London’s fragmented children’s cancer services will finally be reformed following a decade of delays and allegations of cover-up by senior officials.
NHS England has said it will adopt recommendations that will see the capital’s services brought up to standards already common across the rest of the country, with children’s cancer centres needing to be based in hospitals with full paediatric intensive care units.
The changes will be imposed “with no exceptions or special arrangements permitted,” it said in a letter on Thursday.
This means the Royal Marsden’s children’s service at its base in Sutton, south London, will have to move to a new hospital. Currently sick children who deteriorate at the Marsden site have to be rushed by ambulance to St George’s Hospital 40 minutes away.
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.
The changes will also affect cancer care at University College London Hospital which links with Great Ormond Street Children’s Hospital.
The world-renowned Royal Marsden trust, whose chief executive Dame Cally Palmer is also NHS England’s national cancer director, was at the centre of a cover-up scandal before the Covid-19 pandemic.
In 2019, the Health Service Journal revealed a major report, commissioned by NHS bosses in London following the deaths of several children, had been “buried” by NHS England.
The death of two-year-old Alice Mason in 2011 from a brain condition 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, led by Mike Stevens, emeritus professor of paediatric oncology at Bristol University, was never made public and NHS England did not act on the central recommendation to reconfigure services.
Former chief executive, Sir Simon Stevens, a close ally of Dame Cally Palmer, was present at a meeting in 2015 where the decision not to publish the 2015 report was made.
NHS England’s own medical director for London, Andy Mitchell, went public in 2019 accusing his former employer of covering up the report through “bureaucratic burial”. He said 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.”
NHS England was also said to have pressured doctors in 2018 over their plans to recommend changes that would mean the Royal Marsden site would have to be relocated. It also interfered in another national report to have a recommendation on co-locating children’s cancer care with ICU services changed, the first time this had happened.
Following the revelations, former cancer tsar and chief inspector of hospitals Sir Mike Richards was called in to carry out a rapid review and he backed plans for children to have immediate access to intensive care services in order to minimise risks.
In January 2020, Sir Mike said the current situation meant children and their parents were forced to “move backwards and forwards quite frequently” between two hospital sites, adding: “I don’t believe this situation should be allowed to continue longer than necessary.”
In a letter responding to his review, published yesterday, NHS England said the new service specifications “makes co-location with level three paediatric critical care a mandatory requirement with no exceptions or special arrangements permitted.”
It said the hospitals would now work to draw up new solutions and there would be a public consultation.
A spokesperson for the Royal Marsden NHS Foundation Trust said: “We recognise that NHS England’s new specifications are designed to pave the way for a new, future-facing service when there will be greater emphasis on having paediatric intensive care on site. Unfortunately, it is not viable for us or the NHS to build and commission a paediatric intensive care unit at the Royal Marsden.
“Our priority now is our professional duty to share our expertise for the benefit of children with cancer and their families by helping ensure the new service is of the highest possible quality and ensuring a smooth and timely transition for our staff and patients.”