Radiotherapy Unit in Jersey

STATES OF JERSEY

RADIOTHERAPY UNIT IN JERSEY

Lodged au Greffe on 8th December 2021 by Deputy M. Tadier of St. Brelade Earliest date for debate: 18th January 2022

STATES GREFFE

2021  P.113

PROPOSITION

THE STATES are asked to decide whether they are of opinion

1. that, in principle, Jersey should have its own Radiotherapy Unit for the treatment of cancer patients;
2. to request the Minister for Health and Social Services to explore options for delivering a Radiotherapy Unit in Jersey, and for improving the experience and health outcomes for cancer patients; and
3. to request the Minister for Health and Social Services to present the option appraisal and recommendations to the States Assembly no later than April 2022.

DEPUTY M. TADIER OF ST. BRELADE

REPORT

Members will be aware that there is a live petition which says:

Have a radiotherapy unit in the new hospital'. At the time of lodging (8th December 2021), the e-petition has some 2,942 signatures.

The petition was launched on 2nd November and was started by Jersey resident, Rosemarie Shepherd (Rose), who goes on to talk about her personal experience of coping with cancer and its treatment:

It is hard dealing with cancer without the added physical and emotional distress of travelling to the UK for treatment. I had 7 and 8 year old boys. I flew home every weekend to see them. It was so tough. 17 years later I was there again. I got very ill and was scared. I needed my loved ones.

Jersey desperately needs a radiotherapy unit. It can service the whole Channel Islands. Patients who travel for treatment are put up in an apartment. This can be very lonely if one is feeling unwell and unable to get out and about. Not everyone is able to have someone with them. You also have to cook your own meals. Again, not everyone is well enough to do this.'

The main purpose of this proposition is to accompany that petition and gives States Members the opportunity to consider the merits and challenges of having on-island provision for radiotherapy treatment and, therefore, allows the underlying principle of the petition to be debated.

I will caveat early on, that I make no comment about where such a unit should go, nor that it should necessarily form part of the new hospital site at Overdale. Whilst that is what has been asked for by the petitioners, I take the spirit of the petition to mean that they would welcome a unit which allows most radiotherapy to be able to be provided on-island, meaning that so many patients and relatives are spared the trauma, expense and inconvenience of travelling to a different jurisdiction whilst they are sick and/or distressed.

The C word'

In such a close-knit community as Jersey, we are all likely to know people who have battled cancer. The current stats are such that 1 in 2 people will get cancer in their lifetime, according to charities such as Cancer Research UK. As such, we all know people who have had cancer, survived it or have died from it. We also are likely to know someone, or many people, who have travelled to the UK for part of their treatment.

Sadly, cancer is not going anywhere, and whilst there is hope that healthier lifestyles and better education are providing some mitigation, the fact of people living longer, also means that more people will get it.

Whilst there may be common experiences for everyone, how people respond to a diagnosis and any subsequent treatment will be very subjective. It is clear that all of those I spoke to were generally very grateful for the treatment they received from health care professionals in Southampton or beyond. But, on many occasions, the experience of travelling, being away from work, family their own homes, was very difficult, and may not have been conducive to helping with recovery.

This proposition comes after speaking to patients and health care professionals about their experiences of radiotherapy and who told me that they were convinced that some on-island provision for the treatment was not only desirable, but necessary and feasible. I have included some direct experiences from those who have been in contact with me, and I thank all of those for their courage and openness in supporting this cause, as they say, to make sure that other cancer patients might have the benefit of having this treatment at home, rather than, effectively, having to go to a different country.

The case for an on-island treatment

A recent Freedom of Information request ("FOI") dated 28th May 2021 (see appendix 2) revealed that over the past three years, 601 patients had travelled off island for radiotherapy treatment or an average of 201 per year.

Experiences

Patient 1.

Writing in an email to me, prior to starting the petition, Rose told me:

The first time I went [to Southampton] was for primary breast cancer. I had 7 and 8 year old boys at the time. I struggled to fly home every weekend to see them. It was hard enough physically and emotionally but being there on my own was the toughest. It's the time when you need your loved ones around you.

The second time (17 years later) was to treat secondary breast cancer. I had a severe reaction to the radiation and was admitted to hospital as an inpatient. Again I was on my own and very sick. Luckily I had a friend in the UK who was able to drive to see me. Again, I so needed my loved ones around me as I was very scared.

Also, patients are now put up in an apartment. We are not always able to have someone fly over and stay with us. This can make the time there very lonely and scary. Especially if one is unwell and/or away for sometimes 6 weeks.

Rose Shepherd

Patient 2.

I spent 6 weeks in Southampton for a course of radiotherapy over 20 years ago; the awful memory remains with me - it was quite a challenging time (!) it would have helped and comforted me a great deal having family close by at such a distressing time and would have been less distressing and worrying time for my parents who were elderly and didn't travel well and for my poor husband who was not allowed leave from work to accompany me at such a difficult time in our lives.

We would both support the proposal to have a radiotherapy unit in Jersey. Angel Harvey-Jones

Relative 1.

My [relative] has had various cancers over the past few years and has always had to go to Southampton for treatment, with the stress/cost/trauma of travel adding to an already traumatic process. [This year], she was diagnosed with a tumour near her trachea, but treatment was delayed because travel to Southampton was impossible. Her surgery was scheduled for September: she travelled across, only to be told that they had no ICU beds available for her aftercare, so she had to return home. In October, when she travelled over for the rescheduled op, she was told it was too late and that the cancer has progressed too far to operate. Her palliative treatment, in the form or radiotherapy

or chemotherapy will have to be done in Southampton, with the inherent expense/risks and stress of travelling while very unwell, not to mention the near-impossibility of seeing family under such circumstances... It is ridiculous that one of the wealthiest places in the UK doesn't have fundamental medical equipment to support its residents.

Anon.

Relative 2.

My late mother had radiotherapy in the UK. To give you a quote or two: stressful travel to the go to a UK hospital she was unfamiliar with, for treatment, and then to return to a hotel for dinner where she had to sit in isolation from other guests afterwards due to being radioactive. The whole experience was far from ideal, not cheap, but very impersonal and stressful at a difficult time in her life.

Anon.

Health Care Professional

 I felt compelled to get in touch to give you the point of view from someone who had supported islanders with cancer.

I was until recently a [redacted] Cancer Nurse Specialist at Jersey General.

A diagnosis of [redacted] cancer is utterly devastating. There are around [number] in people in Jersey diagnosed each year. Off the top of my head, around three quarters have stage III or IV [redacted] cancer at diagnosis

Quite often the low performance status and co-morbidities of those diagnosed in the later stages means that the prognosis is poor and treatment options are limited to palliative measures.

Patients who have advanced cancer that has spread to the bones often experience excruciating pain. These patients are often referred to Southampton by the palliative care team or oncology team for radiotherapy to help ease the symptoms. This is usually only one or two sessions. These particular people are  very ill indeed. Travelling to Southampton for palliative radiotherapy is problematic, stressful, and extremely tiring. These patients often know that the time they have left is limited, and going to Southampton is precious time away from loved ones.

In a perfect world, we would have access to an on island linear accelerator, clinical oncologists and specialist radiologist team.

I would feel that the emphasis for on-island radiotherapy could be on being able to provide palliative radiotherapy to ease the suffering of those with advanced cancer, and would be too unwell to travel off island.

(Anon)

Palliative Radiotherapy

The last quote above came from a health care professional who had a particular concern about palliative care. Where necessary, I had redacted the submission at the request of the constituent so as to protect their identity.

Currently policy means that, patients who are in this stage of their illness are not offer the opportunity to have radiotherapy in the UK.

It is clear that patients who have an incurable cancer (but whose symptoms can nonetheless be managed) count amongst, some of the most sick and vulnerable patients. Even if they were offered the chance to travel, they are often unlikely to be able or willing to travel off island for treatment, without significant discomfort.

The human cost/saving analysis

Whilst it is right questions of feasibility, cost and location are all considered, I would ask members when considering this proposition, to keep at the forefront of their mind that we are talking about real patients, now and in the future, all over the island. This is something  that  will  affect  people  in  all  our  constituencies,  as  cancer  does  not discriminate. Where there is discrimination, is between conditions. For most conditions, treatments are available and provided on island. But cancer is not one of them (not for radiotherapy). How would we feel if our loved ones had to travel to the UK for hip operations, for example? Even if it were cheaper to do so, and it they were seen by top specialists, I suspect this would still be unacceptable to most of us.

It is right that questions of working with Guernsey are explored, but I do not believe that this should be an over-riding factor in our decision making. There will be latent demand on-island, and whilst we do not have figures about those who currently refuse to travel for treatment, it stands to reasons that there will be many who choose not to do, for a whole variety of reasons, but who would use an on-island facility. For them, this would be a literal life-line and might well mean the difference between life and death.

Before finishing, I wanted to acknowledge the great work of many charities, their staff and fund raisers, national and local, which support families and patients going through cancer and treatment. In many cases, a great deal of the money raised goes to help friends and family pay for travel and accommodation whilst their loved ones are being treated. It strikes me that were a provision made available on island, this third-sector funding could be redirected in another way, to support local cancer patients, including in education campaigns, and on-island support.

Financial and manpower implications

This is an in principle decision which seeks to establish a consensus that having on island provision of Radiotherapy for Cancer Patients is the right thing to do. That in itself does not have any financial implications, and the work on deliverability, is one that is being and will be done in house, by Government within existing budgets.

However, as regard to what the financial implications are for such a project, if and when a unit were to be built and operated in Jersey, that is another question, and one which cannot be answered easily - in part because there are several unknowns, including savings, costs and opportunity costs. Moreover, there is conflicting government data regarding the number of patients who are flown off island each year, which at the time of writing still has not been clarified. It would depend on how

For example, the FOI dated 28th May 2021 stated that on average 201 patients travelled for treatment per year and that the annual cost for travel and treatment was £140k and £139k respectively.

However, at the meeting I had with the Health Minister and his Policy Lead last month, I was given a presentation (in the form of paper slides) which stated that the number of

patients being sent off island each year was 150, at a total cost of £1.1m for treatment and travel (for 2018 and 2019). This was the same time period referred to in the FOI request.

At the time of writing I am waiting for clarification of these figures.

Appendices

1. FOI dated 15th March 2016  

Radiotherapy and  Chemotherapy  treatment  -  references  a  study  on  the feasibility of providing radiotherapy on Island (using a Linear Accelerator or "LINAC") which was completed in January 2015 and includes comments on costs and the fact that such a service would not be feasible for Jersey alone.

"In January 2015 Health and Social Services Corporate Directors and the Future Hospital Project Board accepted that an investment in the provision of on-Island radiotherapy presented too much clinical, financial and strategic risk to be supported on the basis of the feasibility analysis undertaken."

2. FOI dated 28th May 2021 - provides information for the last three years re number of patients and certain costs.
3. OQ.142/2021  asked  on  29th June  2021  where  part  of  the  response was: "Nonetheless, we are continuing investigating what it is possible to do on- Island and we have a working group exploring the feasibility of a clinical and economic case for on-Island provision. The first workstream is updating the capacity and demand modelling and I will be in a position to report to Members on progress and next steps certainly by the end of the summer."
4. Plan for more radiotherapy in Jersey rather than in the UK from JEP dated Oct 31, 2019 - article states: "As part of the Jersey Care Model, the government has said changes will lead to more radiotherapy treatments being administered in Jersey, rather than patients having to travel to Southampton or hospitals in the UK." and goes on the mention the development of a cancer strategy in being produced over the next 5 months.