Leading cancer hospital faces being stripped of child services amid safety fears

The Royal Marsden’s Sutton hospital in south London does not have an intensive care unit and is forced to shunt seriously ill children to St George’s Hospital 40 minutes away

NHS England has accepted recommendations which will mean changes to services it can provide (PA)

The world-renowned Royal Marsden cancer hospital in London faces being stripped of its child cancer services amid safety fears following allegations of an NHS cover-up.

Senior figures have been accused by a former NHS medical director for London of “burying” concerns about the safety of the Marsden’s service and putting pressure on clinicians to soften official recommendations that made it easier for the Marsden to avoid taking action.

On Thursday former chief inspector of hospitals and national cancer tsar Sir Mike Richards told the NHS England board that changes were needed to “minimise risk to patients” caused by the time to taken travel between the Royal Marsden’s Sutton hospital and St George’s Hospital.

He said the current situation meant children and their parents were forced to “move backwards and forwards quite frequently” between the two hospital sites, adding: “I don’t believe this situation should be allowed to continue longer than necessary.”

A series of incidents and deaths in 2009 and 2011 triggered a number of official reviews by experts which warned of risks to children but these were never made public or acted on by NHS England, whose national cancer director, Dame Cally Palmer, is also the Marsden’s chief executive.

She was accused of a conflict of interest and was forced to step aside from any involvement in decisions about child cancer services last year.

The Royal Marsden’s Sutton hospital does not have an intensive care unit and is forced to shunt seriously ill children to St George’s Hospital 40 minutes away. It provides cancer care to children from across Kent, Surrey and Sussex. Elsewhere in England, all other cancer centres do have intensive care units.

More than 330 children were transferred from the Marsden to other hospitals between 2000 and 2015 and in one year 22 children were transferred for intensive care a total of 31 times, with some experiencing at least three transfers individually.

NHS England’s board accepted the recommendations by Sir Mike, which require all child cancer centres to have an intensive care unit for children. Because Royal Marsden does not have the space or clinical services to provide such a unit within its current site, this recommendation will trigger a reconfiguration of healthcare in south London, which could result in children’s cancer services moving from the hospital if no changes are made to the services available at the Royal Marsden. Currently, the Marsden site does not provide other services recommended by Sir Mike as necessary in his report, such as paediatric neurosurgery, a high dependency unit and general paediatric services including anaesthesia. However, the site will be allowed to continue providing child cancer services until the new model of care is ready, and one option is that doctors from the trust that runs Royal Marsden could provide care at another hospital.

The decision yesterday followed revelations last year by the Health Service Journal, which discovered NHS England bosses had failed to act on key concerns about intensive care services at the Royal Marsden following several serious incidents.

The death of two-year-old Alice Mason in 2011 triggered an official warning by a coroner about the Royal Marsden’s model of care and a report in 2015 by a panel of cancer experts warned children were at risk in south London. This report was never made public and NHS England did not act on the central recommendation to reconfigure services.

The former NHS medical director for London Andy Mitchell accused NHS England of “bureaucratic burial” after it refused to publish the 2015 report. He said that in his opinion there had been a “pervasive influence from the top” of NHS England to stop the concerns being made public.

Internal emails between NHS England staff discussing the report in 2016 showed one official warning that the “supposed ‘cover up’ may become the story in itself” and in a separate email referenced the Bristol child heart scandal, warning: “There is the potential for this to blow up in our faces.”

Leading child cancer doctors also criticised NHS England and Dame Cally after they came under pressure to water down recommendations that all child cancer centres should have an intensive care unit in September 2018.

Dr James Nicholson, chairman of the Children’s Cancer and Leukaemia Group and a consultant paediatric oncologist at Addenbrooke’s Hospital, said NHS England’s national cancer team, which is led by Dame Cally, “insisted” on the rules being softened.

“It was very clear if we didn’t accept it, the service specification would either go no further or we would all have to resign en masse,” he said.

He claimed that Dame Cally’s conflict of interest was not compatible with her role at NHS England and that the operating model at the Royal Marsden was “frankly absurd”.

Responding to the NHS England decision, the Royal Marsden’s medical director Nicholas van As said: “The Care Quality Commission recently assessed the Trust as ‘a beacon of outstanding practice’ and our children’s service as ‘good’ for safety and ‘outstanding’ for caring. Patients and families consistently rate us as one of the best centres in the country for patient experience (NHS ‘Children and Young People’s patient experience survey’). We have never had a serious incident relating to the transfer of paediatric patients to intensive care at St George’s.

“The Royal Marsden in Sutton ensures that children and young people with cancer receive the very best treatment and care, including access to clinical trials to improve survival, expertise in oncology, and modern, age-appropriate facilities. If the NHS now wishes to commission and fund a different model of service for children and young people, it should demonstrate that any proposed changes will avoid detriment to patients and can provide a better service for children with cancer and their families. We believe that a proposal which retains The Royal Marsden’s cancer expertise and life-saving research in Sutton will continue to provide the best clinical outcomes and patient experience.”

An NHS Spokesperson said: “Children’s cancer services in London has divided clinical opinion and been hotly debated for 15 years, which is why NHS England asked Sir Mike to consider every piece of available evidence and report back openly and transparently with his recommendations.

“Sir Mike’s report states unequivocally that there have been no serious incidents recorded in recent years related to two site working, however, due to the growing use of intensive therapies, such as CAR-T which can treat previously untreatable cancers, means that not having intensive care alongside children’s cancer services is no longer an option and NHS England is working to rapidly take forward his recommendations.”

Update (05.02.20): This article has been amended to make clear that the removal of child cancer services from the Royal Marsden Hospital is a likely consequence of the recommendations set out by Sir Mike Richards, given that the site does not currently have an intensive care unit for children. We wish to make clear that currently, no decision has been made that child cancer services will be moved from the hospital.