To consider current radiotherapy service options and appropriate next steps.

The Committee considered current regional radiotherapy service options and appropriate next steps.

The report stated that the Three Counties Cancer Network (3CCN) (comprising Gloucestershire, Herefordshire and Worcestershire) had been considering the expansion of radiotherapy services.  Three options had been identified: expansion at the Gloucestershire Oncology Centre in Cheltenham; developing services at Hereford County Hospital; or developing services at Worcestershire Royal Hospital.  It had proved difficult to reach a consensus on a preferred option and the views of the relevant Health Scrutiny Committees were therefore being sought on this point.

The report set out reasons why the development of services at Hereford County Hospital should be the preferred option.  In particular it noted that the development of the Hereford option was supported by the National Cancer Strategy which amongst other things recommended that no patient should have to travel more than 45 minutes for cancer treatment.  Very few places in Herefordshire and Powys, where many of Hereford County Hospital patients came from, were within 45 minutes travelling distance of Cheltenham.

Whilst the form of any consultation was the responsibility of the three Primary Care Trusts (PCTs) involved, the 3CCN had also asked the Health Scrutiny Committees of all three Counties to recommend consultation strategies to guide its decision making process.  A recommended approach proposed by Mr E McPherson, Involving People Manager at Herefordshire PCT, was attached as Appendix B to the report.

The Chairman said that whilst the 3CCN had agreed there was the need for extra radiotherapy service capacity it had not been able to agree a preferred option.  Whilst the development of additional capacity might not be considered critical to Gloucestershire, given the existing level of provision at Cheltenham, both Herefordshire and Worcestershire clearly had a strong interest in the development of a satellite service in their areas. 

Mr Paul Edwards, Director of Commissioning and Strategy was asked to advise the Committee on the viability of the Hereford option and the justification for it.

He re-emphasised the provision in the National Cancer Strategy that no patient should have to travel more than 45 minutes for cancer treatment.  Extra radiotherapy service capacity was needed in the 3CCN area.  The travelling times faced by Herefordshire patients were especially demanding.

A report from an independent consultancy firm commissioned by the PCT and the Hereford NHS Hospitals Trust to investigate the feasibility of radiotherapy services at Hereford Hospital had concluded that the Hospital could justify having 1 Linac (linear accelerator) in the near term with a view to having two machines operating in the medium term by 2015.  The PCT was recommending development at Hereford to the 3CCN with the installation of 2 bunkers with one Linac initially or possibly two Linac machines.

He noted that the development would complement the ongoing development of the Charles Renton Unit for cancer patients at Hereford Hospital.

The necessary capital expenditure would be required in 2010.  The PCT’s assessment was that the number of patients needed to justify two machines would be there in 2015/16.  This meant that the PCT would for a time be paying a premium for the service.  However, it considered that the development of a local solution was right in the circumstances and was affordable.

Mr Martin Woodford, Chief Executive of the Hereford Hospitals NHS Trust firmly supported the development noting the timely opportunity to co-ordinate it with other works at the hospital.  He added that there was an element of financial risk for the PCT he considered it to be worth taking.

In the course of discussion the following principal points were made:

·         The potential patient flow from Powys was discussed.  It was also noted that it was only patients from South Worcestershire who travelled to Cheltenham for treatment.  It was possible that a facility in Hereford might be preferable to some of them.

·         Members commented on the difficulties faced in travelling to Cheltenham, several based on personal family experience, and the fact that there were instances of patients declining treatment because they simply could not face the journey to Cheltenham.

·         Asked further about the justification for the proposed expenditure and whether this was the best use of the PCT’s resources, Mr Edwards said that the extra provision would have to be funded somewhere within the 3CCN area.  He reiterated that he therefore considered a local solution in Hereford to be the preferred option.  He again confirmed that the proposal was affordable, allowing that there would be a small premium to be paid for the service in the short term.

·         The success of the local fundraising effort for the Charles Renton Unit demonstrated the desire within Herefordshire for an improved local cancer treatment service.

·         Asked about the decision making process Mr Edwards explained that the 3CCN Board would make the final decision.  He noted that the West Midlands Strategic Health Authority had indicated support for the Hereford option as the next phase. 

·         Mr Edwards cautioned that if the Hereford option did proceed it was important to understand that this did not mean that all cancers would be treated locally.  Some patients with rare cancers or on initial referral would still require treatment at Cheltenham or need to travel to Cheltenham to agree a programme that could be applied locally.

·         Members overwhelmingly supported the Hereford option as the next phase of development, having regard in particular to the National Cancer Strategy recommendation that no patient should have to travel more than 45 minutes for cancer treatment.  However, it was proposed that, in accordance with the same principle, the Committee should record its support for the development of a treatment facility at Worcester as the next subsequent phase of development after that recommended at Hereford.

RESOLVED:

That          (a)  the Hereford County Hospital option for extra radiotherapy services             provided on a satellite basis be endorsed;

         (b)    the Three Counties Cancer Network be asked to consult on this preferred option, taking account of Appendix B to the report; and      

         (c)     the National Cancer Strategy recommendation that no patient should have to travel more than 45 minutes for cancer treatment is strongly endorsed and development of a treatment facility at Worcester is therefore supported as the next subsequent phase of development after that recommended at Hereford.