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Search forCancer care battle not finished yet
Monday, July 21, 2008, 10:00
So it should come as no surprise that people in Cornwall are fighting to preserve something as emotive as specialist cancer surgery skills in the county.
In reality, throat and neck cancer surgery should already have moved from the Royal Cornwall Hospital at Treliske to Plymouth's Derriford Hospital. It is the first step towards creating a single centre of excellence in Devon and Cornwall by 2010.
The logic, and evidence, proffered by the Cornwall and Isles of Scilly Primary Care Trust is straightforward. The larger the centre, the more operations surgeons perform, the better they get and so chances for patients improve markedly.
But the opposition has been growing, both in number and vociferousness. Patients – some 160 Cornish residents are affected by upper gastrointestinal cancers each year – are perfectly happy with the highly-regarded team led by three consultants at the Royal Cornwall Hospital.
The service at Treliske has also been declared by independent assessors to be of excellent quality, with low rates of complications and mortality.
Campaigners are also questioning the logic of forcing vulnerable patients to travel across the River Tamar, miles from the support of their families and friends.
In the wider context, concerns have also been raised about the loss of such specialist surgical skills which could be used in emergency operations.
As one specialist consultant, Paul Peyser, said: “Removing the service from Cornwall would not only be a serious burden to patients with newly diagnosed cancer, who find they would have to travel long distances just at the time they most need support from their family.
“It would also mean that vital surgical skills will be lost to Cornwall and these skills are essential to deal with trauma, sudden bleeding and other emergencies.
“Other rural areas, such as Northumbria, have developed imaginative solutions that enable patients to have their care locally by clinical teams who have the necessary expertise.
“But the current proposal, which would involve the patients and surgeons driving from Cornwall to Devon to provide treatment, is clearly not in anyone's interests.”
Before matters came to a head at a meeting of county councillors, the row resulted in its first casualty.
Peter Davies resigned as the chairman of the Royal Cornwall Hospital Trust after just nine months, criticising the consultation process as “late” and expressing fears that specialist services will “continue” to be transferred out of Cornwall.
After months of sparring, decisive action was taken by the county council's Health and Adult Social Care Overview and Scrutiny committee last week, as members voted 16 to 2 for full consultation on the proposals. It followed an impassioned debate.
Anna Burton, of the Cornwall Cancer Patient Group, told the meeting: “Separating vulnerable patients from their husbands, wives and families is appalling.”
But the PCT had bought out the big guns too. Chief executive Ann James stressed that their were no ulterior motives – simply the best interests of patients. While a “regrettable and difficult” decision, it would have “absolute benefits” for those needing surgery to beat the disease.
She handed over to leading surgeon Professor Mike Griffin, from the Royal Victoria Infirmary in Newcastle. He reassured councillors that there was “no doubt” that bigger centres gave patients a better chance of beating the disease.
“The more you practice, the better you get at it as an individual surgeon,” he told them.
Ms James clearly thought the argument was convincing and was obviously disappointed when the committee voted for further consultation.
Members backed a resolution from committee chairman Eric Parkin which said the debate was “focused upon the clinical case” rather than the effect on patients, local services and “the longer-term strategic direction of specialist services in Cornwall”.
Whether a full consultation is held remains to be seen. The committee's decision, while hard to ignore, is not binding on the primary care trust which feels its “public engagement” has fulfilled those criteria in all but name.
The trust is currently seeking “further clarification” from the committee before it makes a decision. Behind the scenes, it will almost certainly be seeking advice from the South West Strategic Health Authority and the Department of Health.
Ms James, for one, doesn't believe that further debate will alter the clinical case for change.
It remains to be seen whether the PCT is prepared to have that debate and suffer further delay. Any formal consultation wouldn't start until September.
It also remains to be seen whether it is prepared to press on without further dialogue, and risk the wrath of consultants, campaigners and the wider public. A 19,000-signature petition was handed in to the committee before it met last Tuesday.
Rose Woodward, chairman of Cornwall Cancer Patient Group, still hopes to change the outcome. She believes that they need to “look at all the implications of moving this service away from Cornwall”.
“It means a consultation without the result having being predetermined,” she added. “People will feel their opinions are valued and patients will feel as that their views count for something.
“I hope that it will prove that the distress caused to patients should be taken into account when we are talking about improving outcomes.”
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Terry Murray, chairman of West Cornwall Heath Watch, with Rose Woodward, of Cornwall and the Isles of Scilly Cancer Patient and Carer Group, and Joe McKenna, chairman of Health Initiative Cornwall, who are battling to keep cancer treatment at Treliske
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