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Clatterbridge Centre for Oncology

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 the Member for Liverpool, Walton (Mr. Kilfoyle) may well disagree with me on this point—for a second satellite at the Royal Liverpool hospital, only five 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 five 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 will 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?