Specialised Commissioners are considering moving the location of a diagnostic service in South Essex.
PET CT is a diagnostic service predominantly used for cancer. Earlier this year a new national contract for PET CT services across England was agreed, and included provision to South Essex.
A PET-CT scan combines a CT scan and a PET scan into one to give more detailed information about a patient's cancer. A CT scan takes a series of X-rays from all around the body and uses a computer to put them together. A PET scan uses a very small amount of radioactive drug to show how body tissues are working.
Unlike the more familiar CT scans which is used in most hospitals, PET CT scans are provided in dedicated facilities in selected hospitals. Around 200 patients have a PET CT in England every day, compared to nearly 14,000 patients receiving CT scans in England each day.
The new contract will provide greater numbers of scans. Currently PET CT scans are provided in a mobile unit two to three days a week, at Basildon Hospital delivering approximately 1200 scans per year. However, a clinical view has been put forward that suggests Southend Hospital would be a more appropriate home for the service in the long term.
There are reasons in favour of both hospital sites, as well as disadvantages to each. NHS England, which commissions the service, has not made a decision and would like to hear from people in South Essex about the future location of the PET CT service before a decision is made in February next year.
What is PET-CT?
Positron Emission Tomography – Computed Tomography (PET CT) is a diagnostic service that is currently primarily used to help diagnose cancers. A small amount of a radioactive tracer is normally injected into a patient’s vein. The most commonly used radioactive tracer is a radioactive form of glucose called fluorodeoxyglucose. The scan then shows how the body breaks down and uses glucose. Cancer cells use glucose differently and this will show up on the scan. Approximately 70,000 PET-CT scans are carried out in England each year. More than 95 per cent of these are for cancer patients, but as new radioactive isotope tracers are developed it is expected this technique will have an increasing role in other conditions.
Why are we discussing the PET-CT service in South Essex?
In February 2015, a new provider was awarded a ten year national contract for the provision of PET CT scanning to the North, Midlands and East, South and South West of England – about 50 per cent of all PET CT scans undertaken in England.
Amongst other benefits, the contract includes increased investment to install new scanners and improve the current infrastructure, increased access to services and a commitment to move away from mobile PET CT scanning services towards fixed site facilities.
It was agreed that the South Essex service would be one of the services that would be provided with a permanent fixed site scanner, providing better facilities and access for patients and carers. The new provider of the service has asked NHS England to consider moving the location of the service from Basildon Hospital into a purpose built facility at Southend Hospital which had been built by the previous contract holders but never commissioned. A fixed term PET-CT scanner is a long term commitment. NHS England took the decision that the clinical case needed fully investigating by independent experts and that stakeholders, patients and local people needed to be engaged in the decision over which site should host the permanent home for the PET-CT scanner. This is the process we are currently in; no decision has yet been made.
What are the key considerations?
Co-location with other specialties is a key clinical consideration and as Essex does not have a single cancer centre with all aspects of the pathway provided in one place, a wide range of national clinical experts have been engaged from outside the area to ensure impartiality.
There are sound clinical advantages to locating the scanner on either site. The main case for Basildon is that it is the centre for lung cancer which is currently the largest group of patients receiving PET CT scans. Currently patients with a diagnosis of Lung Cancer will be seen in a number of hospitals and will continue to have any surgery required at Basildon this will not change. Southend hosts the radiotherapy centre and patients from Basildon travel to Southend for radiotherapy appointments. Whilst this group of patients is smaller, radiotherapy planning is the fastest growing area for PET CT and all the independent experts advised us that co-location of the two services was ideal. This is also significant in terms of the future direction of the PET-CT service. Both the national cancer strategy (Achieving World-Class Cancer Outcomes, A Strategy for England 2015-2020, July 2015) and NHS England Specialised Services five year strategy note that there is a need to use PET CT in radiotherapy planning. This PET CT scanner is the only one in the East of England that is not currently co-located with radiotherapy services and a decision to build a fixed unit at Basildon would mean that this would remain the case for at least the next ten years.
Travelling times are important and we recognise the challenges patients have travelling to and from appointments at different hospitals. PET-CT is part of the patient’s journey and patients may require more than one scan as part of the diagnosis and ongoing care. The Basildon and Thurrock population is larger than that of Southend (410,000 rather than 338,800), which is an important factor to note, although some of this population may already choose to go to London, Colchester or Cambridge for their PET CT scans.
Both options would improve the service for patients.
Building the scanner at Basildon will not mean any change for the service, only an increase in capacity, and would ensure PET CT remained close to the lung cancer and lymphoma services. However, it would mean that the national cancer strategy recommendation to increase the use of PET CT in radiotherapy planning would not be fully developed for at least the next ten years.
Using the scanner at Southend would have an impact on travelling times, particularly for patients receiving treatment for lung cancer from the west of the area. However, in terms of the future direction of the service and co-location of services, Southend makes a strong case with Radiotherapy and Oncology, as well as Physics co-location providing sound reasons for delivering the service from Southend, enabling it to develop and evolve in line with national strategy and other PET CT services in the country.
How does NHS England want to involve local people?
NHS England is seeking views on both these options. There are strong local views, both from clinical staff and within the local population. Whilst NHS England has taken advice from national clinical experts who have given greater weight to co-locating the service with the local radiotherapy service, no decision has been made and the commissioners have committed to listening carefully over the coming weeks to ensure they select the option that is best for people living in South Essex.
You can come and find out more by talking to staff at one of the NHS England roadshows which will take place in Basildon, Thurrock and Southend during January 2016, details of which will be announced shortly. You can also contact NHS England at:
East of England Specialised Commissioning Team
PET-CT South Essex
West Wing, Victoria House