An incomplete set of correspondence released by health bosses reveals a massive internal struggle – and ultimately capitulation – over the privatisation of the Churchill Hospital’s world famous cancer scanning service.
The PET-CT scans allow specialists to see how tumours are reacting to procedures and to plan and monitor ongoing treatment and NHS England wants to hand the Thames Valley contract for this service to a profit-seeking company, InHealth.
The emails, released under the Freedom of Information Act, show Oxford University Hospitals NHS Foundation Trust (OUH) defending its service vigorously - until a change of heart suddenly happens.
Between the two points, correspondence to indicate why OUH bosses performed an about turn is missing and the Banbury Guardian has demanded that it is produced.
Oxford specialists say the new contract will be an inferior, less safe service that could fragment the Churchill’s world-famous treatment and research operation.
Two years’ wrangling has risked impacting recruitment and interfering with patients care plans, according to clinicians who prepared OUH’s bid for its own exemplary service.
The OUH bid was rejected in favour of InHealth who offered mobile scanners in Milton Keynes and Swindon.
OUH cancer specialists said the units were not as sophisticated as Oxford’s and some patients might be at risk. The concerned doctors have now backed out of ‘partnership talks’ between OUH, InHealth and NHSE.
NHSE’s plan for InHealth to take over in April, 2018 ,was postponed first to July and then to October, 2018. The contract has not yet been signed.
OUH took out a High Court action against NHSE but this was inexplicably dropped days before the case. Missing correspondence means neither we nor clinicians know why.
However Denis Campbell reported in The Guardian: “OUH’s CEO, Bruno Holthof, was left shaken after then NHSE chairman Sir Malcolm Grant rang him to warn the trust not to mount a legal challenge... despite the Churchill’s international reputation...
“Senior figures at OUH were left stunned at the heavy handed tactics when Holthof told them recently about his call with Grant.”
In a highly detailed report, OUH’s expert witness in the abandoned action, Dr DKB Patel, said: “I would consider it unsafe to scan patients on a PET-CT scanner based on a non-clinical site as proposed.”
He questioned NHSE’s decision to award a contract based on a procurement report that ‘cites a preference for static over mobile sites and a preference for co-location of PET-CT services with existing services’. He felt OUH should maintain services to protect enhanced scans, radiotherapy planning, research and training.
In August, 2018, OUH wrote: “We believe InHealth are playing a game with NHSE at the expense of patient care... that they will fully understand their proposal is not safe or deliverable and certainly reduces (the current) quality of care.”
OUH noted that all its scans are ‘double reported’ - checked by two specialists for opinion on treatment and, where necessary, CT scans are done alongside the PET-CT scan, which would not be done under InHealth’s plan.
In October 2018 Dr Holthof wrote to NHSE about problem areas where the trust had requested conditions to maintain the high quality of service, which InHealth indicated it would not agree.
These included having a senior doctor available onsite, scans taking place at hospitals where facilities meet the needs of complex cases. double reporting, personal attendance at review meetings, maintaining optimum inspection of the nuclear scanners and facilitating OUH’s research and training without expense to the trust.
The OUH then went quiet and NHSE sought ‘costings’ but a Trust Board meeting took place in November.
On November 15, OUH chair Dame Fiona Caldicutt wrote to NHSE’s chair saying: “... the trust board no longer supports a joint approach for the provision of PET-CT services between OUH and InHealth.
“We have reports of experiences of clinicians in other specialities which lead us to believe InHealth will struggle to provide an adequate service.
“This includes evidence from patients and clinicians of poor care.”
NHSE replied it is ‘inevitable’ InHealth’s service will be different to OUH’s but it wanted to achieve the benefits of both. It said telephone discussion is adequate for team meetings.
It said there is ‘no requirement’ for double reporting and using PET-CT for planning radiotherapy is not a service commissioned by NHSE and therefore not part of InHealth’s brief.
The letter said if OUH felt strongly it could bear the cost itself. It ‘strongly urge(d)’ the trust reconsider abandoning a partnership. If not, the contract would go to InHealth.
NHSE’s next steps would include ‘engagement’ with Oxfordshire Health Overview and Scrutiny Committee (OHOSC) and ‘other public involvement activities’.
On December 18, Dame Fiona wrote: “The board (has) agreed to maintain a position that no partnership be sought with InHealth.”
NHSE then confirmed it would contract InHealth.
There was then a ten-week gap in the FOI supplied correspondence (‘a genuine error; no conspiracy’) after which NHSE wrote seeking meetings to pursue the partnership.
Nothing has been offered to explain why OUH capitulated to NHSE’s wishes.
In February InHealth was recruiting specialist staff.
The missing documents reveal a partnership-setting meeting on March 19, where Dr Holthof accepts ‘virtual’ attendance of InHealth at team meetings.
The agenda included keeping the Oxford PET-CT service and staffing at the Churchill with ‘flexibility’ on research. Private phone calls punctuate this saga.
NHSE, in its meeting notes, said InHealth and NHSE commit to flexibilityto sustain the OUH service as a centre of excellence ‘within the confines of the contract and lines of accountability’.
On March 22, NHSE pressed OUH to declare its commitment to the partnership in its report to OHOSC.
On April 12, NHSE noted Dr Holthof would keep discussions away from clinicians until more partnership detail was ready to be shared.
On April 16, he agreed details of a deal in which OUH will be a subcontractor to InHealth via its NHSE contract. NHSE Specialised Commissioning will pay for the conditions OUH demands.
NHSE expressed concern about clinicians briefing the media about their fears. These included concerns about damage to the long-established team, patient safety, the team’s research and training of cancer doctors.
What was the hospital trust’s response?
OUH chair Sir Jonathan Montgomery said in a statement: “When NHS England indicated that the regional PET-CT scanning service provided by our staff at the Churchill Hospital in Oxford since 2005 would be replaced by a service run by a private provider, we wrote to the chairman of the Oxfordshire joint health overview and scrutiny committee (HOSC) to ask the HOSC to take up the issue.
“The evidence which we submitted in advance of the HOSC meeting on April 4, was written with a wide range of clinicians and outlined serious concerns about clinical quality and patient safety.
“The trust board and clinicians have been united in our view that maintaining and developing the current PET-CT service at the Churchill Hospital is best for patients.
“Our chief executive, Bruno Holthof and our cancer lead, Nick Maynard jointly presented our concerns at the HOSC meeting on April 4, and we were pleased that HOSC referred the issue to the secretary of state for health and social care.
“We were disappointed that he said he did not intend to consider the matter further at this time, but we are grateful to HOSC for taking up this issue on our behalf and for the support which we have received from our patients, governors, local MPs and many others.
“We remain in dialogue with NHS England to secure an agreement which is in the best interests of patients – in order to resolve the current contract situation.
“In May the trust board agreed seven tests that needed to be met before we could come to an agreement with NHS England – the commissioners of the Thames Valley regional PET-CT service – in order to resolve the current contract situation.
“Following a number of discussions which have involved both senior managers and clinicians, as well as Executive and non-executive directors, the board was satisfied when we met last week that we now have commitments from NHS England that meet five of those seven tests.
“There is still work to be done to meet our conditions relating to clinical pathways so that future care pathways ensure clinical quality and safety and the funding model for the agreement needs to be finalised, but as a Board we feel that significant progress has been made in the discussions with NHS England in recent weeks.
“If this progress is maintained, I am optimistic that we will be able to come to an agreement with NHS England which safeguards quality of care for our patients.
“The board is committed to achieving a resolution which is clinically led and in the best interests of our patients.
“We are grateful to our governors, local MPs, the HOSC, clinicians and others including the Banbury Guardian whose highlighting of this issue has helped to bring us to this point.
“Without your efforts we would not have been able to make this progress.
“I would like to reassure you that we remain focused on the provision of this excellent service during this time of uncertainty.”
What does NHS England say?
Cathy Edwards, clinical programmes director in specialised commissioning at NHS England, said: “The NHS is committed to speeding up diagnosis to help stop cancer.
“That’s why in the NHS Long Term Plan we set out plans so by 2028 three quarters of all cancers are diagnosed early.
“An important part of that ambition is ensuring we have world class facilities in place so patients can easily access services like PET/CT scanning.
“Over the last five years NHSE has been looking to improve cancer diagnosis, developing a specification for what services should look like with clinical experts and patient groups and informed by public consultation.
“The law says the NHS then has to put these services out to tender with a transparent set of criteria that bidders are then scored against including their quality, whether they could expand access and their value for money for taxpayers.
“In the Thames Valley area, including Oxford, an important benefit of the InHealth bid, which scored more highly than other bids, is a plan to improve access across Oxfordshire and parts of Buckinghamshire, Northamptonshire, Berkshire and Wiltshire.
“Joint work between OUH and InHealth would help the PET/CT scanning service on the Churchill Site in Oxford to be retained and create new services in Milton Keynes and Swindon using state of the art scanners – initially mobile before they are situated inside hospitals.
“The NHS will ensure minimum waiting times and the easy transfer of scans and scan reports between different doctors and scan sites.
“The independent sector already provides PET/CT scans in different parts of the country. Working with the NHS they have expanded access to diagnosis and invested in equipment.
“This proposed approach is to help more patients survive cancer by improving access.”