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The Committee considered report JHOSC-PETCT-0116 from NHS England, including the Clinical Senate Report, further information on stakeholder engagement and some public transport analysis relating to the proposal to site a PET CT Scanner to serve South Essex at Southend Hospital. The Committee received a presentation from Ruth Ashmore, Assistant Director Specialised Commissioning, NHS England and Jessamy Kinghorn, Head of Communications and Engagement, NHS England.
Background
The Committee received a summary of the current position concerning the PET-CT diagnostic scanner used to support the diagnosis and staging of cancer in some patients. In South Essex approximately 0.17% of the population used the service which is provided by an independent provider 2-3 days a week from a mobile scanner at Basildon Hospital. There is a need to increase the service to meet demand and NHS England proposed to move it to a fixed site. The independent provider who provides the mobile scanner service also owns the fixed scanner at Southend Hospital which has never been commissioned and is not currently used. The provider was seeking permission to move the service to the Southend Hospital site to take advantage of the fixed scanner and it believed there were clinical benefits to patients for locating the service at Southend.
The Committee was asked to note the further work which had been done since the initial report by NHS England to the Essex, Southend and Thurrock HOSCs back in October 2015 where concerns had been raised by Essex and Thurrock HOSCs regarding a lack of local clinical engagement, lack of local patient engagement, further information being required on likely patient treatment pathways after such a scan, the impact on patient travelling times and the independence of the review and the extent of any commercial pressure in the decision making process.
Since October 2015 a number of actions had been undertaken, including more research into the patient pathway in South Essex, Patient, Public and Clinical engagement, and an Equality Impact Assessment had been carried out. Additionally an independent clinical review of the case for change had been commissioned from the Clinical Senate. On balance NHS England considered that the fixed site option at Southend offered immediate increased capacity as currently there were issues with access and quality with the mobile scanner. The National Cancer Strategy anticipated more PET-CT scanning as part of radiotherapy planning. NHS England were also looking to future proof the service in South Essex and increase research capability.
Engagement
The public, patient and clinical engagement process had been undertaken by an independent, external organisation. The process took just over four months and covered members of the public not necessarily with any experience of the service, patients already on the pathway and clinicians at the three main referral hospitals. The issues that were important to patients included when they could get an appointment, access, transport and parking. Around 5% of people used public transport to access the service. The factors that were most important to all patients were:
- To be seen quickly
- The difference it might make to the outcome of their treatment
- How good the parking is
Regarding location of the service they considered it was best to be where other services and appointments were.
The engagement with Clinicians raised concerns regarding the impact on the lung cancer pathway, travel and access and concerns regarding delays in the pathway if the service moves.
The key themes of the public engagement were set out in the presentation papers and included putting the scanner at Southend to use as soon as possible, speed of access, the difference it would make to outcomes and being treated in the same place as other treatments. Travel and parking were also key issues.
The cancer pathways were fragmented within South Essex, with Basildon Hospital the centre for lung surgery and Southend Hospital the centre for radiotherapy. A travel analysis was carried out and the results were set out in the presentation papers.
The strategic issues included:
- PET-CT for radiotherapy planning is not currently delivered in South Essex and there is no timetable for introducing it – it is not currently commissioned in South Essex, however there is a clear recommendation in the National Cancer Strategy to develop such services in the future. This is an opportunity to future-proof the service in South Essex, it is currently the only service in the East of England not co-located with radiotherapy.
- Concern that the decision is commercially motivated – the independent provider has an unused asset at Southend and has kept it there at cost to the company because senior clinicians believe Southend is the right option.
Capacity and demand
Some of the issues around what has changed in the last year and what this means were set out for the Committee:
- Demand for the service has increased at an unexpected rate with independent experts suggesting it may be close to 20% and the growth for 2016/17 was expected to exceed 30%. There was no clear reason for this growth. However it was acknowledged that there had been high profile early diagnosis campaigns.
- Radiotherapy would remain at Southend Hospital and this decision was separate to the Success Regime.
- Capacity could be increased to 5 days a week as soon as possible. If demand continues at this level a second scanner in South Essex could be considered.
- The mobile scanner had suffered increasing operational problems.
In terms of mitigating actions it was explained that a robust plan would be developed for the transition, including clear information on travel and assistance with travel where applicable. A more comprehensive Equality Impact Assessment with respect to patients with a Learning Disability and those with mobility issues would be undertaken.
NHS Proposal
Following a lengthy process of further analysis and engagement, Southend Hospital remains the preferred location. Differing views had come out of the process with no clear view. However overall it was considered that locating the PET-CT service at Southend Hospital would enhance the current position due to the increase in capacity.
Committee Discussion
During the discussion the following points were made:
- The scanner at Southend Hospital could be mobilised within 6-8 weeks. To put a fixed site scanner in place at Basildon Hospital, the company estimated would take over 12 months although it could be less. The view of NHS England was that a year had already passed and it was felt that this could not wait another year. However the dialogue with Basildon Hospital would be on-going for the future.
- If there was to be a second scanner in South Essex in the future, mobile capacity would be used initially and then work would be done around where a fixed site scanner could be placed. Within the contract any new scanners would be fixed site as they were considered to be a better option offering more appointment capacity.
- It was noted that both commissioners were supportive of the preferred option.
- Colchester Hospital would be moving to a fixed site scanner soon. However the move to the Southend fixed Scanner would provide an opportunity for Colchester to use the mobile scanner more in the meantime.
- Healthwatch had been advised about the proposal.
- It was confirmed that whilst the growth in usage of the service within the contract was 12% which was lower than the current growth rate, the scanner at Southend could accommodate the 20% growth rate.
- A Member pointed out that there were parking issues at Basildon Hospital as well as at Southend Hospital. It was explained that additional parking options were being considered within the mitigating actions.
- A Member with personal experience of the pathway commented on the distress caused when the mobile PET-CT scanner was experiencing operational issues leading to the cancellation of appointments. The impact of this on a patient was particularly upsetting and caused frustration to both clinicians and patients and could add a week onto patient pathways. The operational issues were caused by moving the scanner around to different locations and resulted in the scanner needing a considerable amount of downtime. A fixed site was welcomed to alleviate some of those issues. It was noted that using the mobile scanner elsewhere, the associated downtime would need to be taken into consideration.
- The need for a continued focus on hard to reach groups had been recognised and some mitigation was planned.
- Patients that were not physically mobile could be eligible for financial support and hospital transport and work was on-going with the local CCGs on the eligibility for this support. The change to the service and impacts would be publicised.
- Historically the provider had tried to increase the scanning capacity but there were only so many appointments available in a fixed week and if the mobile scanner was used more often it increased the downtime. The new contract with the current provider covered the Midlands and East of England and was based on the number of scans with a 12% trajectory. Beyond that would incur costs but not for the infrastructure. Currently 30% activity falls into new modalities of care which is not routinely commissioned and is therefore within the research aspect of the contract.
- It was noted that a high proportion of the patient survey responses were from Southend. An interested individual from that area had done a lot of work and the Echo had picked up on the issue. Roadshows had been run in Southend, Rochford, Basildon and Mid Essex and the Southend ones had attracted a bigger turnout. Feedback had also been channelled through other organisations. As part of the success regime communication would continue and patients already booked for appointments would not be moved.
- It was confirmed that staff from the Basildon service could become part of the new service at Southend.
- Under the Success Regime there would be further opportunities for the three acute hospitals in mid and south Essex to work together and network services as part of ensuring the on-going sustainability of all three of them.
In terms of the next steps it was confirmed that the issue was being discussed that evening at the Thurrock HOSC meeting. Following that the preferred option would be going forward for ratification and a decision by NHS England. The view of the Regional Executive Committee was that this issue now needs to be resolved.
The Committee Agreed that:
- Cognisant of the delay in finding a solution and that significant time had been lost, the JHOSC supports the proposal as submitted and encourages NHS England to implement it as soon as possible to ensure that capacity can be quickly increased enabling earlier diagnosis and improved patient outcomes
- That NHS England need to be clear in their future communications to distinguish this project from the Success Regime and Urological cancer.
- That NHS England reports back to the JHOSC in six months’ time to update it on implementation.