Response to 2017/18 Radiotherapy consultation from West Cormwall HealthWatch
WEST CORNWALL HEALTHWATCH
email: firstname.lastname@example.org tel: 01736 788107 www.westcornwallhealthwatch.com
Modernising radiotherapy services in England
We are a voluntary non-political group, campaigning for over twenty years for the retention and enhancement of NHS care for people in the far west of Cornwall. Our particular concerns have always been to ensure equitable access to healthcare, despite the challenging nature of our geography.
So we write in response to the latest consultation, which seeks our views on developing eleven radiotherapy networks across the country, where specialists will be located in one centre to which patients with less common cancers will have to travel further. We understand that your reasons for seeking change centre around an assumption that patients will benefit from being treated by teams seeing more patients, that you will maximise your investment, and that you have challenges in recruitment
We have concerns about your plan, which is a national strategy seeming to pay scant attention to local needs and geography. Whilst no-one would disagree with your aspiration to access innovative treatments, the means of accessing them in distant locations might for our patients prove impossibly challenging, and unnecessary when innovative treatments are already available in their own county.
Whilst you maintain that the numbers of patients needing to travel further afield will be very small, we understand this is likely to affect around 140 – 200 patients each year from Cornwall. When we read that the cancers referred to are gynaecological, sarcoma (soft tissue), brain, head and neck, upper GI especially gullet, stomach, liver, pancreas and bile duct, we realise that this will many affect people we know and live alongside. If combined radiotherapy and chemotherapy treatments are added to the list, which we understand is quite possible, this will have even more impact on numbers.
We note that our own ‘network’ will cover Cornwall, Devon, Somerset, Wiltshire, Avon and Gloucestershire. That is indeed a huge area. Our own patients with less common cancers may have to travel to Plymouth or Exeter. Note that travelling to Plymouth from St Just is a 170-mile round trip; travelling to Exeter is a 246-mile trip. For those of you in London, that would mean taking trips to Peterborough or Birmingham respectively, which we imagine you would find unacceptable. Cancer patients are frequently extremely unwell, and the prospect of such travel, or of being separated from their support networks for weeks on end, is distressing if not impossible.
Our anxieties are threefold: 1) the financial implications for these patients and their families, knowing the cost of travel to distant parts from west Cornwall. If the patient has a relative able to commit to driving daily for a number of weeks, a return trip would cost around £30 per day in fuel alone. Voluntary transport providers will not drive patients all the way to Derriford Hospital (Plymouth), and initial enquiries suggest that the cost of a taxi would be around £300 per day from Penzance to Derriford. 2) the physical implications of undertaking such lengthy journeys when unwell and battling cancer. Undertaking a train journey from Penzance to Plymouth daily takes over two hours, not allowing for the distance to and from the railway station. Travelling by bus takes between 4-6 hours each way, and current timetables would not allow a return journey in a day; it’s unthinkable that anyone could maintain
that for four to six weeks. Car travel, if the patient has a relative able to drive them, would take around two hours each way. (Note that travelling to Exeter would add over 40 miles each way, each day). 3) the emotional implications of stressful travel and separation from loved ones for extended periods. Once it is clear that a patient cannot maintain daily long-distance commuting for treatment, due to illness and/or exhaustion, it is necessary to find accommodation close to the hospital. Quite apart from the cost of this, the lack of support from all family and social networks at such a difficult time has enormous consequences for patient well-being or even survival.
So we urge you to consider the impact of your proposals on those who live on the outer edge of our country, and for whom your well-intentioned thoughts of modernisation may have unintended consequences. A wellrespected local clinician recalls the time some years ago when patients had to travel to Plymouth for radiotherapy, and how many chose not to undertake the life-saving treatment simply because of the distance and cost. She is appalled at the prospect that this may happen again.
In Cornwall we are immensely proud of our Sunrise Centre in Truro, a centre of excellence for cancer patients across the county, with committed clinicians offering a renowned service. It would be a tragedy indeed if their work was in any way diminished or weakened by your proposals, or if the patients they currently treat might be sent away for treatment. Just a few days ago we heard the following item on our local news:
One of the team behind the Sunrise Oncology Centre in Truro says her recognition in the New Year Honours shows how vital the service has been for local people. Janet Sheppard spent her professional life working with cancer patients at the Royal Cornwall Hospital, and has been awarded the British Empire Medal for her role in getting the new facilities located here. She says it’s made a huge difference: "I saw myself the people who tried to travel and just found it impossible because they were so ill; the people who stayed in Plymouth and were separated from their support networks, which did irreparable damage sometimes to relationships; and people who simply refused treatment because they wouldn’t go to Plymouth - and now we have a complete state-of-the-art department in Truro“.
If Cornwall’s cancer services were in some way inadequate, your aspiration to send patients to centres treating more patients might be more easily understood. However, our cancer centre is second-to-none, and there is really no need to send our patients out of county and much further from their homes. The prognosis for them would most likely be worse rather than better. The Cornwall Cancer Team has written as follows:
“At the Royal Cornwall Hospital we have built up over the last fifteen years an excellent team with a national reputation as a cutting edge dynamic team, offering patients the latest clinical studies and treatments to the highest international standards. Some of our team lead on major radiotherapy studies. We are the lead recruiters into cancer trials overall by far in the Southwest. We have start of the art radiotherapy equipment capable of delivery the most effective and least toxic treatment available. We all work in multi-disciplinary teams, both within and outside our hospital already. …There is no evidence that this disruption will lead to improved outcomes. We already collaborate via regular video link up meetings with Derriford/Exeter with Head and Neck, Sarcoma, Brain, Gynaecological and anal cancer patients. As a group we are committed to the highest standards of cancer care and would prefer to show this by results evidence and through our participation in clinical trials. We are committed to working collaboratively with other centres to ensure patients receive optimal care. We believe this can be done with cross-cover between sites i.e. Derriford and Cornwall and delivering high quality treatment close to patients’ homes.
We urge you to think again for the sake of our residents, and to devise a solution which will maintain local access for all our patients.
Marna Blundy (Mrs) Coordinator West Cornwall HealthWatch