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Clatterbridge Centre for Oncology

Volume 492: debated on Wednesday 20 May 2009

Motion made, and Question proposed, That this House do now adjourn.—(Mr. Frank Roy.)

I am delighted to have secured this debate on the Clatterbridge Centre for Oncology. It is an immensely valuable institution and a source of pride to the local community, but I fear that it is none the less under a degree of threat. My right hon. Friend the Member for Birkenhead (Mr. Field) would have liked to be here, but was unable to be. He has asked me to say that he supports my campaign to prevent moves that could damage the services provided at the CCO. My hon. Friend the Member for Wirral, West (Stephen Hesford) has been similarly supportive throughout the campaign and in this context.

I congratulate my hon. Friend on securing this important debate. May I remind him of a meeting that we had with the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), whom I am pleased to see in her place tonight? Does he remember that that meeting was not wholly positive? Is that one of the reasons he feels the need to bring the matter before the House of Commons? May I urge him to continue his work in this regard?

I am grateful to my hon. Friend. I well remember that meeting with the Minister. Of course, she was listening then, as I hope she will do tonight to the points that we are about to make.

Max, the son of my hon. Friend the Member for Alyn and Deeside (Mark Tami), was given radiotherapy treatment at Clatterbridge prior to having a bone marrow transplant, and my hon. Friend—whom I am delighted to see here—is unstinting in his praise for the services provided there.

I want to say a few words about the history, which illustrates the CCO’s long-standing contribution to cancer services in Britain and to its locality. The centre’s roots date back over a century to the Liverpool hospital for cancer and diseases of the skin, which was established in 1862. In 1882, the hospital moved to a new site and was renamed the Radium Institute. The first Roentgen ray apparatus was purchased in 1901 and the centre gradually developed into one of the two major radiotherapy centres in the north-west of England. The centre has been at Clatterbridge since the early 1950s. It has provided chemotherapy since the 1970s, and CCO consultants were among the first to use multiple-drug chemotherapy. Today, the centre is thriving. It became a foundation trust hospital in 2006. Patient numbers are continually rising, with an average of 50 treated on each accelerator every day. Over 7,000 new patients are registered at the hospital each year.

The CCO has received significant investment in recent years and is now one of the best-equipped radiotherapy centres in Britain. Facilities include nine linear accelerators, which I am going to call “linacs”, a cobalt unit, superficial and orthovoltage X-ray machines, two simulators, two scanners, tomography simulators and so forth. The centre places great emphasis on research and development, regularly participating in national and international clinical trails. It employs 650 staff, most of whom live locally. Any diminution of services would thus be damaging not just to the hospital but to the community.

In addition to the CCO’s importance locally and to patients, it is recognised at national level as an outstanding NHS foundation trust. The Healthcare Commission rated it as excellent for quality and use of resources; and Monitor awarded the CCO green for governance and the provision of mandatory services, and gave it 5—the highest possible mark—for financial viability. It is in excellent financial shape.

The quality of the treatment provided is matched by the service delivery record. There is no waiting time for chemotherapy at the CCO, with 66 per cent. delivered in outreach clinics—the highest rate in the country. That is important for the comfort and convenience of patients.

I know what a redoubtable defender and advocate my hon. Friend is of Clatterbridge hospital and the fine services it provides. That is to his credit, but will he say a little more about the plans for outreach across other hospitals in the region? I know that both he and I support that outreach in order to ensure that the excellent services currently provided get to a wider audience.

I am grateful, as ever, to my hon. Friend, who takes a considerable and continuing interest in this subject. I will of course deal with the issue he raises as I develop my speech.

Despite the CCO’s impressive record in the provision of services and its importance locally and nationally, its future is to a degree under threat. The crux of the issue is that the Merseyside and Cheshire Cancer Network has put forward proposals for two satellite sites with linacs used in radiotherapy treatment. One satellite at Aintree, to be run as a CCO operation, has been agreed and no one contests that it will make an important contribution to providing accessible services for those living in and around Liverpool. However, I am not sure that the case has been made—my hon. Friend may well disagree with me on this point—for a second satellite at the Royal Liverpool hospital, only 5 miles from Aintree. Let me say a little more about this.

What are the reasons put forward in favour of these proposals? I am told that the two satellites are necessary to

“meet demand for these services north of the River Mersey, as this area has some of the highest cancer death rates in the country”.

It is assumed that the establishment of a second satellite only 5 miles from the first will inevitably improve cancer outcomes in Liverpool and satisfy unmet demand. Clinical opinion at the CCO, however, states that patients from the region, and particularly in Liverpool, already receive the best treatments available and that the outcomes following diagnosis are similar to the national rate. In fact, the cancer reform strategy and the north-west cancer plan both argue that late diagnosis is the major contributing factor to poor cancer survival rates. There is no evidence to suggest that providing more non-surgical oncology services in a given area—in this case, in Liverpool city centre—would have a direct impact on survival rates. Improved screening programmes and public awareness campaigns are considered more likely to make a difference.

A related argument presented in favour of a second satellite at the Royal is that Clatterbridge is too far away for patients in Liverpool and that more non-surgical oncology services, over and above those planned for Aintree, are necessary to improve access. I am not wholly convinced that cancer services cannot be accessed within a reasonable travel period by people in Liverpool, or more generally in the Cheshire and Merseyside area that the CCO covers. The cancer reform strategy recommends that travel times to services should not exceed 45 minutes, and 92 per cent. of CCO patients travel by car, ambulance or taxi and are able to obtain their treatments within that time—and in many cases more quickly. When the Aintree site is fully functioning, times will be even shorter.

I want to emphasise that I accept the need for some non-surgical oncology services to be provided at a satellite in Liverpool. Along with the CCO and others involved, I very much support the establishment of the site at Aintree, which the CCO will provide. However, in that light, it is very difficult to see why we need a second site only five miles away. Projections suggest that the Aintree site will provide enough linacs to meet demand until 2017, so the second satellite will lead to overcapacity. Resources, which are always finite, will be hard pressed in the current economic climate; and it seems to me that overcapacity in Liverpool across the two sites will inevitably lead to a reduction of services at the CCO.

Furthermore, even if it could be proved that there is a need for additional linacs beyond those already provided at the CCO and at the Aintree satellite, that would not necessarily provide an argument for the establishment of a second site. Surely it would be logical and cost-effective to increase the number of linacs at Aintree. I am told that the site could incorporate that, and it would prevent the expenditure involved in building another site.

All this must be seen in the context of wider proposals for relocating the CCO to Liverpool, which are outlined in the Baker review. There is now general agreement that such a move, which would cost approximately £150 million, is inconceivable in the current economic climate, and it has been put on the back burner for at least the next five years. However, the chairman of Cheshire and Merseyside strategic health authority has confirmed that it is the “direction of travel” towards 2020.

That bothers me. I challenge the fundamental assumption that the primary centre for non-surgical oncology services in the region should necessarily be in Liverpool. The existing Clatterbridge location is liked by patients, it ain’t broke, it is a pleasant environment and, as I have said, it makes an important contribution to the local community. To move it would involve unnecessary and unwise expenditure, and in my view the idea has no obvious merit. Furthermore, proposals to move the centre seem to reflect a city-centric point of view. In fact, the CCO serves Cheshire and Merseyside and, as we have just heard, part of north Wales—Alyn and Deesside—and in that sense it is centrally located.

The case that the Royal is a desirable location for these services rests on two central arguments. The first is that it would allow cancer services to be in close physical proximity to acute facilities. Although I see the merits of that argument, it does not necessarily provide a reason for the centre to be moved to Liverpool. The CCO is about 15 minutes’ drive from Arrowe Park Hospital. It is also developing its own high-dependency unit to support patients who become acutely ill during their treatment at the centre.

Secondly, it has been argued that the Royal location has advantages in terms of its academic links. However, the first satellite is to be built on the campus of the University Hospitals Aintree NHS Foundation Trust, which enjoys the same status as the Royal in terms of well-established academic links with Liverpool university. It seems to me that there is some confusion between academic status and proximity to the university itself. Moreover, the CCO is committed to developing its academic links and research. I am not convinced that the case for relocation at the Royal has been fully demonstrated either by the arguments about its acute facilities or by those about its academic links.

As I have said, for the time being there are no clear plans for a full-scale relocation, but I fear that, in the short term, the creation of a second satellite may constitute a piecemeal development, which the Cancer Network, the Royal and PCTs hope will eventually lead to the establishment of a cancer centre at the Royal. The second satellite was originally suggested in the context of relocation of the whole centre, in the light of the Baker report. It does not make sense on its own merits. However, the Cancer Network and PCTs preferred to push on regardless, apparently on the primary basis that if the money was available, why not?

This raises important question about how decisions are made about cancer services in the region. I am deeply concerned that PCTs, which have the power to determine the expenditure of large amounts of money—for instance, on the establishment of the proposed satellites—are, in my experience, only notionally accountable and often, I am afraid, profligate. They have not consulted me or other local Members of Parliament—or as far as I am aware, others—about the current round of proposals. If the PCTs are only notionally accountable, the Cancer Network is wholly unaccountable. Although it can only make recommendations rather than decisions, the PCTs do not appear to have probed its proposals sufficiently before endorsing them.

There is a clear need for cancer services in the region to be viewed on a strategic basis. Resources must be allocated and services located in a logical and transparent way, based on an assessment of the current and future needs of all local people and on expert advice.

I have described the CCO as a centre of excellence, and as such it is worth protecting for a number of reasons. It houses an impressive concentration of services and expertise, and continues to develop, improve and carry out research. As such, it is in a strong position to attract investment. In the current economic climate, funding will of course be scarce. Public money must be used even more wisely and cautiously than usual. If services are salami-sliced away from Clatterbridge with no clear plan, and cancer services in Merseyside are spread across multiple sites, no one institution in the area will draw the substantial funding that will be required in future years. Furthermore, if services are gradually moved from Clatterbridge, eroding the critical mass, the centre may well suffer a loss of confidence. It will fail to attract the best qualified staff, and it may start to decline.

I suspect that the Minister will reply to me on the basis of drafts provided by the strategic health authority and the Cancer Network. However, in none of the correspondence that I have received from either of those organisations is there any evidence that they have taken account of the views of the CCO, or, indeed, of the concerns expressed by me and my hon. Friend the Member for Wirral, West. Can the Minister assure me that she will take account of them in her response, and may I tell her that although what is proposed is euphemistically presented merely as a long-term “direction of travel”, in my view it is a wrong direction for which the case remains unproven and the costs very large?

I congratulate my hon. Friend the Member for Wirral, South (Ben Chapman) on securing the debate. He has shown an acute interest in the welfare of his local health services, and in particular the cancer services, and I commend him for the dedication with which he serves the needs of his constituents. I am also pleased that my hon. Friends the Members for Wirral, West (Stephen Hesford), for Alyn and Deeside (Mark Tami) and for Liverpool, Walton (Mr. Kilfoyle) are present.

On 3 December 2007, the Government launched the cancer reform strategy, which sets out plans to improve further and develop cancer services across England over the next five years. It includes measures to improve cancer prevention, speed up the diagnosis and treatment of cancer, reduce inequalities, ensure that care is delivered in the most appropriate settings, and ensure that patients can access effective new treatments quickly. I am sure that we all can remember that at the time when our Labour Government came to power, patients with cancer were having to wait for many months, and sometimes a year or more, for treatment. The latest published data show that 93.9 per cent. of patients diagnosed with cancer start their treatment at the Clatterbridge Centre for Oncology within 62 days of referral from their GP. That represents remarkable progress, and I commend the efforts of the staff in making it possible, backed, of course, by the financial commitment of the Government. We must not be complacent, however, and we must do more to achieve even more progress.

I have listened carefully to the arguments of my hon. Friend the Member for Wirral, South in support of the CCO. I am informed, as was stated at our meeting, that the Merseyside and Cheshire Cancer Network undertook on behalf of local NHS organisations a review of how and where patients in the area who require cancer treatment might receive it in future. Its purpose was to ensure that the aspirations of our Government’s cancer reform strategy are achieved locally.

The current situation in Merseyside is that most patients who require cancer treatment and who live north of the River Mersey travel to the CCO for that treatment. I am also advised—this is very worrying—that residents living north of the River Mersey experience the highest rate of cancer deaths in the locality. Indeed, the figures are some of the highest nationally.

If it is the case that a higher level of cancer deaths are suffered north of the river, would that not best be tackled by early diagnosis? I have seen no evidence that the travel time makes that statistic at all difficult.

I hope that, as my speech progresses, we will come to a greater understanding of that issue.

I should restate that these are among the highest figures nationally, and currently these patients north of the Mersey, who make up 67 per cent. of the Mersey and Cheshire Cancer Network, face longer journey times to the CCO for treatment that may last only a matter of minutes. The review therefore made several recommendations. One of them was to look at the possibility of relocating some services from the CCO to the Royal Liverpool university hospital.

I am advised, and I understand that my hon. Friend has been too, that there is no immediate proposal to relocate the Clatterbridge centre to Liverpool in the foreseeable future. There is a recommendation to that effect by 2020, but that would require the development and approval of a formal business case, and full public consultation. I understand that the strategic outline case for these proposals will not even be complete until 2010-11.

At this stage, I should also point out that the configuration of services is a matter for the NHS locally. I am also happy to restate that no decisions on these proposals have been taken. It would therefore be totally inappropriate for me to intervene in this locally driven process or to comment on the options available. However, I am assured that any potential relocation will be subject to due diligence, and that the process will be objective, transparent and robust and will take account of all stakeholders.

My hon. Friend rightly says that if no decision has been taken and there remains an interest in the process of reaching any decision, it might be premature for her to intervene, but surely in order for that process to give consideration to the right principles and the right issues she can take an oversight view. When one is talking about potentially spending £150 million of public money in the wrong direction—my hon. Friend the Member for Wirral, South (Ben Chapman) says that this is the wrong direction—surely that is a matter for her to examine and have a view on.

I thank my hon. Friend for the intervention because it gives us the opportunity to state again, as was made clear at our recent meeting in the Department of Health, that we should get involved in the process and that hon. Members must be involved in it. The cancer strategy and the cancer team were present at the meeting. I commend those present, as Members of Parliament for the area, for continuing to push for their constituents—that is what we expect them to do in this House—but at the same time they must have regard for local decision making, the way in which the consultation will be drawn up and how it is difficult at this moment for me to intervene in any way other than the way in which I am trying to help tonight.

I understand that these proposals were agreed in spring 2008 by all eight commissioning primary care trust boards. Again, this will facilitate access to treatment for patients who endure some of the worst cancer outcomes in the country. We must commend PCTs in Cheshire and Merseyside for taking steps to address these issues. I must stress that these proposals concern providing additional radiotherapy services in the Merseyside area to meet the demand that I have outlined. I am assured that those additional services do not represent any removal of services from the Clatterbridge centre. In addition, I am informed there will be no job losses as a result of any of these proposals.

I apologise for intervening again, and I shall try not to do so again. Even if there is a case for transferring resource from Clatterbridge to Liverpool, such a move must reduce the critical mass at Clatterbridge. In any event, if such an approach is being taken, is there a case for having two facilities 5 miles apart—one at Aintree, where there is ample resource, and another elsewhere?

The interventions are not a problem, because we have some time available to us. I know that this debate is important to hon. Members, and I welcome the opportunity to try to give reassurance wherever I can. Academic scientists and others are putting forward shocking figures to us that would lead hon. Members to develop their thoughts in that way.

I must say again that I am assured that these additional services do not represent any removal of services from the Clatterbridge centre. This package of developments will, in fact, require significant increases in the oncology work force. Today’s technology makes it possible to deliver most radiotherapy treatment close to where patients live. As typical radiotherapy treatments are delivered over a period of several days or weeks, it is beneficial to the patient to have to travel as little as possible to access this vital treatment—

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—(Mr. Frank Roy.)

I understand that a typical patient may make 15 daily visits to a radiotherapy unit during their treatment. I am informed that, based on optimum travel times for patients, the Aintree hospital in the north of the city was the preferred option. That will be a £15 million investment and will be funded and owned by the Clatterbridge centre, as well as operated by its specialist doctors, physicists and radiographers. I understand that the groundworks for a new building at Aintree hospital—I have noted that my hon. Friend the Member for Liverpool, Walton is in his place—are already underway, and that completion is planned by the end of 2010.

For the avoidance of any confusion among people who may or may not read Hansard, can the Minister confirm that two separate issues are under consideration? The first is about the extension of services to Aintree hospital in my constituency, which my hon. Friend the Member for Wirral, South (Ben Chapman) welcomes, as do I. The second debate is about what will happen down the track, but the current arrangements for Aintree hospital are welcomed by all parties.

I am happy to reinforce that statement.

More action is needed to address the provision of radiotherapy services for residents north of the Mersey. I remind my hon. Friend the Member for Wirral, South that clinical reports, such as the one produced by Dr. Cottier of the national cancer services analysis team review, suggest that the majority—67 per cent.—of cancer sufferers requiring treatment live north of the Mersey. The additional services at Aintree are currently estimated to provide only 30 per cent. of the population needs from the north of the Mersey, and the remaining 70 per cent. will still need to travel to Clatterbridge for their treatment, typically on numerous occasions.

I am also informed that population and disease trend analysis suggests that demand for radiotherapy in Merseyside will rise by 26 per cent. by 2016, from a 2006 baseline. It is for these reasons that the Royal Liverpool University hospital has been identified as the preferred second location for additional radiotherapy services. I am informed that this proposal was put forward after considering the need for greater alignment of associated clinical services and specialist multidisciplinary teams for cancer. I also understand that the proposal has the potential to improve the strength of cancer research in Merseyside and Cheshire by developing closer links with the university of Liverpool and its Cancer Research UK centre, which, as my hon. Friend will agree, is an enormously valuable prospect.

I am taking advantage of the Minister’s kindness in allowing me to intervene again.

I cannot see why all those advantages cannot be gained by an extension of the location at Aintree, which has similar links to the University teaching hospital in Liverpool. I am just not persuaded that the case has been made for two locations. By all means let us provide better services for people north of the river, but why on two sites?

I accept my hon. Friend’s reluctance to accept my argument during this debate. I feel confident that the argument will continue outside the Chamber. I ask him to look at the figures and to accept that the link with the university of Liverpool and its Cancer Research UK centre is, as I am sure he will agree, an enormously valuable possibility.

I am aware that Cheshire and Merseyside primary care trusts, with support from the cancer network, are in the process of developing a specification for the additional radiotherapy units. I have been informed that the latest position is that Cheshire and Merseyside PCTs will consider the proposal of additional radiotherapy provision north of the Mersey at Aintree and the Royal at their next round of board meetings in June of this year. It is important to note that this review, when fully implemented, will lead to a substantial investment in non-surgical oncology, as some £30 million is being invested to bring new radiotherapy treatment facilities north of the Mersey.

However, it is equally important that services are improved for Wirral and western Cheshire patients at the Clatterbridge Centre for Oncology. It is crucial that any improvement builds on the current excellent performance and services offered to all patients by this specialist cancer trust, which was scored excellent for both quality of services and use of resources by the Healthcare Commission in 2007-08.

I am assured that the proposal to tender the radiotherapy service at the Royal Liverpool hospital will be in line with national competition policy and NHS cancer commissioning guidance. I am informed that although the detail is yet to be concluded, it is likely that potential providers will be invited to put forward proposals that identify how they would source capital and what implications that would have for unit costs and tariff. Clearly, the tendering process will be a “commercial in confidence” exercise, and it would be inappropriate for me to comment further. However, I hope that the Clatterbridge centre will be able to tender for that additional capacity in due course.

I am confident that my hon. Friend will continue to champion and support health services and, in particular, cancer services in his constituency—as will all those who have spoken in tonight’s debate—and I encourage him to engage with the local organisations throughout the planning stages. The past 10 years have witnessed real progress in cancer services nationally. I hope that the proposals that he has brought to our attention today will make a real and tangible difference to the people of Merseyside. I know that the prevention of inequalities and the work that has to take place to reduce those figures and that worrying trend are also part of our work as Members of Parliament and as Ministers. I want to express my best wishes to all those involved in the process of achieving those aims.

Question put and agreed to.

House adjourned.