A hospital in London has been accused of covering up a report criticising its children’s cancer services.
The Royal Marsden NHS Foundation Trust’s hospital in Sutton was told in 2015 the way it treats children with cancer was causing unnecessary stress and danger.
Transferring young patients between hospitals for different types of care puts their health at risk, experts said, and was even deemed to have led to at least one child ‘dying in terrible agony’.
But bosses at the hospital trust did not act on the report, according to an investigation by the Health Service Journal.
And NHS England is even accused of covering it up because the Marsden Trust’s CEO, Cally Palmer, has also been the national cancer director since 2015.
The Royal Marsden NHS Foundation Trust’s hospital in Sutton has been accused of refusing to change its cancer services for children which regularly lead to young patients being transferred between hospitals in the region
The Royal Marsden’s care model means children with cancer – the trust specialises in cancer treatment – face being moved around hospitals in the area.
It sends patients to Tooting or King’s College in the city for neurosurgery and to one of 16 district hospitals for less intensive care.
This fragmented model is unlike ‘anything else in the UK’ and ‘thoroughly unsatisfactory’, experts have said.
A report published in 2015 by Mike Stevens, an honorary professor of oncology at the University of Bristol, said the cancer service in Sutton ‘must be addressed’.
But the HSJ says the hospital trust did not take on board advice in Professor Stevens’ report, and had failed to act on other critical investigations over the years.
Professor Stevens recommended one treatment centre be set up for London to include intensive care on the same site, reducing reliance on other, smaller hospitals.
One medic working at the trust told HSJ children were sometimes transferred just to have central lines or IV lines put in.
An inspection of the Marsden by the Care Quality Commission in 2016 found that 330 children had been transferred by the trust between 2000 and 2015.
These transfers were made to numerous different hospitals and, in 2015, six children were transferred at least twice and three of them were transferred three times.
One source told the HSJ: ‘After a lot of thought it was decided it was safe because they essentially export the risk, their patients, to St George’s [hospital in Tooting].
‘They have a very low threshold for transferring children.
‘It’s a much higher proportion than you would expect in other children’s units and that was making it safe.
‘But it wasn’t the best experience for the child or the parent. It is thoroughly unsatisfactory.’
TWO-YEAR-OLD DIED AFTER DOCTORS DID NOT DISCUSS BRAIN SCAN RESULTS
Alice Mason died in the care of the Royal Marsden NHS Foundation Trust in 2011 at the age of two.
Errors made by doctors at the Marsden trust and Kingston Hospital caused Alice’s death, a coroner ruled, by delaying her treatment so much she suffered irreversible brain damage.
Alice had been treated for a brain tumour by the Marsden but, despite recovering well, she became dizzy and unable to walk or sit up without help.
Alice Mason, two, died after doctors repeatedly failed to discuss the findings of an MRI scan. She had suffered irreversible brain damage following treatment for a brain tumour
Her parents, Rosalind and Gareth, pleaded for help from doctors in Kingston for eight days but were told she was probably having chemotherapy side effects.
A routine scan a few days later at the Marsden trust showed signs of fluid building in the brain – called hydrocephalus – but the test results were not sent to doctors in Kingston.
Although Kingston staff had been instructed to order a CT scan if her condition worsened, they didn’t do so.
By the time Kingston realised what was wrong, Alice’s condition was significantly worse and she was repeatedly vomiting.
She suffered brain damage from the swelling and had surgery to drain the fluid from her skull but never regained consciousness after the operation.
Mr Mason said staff at Kingston ‘just didn’t know what to do’.
‘Because we were in the shared care system we were being dealt with by people who didn’t have the specialist knowledge,’ he said.
He told the Health Service Journal his daughter had died in ‘terrible agony’.
Critics have said Professor Stevens’ report – and others published afterwards – may not have been acted on because the trust’s CEO had a potential conflict of interest.
Cally Palmer, CBE, has been chief executive there since 1998 and was made the NHS’s national cancer director for England in 2015.
NHS England, her second employer, did not publish the report produced by Professor Stevens and it was released by the HSJ for the first time today.
The Bristol academic had written to the NHS in 2016, 15 months after he produced his report, asking why it hadn’t been published and saying he hadn’t received ‘any justification’ for the decision not to publish it.
Professor Stevens, who had written the report alongside nine other child cancer experts, said it ‘should have been shared openly’.
He added: ‘It was, and remains, a matter of concern to me that Cally Palmer, as the national cancer director, is also the chief executive of the Royal Marsden.
‘This creates an obvious conflict of interest.’
Another anonymous source with detailed knowledge of the CQC inspection added: ‘Cally is highly protective of the Marsden and highly protected by the upper echelons in NHS England. It’s the only logical explanation.’
And a former director of NHS England told the HSJ: ‘People did not want to stomach the political implications of having a fight with the Marsden and when your national cancer director is the CEO of the Marsden it is very difficult.
‘NHS England corporately covered up [the Stevens report] – that would be my personal view.’
NHS England said recommendations now being put forward to improve cancer services include one saying a trust’s services should be centred on a single site.
And it denied Miss Palmer was involved with the recommendations.
An NHS spokesperson said: ‘The Independent Cancer Taskforce recommended that the NHS should improve “pathways between specialist centres and shared care units” for children with cancer.
‘The draft service specifications have been developed with expert clinical input and were signed off by the children and young adult cancer services clinical reference group, and we are now consulting on the proposals, to build on progress which in recent years has seen NHS services contribute to a record high cancer survival rate.’
MailOnline has contacted the Royal Marsden NHS Foundation Trust and, through it, Cally Palmer, for comment.
The Trust pointed out to the HSJ that it had received high ‘outstanding’ and ‘good’ ratings from the Care Quality Commission in the 2016.
A spokeswoman told the health news website: ‘The CQC commented that there was an open and transparent approach to incident reporting.
‘Patient safety incidents are among the lowest in the country… and the centre has robust data to demonstrate that clinical outcomes are equal to or better than the national average.
‘All paediatric cancer centres across the country work with a number of shared care units to manage patient care.
‘Very sadly, two serious incidents occurred in 2009 and 2011 both as a result of the management of shared care pathways between units and the centre.
‘Both were fully investigated at the time and action taken to learn from and improve the management of these pathways.’