a) Cancer Services – Kent & Canterbury Hospital, Canterbury
b) Chronic Pain Clinic – Queen Elizabeth the Queen Mother Hospital, Margate (to follow)
Mr D Shortt, Concern for Health in East Kent (CHEK), Ms R Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust, Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust will be in attendance for this item.
Minutes:
(Mr D Shortt, Concern for Health in East Kent (CHEK), Ms R Gibb, Chief Executive Maidstone & Tunbridge Wells NHS Trust, Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust were in attendance for this item)
Cancer Services – Kent and Canterbury Hospital, Canterbury
(1) Concerns had been raised locally by Concern for Health in East Kent that the linear accelerators at the Kent and Canterbury Hospital, Canterbury were working at best only 50% of the time and that resources and staff were being moved to the Maidstone Oncology Centre.
(2) As a consequence, patient waiting time for radiotherapy which had been down to six weeks had now increased to 12 weeks.
(3) Concerns were also expressed about how the provision of cancer services across Kent was managed. The specific question raised was: is the service managed through the Kent and Medway Cancer Network or through the Maidstone and Tunbridge Wells NHS Trust? Ms Gibb responded that management of cancer services across Kent was not via the Kent and Medway Cancer Network but was provided by the Maidstone and Tunbridge Wells NHS Trust through the Kent Oncology Centre.
(4) Ms Gibb added that the provision of cancer services nationally was very costly. What Kent had was a different model of cancer services with a Kent Oncology Centre in Maidstone and a satellite centre in Canterbury as a consequence there was an oncologist working across the whole of East Kent. Ms Gibb made it clear that the Kent Oncology Centre could only deliver work commissioned by the Primary Care Trusts.
(5) Ms Gibb informed the Committee that as many cancer services as possible would continue to be delivered at Kent and Canterbury Hospital. It was only the highly complex cases of radiotherapy that would need to be treated in Maidstone, generally services for cancers such as breast and lung cancer would continue to be dealt with in Canterbury.
(6) Mr Brazier, the Canterbury Member of Parliament, expressed the view that there was only so much money available in the PCT budgets for all health services, including cancer. He said that the provision of cancer services at Maidstone was an expensive operation and he did question why, in some instances, very sick people were unable to access their nearest linear accelerator – instead having to travel from Canterbury to Maidstone or vice versa. Ms Gibb responded that there was no point a patient accessing their nearest linear accelerator if what the patient was going to receive was sub optimal treatment because the staff available at the nearest linear accelerator were the wrong staff.
(7) Ms Gibb acknowledged that cancer services were very expensive. It was important that the more complicated services were dealt with in the most appropriate place. What was happening across the County was that patients were receiving a London service but locally.
(8) In answer to questions relating to the skills required by an oncologist and the minimum number of patients an oncologist needed to see to maintain those skills, Ms Gibb responded that it was important within the NHS that staff were continually improving their skills. The point was well made about doctors having the access and ability to undertake procedures regularly to retain their skill base.
(9) Ms Gibb said the proposals known as “Fit for the Future” (a review of all the health services to be provided across Kent and Medway) did not impinge on the Kent Oncology Centre. Ms Gibb added that there had been no debate on this aspect of the Health Service at all.
(10) Asked about cancer services provided elsewhere such as at the Royal Marsden, and Guys and St Thomas’s or in Brighton, Ms Gibb said there were some areas of specialist cancer services which had to be dealt with by specialists elsewhere. It was important that patients in Kent had a service provided by the Kent Oncology Centre.
(11) Members of the Committee and Canterbury City Council members asked a range of questions relating to:-
(a) the usage of the linear accelerators;
(b) the recruitment and retention of oncologists in East Kent; and
(c) how appropriate was it for patients and visitors to have to travel often from Canterbury to Maidstone or vice versa, especially in the case of frail and elderly people, when public transport links were poor and car parking at the locations concerned was also difficult.
(12) Ms Gibb informed the Committee of the opening hours for the Kent Oncology Centre and the work being undertaken to improve capacity by looking at the possibility of opening the Oncology Centre on Saturdays and Bank Holidays. Ms Gibb added that one of the issues for the expansion of services was recruitment of staff to run an extended service. Ms Gibb advised the Committee of a recent recruitment drive which had extended as far as Australia.
(13) Transportation across Kent and Medway, particularly in rural areas, was a big issue. Ms Gibb stressed the importance of all the various partners working together to address this significant issue. It was important that as much cancer treatment as possible was provided locally – but patients needed to receive the specialist care that was most appropriate to them.
(14) Mr Gibbens, Kent County Council Cabinet Member responsible for Public Health, reminded the Committee of a letter that had been sent by the Leader of the County Council to the Primary Care Trusts and the South East Coast Strategic Health Authority, setting out the County Council’s view that the provision of health services across Kent and Medway must be in the best interests of the people of Kent. He acknowledged that it was important that the County had a cancer centre and referred to the Maidstone Oncology Centre as “the Royal Marsden of Kent”.
(15) However, Mr Gibbens went on to say that he thought it was unreasonable for patients to have to travel when they are often feeling extremely unwell on unpleasant long journeys to access health facilities for cancer treatment. As a local member for Canterbury, he said that to access Maidstone early in the morning he needed to be away from Canterbury at 7:30 am to ensure that he was able to avoid congestion at Detling Hill.
(16) On behalf of the Cabinet and Kent County Council, he was keen to ensure that as many health services as possible were delivered locally.
(17) Ms Gibb responded that the cancer services provided by Maidstone and Tunbridge Wells NHS Trust across the county were extremely leading-edge. Ms Gibb added that patients would not get better treatment anywhere else. She asked whether it was better to travel for cancer services from Dover to Maidstone or from Dover to London.
(18) Mr Shortt concluded the discussion, saying he felt that cancer services were being lost locally. He cited the issue of pelvic and gynaecology cancer, previously dealt with in the Queen Elizabeth the Queen Mother Hospital at Margate, which was now being dealt with in Maidstone. He added that even the more common cancers, such as breast cancer, were also now being dealt with at Maidstone.
(19) Mr Shortt added that it was unreasonable to expect people to travel five days a week from East Kent to Maidstone for these services. He concluded that the cancer centre at the Kent and Canterbury Hospital felt that they were the poor partner in the cancer services provided across Kent and Medway.
Chronic Pain Clinic – Queen Elizabeth the Queen Mother Hospital, Margate (QEQM)
(20) Mr Hayton raised particular concerns relating to the chronic pain clinic provision at the QEQM and the number of chronic pain services which were now being provided at the Kent and Canterbury Hospital, Canterbury. Mr Hayton spoke about the experiences of members of a chronic-pain support group in which he was involved.
(21) Mr Hayton advised the Committee that he felt that it was unreasonable to expect patients to travel from Thanet, for example, to the Kent and Canterbury Hospital for pain relief. This was particularly difficult when drugs were administered to numb the body. Mr Hayton cited an example where a patient had to travel to the Kent and Canterbury Hospital where drugs to numb parts of the body were administered which meant the patient lost full control of their urinary function.
(22) Mr Daley added that the issue of chronic pain clinics was a national debate. He stressed the importance of NHS Overview and Scrutiny Committee looking at this at a future meeting.
(23) Mr Kershaw responded that the chronic pain service was a particular challenge for the Health Service and hospitals. He informed the Committee of the East Kent Hospitals Trusts work being undertaken to improve the services to ensure that the vast majority of care was undertaken locally and would stay local.
(24) In conclusion, there was an acknowledgement that services for chronic pain needed to be delivered as locally as possible. The complete range of models to deliver a local service needed to be revisited.
RESOLVED:-
that the Committee should continue to monitor the development of cancer services across Kent and Medway; and
that Chronic Pain Clinics should be the subject of a debate at a future meeting of the Committee.