Evelina London Children's Hospital is the only dedicated children’s hospital in the geography of the Principal Treatment Centre for children's cancer and is part of Guy's and St Thomas' NHS Foundation Trust, which is home to the largest cancer treatment centre in London for adults.
NHS England has confirmed that the children’s cancer service must move so that it is located on a site that provides both level 3 critical care (intensive care) for children, and other specialist children’s services. This is so that children with cancer do not have to move to another site to receive the expert care they might need, and so that innovative new treatments and research trials can be provided for children who need them. These requirements were mandated in a new national service specification following engagement with families, clinicians, children’s cancer charities and other experts, which was captured in a report by Professor Sir Mike Richards in 2019. In order to avoid further anxiety for the children, families and staff in the current service, we agree with NHS England that this change must be made with no further delay.
The following statement sets out the Trust's position regarding the key issues that must be considered when deciding on the future location of the Principal Treatment Centre. There can be no doubt that Evelina London is the only option that can provide the benefits that this service change is seeking to deliver.
World-class clinical expertise
Evelina London is the only dedicated, purpose-built specialist children's hospital in the south London and south east region and was the first children's hospital in the country to be rated 'Outstanding' by the Care Quality Commission.
With 3,000 dedicated children’s staff and 264 beds in a hospital co-designed by children and their families, Evelina London provides twice as much care to children as any other hospital in the region.
The purpose of this change is to bring the oncology team together with as wide a range of other specialist expertise that a child with cancer might need – we believe this is only possible at Evelina London.
While other hospitals provide children's services, none in the region have the scale and depth of expertise that is located at Evelina London. For example, Evelina London has:
- 30 specialists in children’s cardiology and more than 50 surgeons working across 10 complex surgical specialties with 10 operating theatres, including a brand new, state-of-the-art day treatment centre for children who can have surgery and go home on the same day
- the region's only nephrology service for children with complex conditions including kidney failure
- a critical care unit with 30 beds, twice as many as any other in the region.
This means that, day and night, children at Evelina London have access to the specialist services they need, delivered by dedicated paediatric trained clinicians. This is only truly possible when you have the depth and breadth of a dedicated children’s hospital, and means that these services are resilient and reliable.
A trusted partner
Evelina London already delivers over 1,000 clinics a year in local hospitals, bringing our specialist expertise closer to where children live. This is a model we would look to develop for the Principal Treatment Centre, providing greater support to the region's Paediatric Oncology Shared Care Unit’s and paediatric oncologists so that together we can work towards reducing the number of children needing to directly travel to the Principal Treatment Centre.
Our dedicated clinical education team has more than 40 nurse educators as well as consultants leading education in every speciality, and we train staff at all hospitals in the region. We have significant experience of telemedicine, enabling more connected healthcare across a wide geography through virtual clinics and multidisciplinary meetings and our long-established ways of working with local partners can immediately benefit the Principal Treatment Centre and provide more joined up care for children and their families.
Driving excellence across our region
Principal Treatment Centres must also be able to lead a network of shared care together with the local hospitals across the region. Evelina London has this experience, leading 5 complex paediatric networks to improve care, including the South Thames Paediatric Network. These networks include the geography of the Principal Treatment Centre and hence the children's cancer network. Principal Treatment Centres must also be able to support children in the transition of their care from children’s to adult services and Evelina London’s approach is independently assessed as being excellent.
Furthermore, we operate the South Thames Retrieval Service which provides the children's intensive care ambulance service for the region. This services already supports the Principal Treatment Centre and children with cancer, including safely transferring children between The Royal Marsden and St George's sites, as well as operating across the region to ensure seriously ill children can receive highly specialist care where and when they need it.
We will continue to provide this service no matter where the new centre is located, however, fewer children will need to transfer if Evelina London is selected as the new centre. This is because we have the region’s largest Level 3 children's intensive care unit, and a far greater number of paediatric organ and condition specialists based on site who can quickly and easily provide additional, specialist clinical opinion.
Better connected
The radiotherapy hub at University College London Hospital (UCLH) will be a key partner for the Principal Treatment Centre. UCLH have already established that, given the proximity of Evelina London, a service similar to that delivered to Great Ormond Street Hospital (GOSH) would be possible, which would include on site consultations when appropriate. It is particularly helpful in those situations when radiotherapy is not being offered for the clinical expertise to be present in person for discussions with the children and the family.
Alongside the radiotherapy hub, neurosurgery is a key specialism that will continue to be provided in partnership with both King’s College Hospital, where 80% of children are currently supported, and St George's Hospital.
Evelina London has a longstanding partnership where we work as 'one team' with King's College Hospital’s neurosciences team. We have a joint out-of-hours neurology rota, and a paediatric neurosurgeon who is employed by Evelina London and spends time at our hospital. Clinicians from King's College Hospital already provide some highly specialist elective neurosurgical procedures at Evelina London, and conduct clinical reviews for children on our wards, removing the need for them to transfer to another hospital. On rare occasions, due to the acuity of the child's condition, emergency neurosurgery has also been undertaken at the Evelina London.
We are also well placed to ensure all clinicians involved in a child's care can quickly and easily access all the information they need, further improving patient care and experience. Evelina London uses the 'Epic' digital patient record system. This system is also used by the Royal Marsden (current Principal Treatment Centre), University College London Hospital (radiotherapy), King’s College Hospital (neurosurgery) and Great Ormond Street Hospital (under 1s).
Consequently, if Evelina London hosts the Principal Treatment Centre, clinicians transferring from the Royal Marsden will already be familiar with and know how to use the technology, and existing patient records can be seamlessly transferred, significantly reducing administration time. Coupled with the wider use of the ‘Epic’ system across hospitals that support or work with the Principal Treatment Centre, Evelina London is already set up to seamlessly join the children’s cancer care network so we can immediately get to work delivering consistent, high-quality care to patients.
A long-term vision
We recently opened a new Children's Day Treatment Centre and have secured planning permission for a brand new 12 storey building right next to the existing Evelina London Children's Hospital. With the support of Evelina London Children’s Charity, we are planning to continue the development of our world-class child centred campus, co-designed with staff and families. It will have space for new wards as well as more imaging, diagnostics, theatres, and research facilities to enable the growth and future proofing of our specialist services.
Our plans mean that if Evelina London is selected to host the Principal Treatment Centre, we will not only deliver the cancer services that children need now, but we can be sure we will have everything in place to accelerate research and deliver new treatments as they emerge in the future too.
Exceptional research and translation
Research is fundamental to the future of children’s cancer care. Up to two-thirds of children with cancer are enrolled in a clinical trial, and new therapies are being developed and tested every year.
The research panel convened by NHS England independently assessed Evelina London as having the best potential for enhancing children’s cancer research. This is based on our international impact as a children’s health research leader, as well as the Trust’s expertise in adult cancer research which is delivered by Guy’s Cancer Centre along with our academic partner King’s College London (KCL) which has active research partnerships with the Institute of Cancer Research (ICR). King’s College London has committed to the future vision for research in the Principal Treatment Centre, including a vacant Chair position which, if we are successful, could be in paediatric oncology.
Clinical trials
Evelina London’s ability to deliver leading-edge research is unrivalled in the region. We have two dedicated children’s research wards (including accreditation for phase 1 clinical trials), recruit and support more children through research studies than any other hospital in London, and our specialist children's research team is already working on more than 180 children’s research studies with academic and industry partners worldwide.
These global research partnerships have already made a profound impact on the lives of sick children. This includes ground-breaking clinical trials into peanut allergies which have led to changes in UK guidance, and internationally, around the introduction of peanuts in infancy, and pioneering imaging studies that have advanced our understanding of brain and heart function. Our paediatric clinical research and translation experience can immediately benefit the Principal Treatment Centre and children living with cancer.
Immunotherapy
While the Royal Marsden provides exceptional care to children, they cannot provide certain therapies, such as immune therapies like CAR-T because they do not have on-site intensive care. Guy's and St Thomas' work with King's College London, one of the top universities in the world for clinical medicine, to develop and deliver exactly these types of therapies. This includes the current, first ever clinical trial of a new class of immunotherapy, IgE antibodies, to see whether they could benefit patients who do not respond to existing cancer treatments.
Research funding
Our team of 75 dedicated children's health researchers receives more than £25m a year in research funding. If Evelina London is selected as the home of the Principal Treatment Centre there will be a unique opportunity for our researchers to join forces with the existing Royal Marsden team and colleagues at the Institute of Cancer Research (ICR) to co-create a strong and exciting research vision, secure further national and international research funding, and unlock our region’s potential to become a world-leader in children’s health research.
Comprehensive support for children and families
We understand just how tough it is to be the family member of a seriously unwell child, and support each family with a tailored, specialist and compassionate service to help them to navigate this exceptionally difficult time in their lives.
This support is recognised and valued by families. Evelina London and the Royal Marsden were the only two hospitals in South London rated as ‘better than expected’ for their care of children aged 0 to 7 in the most recent CQC Children and Young People’s survey (in 2020).
If selected as the new home of the Principal Treatment Centre, this extensive experience will be brought to bear for the families of children living with cancer.
Transport and accommodation
In particular, we know that families have enough to worry about without needing to think about travel logistics, and that this has been a key concern raised during the consultation process. We already have significant experience of the efforts needed to support children who are especially vulnerable or immunosuppressed due to their medical condition and who need to access the hospital frequently, often from distance and sometimes multiple times a week for months on end. To support families accessing the new Principal Treatment Centre, Evelina London will provide:
- dedicated, free, pre-bookable car parking spaces – with capacity that at least matches the provision offered at the current centre
- a fleet of 12 cars that will collect and return children and their families to anywhere in the region, minimising the number of families that need to drive themselves.
- full reimbursement of the ULEZ and Congestion charges
Families traveling with a neutropenic child can drive right up to Evelina London's front door on Hospital Street, and for those families that need to stay overnight, we have the largest Ronald McDonald House in the region, providing 60 free rooms for families.
Communication and engagement
Communicating clearly and responsively with parents and young people is essential to their treatment experience. We have been consistently praised by parents for the communication they have with our clinical teams and their involvement in decision-making. CQC survey feedback on these points is better than any other hospital in the region.
Relaxation and fun
Evelina London Children’s Hospital was designed in partnership with children and families to be bright, friendly and have plenty of places to play. Our wards are warm and colourful spaces, and our specialist play team help children enjoy bedside magic, music, and adventures so they can relax, or prepare for medical treatment. Children staying with us for extended periods of time can continue to learn in our Ofsted 'Outstanding' rated hospital school.
From next year, children at Evelina London will have access to the new cinema in St Thomas' Hospital, (home to the UK's first MediCinema), located adjacent to the children's hospital. This 160-seat cinema will show the latest box-office films and will be free for people staying at the hospital, including their families. To make sure everyone can enjoy the movie magic, the cinema will be accessible for children in wheelchairs or beds, and a team of nurses will provide medical supervision.
Psychological and wellbeing support
Because Evelina London looks after so many children with specialist needs we have developed one of the country’s largest children’s psychology services, which The Royal Marsden's psychology team would join. Together, we will support children and their families from diagnosis onwards with regular and ad-hoc counselling (including out of hours). Parents will be involved throughout, and children and their families will be supported with the range of issues that commonly arise from such a difficult experience.
For the rare and extremely difficult times when a family loses a child, we have a dedicated, highly experienced, and supportive palliative care team and bereavement service as well as holistic (emotional, spiritual and psychological) support.
Support for staff
Feedback from staff, including through the NHS Staff Survey results (which are better than other hospitals in the region) and other NHS statistics, shows that Evelina London is a great place to work.
The children's cancer team from the Royal Marsden would join this supportive environment and through visits to Evelina London during this pre-consultation and consultation period, we have heard from the Royal Marsden team just how welcoming and child- and family-centred they have found the environment and the ethos at our hospital.
Evelina London was one of the first hospitals in the country to support the need for staff psychology provision. This is now something that is offered to help staff respond to difficult circumstances such as an unexpected death or serious incident or as part of the ongoing provision for staff to help them provide the best care to children and families whilst looking after their own wellbeing.
A dedicated paediatric charity supporting incredible care
Evelina London’s work is supported by one of the largest healthcare charities in the UK (Guy's & St Thomas' Foundation), which has established a dedicated children's charity (the Evelina London Children's Charity) that has raised almost £20m over the last five years to support projects benefitting the children we care for, their families, and our incredible staff team. This support has enabled us to provide ground-breaking medical equipment including:
- a new MRI and intervention suite
- the development of the children's Clinical Research Facility enabling early phase trials to take place in the heart of the hospital
- a new children's cardiac and critical care ward
- numerous projects improving patient environment, patient experience and staff support
We expect to raise much more for children's cancer, helping us provide even more support to the children and families using the Principal Treatment Centre, in addition to continuing to benefit from the ongoing and generous support of Guy's & St Thomas' Foundation.
To reduce the impact on core NHS funds, our charities would part-fund the costs associated with transferring the Principal Treatment Centre to Evelina London and acquiring the brand new, state-of-the-art equipment needed to best support children living with cancer. This includes underwritten support, confirmed by the Foundation’s board of Trustees, for a minimum of £10m to support the build and development of the facilities, as well as dedicated support for the service with fundraising each year and an ambition to grow current fundraising and philanthropic income. We would develop this fundraising and philanthropy strategy in partnership with the team from The Royal Marsden and Institute of Cancer Research.
This confirmed charitable support, together with the agreed capital funding from NHS England (to enable the move of the Principal Treatment Centre) and existing Trust capital funding, will enable Guy's and St Thomas' to create the facilities required for the new Principal Treatment Centre without the need to seek any additional funding and regardless of any competing financial pressures.
A once-in-a-generation opportunity
We have engaged widely with clinicians and communities throughout the consultation period, and time and again we have heard how important it is for specialist children’s services, including the children’s cancer service, to be co-located. The decision to relocate the Principal Treatment Centre is a once in a generation opportunity to achieve this. We have also engaged, as deeply as we have been able to, with the team from The Royal Marsden, and we have heard feedback about the clear benefits that a children’s hospital and the environment it fosters could bring to the Principal Treatment Centre team. This is a difficult change, and individuals will have their own perspectives, but it is clear that the team from the Royal Marsden appreciates the opportunities that Evelina London's facilities, expertise and ethos provide.
By choosing Evelina London you would be choosing a clinical team with an exceptional track-record of driving advancements in the care of seriously ill children, both within our hospital and across our region. You would be choosing a proven service delivery model that already operates with great success across the UK and internationally. Finally, you would be choosing a Trust that has consistently invested in children's services, and training and development opportunities for paediatric clinicians.
By combining the outstanding team from the current Principal Treatment Centre with Evelina London's established paediatric expertise, we can together provide the joined-up care, experience and access to emerging treatments that children with cancer deserve and enable them to access the benefits that being part of a comprehensive and dedicated children's hospital brings for their care.