Patient and Public Campaigners who objected to NHS Bath & North East Somerset’s refusal, on the grounds that the RUH did not serve a large enough population, to consider keeping a joint Multidisciplinary Team for Bristol/Bath and surgery in both cities, were bemused to read this Freedom of Information Response from NHS South West in respect of Taunton:

“I refer to your Freedom of Information request of 22 June 2010.  In compliance with the Freedom of Information Act 2000, the South West Strategic Health Authority is able to respond to your request as follows.

1. Who made the decision that Taunton should become a Gynaecological Cancer Surgery Centre, despite not meeting Improving Outcomes Guidance recommendations in terms of population numbers?

The decision to designate Taunton as a gynaecological cancer surgery centre was made by the National Cancer Action Team in 2004, in response to an action plan signed by the Dorset and Somerset Strategic Health Authority and the Taunton Deane Primary Care Trust in June 2004. The proposal took into account the population size of 0.5 million and proposed that Taunton would be part of an Avon, Somerset and Wiltshire multi-disciplinary team with subspecialist support and continuing professional development provided by the Bristol specialist team.

The National Cancer Action Team provisionally agreed to Taunton as a centre subject to it performing well under external peer review in early 2006. The Peer Review Report for the Avon, Somerset and Wiltshire Cancer Network published in September 2006 indicated that the Taunton specialist gynaecology team scored 97% on 1* measures and 80% on level 1 and 2 measures. Against all measures the Taunton centre scored better than either UHBT or RUH Bath.

Therefore the decision to designate Taunton as a gynaecological cancer centre was made by the appropriate bodies and it does meet Improve Outcomes Guidance standards, as the Guidance allows for a centre serving a population of 0.5 million provided it is part of a multi-disciplinary team with a larger centre.

2. What were the reasons for making Taunton an exception?

It is not an exception.

3. Please describe what, if any, consultation took place with Somerset patients, the public and Health Scrutiny Committees to obtain their views about whether they supported the establishment of a non IOG compliant centre for their community.

No consultation took place with Somerset patients and the public and Health Scrutiny Committees about establishing a non IOG compliant centre as the centre was compliant with the IOG.

4. If patients, the public and Health Overview and Scrutiny Committees were not consulted under Section 11 Health and Social Care Act 2001/Section 242 Health & Social Care Act 2006, why was that?

Consultation with Somerset patients, public and health Scrutiny Committees was not necessary as this was the designation of a service as opposed to a substantial variation.

5. Please send me copies of all the documentation to show the audit trail for the decision to make Taunton an IOG exception for Gynae. Cancer Surgery.

Documentation on the 2004 designation process and the 2006 peer review is not held by the South West Strategic Health Authority. It is not an IOG exception for gynaecological cancer surgery”.

Note to NHS South West. The RUH serves a population of approximately 500,000. Taunton and Somerset NHS  Foundation Trust serves a population of approximately 340,000 (source NHS Education South West – Severn School of Medicine).

Despite what the SHA says, serving a population of only 340,000 certainly makes Taunton look very much like an IOG exception to patient & public campaigners – an exception that seems to be performing better than Bristol, the PCTs’ preferred site for a centralised Bristol/Bath Service.

Cornish people who campaigned against imposition of Cancer Improving Outcomes Guidance (IOG) without public consultation may well wonder why they appear to have been treated differently to Somerset people. Cornwall lost its Upper GI Cancer Surgery to Devon, despite John Watkinson, former Chief Executive of the Royal Cornwall Hospitals Trust (RCHT), obtaining legal advice indicating that to transfer the surgery without public consultation could be unlawful. Health Secretary Andrew Lansley recently ordered an inquiry into the circumstances leading to Mr Watkinson’s dismissal by the RCHT, including whether it was motivated by his position on the Upper GI transfer.

However in Somerset, despite Taunton not serving a sufficiently large population to be IOG compliant, a Freedom of Information response confirmed that “the establishment of Taunton as a specialist cancer centre for gynaecology was approved by the National Cancer Action Team, the Strategic Health Authority and the Avon, Somerset and Wiltshire Cancer Services (ASWCS)Network. The rural nature of Somerset as a county and its distance from Bristol was a strong influence on this decision”

Campaigners involved in an NHS Bath & North East Somerset (BaNES) led controversial review on reconfiguration of Bristol/Bath Gynaecological Cancer Surgery questioned why Taunton was allowed to be an IOG exception. One was told by a management consultant employed by the NHS to “forget Taunton”.

When quizzed at a July Steering Group 2009 meeting, NHS BaNES’ official transcript of the meeting records its former review Chair, Dr Kieran Morgan saying “Yes, well we took the view…….. NHS BANES took the view that that was Taunton and this is here. Whatever the reason for taking that decision is in the past and isn’t really anything to do with us”

The Steering Group was unable to agree whether the service should be centralised at Bath or Bristol. Later in the transcript, the former Medical Director of the Royal United Hospital, Bath, is recorded saying to Dr Morgan “you set up a process, you have reached the end of that process and beyond that we are now making up a series of things on the fly”

According to NHS BaNES, the Bristol/Bath Gynae. Review is now on hold following “a new policy direction from the Secretary of State for Health requesting PCTs to review health service reconfigurations”. Presumably to see whether local people have been properly consulted or had change foisted on them “on the fly”.

This bit of the site is an extension of my Private Eye column, Medicine Balls, which alas only gives me 800 words a fortnight to highlight all those vested interests and abuses of power in the NHS. My in-tray is forever full and some stories I never get round to covering in sufficient depth, or at all. By putting them in the public domain here, I hope they’ll gather their own momentum.

Health stories are often difficult to get to the bottom of, and complex to understand, but generally benefit from having a light shone on them.  Please feel free to post here, particularly any Freedom of Information responses (enlightening or otherwise) you’ve managed to drag out of the system, and responses to posts you’d like to challenge or clarify. The aim is to debate.  I’d rather you added your name, but understand that whistleblowers can still be vilified in the NHS. However, please don’t use anonymity as a mask for something clearly libellous.  The bottom line is simple. If it’s true, it isn’t libel. And who knows, we might gather enough truth for another book!

PS The title FOI Balls was suggested by tenacious patient advocate Daphne Havercroft who already has enough FOI responses to fill two books.