportion of the the children are treated across nearly one across both areas, nearly all children are seen as outpatients, but 23% of them just under a quarter have an inpatient stay next slide, please.

so we've been working at this quite a long time, it was a bit of a pause during the Covid pandemic, but through a long process that we weren't going to hear and we've been in see before we arrived at to shortlist, adoptions wants to transfer the majority of the service to Evelina children's hospital which is part of the Guardian St Thomas's or to transfer it to St George's that the whole service and so that the small portion that's provided now to St George's both both solutions will provide really good solutions.

so providing the best children's cancer care, and we'd be we'd be very happy with either.

and for either option conventional radiotherapy and access to a proton beam would be it University College Hospital.

both the Kate, both locations already deliver outstanding children's hairs rated by the CDC and we're confident that with either option, children would have.

we will have the highest quality of care and we'd be able to deliver a good experience next slide placement.

so I want to talk about the options in detail because you're going to hear from both Trusts in a minute.

but while we are confident that whichever option we choose will deliver an excellent and improved.

care for children, we will save that from the BBC, the transparency they say, this isn't, this is not the closure of a service, it's the transfer of a service to a more suitable location and although both options are really good, the assessment and option appraisal we did

did result in us because of potential improvements in quality and access to research, which helps deliver good outcomes now and in the future, we have a small preference for Evelina as the final option, but part of the purpose of consultation is to hear input from a wide range of stakeholders and ensure that we're able to make the best decision possible when we do so next Lively's.

as I say I, I expect the trust will will talk about this in detail and to two of them, so principle differences between the sites which people talk about is there is neurosurgery at St George's for that for an

the largest proportionate surgeons who need neurosurgery have it done at King's College hospital where they deny neurosurgery for the more complicated patients but a significant proportion haven't done it at St George's and there's no there's no provision for elective neurosurgery at Evelina if the service moved to Evelina they've got robust arrangements to provide emergency cover for patients in the very rare event that they have a neurosurgical emergency.

on the on the flip side of that.

Evelina, they have specialist and tertiary cardiology and renal services.

which which are not available at St George's, so there are some important differences between the tertiary provision on the two sites.

under both scenarios this is a movement, not a closure of services and we will plan for as many staff as possible to move with the service, obviously people have free will about that I'm going to hand over to Elsa Williams who's gonna take you through the rest of our presentation, thank you and good evening everybody, I'm all for Wellins and I'm the programme director for this reconfiguration from NHS England and so just just as a brief summary,

during the pre-consultation period when we met with before just back in June time and that that that continued until late August and that was really valuable, enabling us to hear from a wide range of different people to help inform the consultation that were obviously now in.

we were able to also respond to feedback that we received from the JOSC over that period, so if we just move to the next slide, I will just pick up a few examples of how we have done that so.

when we met with the JOSC, it was really a relatively early in our pre consultation period and over that remaining period we we, we we we, we did a lot of work to hear, hear from parents to build on the understanding that we already have around their concerns and their views around the service charge on what would be important to them and spoke, I think entitled for around 120 families,

you also encouraged us to speak to.

families around their preferences for travel and again that we we, we spoke to a range of families using their current service at the moment, which allowed us to better understand their preferences for travel and inform that that that has allowed us to give further consideration to our plans in that regard and I'll touch on that shortly.

we've done further work to also consider mitigations that would support travel and access, and we have also shared more information with the JOSC, both before the consultation but of course in consultation, to respond to the information request that you ask for, and we shapes quite a few of those specifically and to include a level of detail of it that yourselves were after.

we also, I think, at the point where we met with you intending to consult that an earlier period than we were, then we ended up doing in the end, and one of the drivers for shifting that was to respond to feedback that we had from people around concerns around consulting over the summer holidays.

just if we just move to the next slide, I'm with regards to travel and access.

we know that it is one of the really significant concerns that current families have around our proposals, and that came through through the conversations we had before consultation and is continuing to be a theme.

a really important theme, as as as as we go through consultation to I'm happy to take further questions on this as as we come to the Q and A section.

that we've also done some further work to clarify what arrangements would be existing in both sites, so just for example.

both both sites would offer parking dedicated parking for people travelling by car to the two sites, and

we are also aware that it's really important to make sure that arrangements are in place to make the ability to reclaim travel costs as easy as possible schemes already exist at the moment to reclaim yellows charges, congestion charges where it is applicable we know those aren't that easy to access.

but that that is an area where both providers have committed to doing more work in the future, alongside other mitigations, to make to make access as easy as possible, noting that journeys by road on average will be longer for many people going to St George's, and most people going to Evelina travelled by transport is a more straightforward option to to to to both sites, but we know that the preference of parents is not to travel by public transport. That said, we know not everybody has a choice, in that a few people may prefer to do that, and there are advice from clinicians is that it is safe to do at particular points in patient's pathway, so as part of our work, we're also looking at public transport, but note that the priority is really to consider travel by car, and that is where we want to hear more from people. Through this consultation around ways in which

either of the two options are able to do that in the future,

if we just move on, I'm going to hand over to Fiona, who is going to take us through the next set of slides, where we're going to talk in more detail about our mid-point review, thank you.

thanks Elsa my name is Fiona Gala, I support the programme from an engagement perspective, I'm so I'm gonna talk a little bit here about our consultation plan and then move on to talk about the mid-point review which I'm sure everybody is very interested to hear about so in terms of our consultation plan as you will remember, hopefully we develop that with input from yourselves from other JOSC on overview and scrutiny committees across the catchment area.

with key leads in the trusts our stakeholder group and the consultation institutes, are they all input into that consultation plan, and we used a similar group to test our consultation questions and looked at both local and national examples of consultation plans, consultation, questions as part of that development process to make sure that it was,

good enough that it did have the right things in it and that the questions had the level of detail that we would need to support our decision-making, we also made that consultation plan proportionate to the size of the change and the scale of the change, so hopefully you'll see that reflected in the consultation midpoint information which I'm gonna move on to now if we go on to the next slide.

brilliant. So what is the purpose of a mid-point review, so really, for us, the mid-point review is about looking at everything we've done to date, it's looking at whether the plans that we have in place for the next four weeks until the close of the consultation, whether they put us in a good place to reach all of the groups, that we need to to see whether there is still any gaps in in our plans and to think also about the key findings that are coming through the midpoint and whether we need to do anything differently in terms of providing information differently.

and sharing that in a different way with people so that they get access to that and can respond part of our mid-point review what the entirety of it has been undertaken by an external market research company called explain they have looked at all of the feedback that we've had today all of the information and that we've provided around how we've communicated what meetings that we've had and I believe you've seen a copy of that report and would be happy to take questions on the detail of that after the presentation.

so next slide, please.

so we asked explained to sort of give us a little bit of an assessment about where we are compared to kind of other consultations at this point and what they told us is that what would they would expect to see in a consultation is that there are a significant number of responses at the beginning, it kind of tails off in the middle and then at the end we get more of a boost of responses as we come to close. We are in line with that at the moment. They also noted that normally it takes people time to pick up messages and certainly we're seeing that

with some of the stakeholder groups, so it takes time for people to absorb information so that might explain some of the low response rates from different groups and that they recognise that the majority of the activity is likely to be a miss last period, so we know that a lot of things are planned and are going to fill the gaps that we have so they felt that actually we were in line with other consultations of this type and that we were we were in a good place.

in terms of when they looked at us a couple of weeks ago, next slide, please.

so this gives a little bit of a summary about the communications and engagement activity that we have done to date in terms of how we have promoted disseminated information about the consultation and the engagement work that we have done so. Communications have been in a bar in in a number of ways, so letters directly to patients which have been distributed by trusts on our behalf and we've shared information with people to cascade through their networks. There has been coverage on social media and in the media and we've done a lot of proactive phone calls to organisations to make sure that they're aware of the consultation and that they can choose to respond and trusts have hard copy documents in their hospital departments for people to pick up and for staff to look at

if they wish to in terms of broader engagement and I'll come on to talk about south-west London and Surrey specifically in a minute, but broadly we've run on community focus groups play specialist sessions on wards, public listening events and we've had meetings with wider clinical colleagues MPs and obviously coming to meetings like this and with overview and scrutiny colleagues,

next slide, please.

so in terms of south-west London and Surrey, specifically, I won't go through the whole list but on the left-hand side there is there is a kind of a breakdown of the types of organisations that we've contacted across south-west London those vary from Healthwatch organisations to voluntary and community organisations that work with equalities groups that were highlighted in our equalities impact assessment.

and we have partnered really closely with south-west London, ICB and Surrey and ICB colleagues to cascade that through their networks as well. So a lot of information has gone out via those channels and by our trusts as well, to the networks that they have. So thanks to to those partners, for supporting, from a commerce point of view in terms of engagement, take it undertaken in south-west London and Surrey area. As I mentioned, we've done a lot of calling cold-calling amount to organisations to make sure that they are aware about what is happening, and there's a range of meetings that we've been to, as well as the site visits that you you mentioned at the beginning there, with a variety of different organisations. That would be happy to talk more about that if there are specific questions, obviously there are more plans in the diary which also happy to talk about

next slide, please, so you will have seen the figures on the left-hand side already, those are from the mid pen mid-point documentation that you've already got, what I've done on the right-hand side for you is just update that so that you've got a fresher set of numbers based on where we were at the beginning of this week, so maybe 800 responses to the consultation so far and there's a little breakdown there of how people are engaging with, particularly the website content in terms of downloading documents watching the animation

and to date we've had over 40 meetings, which have been a mix of briefings and feedback sessions, so we've got many more planned in the diary next slide, please.

so in terms of uptake of the consultation, you can see that nice coloured map on the right-hand side and the darker purple areas are where there is greater response rates, and that is south-west London and Surrey generally, so we are hearing more from stakeholders in south-west London and families who don't have direct experience of cancer which may be due to local promotion possibly and in terms of where we're hearing least from people it's children and young people and families currently experiencing the service we have active plans in place that are reaching those so, for example, we're doing more play specialist sessions on wards and online sessions.

and currently now we there are parents sessions going on this week and next week with more planned in, if there is demand for that, so we expect that gap to be filled, also from a staff perspective, we have staff sessions face-to-face going in with all the trusts a number of them have already confirmed, so again we expect that gap to be filled.

the other groups that were hearing beast from are some equalities groups, and one of the things which we want to talk to you about this evening is how you can help support us to reach those groups in your communities, as you have great sway there, so any help you can offer in reaching most communities in particular, in addition to what we're already doing would be really helpful and obviously, as we're hearing more from stakeholders in south-west London, that means we're hearing less from people outside of London, and we have plans to reach those groups to balance that out so that we're hearing from those outer London families. Our plan is to share the detailed action plan with you as well, so that you can see all of the activity that we are doing and that is being updated daily at this point in the consultation. So this slight just gives you a bit of a visual summary of, from an equalities perspective, looking at the protected characteristics and where we are, from a RAG rating perspective, in terms of reaching those communities now you can clearly see that there are some gaps there around race and ethnicity, people living in more deprived areas, people with poor literacy and language barriers, and also families with caring responsibilities now that's not to say that we haven't heard from anybody from both communities, we just recognise that we'd like to do more there.

so that's hopefully helpful, and that is our own assessment, that's not something that explain have produced for us just for transparency.

next slide, please, so just focusing on south-west London and Surrey I know that the feedback from some members was that you wanted a little bit more detail about the percentages of what it means for you guys here in south-west, London and Surrey. So when we look at south-west London, around 39% of our survey, responses at the moment are from people living or working in south-west London. Obviously that doesn't take account of the face to face work that we've done so. That is just survey data, one of that 39% 12% of children and young people and families

with cancer and or who have had treatment for cancer and 29% of staff within the current service, what we know is that we're hearing.

more slightly more in south-west London, from people from black and other minority ethnic communities. About 26% of our survey respondents come from from those backgrounds and if we are to look at the figures that Chris gave earlier in terms of the numbers of children in south-west London who are treated in the treated in the service is around 250 children a year, and if we look at that number, what we if we aggregate that with the survey responses we're hearing from about 13% of the patient cohort at the moment, if we

look at that data, so looking at Surrey from the same perspective and slightly less response to the surveyors we said we're hearing more from south-west London and stakeholders, so around 18% of survey responses from people living or working in Surrey of 18% 20% of children and young people and families and who have cancer or have been treated for cancer.

and 23% of staff with direct experience of working for the current service.

less, we're hearing less from black and other ethnic minority communities in Surrey and based on the number, if we do the same kind of proportion based on the number of children in Surrey receiving cancer treatment on an annual basis, we've heard from about 8% of the patient cohort, so what we know is that we are reaching them we'd just like to hear more,

for most particular groups next side, just advise you've got about five minutes left, no problem I will speed through, so in terms of key themes, then I think it's fair to say we're hearing very similar things to what we had during pre consultation about the case for change, about travelling access about perceptions of the different providers and how able they are to.

provide what was needed in terms of be principal treatment centre, and when we come to get the independent consultation report, there will be an exact summary and chapters by stakeholder groups so that we can understand the different views, although there might be weighted, but we can look at them and understand for what did parents think versus staff to really understand the differences, because there may be differences that are important to understand, for example, if we put in place different mitigations for different geographical areas or different stakeholders,

so next line, please, so just thinking about how we have responded to the mid point review. Obviously we we really welcome and the report that explained have produced, and it's been really helpful in guiding us in terms of thinking about next steps, who else that we need to be engaging with and, as I said, we plan to share the action plan reviews. But you can see all of that detail and we do welcome feedback on from the committee about how how else we can be engaging next slide. Please, I'm gonna briefly, take us through the headline recommendations that they gave us. There are more in the pack which are reflected in the action plan, but there were six, so the first was around addressing gaps in representation from specific target groups in geographical reach. I've talked quite a lot about that in the pack and we think that we're in a good place in terms of reaching all of those number 2 is around maximising reach from communications activity. As I mentioned earlier, what we know is that sometimes people read it, but actually they don't feel necessarily feel it is relevant to them or that they want to respond, so actually it's thinking about how we can change the wording, to encourage people to respond, how we can make it easy for people and would take away some of those barriers.

the third recommendation is around objections to the proposals, a lot of the feedback that we're getting is about the case for change, which is obviously outside the scope of the consultation, so I'm explained, if recommended, we make the case for change even clearer, so that we can capture meaningful feedback during the consultation number 4 is around comprehension of the proposals, making it really easy for people to read about and understand both proposals so they can comment on both of them when the process of producing an audio version of the proposals and also embedding information in the survey itself online. So people can read it as they're responding and make it really easy for them.

number 5 is around support to complete the survey for specific target groups, so those who don't speak English as a first language and those with a learning disability, so we are looking at how we can work with organisations to support people to do that and many already are on our behalf and we have,

agreement and a confirmation that they are doing that for us, which is really really helpful, and number 6 is around the focus of the children and young people's play specialist sessions. Obviously, as you can imagine, trying to engage very young children about changes of this type can be challenging in that they're not able to comment necessarily on the proposal. Specifically, so we have worked with PHE and split play specialist company that we have commissioned to think about how they can more easily get relevant feedback from children and young people that can help us, but those sessions have been really fruitful and we have a number still booked in

thank you all, so I might be able to you in interest going to very quickly wrap up, so after our consultation closes, we will, as as as just summarise by Fiona, have the consultation report that will set out the feedback that has been provided through the consultation for NHS England leaders to consider and we will, we will, we will. We will consider that as part of our decision making, particularly looking at the feedback provided by different groups as set out in that, although we hope to be able to make a decision early in 2024, the services themselves aren't proposed to move until at least 2026 and they are going to be a number of priorities during that period to help ensure that the service does

transitions smoothly priorities are going to include supporting the staff within the current principal treatment centre to transfer to the service we really want to encourage as many of those as possible to make that transition, maintaining the current levels of research, which are very good at the Royal Marsden in their partnership through the Institute of cancer Research in particular.

ensuring that dedicated space within the hospitals is ready for the children to come to when the service transfers, but last and not least, making sure that the service transfers smoothly, particularly for those patients who are unfortunately in treatment at the time that happens that will be a real priority focus for us.

the the the management of other things that are important during this time will be overseen by an implementation Board that will be established between all the relevant organisations, including NHS England, and will have a real focus on ensuring that that change happens in a timely way, but in a way that will secure high quality services for the future so last last slide for me is is really just a plug, we really want low as many people as possible to respond to this consultation which is planned to close on the 18th of December.

we'd like to encourage the Committee to to really share share as much information as possible with your local communities, encourage people to reach out to us, share their feedback and,

if there are particular community groups who you think would be particularly interested in hearing from us, let us know, we'll get in touch with them and and we'll find an opportunity to hear their feedback directly, so would welcome your ongoing support in that including any suggestions that you have as well based on your knowledge of your communities as to where we where we need to reach out, so thank you very much for for listening to us and we welcome any questions thank you.

thank you, we're gonna open up to questions now before I open it up to questions from the committee, I just want to welcome Stephen Hickey from once as Healthwatch here this evening.

Stephen will be asking questions towards the end of each item, where he has them so welcome Stephen and we'll come to you if the Member questions, so I know the presentation has risen, it raised a few things that I am intrigued in open up to other members first though in questions Councillor O'Shea,

I've got three questions, socialise one and then go round again, that said, I'm not hugging the entire time yeah, I will do it like that, I should have just flogged, we've got we've allocated 25 minutes for questions in this period as well, so I'll try and keep us as close to time as possible great so I'm interested in how the consultation is going to feed out into the into the evaluation of re-evaluation of the schools, so I think I understand how qualitatively the outputs can affect the score within the weighting by the curious to understand whether the weightings themselves could change as a PA as a result of the consultation so, for instance, I know that from some parent representatives there has been concern that the private transport element had been underweight in their opinion for the purposes of this consultation and whether that tie,

yeah about whether that could be revaluated following the consultation.

thank you for your question, Councillor, so just after the consultation closes, we will right what is what is called a decision making business case, and that will set out all the information that is considered relevant for the decision makers to take a decision on on on where the location of the service goes, so that will take into account the information that was available to us before the public consultation, the information that comes forward through the consultation itself and other relevant information that is available to us at that point in time we take the decision and the decision makers will look at all that information in the round to inform their decision and,

in particular, notes will be new information that comes forward to us through the consultation which we will look at and consider what bearing it has on our understanding of the options that we've got to take a decision on, we also expect much of the information that comes forward will also be really valuable during the implementation phase, so we're encouraging people to give us lots of feedback around how the impact of the change can be managed, what's really important to them so that that information can

be a really important building block in the implementation phase to support the transfer of the services, you note that travel analysis forms part of the pre-consultation evaluation exercise that happened and that travel was one of several domains within one, one of our four overarching domains that we looked at comprising patients' experience we also looked at travel for staff as well in another domain which which also we recognised to be really important.

the weighting of those domains during the evaluation was based on

a group of stakeholders, including national charities, parents, and and how they assessed, that to be what we have done, recognising feedback around.

thinks that we've learned around people's preferences for travel have done some sensitivity analysis already, looking at how schools might have changed if even if, for example, of 100% of people may have chosen to travel by car as opposed to public transport, which which which we know not to be the case and,

that has shown us that it wouldn't have had, based on the pre-consultation, evaluation and overriding change in the overarching scores. However, as we go forward, we we we, we recognise that that transport is going to be really important wherever the service ends up going, and I know both providers are already committed to to looking at to looking at access to make the journeys as easy as possible. So it is really important, but it's only one part of the information as well, but we need to consider we need to consider other aspects of patient experience, we need to consider clinical outcomes, all the things that are going to make the service work really well, and also research, which offers the potential for for new treatments for children in the future. We've got a lot more information on travel on our website because we know lots of people are interested in how we did. The evaluation

other analysis we've done on travel, so please do have a look at that and if, and if you have more questions, do get in touch.

actually I'll come in on this bit because it's all links to Councillor OJ's initial will be the answer to his initial question just on, just under a wider engagement plan and the consultation plan I was interested on the discussion around input from stakeholders and I know there was mention of

engagement with councillors and MPs,

for my knowledge and experience, a lot of the stakeholder engagement with local politicians, both within Wandsworth and more broadly, across the JHOSC hasn't been particularly fruitful or productive.

there have been issues that have been issues as well, raised around how long it's taken to notify some of the stakeholders, and I just wondered how fruitful these were given, the engagement with politicians hasn't been productive, especially when we're looking at its being lumped into the same category as certain events like specialist play, specialist sessions, various listening events so I guess the questions two parts how many people actually have attended these events so far?

and if it's anything like engagement with local political stakeholders, was it actually as fruitful as has been made out?

quite sure, how are we supposed to answer?

we've been pretty open and willing to meet as many political stakeholders as wish to meet us.

I think we don't want to give the impression that the idea of those meetings is to make people who've got quite strong opinions about these changes or potential changes to change their mind, it's probably to make sure that we share them with we share as comprehensive information as possible in those meetings and and listened to people why I hope we've managed to do that to the best of our abilities.

but will, when we're not in the business of trying to change politicians' minds, that they they both have free will and and in an inner self, absolutely central role to represent the interests of their constituents and and so we're coming into those meetings in a different place, but I hope our availability and willingness to share information and participate voters is pretty as good as it can be, were perfectly prepared to have more meetings as as necessary in the remaining three and a half weeks of consultation. I guess our main question, as a result of that was bearing in mind the context of what we're able to know as the political stakeholders trying to get to grips with what the rest of the engagement was like and the broader wider engagement plan. So looking at what was the detail of the play specialist sessions, what was the detail of the various listening events and of how widely engaged were those, because I think that the committee would like to know that I'll hand over to Fiona, who is the expert on this? Thanks for your thank you, so you'll write this is a very specialist topic and we're not expecting the general public to understand or have experience of those particular services,

so play specialist sessions, those with parents and carers who currently use the service. Obviously they have been engagement from those groups has been very fruitful. We're finding that more than the survey, face-to-face conversations are much better because we can set the context more easily. People can ask clarification questions which we can't do in the survey, so the focus of the kind of face to face sessions and listening events has been around the consultation questions, which is understanding people's feedback about both of the options. So what is the impact of implementing either of them that will help us think about what mitigations we put in place, and also thinking about the impact of relocating radiotherapy as well, so in terms of the quality of the engagement through those routes and from clinicians, it has been really fruitful and really helpful in terms of bringing up new content and what we're finding through the surveys, that people are giving us feedback that is quite similar to what we've had already and what explained through the mid-point review did indicate to us is that that might be, because people aren't reading, or perhaps understanding the Pro proposals, and they were better able to have that conversation with people in person, which is what we're more trying to do so what I would say is yes, the quality does vary,

but we are consistently trying to go out and have those conversations with people to help them understand, and particularly for groups like equalities, groups that may not have direct experience of the service but because of their particular background, for example, the learning disability community. They might not use the service ever, but actually their experience of changing the location of a service and the impact that that will have on them. That is how we're having that conversation with them and not expecting them necessarily to comment on the proposals, but comment on their particular experience and how that change would impact them more broadly. So I definitely think for face to face work is better quality compared to the survey work. Thank you or any other questions, so I've got Councillor Akyigyina, then Councillor Harker, then Councillor Joyce

thank you to you,

I've got a few questions, but I'll start off with this one.

according to your consultation, NHS England consultation document St George's proposed involved, little capital cost has a better revenue impact and is better value for money when the NHS finances are so challenging, so we're told why house they did not have a new impact or choosing a preferred provider, it seems very strange to me that when you can get just as good or even better at a better price they will be prepared to do so.

particularly more expensive ones are, can you explain why please?

attraction so and are not defendants as a speakers Dr non-cap novella counselling, we had a bar a threshold of affordability which allowed beds and both the St George's bit, and the Evelina bid met that bar of affordability.

and

the money has to be thought of in two ways of capital and and revenue ongoing expenditure, the difference between the two bids is is only initial capital expenditure which we spend once and hopefully that's it for years for decades.

the the ongoing revenue implications.

have to sit with within commissioning affordability, and in both do I I will be uncomfortable.

about proposing I, I am sorry, but what I think we want to do as commissioners is choose the service within a boundary of affordability that delivers the best outcomes and the best experience for children and their families, and I think that should drive our decision making not actually what in the grand scheme of things is a small amounts of money from the initial investment.

I am quite happy to defend that, but that's the the decision we've made, that we could have made a different decision, but that's the decision was made and I think it's in the interests of children and their families thanks do you have a supplementary report to that question or et cetera.

it is implemented because I think when you say that you've picked it in the best interests of children, I'm sitting here I don't know whether I'm speaking out of turn and I'm speaking here and I'm thinking, are we are having a consultation, are always just sort of a done deal.

I identify here being something else, but I just said that both both hospitals, they are good at delivering services for children, I don't know how you can suddenly decide that you know, you're going to pick one, that you know which anything gonna do better unless I'm not hearing that but I,

I I just need that explained.

I'm very clear we are consulting to help us decide which of two excellent options we choose, both of which are affordable and both of which will deliver safer, and, I hope, better quality care for children and their families.

we have an open mind about which ones we choose, based on our evaluation, so far we have a preference, but we're still open to changing our mind if we hear something in consultation that convinces us that.

both the outcomes and safety and experience of children would be better with choosing a different option we have, we will make a decision on that basis, we absolutely in words and one civil haven't yet made a decision, and we wouldn't want to do that and we're not allowed to do that.

if you've got any other questions, we'll just go round to make sure that everyone has a fair share as the Councillor Hogg next thank can capture.

what I want to understand is really what work you've done on the accessibility of the consultation.

not just for those with protected characteristics, but the general population, because a lot of the comments that I'm getting are that people are finding it hard to actually answer the questions.

and although yet you may be offering some support for people to.

actually you get a bit of help to answer the questions people feel inhibited, but to do that sort of thing, of course, so I think this may be sitting at the root of some of the issues you're getting with a lower response from parents because you've just asked too hard a question and frankly or not phrased it in a way that the ordinary lay person understands so yeah, well, I would say to you, is you really need to have looked at the accessibility, and I know that Fiona Galás comments touched on it a little bit earlier on so,

it is a major concern, I think.

yeah, you're right, it's complicated, and for people to understand the technical detail of both of the proposals is a challenge there are, there are many ways in which people can respond, one of the one of the ways which we're finding is more effective is one-on-one conversation so I did interview

some parents last week and that one-on-one conversation enables us to give the give them that information, but also for them to just respond in a more conversational way, and that the parent that I spoke to on Friday, particularly they found that much more helpful and also,

a lot of the feedback we've had is that you know parents don't necessarily have the time to sit down and fill out a questionnaire, particularly if their child is currently in treatment and that offers them the opportunity to kind of pick up the conversation dropped the conversation and restart it so that they don't have to sit for a designated amount of time at a computer and fill it out. So that is one of the ways that we are looking at it. There is also an easy read questionnaire which asks the same questions. But it is much shorter for people to respond to, so we do encourage people to look at that. The other thing that we're doing, which I mentioned earlier on, is audio versions so that people can listen. While they are completing it, they can and s they can pause it. They can kind of take notes if they want to, and they can also directly e-mail ups as well. So there are a range of ways, none of which will be perfect for everyone, so any other suggestions that you have, particularly about what we can do around accessibility will be really and pleased to hear them, to make sure that we can consider them in the time that we've got left

Key

any supplementary Councillor.

yeah, I'm just gonna pick up on that a little bit more because, specifically, what are you going to look to do to get the responses that you need because, yeah, it got some of the parents, maybe?

but there's a bigger population there that have gotten interests that are concerned about what would happen with their children, because it's not just the children you've got going through the process at the moment and their parents, it's something every parent worries about, so really you know the question is,

how are you going to actually get that hard to reach group because certainly an chair of a community group for an area that has got severe education issues?

very hard, quite often for us well educated folk to actually understand just what is required and the effort that is needed, and I question whether I'm seeing that efforts at the moment.

yeah yeah, so your your completely by, in terms of reaching community groups and one of the things that we are doing is going to groups where they are. I went to a a coffee morning on Friday with parents who have children with special educational needs, and they talked a lot about. Although they don't have experience of cancer, they have experienced a very complicated needs. They have multiple children who have special educational needs and the impact of changing anything, the impact of being in an in-patient unit for their child, regardless of what condition may have on the impact of that and changing that environment, and what needs to change any way based on their experience. So going to people where they are is really powerful, as he said, going through groups where they are, we are doing Matt in terms of

kind of looking to hear more from kind of broader families, we have commissioned an organisation that is doing community focus groups on our behalf in the more deprived areas across the catchment area. They are working not just with children and young people, but also with parents as well. They're doing work with children in care children from socio-economically deprived backgrounds, children that might have long-term conditions to really hear their views EVE again, although they don't have cancer, it is those more wider family

family issues that we need to hear about and actually what we found during pre-consultation, is that whether we heard from families who have cancer or families whose children don't have cancer, actually their feedback was broadly the same about what was important to them, so we know that, although they might not have direct experience, that is really valuable when understanding how affects the whole family, an aspect called agreement and Jenny is a member of that who's here tonight we've heard really clearly from them about the impact that it has on the entire family, so we are doing what we can to go to groups and hear from them directly, so we'd be happy to come and visit your group particularly if you have something coming up and we would we would love to do that.

thank you, Councillor Joyce.

so we were disappointed to.

look at 2.00 areas, first of all, I wanted to understand that the understanding of it which will be presented to councillors and other interested stakeholders in Sutton is correct, so when we spoke before, the question that I raised was.

what was the what were the ratings related to transport and accurate, and at that point it was said I think 50% were going by car and 50% were gained by public transport, and that following that you mentioned that you didn't really know, because it wasn't possible to find that from the existing parents who were looking at general issues, which was reasonable, I think, and now we have a situation where you are speaking to the parents directly, so the ratings would change. As far as I understand it as a correct me if I'm wrong to 70 30, now, the question I have is now that you're obviously speaking to the parents directly at will. If it turns out that the numbers are different, will the weightings be related? So, in other words, will will the numbers and the create a totally changed, or will it just be considered? So I don't want to get a feel for not just that issue that issue as an example of how you're going to look at it on the 18th of December, and the second question I have relates to staff, because, obviously, whether this will go to the new site is important, and one way to find them is how many of them on the out respond and therefore a captive audience of intelligent, able people, and also we have it's not just adopters also the nurses, so those by that that consultation seems really important to me, that we should be trying to get nearer to half or 75% or whatever, and to see whether they're going to move.

do we have any feel that you gave a snapshot, do we have a feel of what percentage of responding from the different hospitals, from St George's from particular mile, half between Sutton, and I'd really be interested to know what the breakdown is and what's going to be done to ensure that we get the answer to the question is, are they going to move if they need to so give them

so Fiona will probably answer the second part in a bit more detail than I'll be able to do, and I'll hand over to her to do that.

the first part about the waiting for transport.

with the evaluation that we did in December last year is is a fixed point in a moment in time. We've done that evaluation and we stand by it, but we that is only like the consultation that is is data that will use to make a final decision. It's not a decision, it's it's data that we use to make a decision. It's actually important data, but it is only that what we did do when we, when we did it is, is there a sensitivity and analysis, so we changed the proportions so that we we we we put an assumption that that

that everybody?

came by private car, not that the current proportion, which is somewhere between 75 and 80%, and it made a small difference to the overall score, but it made no difference of the valuation between the two options. Transport is a really important components of patient experience, and patient experience is the most highly valued bit in our assessment, other than quality and outcomes which we defend forever as being the most important bit and but travel is really important, but it's not the only thing that delivers a really good patient experience and people will know that there's a really good patient experience delivered at Great Ormond Street, which has really profound

year, travel and access problems. So, yeah, it doesn't despair us from providing a good experience, it does make it more difficult than either St George's or Evelina will have to meet that challenge and work with the Marsden and with patient groups to do that, there is another nothing also the the current model of care that we

is it the end, the component that is delivered at the Marsden?

does involve quite a high number of journeys to the Sutton Marsden site, some of that might be related to its relatively accessibility by car, but it is, it is an outlier compared to the 12 other principal treatment centres in in in the UK and some models outside the UK, and so there are more journeys into the centre than in the than in the catchment area of the other principal treatment centres. And Councillor Hogg was saying that patients from Frimley are, in fact, that people in Frimley have chosen to send their patients to Southampton, which is nearly 50 miles further away than the Marsden, partly because the model of care is different and there is a greater proportion of care that takes place in what we call paediatric oncology, shared care units and in the future. And that's a piece of work for either George's or Evelina to do in the future with the prosecutors. The paediatric oncology shared care units, is to try and shift the model of care so that more care is delivered locally. So we might end up with a compromise situation where people have a slightly more difficult journey, whichever option we choose, but that they make fewer of those journeys and have more treatment at a local hospital that will involve really careful work, the prosecutors, because we need to make sure that's done safely, but this is the new thing. It's what actually most of the rest of the country do already, and we want to work on that really hard. I'll hand you over to Fiona, who will give you a bit more chapter and verse on the

on the proportion of staff thanks

thanks, Chris say of the total survey responses today, about 17% are from the Marsden or George's, and may currently work in the principal treatment centre now what we know from the Marsden and obviously they're not here this evening to confirm that, but what we know from them anecdotally is that a proportion of staff are choosing to respond anonymously because they don't want their feedback to be.

affected in or they don't want their employment in future to be affected by whoever whoever receives that feedback, whichever trust it is about their proposal, so for for whatever reason they're choosing to respond anonymous anonymously so we know that that number is slightly higher than what we've got additionally, 28%

of wider NHS staff that support children's services, so colleagues from Evelina London from paediatric oncology, shared care units and operational delivery networks and paediatric networks, that 28% of responded from that community as well, so we're getting kind of feedback not just from people in the current principal treatment centre but wider children's services staff as well that have kind of relevant feedback about the clinical model so that's where we are at the moment but as I said earlier we have plans with all three trusts to have face-to-face sessions with staff which will increase that,

naturally.

thanks I know where we are now we're running low on time on this section, but I want to give Councillor Joyce the opportunity to come back with a supplementary and then Councillors O'Shea and Akyigyina, to come back with the other questions that they had just wanted to get it, could you just give me those numbers again broken down to?

clinicians, nurses like nurses to put the hospital is involved, and also just one point editor in answer to this, but I would say that certainly from what I've heard, the fact that there were changes made after the first after those issues were raised was appreciated and were seen as a strength of the consultation that it was a willingness to change, and I think that if it comes back that there were different numbers but they they didn't affect eating so they were taken into care. I think we need to, if possible, get those changes so that we can really see the evaluation but yeah, so just if you give me the numbers

is it helpful if we send it in writing afterwards?

yeah, yeah yeah, I've broken down after I yeah, thank you.

Councillor Ross,

thank you, so, looking at the two services you mentioned in the report pack that there's kind of trade-offs between the services that would and wouldn't be available in that Evelina won't have narrow surgery and St George's won't have specialist cardiology and nephrology, I was wondering if you could,

tell us a little bit more about the impact of those comparatively, I what's the incidence of paediatric oncology patients, who would who would have one of those, and perhaps, where what the differential impact is, whether you tend to get more, perhaps more fragile patients will be less able to travel to a different centre between those different conditions.

I won't give you precise figures one because I don't know them and to, because there are people in the room who know a lot more about this than me from Evelina and St George's.

we, we have got some numbers on this, and I I suggest we probably give you a written answer written answer to this, we, we do know one and the the eventuality of either service Y so any of the three services, so kidney support, cardiac support or neurosurgical support is relatively infrequent, and both Evelina would potentially have an arrangement for a King's neurosurgeon to be available really quickly.

to deal with emergencies and they already have some input from a king's neurosurgeon for other complex patients at Evelina and St George's. They currently have really robust arrangements, in partnership with Evelina, to provide tertiary kidney and cardiac advice, so we were confident that either way round we will keep people safe. There is a bit of swings and roundabouts about those those to specialise just to yet the the only number. I'll I'll probably says we, we did get some information from St George's about how often there was a neurosurgical emergency that required a surgical intervention and

it was of the yeah, it was a number that was that was 3 3 or fewer in a year.

obviously that might be a 6 1 year and 0 another year, and it's really important for those people, and we absolutely need robust, robust arrangements, the most complicated neurosurgical patients are dealt with at King's, and that will remain the case thanks.

and can I just bring in Councillor O'Dea because she did not have the questionnaire and there was.

got one more question from the committee before wrapping this section up, thank you Chair.

it explained to us today that is the harder to reach groups, I'm not engaging with the survey or the consultation.

can we be assured that you're due a?

further analysis at the end of the consultation to incorporate the additional responses.

and also with that, can we see a comparison in terms of the borrowers that are affected all round those around the hospital?

in terms of the response rates that you get per borough, so we can see the difference between each borough and some kind of analysis in terms of the responses, especially the takes in text analysis and how that's waiting, thank you.

yeah. That's an so in terms of kind of harder to reach groups, I think it's fair but to say that we have reached many. There are just some gaps with with specific kind of characteristics, particularly around race and ethnicity, and kind of deprivation. Yes, we can share a kind of individual borrower response rates, but because of this relatively small numbers, anyway, it will be potentially identifiable because of the small numbers of it, but we can look to do that, perhaps at the end of the consultation, as part of the consultation report and the same with the kind of breakdown our plan is to with that report, at the end, is to have an exact summary but to have chapters both by stakeholder groups, but also by area. So, for example, if there are particular issues from a south-west London and Surrey perspective, you can understand that them and take that use that intelligence of yourselves in this area, as well as us think, considering it from a programme level, because it might be that there are things for you come up in your day-to-day work that you can learn from from this consultation. So yes, we will do both

thank you and Councillor Akyigyina, can I just go back on Councillor David Richardson about the hard to reach.

we just said there'd be the number would be quite small.

I am surprised that number will be quite small if you're trying to reach the hard to beat you to try and reach the hard to reach not just a minority group of people, because basically I just feel that I am quite happy to get the hot tub, I could get as many hard to beat, but I'm reluctant to get the hardship because you have two years with parents and basically when you finish you didn't put anything they actually wanted in them. So how can actually be something or groups of people putting you to work with and you basically not for what they want to, so you've got to be reassure us, reassure everybody that when you mean that you're going to consult with them, do you actually going to consulted and not just use them as a tick-box exercise? So because those days are over, people are hard to reach, they don't want to know anymore because that's what's constantly done

yeah, I have been an engagement professional in the NHS for 15 years and I couldn't agree more in terms of apathy in most communities because we don't follow up with them, so it is really important, and with our consultation questions we have been really careful to ask questions that are genuinely going to help us make a decision.

you know, we're not asking people to compare the options, we're asking them about how it would impact them, specifically, so that we can understand equally we we can't promise that we will action every single bit of feedback that people gives us, but we will be transparent about how that feedback has helped inform a decision, but also how it will be passed on to whichever provider is successful for them to consider, because actually a lot of the feedback that we are receiving is about how how the service should be implemented and what the service should look like, which is really important intelligence for whichever provider to take forward in terms of the kind of best small numbers. All I meant was at the moment that because the response rate is, we've got about 800 survey responses. Breaking that down by borough will mean that those numbers are small, not that we're trying to only engage with a small number of people. Obviously we want to speak to as many as people as possible, but the data we have at the moment will mean that the numbers are quite small, because that's who's responded just to clarify,

so why whorehouse the clinical experience of two judges, as you know, has been ignored as part of the scoring they have 25 years of experience built up between different clinical specialists, treat each other with cancer, but this wasn't taken into account in the NHS assessment can you explain why it wasn't taken into account or if it was why wasn't it?

so I think we would refer to of the extensive documentation we sent people about how we weighed up the options, but.

the experience of St George's is really valuable, it is mostly in the delivery of cancer surgery and intensive care.

that is a really important part of cancer care and is part of the motivation for us, making the changes we're making, but the majority of inpatient and outpatient care takes place at the Marsden, so if we chose not.

to send the service to George's and chose to send to Evelina.

the the major change is in the movement of the medical oncology, met medical cancer services from the Marsden, so that that that experiences incredibly valuable, but it's not the whole pathway and needs to be given what we, we feel and used a lot of independent experts to help us the correct weighting rather than a disproportionate waiting in either way, so we hope we haven't get a bit too little waiting then we hope we haven't given it too much waiting and that's the balance we have to get to with with a bunch of Y.

independent and relatively dispassionate people thanks.

thank you, and I just want to bring in just before we close this up.

section of the meeting I just want to bring in Stephen Hickey from Healthwatch for his questions.

thank you very much.

can I just.

so thank you.

two months ago.

1 second Stephen, are you able to try the microphone next to you because at once cutting out a lot?

is this better?

sorry.

some of the feedback that I think you're getting some of the feedback.

I think, as I suspect us from people who feel puzzled by the scale of the change in the first place and the exam question is clearly expressed in various binary terms, is it of Lena or St George's?

but I guess people have made some people, I'm not saying everybody, but some people to feel a bit frustrated that the exam is as limited as that and that they haven't got the opportunity to actually make the case for something that builds on what we've currently got and the impact of the change is quite obviously very serious for the Royal Marsden potentially very serious for St George's, so there's a kind of sense of slight disproportion and I just wonder people who when you get feedback from those sorts of people and I appreciate it's only

the proportion, how are you going to handle that that feedback, because it seems to be quite important, but it sort of excluded, because you said the fundamental exam question is non-negotiable and cannot be changed, so that was my question.

it's it's not my job, no normal entitled in any way to.

to influence or change the national service specification.

the national service specification was arrived at at quite a lot over quite a long period of time, with the motivation of providing both the safest care for children and, hopefully, the best outcomes for children.

there is nowhere else in the country.

where the third at the PTC is not co-located with a children's level, 3 intensive care unit and the year in the places we've looked around the world, that's also the case, it's what's being done at the Marsden over many years has been excellent and delivered good and improving outcomes for children but if it is,

it has been a year like a great past, but it is not the future and one I and others wouldn't be doing our job properly if we agreed because it's a bit difficult, so a compromise which was not likely to deliver either the safest care or the best outcomes for children and the current workaround we have which, as you know involves the transfer of that of a small number but a significant number and a really big deal for them of children when the sickest,

like across London, it is not OK and and yeah we've had a workaround for some time and at some stage we have, we had to say enough is enough about that, and this is at that point. I think the other point I made earlier about working really hard with the paediatric oncology share care units to make sure that as much treatment as possible can be delivered locally and safely. Is a task for us, and either St George's or Evelina to work really hard on in partnership, and I've got, let's have had my colleague from the south-east region and her and Christopher Tips, who's on many teams waiting. There can be really important in driving that general improvement in quality for people on the target. But but I don't think we should yeah because it's difficult, sometimes we shouldn't compl compromise about stuff that's fundamental about the quality and safety of care. That's anything further from Healthwatch, Stephen

OK thanks for that, I think there were a couple of points and they came up from members helpfully around areas in which written responses would be helpful.

and I also think that, just from the presentation itself, a better idea in writing to clarify it, when wouldn't be only mentioned about making the survey easier to respond to you and you're going to take some of those points into account if it could be confirmed in writing as well when those changes will be made, and I think it would be given the very, very quick timeframe that we're talking about here. I think it'd be helpful with these points could be responded to in writing by the end of next week. If that's realistic, because I think you've got the information, it just needs to be sent over. Thank you, and I know we've ever run a little bit on this section, so gonna move on now to bring in the trust, and I think one points the flag, if there is anything that has been covered in the presentation from NHS England and the Q, and A that maybe you'd wish to respond to or clarify from a Trust perspective,

please do so in the time allocated to presentations we have, we're going to have 15 minutes for each presentation and we go in to start with Evelina, so please do introduce yourself when you turn the microphone on it before we start the presentation, so over to you thank you and thank you everybody for having us here this evening.

and Sara, I'm medical director of the Evelina London.

and I see you consultant and have spent 20 years working in the region, delivering, I see your care and and one of the consultants that develop the retrieval service that you will have heard about in terms of how the children currently, when they are unwell, I moved around,

I'd really like to thank Councillor Forbes and others who came round the Evelina in the last couple of weeks, I hope those visits were helpful in terms of you putting some images to the words on the page, I'm presuming that you've all.

looked at the slides, and so I'm not going to go through them,

I'd like to give you time to quiz us as much as possible.

and to answer all your questions, but I guess just a couple of few things to emphasise, and I mean we we've put a bit forward because we do think it's the right thing that we do put a bit forward, we've developed the children's hospital over the last 15 years or so since we moved into our building 20 years ago to be something that would be recognisable around the country around the world in terms of,

the kind of 24 7 breadth and depth of services without children who require specialist services and something like.

a cancer service needs.

just one thing to to correct in terms of what Chris said we do have elective neurosurgery they have, Elena is one of the things we've developed more recently, in conjunction with King's College, we employ employer neurosurgical consultant and he performs neurosurgery on a regular basis, but the tumour surgery on the brain is obviously provided and performed at.

King's College hospital, and also St George's, are similar to the numbers that Crispr gave children without cancer within our children's hospital might want saw up to three times a year, need urgent neurosurgery, and that will either be done by transferring the child to King's if they're stable enough to do so or at Evelina London if that's considered to be the best option for the child.

however, when you ask families, children and young people and staff that work with children with cancer, what they think is most important, and I mean not specific to this process, but just in general, it is the access to specialist care that they talk about and it is the access to advanced therapies, new therapies, therapies that other places can't provide that they put his number 1 and 2 on the list.

I would reiterate with Chris that the service at the Marsden we wouldn't consider to be closing. It is about a transfer and therefore how the staff there, and I think you're absolutely right councillor, when you say this how they feel about the process, how to feel about what will happen, how the transition will go is exceptionally important how we keep those people in the service, it's also about the people in the future, it's about the staff and the future, you mentioned the children in the future, it's also about the staff in the future, and how do you make sure that you can continue to attract people not just from this country but from across the world when you're talking about specialist clinicians, looking after children with cancer, how do you attract them as well as keep the woman you ask them? It is about things like education and training, opportunities around research, clinical and academic, but also made about the children they look after and their families

and the teams that they work, with those multi-professional teams across doctors, nurses, therapists.

the sub specialists, the people that really know absolutely everything about that one particular thing, and that's what you get within the children's hospital.

we don't provide children's cancer service currently, but we do look after children with cancer.

so probably about one in 10 of the children that come through, the Royal Marsden will also have some.

delivered by Evelina London, and that might be at the Royal Marsden in terms of the clinics that are provided, though it might be in the Evelina London, or it might be in one of the specialist clinics that we do across the region.

when we do specialist clinics across the whole of that geography, that you looked at looked at earlier in every single at the hospital there, possibly only not Frimley, because they have moved to Southampton.

so we also, I think, it's important to say.

look after groups of children and large numbers of children who, like the children and young people in the families that have cancer, have very similar needs.

it's why we've developed our children's hospital in the way that we have, we have children that have very high needs for specialist imaging, and so all of the emerging that's provided, both in the children's hospital and at St Thomas's, can be used for the smallest children, and that's not the case everywhere small children having an MRI scan of PET scan may need to have a general anaesthetic all of those facilities over the last.

10 15 years of being built with children and the smallest children also in mind, so they have that similar access.

and the children that we look after come from all over the region, as I said, they also come from beyond that come from all over the country, and so we understand a lot about those kind of childhood, they also have similar vulnerabilities.

they need the same sort of treatments, as I've said.

and I think that's really important, and there are many children around here who have their care forever in London for other things.

they also access our specialist services very similar to cancer, so they'll present to their local hospital in, say, Margate, and it'll be through the local paediatrician that they will come in contact to our specialist service and that shared care will then continue and Christmas mentioned the post queues and that's really really important how we feel that we could support the Posthumus in terms of their development because we have such a knowledge and footprint within the region we provide 1,000 thousand clinics a year.

out in every hospital other than Frimley.

and we also, we will have specialist nurses visiting families in their homes.

we have a palliative care service that looks after children across the whole region, working in in a partnership with many of the children's hospices, but for years on, end visiting families in their homes, and we have children who stay for a long time in the hospital.

weeks months years, sadly.

and we also have children who have to come very often we have one group of children who have life-saving dialysis, they cannot live without that and they have to come up three times a week and they come from everywhere they come from Margate.

I come from Brighton.

they come from far afield, and so we and actually that group of children are disproportionately from families that have low income.

and and also from black and south Asian in particular populations.

and so we do understand the experiential side of things we do understand, it's not all about the specialist and him being there or had been there on a particular day, we understand the importance of transport for those children.

many of those children who do not have a family car, they access three times a week to the hospital, with transport that we provide to the door and then back home, four or five hours later, when they finished that analysis and we do understand about the cost and we understand about the cost of living in London when we reimburse.

parents in terms of the various charges that come with using your car and we do have parking and you can leave your

child and their mother or father or carer in front of the hospital and go and park your car, and we will have free car park spaces that is all really really important.

I think the other thing to say is that the trust that Guy's and St Thomas's it does deliver cancer care has a very large cancer service that delivers care to adults, it also has clinical researchers and academics who currently develop therapies, chemotherapy and other therapies for children with cancer they are already involved in that.

the university's KLB ICR, that has been mentioned, they all work across the whole country, incredibly collaboratively, and we would very definitely see that as a as a big factor in why we could help continue the excellent work in terms of drug development for children, but also enhance it.

I think the last thing to say that, whatever the outcome is, it's going to be incredibly important for children and young people, for families to staff that currently provide the service at the milestone of front and centre and how any plans are made.

we've produced plans, but we haven't actually been able to go through what any sensible planning would do, which would be to involve those people that are delivering the service so.

using that service to be involved, and that is something we have a lot of experience.

in all the years that we have been developing with refurbished with built facilities, we know how to involve parents and children and young people in how they look how they work at the end, and that's really really important and then the final thing, and then I will be quiet,

it will be really important how the providers that you've heard of today,

the King's colleges ourselves, the George's, the marathon, how we work together.

because that will be crucial for this to be a success, I believe it can be, and I believe it can provide for the children's cancer service from the Marsden, a future that will.

that will allow them actually to develop further who have already, but only if we do it, we do it properly and that principle, as ever would be to just do the right thing.

thank you thanks, so much will open up now to questions from Committee members, so any questions at this time, Councillor Hogg, then Councillor time.

thank you.

the logistics are important, parents is one of the reasons why they go from Frimley to Southampton, because it's got good parking, it's easy to stay in the area.

it looked after their children because that's what parents want to do, Surrey compared to other areas, has probably got more car owners as well, because quite a lot of it's rural.

and therefore the car is important somewhere to stay, it is important.

and yet, but I cannot hear from the paperwork on the Evelina is what you're offering is access to a shared car park, access to shared housing.

that is the sort of thing will worry parents, so I already booked appointments that are how you are actually going to maintain a sort of separation and things like that, because if you are talking about children with cancer, some of them will be immune suppressed even if they are not immune suppressed parents will wrap them in cotton wool because that's what parents do for their children so already want to understand how you actually ought to keep that environment.

separate and looked after where there's capacity that it's easy to access, bearing in mind that you're in this very central London, constrained location.

with us charges and all the rest of it to worry about, how did you get to do it?

so thank you, so I mean to point we have many, many children and families who have vulnerable children, we have children that are Immunosuppressed for reasons that are separate from cancer therapy.

and so we can clearly understand that, starting with two things as long as the clinical environment and it's absolutely the case that the inpatient area will be a 100% Councillor Ward, it's we we had.

we've had many, many staff from the Muslim Cameron visit, I think, for maybe 50 60, the last week touring round with some of the clinicians and they say, How can you guarantee that there won't be a random child put on me?

Councillor Ward, and what I said to them was well one, because that would be crazy, but to it's very similar to some of the cohorts of children we have so, for instance, our cardiac ward. We would not admit a child coming through the emergency department with pneumonia or bronchiolitis, it would be the cancer, the cardiac children, hot children go to that ward, so within the bounds of other areas where we can be quite flexible, there are certain areas where there is no flexibility because that would be wrong.

the outpatient area, the day-case area, would be a separate area again with a separate entrance to your point, because we do know that that is really important to the families with children with cancer.

in terms of accommodation.

so we have a, I think, 60 bedded Health, Ronald McDonald light.

all of the children's hospitals have around the country.

we wouldn't we are not, and I would be wrong to say that we, we would be building a new only for cancer parents, accommodation that would not be the case, they would be obviously able to access Ronald McDonald House and all the things that are in there.

and the parents would a parent would also have been able to stay with the child in the in-patient area, which is currently what we have for all the children in the children's hospital.

what else did you say the car parking, we would have an area that's because we've said we will have free car parking and it will be available, and it would be the number of spaces that well, it's equivalent to the number of spaces that are ring fenced at the Marsden maybe that's not enough I don't know so that's my point about we would have to work with the

service and from their families as to whether that's an adequate amount. We do have a very large car park, but you're right, all hospitals are difficult to car parking, so it would have to be would have to be ring fenced, but we wouldn't have a separate car park, I wouldn't be wrong to promise you that

what else did you say?

without it, I think the trophy transmits the transport for for those with cars, it's about making sure that we can, they don't have to pay and making sure they can be reimbursed and reimbursed before, rather than after, because for some families that's a very big deal.

for those families who don't have transport, I think the the the the patient transport is really important, so for instance, our children are coming from dialysis who don't share transport with anybody else because that would not be appropriate for a child coming from dialysis, many of whom are very, very vulnerable.

and that's the most that, but that is, I think, our best offer that we give to our families.

not all the children that we look after can have that it's not a resource that can go for everyone, but there are certain cohorts of children, the cancelled children would fit into that cohort by virtue of how often they have to come out and their vulnerability.

thank you for that on what other writer on that is palsy, NHS England analysis is the use of public transport because, et cetera, London location, I don't think many parents will feel happy with that so yeah, I think there is a concern about that generally.

obviously you've got patient transport, but if you are already providing for those where you got a clinical concern.

that may be an inhibiting factor for many parents, they are safe to smoke, I might come back, so it would be for the children with cancer, just as it is with the children that come into diamonds, so the children that are Immunosuppressed and particular groups then of families where their circumstances is such that they need that support.

the public transport, I think, probably more relates to the staff, I don't mean just the staff that currently work in the service, I mean staff that work.

in the future, and also parents will now, when they are visiting, not both parents will be with the child the whole time during their treatment, so the public transport is important, but I totally agree with what interests them.

thank you, Councillor Down.

thank you Chair.

and residents and community creation is a really important and for a lot of our airwaves them from Croydon.

and this change in terms of the intensive care unit we have been either to St George's on your site, Eveline site, what I'd like to know is key in your brief, I haven't seen anywhere in there in terms of the impact of the move in terms of the locality, the residents and the community, so can you assure us that there will be an analysis in terms of the potential effects on the local community?

the provisions within the existing hospitals and the healthcare services and the impact on social cohesion within those localities.

thank you, yeah, so I will answer and I will ask my colleague Jackie if she's got anything to add, so the answer is yes, because that has to happen as part of any process when you're when you're building anything.

I think it's we have gone through it and other other things that we've done some of those who actually haven't built, but we'd gone through that process in terms of the business case, so it is really really important, I guess my question to you was would would be if you wouldn't mind would be a therapist, specific aspect of the community that you would be worried about in terms of the impacts of this service move to the community around the Evelina,

I don't have a specific group, but I am concerned in terms of the impact in terms of current services and what that will look like, yet it moves from one site to another for year on both things, whether it's that we need building in they forget when the site was St Joe George's and for the residents is worse, I need to understand how that would look and how that will impact on the existing communities. Yeah yeah yeah, so I mean it may be that NHS England want to talk, but I think it's specific to the Evelina, so so we've developed a lot of specialist services over the last 15 years and talked about that quite a bit we have an A&E they have an emergency department, we have we look after the community care of Lambeth and Southwark we provide the health visitors and school nurses or the universal healthcare.

it is fundamental to our strategy that our local services for children develop along the same lines as our specialist services.

it.

we can evidence how that has happened over the last 10 15 years, so the developments have not only been in specialist care, they have been in our local care to for the other specialist services.

I think it's fair to say in any case where we're expanding a service, we have to look at what are the impacts on the other services and how will we provide that, and I guess the main things for this are our pharmacy.

they are surgery and theatres, they are.

imaging imaging and diagnostics in terms of lab support, and we've had to think about that a lot.

but if we're successful, that's the point in which we would do a proper business case around all, and we work out exactly exactly the impact and spend an awful lot more time on it and and money than is currently happened, but I think your question is really pertinent, I think probably out of my depth in terms of social cohesion.

yes, I can add, and certainly as part of our work, we have done an interim inequalities, impact analysis which has allowed us to identify from right across the catchment area, different groups who potentially are going to be impacted in different ways by by this change so there are some groups particularly,

groups in parts of south-east London parts, at groups down on the coastal areas groups down in Kent and Medway who potentially are disproportionately impacted by this service change, including potentially because of because of their income levels. And we, we we, through our work, want to hear more through the consultation about the impacts that people perceive. This change is going to have on them so that we can take those further into account as we itch re and develop our impact analysis through the next phase of our work and and and we really want to get people's feedback on on where we think potentially more work is gonna need to be done during the implementation stage to manage those impacts on different people so that work won't stop when we make a decision. Whichever provider takes the service going forward will absolutely continue to do that work and we'd anticipate them working very closely with communities to make sure that the service is is is meeting people's needs and is being tailored to people's needs. And we've we are into our interim

impacts analysis is published on our website and we welcome feedback on that, too, as part of part of the consultation and obviously happy to talk more about that as well, sort of separately if the facts of interest. Thank you thanks, Councillor Damme, then I think Councillor Akyigyina, you had a question sorry just to follow on from that my main area that was looking at there. It was in terms of the environment, how long it's going to take to build the disruption within the area, how that's going to impact on the local communities? So I need some kind of comparison across both sites in terms of what that's gonna, look like for our residents as well, suddenly that I didn't see any of that in the report

perhaps I could just comment briefly, and in so far as both hospitals will want to add their own view, both hospitals are proposing that space within the existing footprint is refurbished.

at Zara tell us in a minute, but in Evelina the proposal is that.

existing clinical areas are moved to be delivered in other areas of the Evelina footprint to make space for the cancer service, but that in that area would be refurbished specifically for four for the children of cancer in St George's omits, existing administrative space that would be repurposed for the purpose of the cancer centre, so it's not new-build, but it's refurbishment that will cause a level of disruption and as part of our work we're working with the trust to make sure that we've got good implementation powers and that to make sure that those build programmes can progress, there will necessarily be some disruption, although perhaps not to the level of a new-build programme, nor the same level of risk that exists with with a new-build programme but I'll let the trust comment they are about far closer to the detail than I

yes like him, sorry for misunderstanding your question yeah so Elsa's right, so in terms of the inpatient area that is currently a ward, we have experience from another world, the top floor of the children's hospital was officers when we first moved in we converted that into a clinical space a cardiac ward and an intensive care area, and so we do have experience of that and similarly the day case and outpatients we have two empty floors, two and a half empty floors above or

Day surgical treatment centre.

there already have separate access.

and so it's mainly the refurbishment of those areas, so the disruption we've probably had the most disruption in building the day surgery unit, but obviously in taking any plans forward that would be a key part of of being able to shoot, to show what that is and how anything is mitigated how it does it change the care and access for all the other children that are coming into the children's hospital and their families.

thanks I've got Councillor attitude.

thank you, thank you, thank you very much for taking this round, the other day was interesting and soon-to-be you got questioning for their children, so the s St George's this Christians were both survival suits or start with you.

what it took about impact, what will be the impact of you not being chosen to provide it to the children's services that you run.

so I guess the main thing for for us would be a loss of opportunity, you know we have, we will continue to build our children's hospital in the way that we think it should go where on a journey and we're quite a long way along that journey, but we've still got things to do and services are continually developing and new services things you never even thought of as a service become on the horizon quite quickly so and so the impact will be in in our opportunity really to provide for the cancer service I mean it.

I am going to be honest with you, in terms of the Councillor service needs all the kind of things that our hospitals provide and and it gives another group of children that you, you must provide that care for, and so it is helpful in terms of recruitment and retention of staff I've already already mentioned that.

so it's more around the opportunity Councillor

Councillor Joyce,

so my question is related to staffing, when we were very grateful that you let us come to the hospitals that are stated to.

st George's.

when we went there, there were six incubators that were not in use because of a lack of staff, or that's what was mentioned, I'm not sure if you could just let us know why those incubators are not in use and whether that's a reflection of staff issues as we come from Sutton and a lot of people move out to Sutton or other outer London boroughs because we've worked in London before we want it not travelling into London, I just wondered whether that would reflect our problems potentially moving staff from statins hospital.

nurses and so on, and if you, if you've got any comments on that, I will be fair and ask the same St George's yeah, I know it's a very fair question to the specific of the for God's the an amused, but better cuts on the 6th will add a 10 bed step-down critical care unit, and it's true we've only been able to staff at 6.00, so it was empty, as I explained to you, open very quickly around the pandemic and then spent

we spent probably 18 months either looking after adults or moving off our children's IT you up there, so when we started to increase the staffing to actually properly staff our area,

we we.

we went out to get to actually staff 6 cots, so that's what we staffed, we would like to staff more than that, and I'm not going to lie to you and say that it is difficult to retain and also at the moment retain rather than attract intensive care nurses, particularly in paediatrics particularly because of the impact of the pandemic and what people were doing joining those at that time but we have seen

an improvement.

in that regard over the last six months and our intention is hopefully over the next six months to have that unit fully up to 10, we need to do it because we have children who need a elective surgery and or to get more of the waiting lists down that are the case across the country so that's our intention but you're right it is a continual focus for all NHS organisations and Everdeen in London Guy's and St Thomas's are not immune.

but we also have an awful lot of stuff that attracts particularly specialist workforce.

and so.

as I said earlier, things like the education and training offer and the ability to be involved in research and and and look after these complex children is very important, but it's intentionally, though Scots are are currently empty because we haven't recruited to those yet.

but the intention is to do so over the next six months,

thank you any further questions from committee members.

now, if not Stephen, do you have any from Healthwatch just one question?

it would be helpful, I think, and maybe it's been picked up earlier, to have more clarity about the treating of patients who need or might need neurosurgery. I'd certainly thought that the proportion was actually quite high. I'm up higher than struggle suggested and having to correctly those patients would generally not all but generally have to be transferred then either to King's or St George's. So I think be helpful to have some clarity about what numbers we're talking about here, because obviously further transfers are a downside, and clearly I know it goes both ways. It's not just neurosurgery, but I think some figures on that would be really helpful.

yeah, so I might struggle with exact figures, but I think it's people behind me at probably correct rate, I think it's probably this found 15 neurosurgical procedures, at George's, I might have got that wrong 15 or 20 and then sort of 70 or 88 at King's the way that those children come in to the neurosurgical services generally straight from their local hospital they present with symptoms related to their brain tumour and they have their surgery.

and then they go on to have their chemotherapy and and currently affect Eric King's the majority of them, they will be transferred to the Marsden to have that chemotherapy, what what we would.

understand is that that sort of proportion of children will continue, so a smaller proportionate george's to the larger, more complex at King's, we would really want to actually strengthen, particularly what currently happens at King's in the way of the oncology provision, and they also have been working on that and they've just for employed.

a couple of oncologists for their own.

you know for their own service.

and I think we could do that, build on what we've done with Kings clearly.

we haven't had that interface with St George's around, that we interface over other things, but we would want to work out.

what it is, that's gonna make this continue, J George's, I am now not speaking to them, but I am sure you know if if, if they're not successful, we would continue to provide the shared care for children, the locality and whether there's something particularly similar to King's that could be done in terms of,

augmenting what would normally be seen in a post-EU, we would definitely want to be part of that, I think that is going to be really important, we've brought around a colleagues from Brighton last week, it's a long way from Brighton to either Tooting or,

Westminster and

they clearly have appetite and ability a capability and infrastructure, and someone like Brighton, and I think there's probably maybe two or three other places in the region that could.

probably.

if done properly, and the trust from the start between the post-EU and the and the PTC as is put in place for these things, can happen locally, I think we would add a great opportunity for the fact that that,

in terms I mean, I think I'll repeat it, but I think I already said to you in terms of one if a child is at the Evelina.

having had neurosurgery at King's or St George's, and they suddenly became unwell and needed neurosurgery.

then?

they would, I think, most likely be transferred either to George's or Kane's now, as I've said, we have had children where we've made the decision with our kings neurosurgeons that actually that's not the right thing to do and they therefore had the surgery at the of Lima.

because we have developed our elective neurosurgical programme, which is not, which is total, I say our, I say that kings and ourselves, it's not brain tumour surgery, but it's other neurosurgery, we have very close working and we have the imaging capability in theatre, for instance in order to do that with an

the City scan within the within the theatre,

anything further steam was OK.

yeah

I think it was just just a quick one from May, following on from Stevens question, it would be interesting to know what your plan would be on transfers in those specific cases, because obviously we are talking about some really incredibly ill patients.

is there a plan on the transfer process in those cases, should you schedule bid be successful?

yeah, so we already have experience of both moving children for my forever in the region, so either judges, kings ourselves or across the river to other centres.

we already have children, as I say, that occasionally need to be moved as an emergency to another hospital, as I said, very infrequently to King's for neurosurgery, occasionally to Great Ormond Street.

we have moved children from Great Ormond Street on ECMO, which is not just hot but not just long, but Hart supports probably the highest risk transfer you can do so, we have a lot of expertise within the service, already, we have already moved these children, so if the child has been operated at King's or George's and they're at home and they develop complications of their surgery or of other tumour,

they will present to their local hospital and we will be involved in that transfer, we will be involved in the process of it, we may sometimes not do the transfer because it's so urgent, and they're in Margate, it's actually in the child's best interests for the local team to do it but more often than not we would do then go and get the child.

and bring them to George's or Kingdom, Joe s, if they are under duress for their cancer treatment of the neurosurgery.

thank you, and thanks so much for coming and presenting and answering questions from us this evening. That moves us on to St George's is your time 50 minutes for presentation, then followed up by Q and A just the same as if we have Elinor and do please, or introduce yourselves when you speak, it's over to you. Thank you very much and thanks very much for inviting us today and for coming to visit us as well. I'll I'll quote, quickly introduce people. I've got here, I'm Jacqueline Totterdown, a chief executive George's Epsom and St Helier. I have a seizure Francis, who is the clinical chair for paediatrics. I have a Bruce Keogh, who is one of our paediatric cancer surgeons, along with Ms Kate Burford, who is one of the other paediatric cancer surgeons of which we have three, and I'll talk about that in a moment, so St George's does have a large children's at hospital that looks after children in the Lee south of London and the south-east,

we have 25 years of working with the Royal Marsden in partnership, we have close relationships with them, we have pathways with them and we have a good relationships with them, and in the current regional cancer service, at the majority of outpatient appointment, diagnostics and chemotherapy are delivered at the Royal Marsden.

but the majority of surgery, expertise from regional paediatric specialists, such as gowns, gastroenterologist, neurologists, dermatologists, etc are all given by St George's, and also we have a children's intensive care unit at 1.00 of your colleagues asked for some figures, so if you will allow me just to to respond to that.

so, in regard to a neurosurgeon or brain cancers, one in four children who have cancer will have a neurological cancer will have a brain tumour,

and only a handful of these about five require urgent emergency neurosurgery or new neurosurgical input, usually for lead on the brain.

in regards to children who require?

kidney support at roughly about 3 year will need to go to the Evelina or admitted overnight and in terms of children who need cardiac input

we usually say about 25 a year.

most of those, if not all of them, can be dealt with at St George's, so the impact the impact of those specialist services on their 250 to 175 children, who present with cancer into the PTC a year is that can be done, it is mainly done locally.

just a bit about our paediatric surgeons.

and they can talk to himself later if any questions come along, but there are about 20 paediatric oncology surgeons in the country, at 3.00 of them at St George's, and it takes a long time to train somebody who comes out it's adoption decides during surgery into being a new into doing a paediatric surgical training and even once they've qualified as a consultant it will take four or five years to get them to a level so that they're not freely available in the in them in the country and then there are

small but a lovely lot.

I think just also to add in some of this is that small children ii, those under the age of two, will go to Great Ormond Street, and I think that remains the same in the in this consultation as as it does in as it does currently.

so just really to to to update on that, and also that those patients I was talking about who come to St George's at their about a third of the PTC workload, so it's not, it's not tiny small and it's the specialist most policed patients who come to St George's.

in regards to the proposal for for children's Council services.

should this come to St George's and we will bring our colleagues from the Royal Marsden as as their owners, I think it was, I also said, it will be built in or an administration building, Willis Owen outpatient department, its own, its own entrance in with a co-located the ward along with co-located research facilities and a day-case unit so all of it will be in one building accessible directly and with a car park.

and with that I'm going to pass only to to CJ

thank you, Jacqueline as Jacqueline has said, on the original Geoff, with responsibility for children's services, at St George's and clinically on A and E neurologist, which means I look after newborn babies.

I think it's really important for us to prescribe and talk about the range and breadth of expo expertise that at St George's as Jacqueline described, we have a comprehensive children's hospital we provide, the vast majority of children's specialties are recognised by the Royal College in my day job I look after babies from 400 grams upwards and RPI Sue looks after young people, some of whom are bigger and weigh more than I do so we are used to looking after.

a range of children anywhere from 400 grams up to over 100 kilograms.

and all our services that are that are developed around those needs, be it surgical services beat imaging, be the major trauma service.

designed to look after that breadth of children.

but it is also crucial to whom you describe where our confidence around developing the cancer care comes from.

it doesn't come from a confidence that we can develop the service, it is a confidence that comes from the competence and outcomes that we currently have, as Jacqueline's described, looking after some of the most poorly children who have cancer and, crucially, providing them with the neurosurgery and the paediatric oncologist including the most complex surgery in children.

which? Blues and kidney might be described in just a moment, I think that that's not just a confidence in those services to themselves, but actually the way those services.

work together with a range of paediatric specialties and not just paediatric specialities is important, it also recognised that children's cancer care requires an entire hospital behind it, including adult services, who sometimes have crucial expertise in developing some of the things that are then brought on into children, so, for example,

bristol's it deserves more detail, he works very closely with our foetal surgeons.

some of them have developed expertise in some of those skills that are required through the major trauma service that we have through our adult cancer services through our adult interventional radiology services, and also through some of the services we provide adult cancer patients such as bone marrow transplant and, crucially, some of the evolving treatments for bone marrow transplant upper adult patients with cancer such as Kochi and some of the newer cellular therapies that are being provided and that's that's really what our confidence around this comfortable.

before I describe that in more detail, it is really important to also talk about how difficult it is.

not just to develop those skills but actually to have those those individuals worked closely in a multidisciplinary team within St George's, but also with oncologists at the Marsden.

at this point, I'll hand over to Bruce who, as a surgeon, who undertakes those procedures and does that work is probably in a better place than me to describe those challenges.

good evening my name's Breeza Karim, a consultant paediatric surgeon.

pleasure to meet some preview of the other day.

I'm a paediatric oncology surgeon, but I also both Kate and I.

also specialised in complex paediatric thoracic surgery, so we we perform a lot of complex surgery on newborn lungs and things like that, and that fits in very, very nicely with oncology, because we do lung metastases and all of assaulting saw fits together.

but we also still do the full range of paediatric surgery, so we still deal with trauma, general surgery and now has a full thing.

and I think part of the reason why Jacqueline and seizure wanted me to attend was because, because we certainly are quite simple people, they thought that we architects, I could kind of paint a picture quite simply of what we do and kind of illustrate to you.

the ease or difficulty of moving a service like that, so if you just forgive me I don't want to sound patronising, but.

so for cancer you have, we have liquid cancers, what we call liquid cancers.

and these are things like leukaemia, lymphoma, these are things that are not big lumps or that can be treated with surgery.

and then you have solid cancers, which are the big lumps that would need treatment, and eventually you need surgery now.

you might imagine that for liquid cancers you don't need a surgeon, but every every new liquid cancer does need a surgeon from the beginning, because all these children need Venus access, basically for them to have chemotherapy one of the advantages.

one of the branches of of of a place like St George's is that our entire surgical team is geared towards providing that service. So although that's only us that do the oncology, the entire department does the central venous access. So there's a lot of experience, there's two or three of us who are older and have done a lot of very difficult lines are there to help, but the whole team, the juniors everybody, and so there's a lot of training as well in central Venice access for children. We do very large numbers of that, so you'd need to have a surgeon

involved at that point and that involved a lot of coordination, because this is a busy paediatric surgery, and it doesn't just do oncology, but then there's neonatal surgery, there's trauma, as I said, there's abdominal surgery. All these things need to be co-ordinated, so you need good relationships with an X-ray department with your anaesthetists, we have a dedicated paediatric emergency list every day so

most children who need a lion will get it within 24 48 hours.

I've been at St George's 2021 years and I trained under a senior colleague Keith hubs for eight years before he left and I was able to take on the services that are now working with me, and I just say that because what I've described with something as simple as a central venous line involves so much communication with so many different people you need a well oiled machine.

if you don't have a well-oiled machine, there will be delays and miscommunication, etc.

that's taken a very, very, very long time to develop, yes, it can be moved, but it's going to take a very, very long time to acquire that smoothness of operation, and in that time there will be problems potentially and when we come to the solid tumours again,

from the beginning we are involved, so we get a direct consultant to consultant referral for a solid tumour we liaise with oncologists, we have the images sent across the mapping, conquest or bright to know whatever we get the images over, we'll look at them we decide on the best way to biopsy them, whether they need or whether it's interventional radiology or whether it's the surgeons will they need a line whether they need bone marrow, etc.

all that has to be coordinated with people who are used to the service and and again were able to get these kids over within 24 hours.

and have their procedures done, something, be managing the surgical beds and will be managing the oncology bed, and then we need to liaise with the pathologist we have found. There is a real shortage of paediatric pathology in the country to think people know, and we have towards the best really fantastic, but we need them, so when there's about to be done there, primed they know, it's coming, we get the specimen fresh to them, we have to make sure that they have the right number, of course,

it's very, very, very complex operations are on the on the surface. It sounds simple, yes, surgery, but actually the amount of coordination and the number of people that need to work together to make these things work so that the children have a smooth journey

it's very complex and I'm proud to say we do a fantastic job with that now when it comes to the children who will, following their biopsy chemotherapy, and all that will need an operation.

this is, this is quite complex surgery, one of the busiest surgical centres for oncology in the country.

I sit on various national committees and were part of all kinds of national international trials and on all that, but some operations can take six seven hours.

some shorter, but it's.

I worked with a Methodist, Linda Murdoch, for 15 years before she left and we had unspoken communication across it, she knew what I was thinking and I knew she knew, and I was worried, and when I wasn't she knew how my patients would react at various stages of the operation she knew.

went to start giving more fluid when it was just and fortunately she also worked on PSE, so I always got to PSG bed when I wanted one, but.

that partnership was invaluable, and while she left I now work with another colleague who I've known for about 18 and 19 years, and we'd been working together since since Linda left, so I have the same anaesthetist all the time at the same team who can read who can respond to because we do get horrendous bleeding and things like that occasionally they've seen it all before they can react, they know what to do.

please tell me from going.

we will, we will need to start wrapping up in it, so so just to wrap up, but what I'm trying to point out is that this is a very complex of complex.

special regard to solar, and I'll just say P's use is vital because they know if, for instance, I remove a large neuro bass stoma, they know about the fluid shifts that these children have, they know what's going to happen in the first 24 hours 48 hours.

I can give you some examples, so yes, things can be moved, but it's taken over 20 years to build up this machine and I'm not getting any younger.

it could move, but it will take years to build up this kind of of.

of well auburn shade, and my concern is that in that time of transition there will be significant errors, made, mistakes will happen, and it's impossible to believe that there will not be more complications and miscommunication, etc during that transitional time, so I think I said enough,

if I'm here, I'll.

of course,

I think also of talking to some of the questions that Councillor Sheard asked earlier around the relative impact of different services and availability of those on-site from our perspective, providing the service, we know that we've got the services that matter on site for neurosurgery for example, we don't need to have a workaround, we don't need to have a mitigation, the neurosurgeons are on site,

we've also looked at deaths at the transfers that were provided through the data leak by NHS England, and we are very confident that we can reduce the number of transfers to less than two a year and both of those were for inpatient renal care thing.

so we have a lot of confidence in the fact that we can deliver the services on site, but also, crucially, we've engaged a lot of the families that use our services and with the service and, crucially, cancer care, but also the broader sort of children's services that we have on site and that has led us to develop the model.

around our both our state solution, but also around how we want to try and deliver the service in the future and, as Chris has described in one of the book, one of the more important things is going to be around delivering more care closer to home. Indeed, we are one of the prosecutes for our readiness, so we understand the importance of that. It's also been important to describe it on a number of our special specialist services, including our paediatric surgery service. We already go out to local hospitals and provide services locally for them, especially specialist patients, so that the patients don't have to travel to the specialist centre and also be using a lot more telemedicine and remote medicine with colleagues in industrial hospitals and lastly, there was a question around what would be the impact on St George's will be to lose children's cancer, and that's a really important question. You've heard from both myself and from from Bruce about how closely intertwined

cancer services are with the specialist services that we provide and how some of them are incredibly difficult nationally to recruit to, we feel quite concerned that there would be an immediate and direct impact on some of those special specialist services, especially on paediatric surgery, and how we would provide our major trauma service.

but also only the impact on things like pediatric pathology and the impact that would have if pediatric cancer moved on the pathology service and thereby the impact of not being able to deliver the same quality pathology service on other surgical specialties that rely on it, there is also the impact of the attractiveness and I think,

Sarah alluded to this.

there are many different factors that attract staff to work at different hospitals and the breadth of what we provide, including children's cancer, is quite an important growing point, not just around nurses, nursing staff therapy staff, but also in drawing some of the most talented paediatric surgeons and other specialist specialists and we are concerned that that there would be an impact not that straightaway but over time.

on how well we would be able to provide those services.

for a fairly wide published across south-west London Surrey and parts of Sussex that rely on us to provide those services and we think that is really important to be considered as part of this process and for that to be considered by yourselves and others I'm going to stop there cannot be for out of time and it would be very happy myself Jacqueline others to answer any questions that you have so much and will open up the questions now from committee members to Councillor Hogg then Councillor Cheney then Councillor O'Shea, thank you Chair actually you asked the same question as I asked previously, which is for you to talk about logistics because,

in this situation, parents want to wrap their arms around their children, there are other children in the family that are affected by it all as well.

so logistics.

family support for the CHA, sick children is dreadfully important.

and, given the nature of the move, it kind of pushes people towards public transport, is it easier to use in some respects than getting a car there because of logistics and all those sorts of things, so I really want to understand what you are offering and what the differences are.

thank you, I'll start and I'm sure Jacqueline and Alice can can add to what I'm gonna say.

I think the point that you you make any questions you ask is really important, something that we considered very carefully and if you listened to not just our patients with cancer, but the patients who access our specialist services and

much like the airliner, because we have a range of services, including major trauma, where patients can be brought in from anywhere, that is that there is a range of families who have needs.

and in considering how we would provide the paediatric cancer service, we've also looked at what the Marsden cannot currently provide, what's really good about the services they provide a fantastic service and how we could replicate and build on that in terms of adding on what families say is very important but in terms of actually getting to the hospital as many people have talked about.

coming by private transport and being able to come by private transport is really really important for families, which is why, when we consider where we would place the service and and how we would.

enable that people could come to the service very easily, we chose a site which would be accessible very easily to car parking that we already have on site.

and how there will be made accessible for more families, I think that that's really important from a public transport perspective,

we are where we are, we are in Tooting, there is a lot of bustling within south-west London that come towards St George's being a major hospital site, I already know that there are a number of our families who come from Croydon Burton and other areas do use it.

there is also the national rate at Tooting station, which goes across a range of pace and interconnect within central London to services that go to Kent Sussex, etc. Have you also have the Northern Line is a tube and, from my own experience as a clinician who looks after patients who come from some of our patients coming from as far west as north London, not east London,

sometimes from Medway, we talk a lot of families about the challenges that they have, and what parents do tell us is that, yes, it's not as easy as going to their local hospital, but it is accessible and, crucially, the support that we provide, whether it is through financial support or through support or car parking etc. It makes the site accessible enough for the quality of service have been getting and for them that is the most important in the quality and breadth of service that they can get.

recognition that they can't get that to their local hospital.

parents want ultimately what's best for their children and they will accept a degree of hardship for themselves.

but we've also heard very much from our for patients with cancer, some of whom have prolonged treatment and some of whom are in hospital for many, many days, but there's a significant impact on the wider family.

crucially, on siblings and importantly now, I think.

changing patterns of work, I see increasing numbers of families working from the hospital while they were their children because they can, and that means they don't have to make that choice, and so we have improved the wifi that we have available, recognising that and making it faster and every more throughput we have a excellent psychology service who currently look after children with cancer so they understand the needs of children and their families who can't send me.

they support the siblings of children who have cancer. The school obviously provides an outstanding service which allows those children to continue with education as well. But what we've also looked at is the international experience of providing care for children where services are far more centralised than they are in the UK and we saw some interesting models where people provide family suites where families can stay and siblings can come and do their homework

a child still is very much a part of that family, even though they are in hospital and some of our children with complications, postpone bone marrow transplant and in hospital for four five six months.

and so it will be designed our state solution, we've designed it in such a way that some of our rooms can be converted into those family suites to enable those families to be able to spend more time together and lastly, we've also looked at what is important for those patients in terms of their experience in hospital and what a lot of families have said is that it gave him the in hospital for a really long time, but really it's important for them in that sense of community sharing that experience with other families who have this very same experience that they have very few other people find easy to understand and so again

in the design, we've created opportunities for families to be able to mingle safety or communal fashion, which again provides the emotional support, so I think those are all really important things and I think again this is where some of expertise, not just with cancer but with other patients but crucially with cancer has allowed us to think about this and,

many of us in this programme have felt rather.

dispirited by the length of time it's taken us, there are two or three years at the moment.

I've lost count a little bit unsure where colleagues in NHS England have as well, but it has allowed us to develop a very comprehensive solution which we feel very confident.

thank her for lots of.

thanks I think it was Councillor Kitchen I next and Councillor O'Shea and Councillor George, thank you very much, thank you very much, Members of St George's was for having received a day that was also very interesting and you pre-empted me on the question and you responded so I'm actually going.

Australian NHS members.

the in the consultation document states that St George's worried about the impact on other services if the Councillor service mood, have you agree, interesting George's way of mitigating the potential impact, and I would also reiterate that only Evelina, even though Evelyn associated mainly misses opportunities, so if she can respond for both please,

I would just be bought responses on this just because I know that there's a lot of questions still to cover for St George's, if their responses can be quite brief.

yeah

so we thought about it. A great deal with the Commissioner of complicated and complex children's services NHS London, solid NHS E, in London, so we would work very hard to ensure the weren't inadvertent knock-on effects on other services s to name a couple paediatric pathology is luckily something we don't need very often and is the ultimate solution for paediatric pathologist. It's a network solution that covers the whole of south London, not an individual service for one hospital, which is not a sustainable model or the the best, the best thing for the population we serve in terms in terms of surgery. I think all I'll say is that

the St George's C 60,000 children a year.

and the explains how you look at it, there's around you somewhere near 200 patients are receiving patient care for cancer at St George's children receiving in-patient care, so these these 200 or so children are really really really important, but there are a relatively small proportion of the

of the children's workload, and there is a massive backlog of elective care in the health service, including in children. So there is absolutely plenty of work to be done for children at St George's, and we will work very hard to make sure that we're sustained if at some stage, the service, the surgical service and the intensive care unit, which is the component done at St George's at the moment and moves out after this consultation thanks, and I just offer the opportunity because it's obviously about St George's and we're still on acute, and if there are any points in that you wanted to respond to in Chris Davies response just that they welcome. Not the Fiji is not the

I'll I'll start and I can see my colleagues might want to add a bit more, so the waiting times of St George's for children's surgery is less, it's one of the shorter waiting times.

and and I think the sorts of things that Chris is talking about about filling the gaps are not the sorts of things that are not the complex cases, but actually we do so well.

that is, that is the difference between Sarah, can fill it up with lots of E and T teas and ehs hernias etc when actually these guys are trying to do really big complex operations. It's a waste of their skills to actually think that we really can issue a few few children over that. I don't think, but I don't think we really looked at that in any great in any great detail, even though we keep asking to have a proper look at the impact on St George's, so that's my MA point really, I think just the bit about pathology, that's not something we've talked about as part of any conversation we've had about before about joining pathology, except it might be something we need to do, but it is something that we need to consider as part of a separate process

there was anything more yorkstone.

I was just going to say that.

and that's why I kind of wanted to break down, to try and actually paint a picture of what we actually do, I think that to answer that question with 200 patients, and it's a small, is a small proportion were well for a paediatric surgeon for paediatric surgery, those complex cases is the reason why people become paediatric surgeons, for example,

the condition called oesophageal Tricia.

there are about.

100 in the country a year, so most most departments will get to do five or six a year, but that's the breadth, and that's why people want to become paediatric surgeons.

and the same amounts for a lot of other neonatal cases, and it's the same for cancer, so people want to come to St George's people want to be trained at St George's because they want experience with venues access to they want to experience with oncology. They want experience with complex thoracic surgery, Thurrock, a scoping surgery, the numbers are small, but the impact is huge, so my operating list

I may have one case on that list or two cases.

but all the trainees and nobody wants wants to come and see those cases have to be trained on those cases and then maybe thousands of hernias and hydro sails, but that's we're not comparing like with like, so I don't think it's possible to answer that question, I think that might be a bit of a simple way to answer what is actually a very complex impacts on the Department or on the hospital was to liberalise oncology.

just sad that the PCC ran between George's and and the Royal Marsden is the second biggest in the country so even though it might only be 200 or so patients, it's still the second biggest in the country second to Great Ormond Street thanks Chris, you indicate you will do it again, it will be brief and then we'll meet all of the reasons I gave a brief answer you asked me to would brief.

we are not citing at all. The surgeons who are used to doing highly complex work should shift over into simpler work, and that's not not the point at all. I was talking about the impact upon the fabric of St George's of a small area of really important work being removed. It is completely normal practice and there is free willingness and Bruce and Kate have free well, but it's completely normal practice for people to do part of their complex social practice in one hospital and another part of that complex surgical practice and another that's commonplace for the Marsden in adult cancer surgery, where lots of people work at Epsom and St Helier and the Sutton site, and lots of people work at St George's and Chelsea and Westminster and Imperial and the Fulham Road site. So we would want if, if the service moves and it's an issue because we're still considering two options, but if it moves we would have to negotiate a negotiation with people as to whether they wanted to move the ecological part of that practice to another provider in that eventuality, and that's the discussion with people with free will, and they can make their own choices, but there's the there's, there is no, there is no medical reason why those two practices can't be separated and that it's been done before it can be done again. Thanks, well part this now because I actually imagine, based on conversations, that we had a beef trust last week on the visit that Members may have additional questions on this point, especially where it comes to a more long-term impact on George's and also the likelihood of staff meeting.

I because I know this is something that several Members covered.

so I think I've got Councillor Roche next.

thank you, so I wanted to touch on the point of research because I noticed in the scoring evaluation one of the elements was where Joe trails were scored slightly lower, was on research capabilities, so I'd like to understand in your perception what what drawback, if any that is to be slightly treated to have or not have research capabilities and to what extent that can be rectified if you were to expand with this with a segmented children's cancer service.

thank you consultation.

I think if we look at the evaluation criteria.

what it showed was that we were is called less than the Evelina, but it didn't say that we didn't have such capability, we had very strong research capability, I think it's fair to say that St George's as both a university and as a hospital has a smaller research footprint globally across all domains than King's College and King's partners but around children's cancer and I think some of this data was presented last week when Councillor Les Carter came and visited St George's.

we were able to demonstrate how, over the last five years, St George's has quite substantially increased the number of children taking part in complex clinical trials, including those but involved in into one.

investigational medical products which are the most complex kinds of.

research trials, and those numbers have not just surpassed what we thought we would do, it also surpassed what others with the region have done around children, so we are very confident in our ability to provide the children's research, and we already worked very closely with the Marsden and ICR on a number of children's cancer trials the very complex to set up the very difficult to set up, especially across multiple sites, and that has been a challenge in the past but,

Over the last few years we've managed to find a way through it with our joint research office enabling these trials to work across multiple sites, so so that's that's a lot of learning that we've got, which should make that transition of the clinical service across the St George's work very well without any disruption to the the research capability at the ICR and the Royal Marsden.

I think the other other important point around around research is that again, research requires not just the wider capability within the organisation, but also the research mentality of the individuals that at the institution, and we have.

one of our lead, children's researchers, Professor Heap, is also a lead for children's research across south London.

a large number of our clinicians and an increasing number have been involved in children's research across a range of specialties over the last few years, and that number has been increasing, so while St George's has a smaller footprint from a historical perspective,

in terms of where we are going, we ought to pathway, we satisfied the party that we're on is bearing fruit in terms of the both the rate at which we are increasing and the complexity of the transit rate we were taking part in and for children we are very confident that that collaboration that we are having with not just local but national, regional and,

and, crucially, international partners will allow us to provide a seamless transfer of that research service and enable the ICR and the Royal Marsden research programme to continue, at St George's, with the patients being at St George's.

thank you, Councillor Joyce.

so my question is the same as it was to have Elinor.

they obviously are scrutiny, we are responsible for making sure that it has a major problem, that we shed light on it, and so we need to just understand whether whether that could happen, and could you tell me on the staffing side, I mean obviously you're the in situ so you've got the staff but some will come over and do you have a feel for any issues that could arise and obviously you've got the either the intensive care beds had you

got staff for all of them at the moment.

thank you, Councillor Joyce.

your item, recognising that we already have the PCC that provides all of intensive care for children with cancer and OPCC, has recently been able to increase its capacity in response to demand, working with the London Odeon, not just in terms of doctors and nurses but also in terms of therapists and other other professionals that are required to provide the intensive care service.

Sara is absolutely right, recruiting specialist clinical staff be doctors, nurses, therapists in London.

and retain them is a challenge.

but I think we have done really well over the last few years in listening to our staff survey and listening to the feedback that we've gotten from our staff, about what it is that they wanted to be able to stay at St George's and we've been able to improve our attention and our turnover in paediatrics is now amongst the lowest amongst all the staff groups and the trust that shows that the world could be doing around children's services.

it certainly helped him to keep that stuff that we are training and, crucially, that's really important that we often had to take people who don't have the training we trained them up, so it's really important that we don't lose them, so the work that we've done has given us confidence that we can retain that stuff and that leads on to a second part of your question which is around the staff that are currently at the mast at the Marsden.

I think it's quite a challenge.

you have described some of the factors that make people choose where they want to work, including travel, family and childcare, all those other things that are really important and even though we are not in central London and Tooting, we are closer to central London than Tatton and therefore the cost of living is greater, I talked earlier about some other transport options for four patients.

be honest and say that the private transport options for staff, it is less we are less able to provide that because the site that we are at and the difficulties that we have around it.

we know that a lot of our staff come from from quite a wide range of areas, not just in Southend but actually from north London using public transport, and they are quite comfortable doing that.

the second part of it, of course, is what draws people to the institution we talked earlier about how we work very closely with our Royal Marsden colleagues, we have a very good working relationship with, and not just at a medical level, but nursing staff.

anaesthetists and a number of other specialty psychologists, there are a number of joint appointments, for example the paediatric cancer research nurses jointly appointed between St George's and the Royal Marsden.

so these are people who will know each other and work well with each other.

and, as an example, recently, when the Royal Marsden had some difficulties recruiting a senior nursing leader for the paediatric service, one of our colleagues was seconded over there and they've stayed there to continue to support that service, so we have a close relationship with the relationship that people value

and that, along with the work that we've done in the demonstrated what can be done in terms of being able to retain our stuff, I think it gives me and I'm sure that there is a degree of confidence that colleagues at the Marsden would want to come and continue working in the service with people that they already know trust and do the job that they love.

I don't think that the state solution that we're offering, which is what we've had our Royal Marsden colleagues, really fits what they desire for that service will do any harm to what I'm saying, I think it would be a very strong drawcard for them because that would be very honest again has been one of the challenges that Marsden colleagues have seen with the St George's offering for children's cancer and we are rectifying that in a way that they have wanted us to.

any further questions from the Committee.

can I just come back because I did ask him to tell me what happened.

I believe that as well I know it's mainly,

sir John.

sorry, could you repeat that I am even microphone a little bit closer, I think as well I asked what the impact would be on St George's, which are just below the sorbet is also asked about what the impact would be if Eleanor didn't get the set of this would be the impact I know the Dr said it was more or less a missed opportunity, but what would you do to mitigate the missed opportunity?

can you just clarify here that's a question addressed today because they, from the vantage St George's, I want to know what, what sort of work would they do to mitigate the impact on Napoleon, they've already answered St George's wanted to check what we're going to do.

so.

we don't think that there would be a massive impact other than a missed opportunity to airliner, but it actually.

our priority is to deliver the best care for children with cancer and then to mitigate any knock-on effects on either organisation if we don't choose them, and so the the first principle is to provide the best outcomes for children with cancer, the second principle is to provide the best experience for children, their families with cancer and there are ways we we in some ways have some levers, as the commissioner of services to make sure that,

at the hospital it doesn't get awarded, the service is is protected and looked after mitigated etc but there's there's not a specific concern about the future Evelina without it.

year

thank you if there's no further questions from committee members, I'm gonna go over to Stephen Hickey.

questions it's just I'm going back to the consultation.

obviously, the people who are most concerned at the consultation are those whether it's parents, families or indeed staff, who work in the current service will know about the current service and are concerned about it, not very immediate context, with a lot of people who have no particular experience of child cancer and don't expect you know rightly or wrongly ever to be involved in that world.

I might feel this exercise is of no interest to them.

actually might feel concerned at the broader implications, particularly people in south-west London, I'm talking about here not so much south-east London and so on at the at the risks, as it were, that's been articulated to the wider services for children at St George's and I guess my question is whether whether whether it's George's or NHS England also needs to do more work to,

articulate those risks and will explain what what they are, so that people who aren't actually very interested in knowledgeable about child cancer as such, nonetheless be encouraged to contribute to the consultation.

I will open it up to whoever wants to to answer it, because I know there was there are specific asks, obviously to NHS England directly, but also the trusts themselves in an encouraging greater engagement.

so I think the biggest risk is an impact on specialist children's care, children's surgical services and yeah, I think Bruce and Jacqueline and colleagues are right to highlight what we think if we we choose and it's an if if we choose to.

to deliver the service from Evelina in the future, we will have to mitigate that risk, we think, and partly because the quantitative arguments of of expressed already that that risk is perfectly mitigate, able some of exactly how you do that re depends on absolutely legitimate choices made by the the expert surgical oncology staff and including medical and nursing staff, and we'd have to in some ways cross that bridge when we come to it.

but big because of the

it's a complex problem and we'd have to take it seriously, and it's one of the things that other London would work with providers over the two and a half years of implementation to make sure we managed it as carefully as possible,

it probably added that we have talked about the concerns that George has happened, others have at our programme board that it includes George's, then Guy's and St Thomas's King, through our Marsden and Great Ormond Street, and

what the risks are acknowledged are an absolute commitment amongst all those involved and also wider paediatric networks that exist across south London and beyond to the ongoing delivery of really good children's care right across the catchment area, so the nature of the NHS is of course we are 1 0 1 1 big organisation really and from what I've heard from those conversations you know.

there is certainly work to do, but you know, I'm I'm sure that people are committed to working together in the future effort for for the best outcome if children, which is what we are really all here about at the end of the day, so I just wanted to add that,

thank you anything further Stephen.

I don't know whether George's wants to comment on my question.

I think I think there is the several bits to this, there is the first bit about agreeing how much that was and how much can be mitigated, because that's why we haven't quite landed an agreement there, that you can hear that I think the second bit is the impact it will have on potential other services not within the first year or the second year but it may be three or four years down the line.

and I think that's also the bit that will resist, and that's difficult to quantify it's, it's one thing to say, Don't worry, we've let it happen and I believe I believe the regional office and they say that but the light, but I will come up with a capital J J St George's long term and there is something about what network naturally might happen, though it doesn't matter what we agree, it will happen and we haven't really thought about what that been means for trauma and what that might mean for, therefore, neurosurgical services at George's. So there's there's there is bits about unintended consequences. That is equally

a concern to us to the long term.

can I just say on that point, because it was something myself and others raised last week at the visit as well, the question around unintended consequences as you're saying.

and the access to certain pots of money going forward from the H NHS England. This is something that I think in terms of a consultation and in terms of mean AMA Wandsworth councillor, hence why we're here tonight, St George's is in my ward and you know we're really really pleased to have such a huge teaching hospital in in our ward and obviously lots of lots of people who live

one of my local residents work within the trust.

it's something that we want to understand what the knock-on impact for our residents are, and that's true for me as a ones of Councillor, it's true for everyone else here, representing their councillors on the JOSC this evening, and I think this is something that.

yourself as a trust may may be able to calculate, but it's difficult without knowing what sort of future pots of money will be available, and I think our residents do deserve to have the information and I think this is something that would be. This is something that has come up, and I know colleagues across the draft tonight have been trying to pinpoint what the impact on their residents will be, and this is something obviously for those who live more closely to George's. Especially, it is something that would be helpful, I think, within the consultation process, when people are filling in the consultation documents that have this understanding of what the future will bring to their local community and what the impact on services that they might. As a Stephen, you were saying they might be more familiar with other services as opposed to just paediatric oncology, so I'm not sure if this is something that could be made available. These are figures. It could be made available

towards, but it is something that I think would help also help engagement in the consultation because, as people are seeing the wider remit of the future impact on this, which goes to your point, I think Stephen if that's fair to say.

would you mind if this could I just serve as a surgeon and training an oncology specialist interest, I have worked at 7.00 different paediatric centres.

it worked for Oncology centres in my training I decided in 2012 I wanted to be a paediatric oncology surgeon, with that expertise, and did two years waiting for a consultant job to come at George's to have the opportunity to be trained by Mr Okoye and,

I saw three jobs come and go at the Evelina I didn't apply for any of them because it was something that was so passionate to me in my training, so I think it will have a huge knock-on effect in terms of trainees that come through St George's and paediatric surgeons.

some of the stuff that I've seen and now hybrid cases we do with I are and with the EA in t surgeons and with HB surgeons in other hospitals that we've built up over so long, for example kidney tumours, where we can do synchronous receptions that I've worked in other institutions in London though that they don't have the expertise to do that because of the broad range that we've got on offer at St George's and the idea that you can compare an adult surgical cancer with Peeths cancer when we're talking about such a heterogenous group of cancers, the liquids and the solids, and you can somehow come as its two site being that part or were on call 365 days a year between the two of us, you know, even when we're on holiday, we're answering advice

so it's not, it's not quite as easy as is just coming to do the big stuff and then going it's you know that the thought that's involved with each of these cases to make it happen and try and minimise the number of anaesthetic that each of these 200 children get, which were 175 lines a year, we do 40 to 50 solid tumours. We do all that gurnard or cryopreservation all the lines, everything else, so it is. It's it takes a lot to to get through to that that training and obviously as Bruce says, we've got the trauma, we've got the thoracic

care, so I think it will have a knock-on effect for the paediatric surgery service at St George's, thank you, thank you for clarifying that I think at this point and I am just aware we are obviously overrunning if anyone does need any more water just to point out there are boxes of water down as I do please help yourself we're not just hoarding them up here.

I'd now like to turn to Jenny Watson, thank you so much for for coming this evening, sorry, it's now getting so late, but that doesn't impact how long you've got.

we do, we still have unknown things.

it wants to see Porto, OK we because we were supposed to have, in addition to Jenny Ali Martin, I understand she and she has joined us online so.

Over to you, you've got 20 minutes and then we're obviously going to have a cabinet as well, then so thanks so much.

OK.

it is working, it is OK, thank you, I will first.

is it still look, good, okay?

Surrey

yes, thank you for inviting me, and I know I've met some of you before along this process, so I'm really pleased to be here tonight and to be able to have this opportunity to speak because, as many of you know, there have been multiple concerns about the consultation process from the parental group stakeholder group, and I would like to clarify a correction to a point Elsa made earlier talking about transportation being an area that we scored, as I've said previously, we have that taken away from us, so that is not correct that we were able to school that as part of the evaluation, so that was done externally. I'm also after tonight I fail as I'm sure many of you do. There are so many unanswered questions still

I feel like our concerns, and many of the public's have been growing consistently and the impact of the either option going forward and changing the model that is in place now are huge and the implications, as I know all of you, are taking really seriously thank goodness because,

we're being told very many times that the case for change is there, and this is why this is happening, however, the case for change is being really questioned, because there are so many issues with it that are are flawed, and so when we're talking about both proposals and I have the utmost respect for both of the hospitals, so I am not here to parade anybody and I'm in all of everything that you do

however, it can't be minimised that we're talking about saying the safety of children, yet we're not providing a single site solution with either of these options, and we've talked tonight you know everything is. We haven't even talked at length about the impact of radiotherapy and how that is going to be hugely hugely impacted if services are moved. Also, we're saying it's not a closure, it's absolutely a closure of the Children's Centre at the milestone of 16 million pound purpose-built unit would be closed because it would not be used anymore, and we are reliant on those staff moving, the majority of which which I've said previously, are hugely concerned about this. The majority live locally to Sutton 80% of them do drive to work. So on that transport issue, I know some of the hospitals have covered this and NHS have commented on it. It's a huge issue. There is a national shortage of staff to recruit and a massive issue with the Marsden staff wanting to relocate, so that's a massive flaw, if either one wins the bid, they haven't got staff to service this in the first place.

I do think it's really worrying as well with the whole public consultation phase that we're being told. Relevant feedback would be considered in the evaluation. However, if it doesn't relate to spit seismicity, specifically part of me to a particular aspect of each hospital's bid, it seems to be being discounted. I personally believe that there are huge amounts of valid concerns being raised, some of which tonight about the legitimacy of this move proceeding that are being told this is not going to be counted, so I'm worried about the authenticity of who is considering this information to be relevant.

we were told originally that petitions were going to be included in the evaluation. However, we have a petition of over 8,000 actively engaged people who have, as I say, huge concerns about this, yet we're being told it's not relevant because it's not specifically in relation to either bid, yet these members of the public, as you mentioned Stephen, there are huge amount of members of the public that have concerns. We haven't had a point before now. This is the first time people have heard about it and, and they're really concerned again, impact with MPs and interaction with them. I've had lots of interaction with MPs about this, not one of them has been in favour of this decision, so to say this conversations going on, most of which I know have confirmed that they have written to the NHS to oppose this or share their views of concern about what this actually entails if this goes forward. So I think that also needs to be looked at

there are huge we're talking about. These conversations of this is massively linked to postcode, and it's going to be very reliant on making sure that services are also managed within the local postcode, but there's no detail on that which is terrifying. There's no clarity on having dealt with different postcodes like actually which ones need to be brought up to speed, which ones don't? I've been in a stakeholder meeting where it was discussed that, while they all need to be of a key level to be able to take this service on board, so not everything would happen at the the PDC, but actually where is this going? When is this going to happen in the process? Where are the costs for this because this is huge? We're already talking over 40 million for the initial stage of this happening. This isn't that cannot include the impact this is going to have on post-coup redevelopment rebuild getting them up to speed. I have personal experience of that transfer from the Royal Marsden, and it was absolutely terrifying when you go somewhere, and they are not trained to the same level. They don't have that oncology specialism and to think that that's just going to be easy to roll out to the whole of the area that is affected by this move. I think is it not being discussed enough? I think a lot of people have also fed back on the consultation that it's very misleading one sided. It's the statistics, some of which are out of date. There are a lot of sweeping statements in there that can have holes picked in which we do, yet we're still told that that's not relevance. It's not specifically related to the Evelina proposal or St George's. When you look at the statistics and I've said it before, we are talking three children a year last year who needed that transfer from the Royal Marsden to St George's. Yet more children need transfers for radiotherapy and how are we not, including them, how we not, how are we discarding that that is key, because those children who are part way through needing bone marrow surgery yet need radiotherapy every day, how is that going to work to be transferred to UCL for radiotherapy I'm very unclear how that is not classed as,

a really big issue. We've also talked about the neurosurgery issue. The care of transfers. These are all still taking place. We are not solving the issue of children needing transfers. I create by going ahead with this move, all we are doing is further complicating a system that is established and works, and I think the way the Royal Marsden specialism are not, I mean they're obviously not able to be here to speak for themselves, which I also question, because I feel like there's so much knowledge they have and there's so much that they are able to feed back on in terms of the fact that there is a reason, this works, the relationship with St George's, it works for a reason you know there are no fatalities linked to this system that has a clinical team on board and I think

at every stage of this public consultation, people are trying to voice, but we're being told that what you're saying is not quite relevant. Well who's deeming it not relevant because we've also been told that if enough mitigating reasons are outline for either bid not to be valid, that they would go back to the drawing board because it would be deemed that actually this is suddenly the costs are escalating, there's more complications, there's more transfers. When you look at all the other aspects of Councillor treatment

yet them were told in the next breath, although this will be going ahead, so is it going ahead regardless and one of these hospitals will get it, and the Royal Marsden will be closed, whether or not there is enough reasons why it shouldn't go ahead and not really concerns me.

another thing is we're being told parking is sorted and it's being reimbursed, yet there were actually, when we talk about when we go into the fine detail, it's actually only one parent who would be reimbursed and most people I know when we have a critically ill child would not leave their child there on their own their next partner would switch so that parents who drives into central London pays parking pays congestion charge is not going to be.

Britain bursts. So again, the wording is misleading because there are a lot of costs that parents and family members will have. I do have some other points as well. That was another point. The charity funding, I'm really unclear on how this is also being considered in the costing of this. So the Royal Marsden cancer charity is obviously a huge charity that raises a vast amount of money and where is the that money going to come from if this goes ahead and where is how is that being included in the cost of this because if they are raising

millions of pounds per year, how is that going to be matched for the staff that are required for the other aspects of the hospital and the young people in the teen unit if there's young people, if the sorry their younger children,

aspect is moved, and again it's these numbers that were told that a relatively small, so 200 of the proportion when you're talking about St George's, or that's a relatively small number yet three children needing an intensive care trans colour, that's a huge number to justify why we're all here tonight I'm just a bit confused why we can pick and choose what's important in this whole process.

and I probably should leave some time in case any, I think, is still with us in case she has something she wanted to add, but thank you thanks yeah, anyhow indicated.

and their families it really shines through.

my daughter has received treatment with you and in all sorts of various support, the new hospital, and we've always been really grateful and found the service to be excellent, in conjunction with Paul Martin's surveys.

I just have a three main concerns around the consultation process itself that I'd like to highlight a further has been a huge lack of clarity.

around catchment are West Sussex, which is where I live, was removed from the consultation document some months ago now.

East Sussex are on course to is in East Surrey, and so they refer us to the Royal Marsden and I assumed that we would therefore be part of this and we were initially but, as I said, suddenly West Sussex disappeared from the front of the document but I asked about it I was told that we will now be sent to Southampton.

Southampton, it's very difficult to H Malik at Marsden is a 40 minute journey and Uphampton is two to three hours, and Evelina also two to three hours, St George's just under two, the 40 minute journey and some weeks we had to do that four times there and back full-time, so my dose was having.

Kimetto's and B M teams béarnaise all sorts of stuff and in a lot of pain, because she was having a uterus put into her back into her spine, so it's a very difficult journey and perhaps a 40 minute journey to think of it as a two and a half to three hour journey I I don't think we would've been able to bear it.

that's my first point lacks character and catchment, the second point I'd like to make is about the the weights, and, I suppose, respect given to the parent panels lived experience we were asked to assess as accessibility.

I think that it was removed as a category for us to consider, and we will replace our feedback was replaced by an algorithm.

which has now lived, experiences its A and R and

I feel that the algorithm trails completely to to understand and actually represent the realities of travelling a child with cancer.

and it was a huge blow to have been asked to give my experience, then have it taken away like that, especially in an area that I feel is one of its key and being able to access a service, no matter how good about the services being able to access it is massively important especially on the job in each peer.

the third point I would like to make one final point is about the lack of clarity around how the service will run in the future, so we are talking about pushing more services to couscous.

also, this creates serious equality issues, my daughter's level or possibly the level 1, which is the lowest level and cannot be compared to a level 2.

former level 3 7 7 3 she can't even receive infused Kemet therapies, so she'll be forced into PTC which, let's remember, is two to three hours away.

I understand that whether it is going to be a piece of work to be done in the future, that's not good enough, we need to know now we need to know what we're looking at, we need to know what we're voting for, we need to understand it fully, we can't just say Let's go French its plan for the future, let's think about later these things have to be in place, it has to be nailed down

in addition, are seeing no budget to levelling up across schools to enable them to offer and obtain the high levels to accommodate greater accommodate which patient numbers, I have not seen that that piece of information and I think that needs to be included within this budget.

because my daughter wouldn't be able to access Katherine at 2.58 hours away, so we would be forced to go topless school, whereas our post-school is the same distance as the Marsden, it's the same journey time as the Marsden, so our service, our access to the service is going to be greatly reduced.

and finally, I just want to understand why the Royal Marsden and St George's or Marsden, and a Berliner option has not been fully considered, in my opinion, and all outpatient clinics could remain at 4.00 Marsden, for example, there are no risk easy to access cheaper to access, certainly cheaper to build because it's already there and in operation brilliantly.

I'm not there tomorrow, my daughter is gonna be really quick there and back then she can get back to her GCSE fish and hear from next year.

yeah, so that that's what we wanted to say, thank you for the opportunity, thank you, and can I just track both both journey and I it's probably easy for the journey to indicate as well because you, because you both raise several questions that would it be helpful to put it forward, and probably mainly to NHS England, to respond to some of those now before we open up the Q and A or would you rather go straight to Q and A to see Wales comes up?

I'm happy whatever works best for you, I'm aware of the answers I generally get that won't answer the question anyway but feel free.

given you know easy for 20 minutes, let's open it up to anyone that wants to respond to any of the points that both Jenny and Anna just just made, because it might help with some of the Member's questions as well, so if anyone does want to come in from either of trusts or NHS England,

hello Darren, and thank you Jenny and Amy for for your comments just now.

there's lots in there, and I know we have spoken several times around some of those areas, but probably just a few things probably to pick up.

the got ready to start.

this this is a complex programme and, and it's a complex decision that we need to make here, we are we are, we are focusing on on the two options, because those are the options that are the work that we've done prior to consultation to look at all the ways to meet the national service specification has identified as the two viable options for delivering this service that doesn't mean that,

the the wealth of experience at both of you have another PE and other parents have is is not important in helping us to shape what this future service looks like and and your ongoing feedback, including through our stakeholder group stakeholder group, is helping to shape and inform our process as we go and say thank you for your contributions to that. I note that sometimes you know we have had potentially different views around things in and you know we have acknowledged that also in the consultation document and also in discussions.

travel, travel or travel is an example of that of the travel or time analysis that form part of the evaluation, followed a standard NHS process that sees typically for many of these reconfigurations for looking at travel. That's not to say we haven't taken into account and are listening to the feedback that we're hearing about the importance of travel through the consultation and and and hopefully, as you've heard tonight, that's gonna continue to be really important for us, but also for both the options in the future in terms of finding the best solutions of that for patients when we move, and similarly for radiotherapy, we've not talked about it much this evening, but

there are a number of benefits and reasons why we propose that the services move for radiotherapy, but you're right to highlight that it will mean for around 40 patients or so who currently have their courses of radiotherapy at Saturn that those patients in the future would would travel to University College London ends in central London for that service and are in again travelling accesses, it is one of the biggest impacts on that group, although overall you know we hope clinically it is the right thing to do to co-locate the services for radiotherapy in the future at that site.

the question of catchment area.

it is an important one to raise formally the catchment area for four, this is the is the Brighton and Hove and East Sussex part of the catchment area that is defined by.

the paediatric network and the NHS working as part of this, that's not to say there's not patient choice and we know families like Annie's because of their alignment with the paediatric oncology shared care unit in Red Hill do get their services from the Royal Marsden and indeed other patients across across the country do have the right to choose to get their services from the Royal Marsden or from other any other PTC sizes as as it happens, so through this consultation we would welcome the voices of of of of everybody who's got an interest in this and there will be

that there was not expected to be any formal change in alignment in the way that the post keys that currently exist within the catchment area point in terms of their the way that they send their patients and their pathways, so say to Annie's point about being sent to Southampton that isn't that isn't a proposal that that forms part of this and and we would anticipate, patients in that area would continue to if they choose to travel to one of their future sites in the future.

there's lots that I will stop there and potentially invite Chris to add to that, because there's lots of yeah, I'll just add something about the post keys and and let other people contribute out about.

the prosecutors are not part of this consultation and it's complex enough as it is without adding another layer of complexity.

there is a point that we need to be explicit about the model of care provided by this PTC is out of kilter with the model of care in the rest of the country, and more people get seen in post queues for the other 12 PTC than they do for this one.

in some ways, the geography here, although it feels quite a long way for people, is less constrained than if you look at the West of England or the the north-east and northwest, but we do want to adhere to a principle with our colleagues in the South East region of where possible and where safe, which is the

it needs to be both practical and safe that we do look after people in imposture, use that that is a letter to tasks that will have to do in sequence and work with whoever the provider at St George's or a Berliner.

and with the south-east region

to develop the post-EU use so that they can maximise the availability of safe shared care services locally for people.

but and to enter into a reorganisation of prosecutors at the same time as we do, this would would not only be sensible and would make the task too complicated to deliver, and just to reinforce else's point, that we are constrained by the national service specification which is fundamentally about the safety of patients and and you know and I fully support the idea that the sickest children, those that need intensive care and there were 35 advise not not three.

transferred out of the Marsden, 15 of which needed intensive care in intensive care support in the last year we count it, which is 2020.

thanks for that and thanks are there clarification that and we are opening up to members and Minister just a note for Members as well.

the questions, obviously, as I go into genuine honour, we will open up to wider discussion to the trusts or NHS England because it's already late we're already overrunning and it could take forever, so please do direct your questions to Jenny Onana and make sure all the questions that you know can be reasonably answered by the patient rats aside Councillor Joyce,

so as a Sutton Council Councillor obviously had my heart is with Marsden, and I would like to offline with you, but I would want to ask if you have to choose between evolution St George's, what's your view of the patients?

the parents, I should say as to which of those is a better option, I'd read it in the report to some extent, but I was wondering if you could explain that and your your views.

and I think any touched on it earlier, and something we've been trying to understand why it was discredited so early on was the risk adapted suggestion of maintaining services, so actually there isn't a closure and the removal of services, but those that are diagnosed and in critical need are likely to need the intensive care would be treated at St George's.

as they would be now that the vast majority of those milestone patients would stay at the Marsden, because the upheaval is huge for many of them unnecessarily, and we do believe that partnership works.

from a personal perspective, my son was diagnosed at St George's and the consultant worked between St George's and the Royal Marsden and most of the parents. We now have that relationship and understanding and know that that PTSD relationship of 25 years can't be discounted, and I think a lot of people have a now and it's no disrespect to Evelina at all. They're an incredible hospital, but the fact that there's such a fine line between them becoming the front runner when there is a lot of established relationships and people who have that lived experience with St George's that doesn't seem to have come across and, as I've said before, the scoring process and the evaluation we all felt was hugely flawed. So when you're looking at who's come out on top, actually the parameters that were put in place for us to score, which I know I talked about in the June meeting, it was impossible to get any distance between either of them, so they both came out very, very similar because of course they both felt the brief, so we don't believe that that was, and I know we've been told it's an official NHS evaluation process that we went through. However, I don't understand how the transport issue being taken out is a traditional NHS method because we were never told that until part way through the process movement were brought on, that was a key aspect. We were going to be scoring, that was then removed, so either the wording was changed or communication was but yeah, I don't see how there can be a

devoid of based on the evaluation process,

thank you, Councillor Akyigyina.

what is your actual wish, but would you like to be done?

to feel that something that the consultation is on the right track, if you feel that consultation is not going below, is not being done fairly, what you say it should be done for truth, I think it needs to be considered that we are constantly being told that this is the case for change. You look at the consultation document, here's our case for change and here's our solutions, but it isn't a solution. We're creating so many more problems by this than already exists. There's one thing you're helping, and this is the small numbers which I would say there were all marks and disagree with the figures. Chris Draper is saying they're based on last year either, which way this is one aspect of a service and huge amounts of thousands of children who are going to be affected, and I don't

I don't think when you're saying as well, we need to look at how people are going to do the questionnaires, because actually it's being fed back that we need to make the case for change clearer. It's not really the case for change. Isn't clear, it's just that it's flawed, so I don't see how we're all basing our responses to a questionnaire or in a case for change that has issues, and we are not solving a problem by going. This is not providing a single site solution, so why are we doing this at a cost of over 40 million minimum when there are so many aspects that we're not looking at, and we very very lightly touched on the impact of Southampton, but in terms of that, how how are the costs for that going to also be included in this? If a sudden influx of patients are going to be going there in place of going elsewhere? There's just so many issues with every aspect of it, and I don't believe the public consultation document fully lets those issues be taken into account, because they're not deemed relevant.

thank you, Councillor Harker.

charities such as Christopher's smile raise huge amounts of money for pediatric cancer, what do you think their reaction is going to be to this sort of change as to whether they'll actually continue to put the sort of effort in are currently doing?

what's likely to happen in your view, I know first-hand how that charity fails, and I think very much dumbfounded and really concerned about what this means for the future of that relationship is so established with the ICR you know and it it is being belittled that relationship of having it on site at the Royal Marsden, I've seen first-hand how that works intrinsically with children's treatments, and when you're talking about the quantity of money that is being raised, St, Christopher smart has raised over a million for them, for example, that it's it's hugely impactful, because how is that going to work? We are still so unclear about how it could work and yes, we are being told they will work with either of their future partners, but it is established to such a degree with the Royal Marsden. It is intrinsic to how treatment plans are put together, how those drug development trials, everything that they work together on, and I think it's it's really being belittled in the consultation as a whole and understanding the impact of that funding. It's like I said, with the impact of the funding of the charity as a whole. Where are these millions whereas that deficit going to come from if it's not coming from people supporting Royal Marsden, because that unit is going to be closed? If this goes forward so saying it's being moved, if there's no staff and there's a closed unit to meet, that is a closure, and it's a huge worry

thank you.

if there's no more questions, I'm gonna go to Stephen Hickey new questions from Healthwatch.

thanks very much Jenny and thanks, Annie as well, for joining us online.

I know when he came to JOSC previously or committee members found it very helpful, so thank you so much for joining us this evening and staying with a satellite sorry that's bringing us to the end of the meeting, apologies again for aero running, but I didn't want to have committee members not have a chance to ask NHS England mattress everything that they needed.

so what will what we'll do now is run through?

like a few points on the procedural points of where we are going to go next before we'll bring this meeting to a close and then as a committee members will just go into a room on 40, I think to this then have a concluding conversation just amongst ourselves so.

I am going to ask the sub-committee whether they are happy to delegate the final sign off on the consultation response and covering letter to the Chair and Vice Chair of the Sub-Committee, in conjunction with the Chair of the JOSC, as I agreed.

thanks it's agreed unanimously, I'm going to ask the sub-committee whether they are happy to delegate the final sign-off of a draft report to be submitted to the JOSC to the Chair and Vice Chair of the Sub Committee in conjunction with the Chair of the JOSC.

agreed unanimously, thanks so much everyone, that concludes the meeting of the south-west, London and Surrey josep committee, thanks for staying with us.

so late into the evening.

and goodnight everyone at the committee, we're gonna go to Room 40 where we were earlier for a premium, so hopefully it shouldn't take too long, but thanks everyone.

Joint Surrey and SWL Health Overview and Scrutiny Sub Committee - Wednesday 22 November 2023, 6:30pm - Wandsworth Council Webcasting

Joint Surrey and SWL Health Overview and Scrutiny Sub CommitteeWednesday, 22nd November 2023 at 6:30pm

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Joint Surrey and SWL Health Overview and Scrutiny Sub Committee
Wednesday, 22nd November 2023 at 6:30pm