Children’s cancer centres (known as Principal Treatment Centres) are responsible for making sure every child with cancer gets the expert care they need. They are mainly for children aged 15 and under with cancer (they can carry on caring for older children if that is best for individual patients).

NHS England (London and South East regions) ran a 12-week consultation, from 26 September to 18 December 2023, on changes to where very specialist cancer services that lead and coordinate care for children aged one to 15, are based. These changes affect the Principal Treatment Centre for children with cancer living in south London and much of south east England.

The Principal Treatment Centre for south London and much of the south east is currently provided in partnership between The Royal Marsden NHS Foundation Trust and St George’s University Hospitals NHS Foundation Trust.

The teams leading and coordinating specialist care for children with cancer, including chemotherapy, conventional radiotherapy and bone marrow transplants, are based at The Royal Marsden’s site in Sutton. Life-saving intensive care, most children’s cancer surgery, and other specialist services needed by children with cancer are led and coordinated by the teams at St George’s Hospital eight miles away in Tooting. The service currently provided jointly by the Principal Treatment Centre is high-quality and safe.

There are five main reasons why the specialist children’s cancer services at The Royal Marsden need to move to be on the same site as a children’s intensive care unit.

1. The current Principal Treatment Centre does not meet national requirements 

National requirements for Principal Treatment Centres are set by NHS England and set out in the service specification. They say very specialist cancer treatment services for children – like those at The Royal Marsden – MUST be on the same site as a level 3 children’s intensive care unit and other specialist children’s services. This is non-negotiable. The current Principal Treatment Centre does not and cannot meet this mandatory requirement.  Therefore it must change.

NHS hospitals that have a children’s intensive care unit on site will, by definition, provide many specialist services that children with cancer may need. They can provide holistic, multidisciplinary care to children who are very seriously ill because of their cancer or side effects of their treatment. The Royal Marsden cannot do this.

Service specifications for specialised services are produced nationally based on clinical evidence and set out the standards and requirements for delivery of these services.

2. Hospital transfers of very sick children for intensive care add clinical risks and stress to what is already a difficult situation

Children being treated for cancer can become very ill, very quickly. Every year, a small number of very sick children with cancer, who need intensive care, are transferred eight miles from the specialist children’s unit at The Royal Marsden’s Sutton site to St George’s children’s intensive care unit at Tooting. This is done as safely as possible. But urgent transfers of clinically high risk and very sick children to another hospital for level 3 intensive care services that can give life support, even in a special children’s ambulance with an expert team on board, add avoidable risks to what is already a very difficult situation. Although these risks are carefully managed, while the current service arrangements continue, the risks continue and can only ever be mitigated. Transfers of very sick children also put added stress on patients, parents, and the staff involved.

Patient transfers from shared care units in local hospitals to the specialist children’s cancer centre, including emergency patient transfers, will continue to be necessary and will not be affected by our proposals.

3. The intensive care team is not currently able to provide face-to-face advice on the care of children on the ward 

Currently, the Principal Treatment Centre’s intensive care specialists are at St George’s Hospital while most specialist care for children with cancer is at The Royal Marsden. Some children every year have to be transferred by ambulance from The Royal Marsden to the cancer ward at St George’s Hospital as a precaution, in case they suddenly get worse and need intensive care.

Intensive care specialists can’t work closely with specialist cancer teams to help children stay well enough to avoid intensive care if they are not all on the same site.

4. There is a need to improve children and families’ experience when patients require intensive care and other specialist children’s services

Currently children have to travel to other hospitals for these services named in the service specification which are not on site at The Royal Marsden: intensive care; emergency surgery and most biopsies and central lines; specialist cardiology; children’s cancer surgery; other surgery for children; infectious diseases; gastroenterology; specialist nephrology; neurosurgery; ophthalmology; and some types of radiotherapy (proton beam and superspecialist). Staff at The Royal Marsden arrange for children to attend or be safely transferred to other hospitals as needed.

Parents and staff say having to get to know new members of staff at different locations, especially at a time of crisis, can increase families’ anxiety and distress.

Children’s cancer care is complex. Our proposals would not eliminate the need for children to get specific kinds of expert care at different hospitals. Under our proposals, conventional radiotherapy would also move to University College Hospital. Instead of some (as now), all children who need radiotherapy would go to University College Hospital.

5. Although it offers a wide range of innovative treatments, the current Principal Treatment Centre is excluded from giving a specific type of new treatment, and others expected in the future 

Innovative cancer treatments are bringing new hope for children and families. Some have a greater risk of complications – such as too big a response from a child’s immune system – that could require urgent support from an onsite intensive care team. As a result, they can only be given at children’s cancer centres on the same site as a children’s intensive care unit. This is the case for ground-breaking CAR-T treatment, which uses a child’s own, treated, cells to fight their cancer.

At Great Ormond Street Hospital, even with pre-emptive treatment to reduce the reaction, 10 to 20% of children having CAR-T treatment currently need some kind of intensive care. The most recent CAR-T trial treating children with acute myeloid leukaemia requires the CAR-T cells to be administered on the children’s intensive care as a precaution because of how quickly these children can react to the treatment. Many more of these treatments are expected to become available in the next few years.

The Royal Marsden’s children’s service is excluded from giving CAR-T because it is not on the same site as a children’s intensive care unit. There is a compelling case to move the centre so it has the same opportunity to provide future treatments as other major centres worldwide.

It is a national clinical requirement for very specialist cancer treatment services for children to be on the same site as a children’s intensive care unit and other specialist children’s services.

The current service for children with cancer who live in south London and much of the south east does not and cannot meet this requirement. As a specialist cancer hospital, The Royal Marsden does not have a level 3 children’s intensive care unit (which can give life support) on site. Children’s intensive care units are always on sites used by tens of thousands of children every year because intensive care teams need to see high volumes of very sick children to maintain their specialist skills and expertise. This wouldn’t be possible at The Royal Marsden due to the smaller number of children who need treatment there.

A children’s intensive care unit needs to be on the same site as supporting specialist children’s services. Children’s intensive care units are always on sites used by many thousands of children every year because intensive care teams need to see high volumes of very sick children to maintain their specialist skills and expertise. The Royal Marsden is an outstanding specialist cancer hospital but therefore does not see enough children to meet these requirements to have a children’s intensive care on site.

In future, the children’s cancer centre for children living in south London and much of south east England will be at Evelina London Children’s Hospital, with radiotherapy services at University College Hospital.

Evelina London will have all the specialist children’s cancer services currently at The Royal Marsden (except conventional radiotherapy) and the specialist children’s cancer services currently provided for the Principal Treatment Centre at St George’s alongside its well-established children’s intensive care unit and other specialist children’s services.

St George’s Hospital will continue to provide a children’s shared care cancer unit for local children, and neurosurgery for some children, including those with cancer.

Children will continue to travel for some specialist cancer services – such as for bone, eye and liver surgery – because of the specific expertise different hospitals have in these areas.

Research for new drugs and treatments will continue at the Institute of Cancer Research in Sutton, working closely with staff at the future children’s cancer centre.

Retaining the expertise and knowledge of the staff within the current service is a priority for us. We will work closely with staff as well as patients and their families in the current service, the cancer network, the Institute of Cancer Research, and other Trusts who provide specialist cancer services to ensure that the move to the new site is as smooth as possible.

Our vision for the future centre is that it will build on all the strengths of the existing service and give best quality care, achieving world-class outcomes for children with cancer for decades to come.

About 1,400 children, most aged one to 15, are under the care of the Principal Treatment Centre at any given time. More than 60% of the centre’s patients are from outside London. About 190 children aged one to 15 living in south London and much of the south east are diagnosed with cancer every year.

Our process to identify possible ways of providing very specialist cancer treatment services for children which are currently at The Royal Marsden found one solution that met all the criteria. This is that the future service must be based at an existing hospital in south London that provides specialist children’s services and has a children’s intensive care unit.

This led to the two options that were under consideration and that we received feedback about in the consultation. They were for the future Principal Treatment Centre to be at either:

• Evelina London Children’s Hospital, in Lambeth, south east London, run by Guy’s and St Thomas’ NHS Foundation Trust, with conventional radiotherapy services at University College Hospital

or

• St George’s Hospital in Tooting, south west London, which is part of St George’s University Hospitals NHS Foundation Trust as well as St George’s, Epsom and St Helier Hospitals and Health Group, with conventional radiotherapy services at University College Hospital.

Under both options, the children’s cancer shared unit would continue to be at St George’s as would neurosurgery. All radiotherapy services would be provided by University College Hospital. Children would continue to travel for some specialist cancer services because of the specific expertise hospitals have in these areas.

We followed a best practice approach to understand the possible solutions for the future centre. Working in partnership with parents, cancer charities, staff, researchers, independent experts, the Trusts and the Programme Board (which oversees our work), we did this by:

1. agreeing a list of things that will not be affected by the service change (such as the specialist services which will continue to be delivered at specific hospitals, like neurosurgery, which will remain at King’s College Hospital and St George’s Hospital wherever the future Principal Treatment Centre is based), which we have called ‘fixed points’. It is a fixed point that the proposed options must deliver a Principal Treatment Centre on the same site as a paediatric intensive care unit. This is the purpose of the programme. Its success must not depend on changes to other models of care.
2. agreeing basic things that need to be delivered by any option we put forward, which we have called ‘hurdle criteria’. They include:
   • the need for the service to be based in Greater London so it is accessible for everyone across the catchment area
   • the ability to comply with the NHS England service specification including the provision of a level 3 children’s intensive care unit.
   • the ability to deliver the future centre within two and a half years of final go-ahead
   • the need for the option to be affordable.
3. drawing up a list of every way the Principal Treatment Centre could be provided in the future
4. applying the fixed points and hurdle criteria to the initial list of eight possible solutions. If you would like to know more, please see our information on how we identified the options.

This identified that the future service must be based at an existing hospital in south London that provides specialist children’s services and has a children’s intensive care unit. This led to the two options that were under consideration and that we received feedback about in the consultation.

Before the consultation began, both Evelina London and St George’s answered questions themed on key areas which are considered very important for the future Principal Treatment Centre:

• clinical services – aspects of the services the two hospitals provide that would be important for the future centre
• patient and carer experience – how the two hospitals would support children with cancer and their families

• enabling (non-clinical) factors – everything the future centre would need to have to work smoothly. This included looking at impacts on staff
• research – what the hospitals, and the Trusts that run them, do now for research and what they would offer the future centre.

Their answers were reviewed and scored by four panels, one for each key area. In total, more than 30 experts – independent nurses and doctors from London, the south east and further afield with no involvement in the current or future Principal Treatment Centre, parents, representatives of children’s cancer charities, independent researchers, managers, experts in specific fields including emergency preparedness and human resources, and staff from NHS England London and NHS England South East regions – were part of these panels. Some areas – including travel times – were scored using statistical data, not assessed by the panels. If you would like to know more, please see our information on how the evaluation criteria were developed and how the options were assessed and scored.

In the evaluation by the expert panels, Guy’s and St Thomas’ NHS Foundation Trust’s proposal on behalf of Evelina London Children’s Hospital scored higher than St George’s University Hospitals NHS Foundation Trust’s proposal on behalf of St George’s Hospital (80.5% compared to 75.3%). The biggest differences in scores were for clinical services and research. Evelina London scored higher on three of the four sub-criteria for the clinical services key area and on all three sub-criteria for research. St George’s Hospital scored higher on two of the five sub-criteria for patient and carer experience. Other scores were the same or very similar. If you would like to know more, please see our information on how the options were assessed and scored.

The assessment undertaken before the consultation by panels of experts gave us a better understanding of the strengths of both options. Both options scored highly in the pre-consultation evaluation but Evelina London Children’s Hospital scored higher. On this basis, we made it clear ahead of the consultation that, at that stage in the process, Evelina London was the site we preferred for the future Principal Treatment Centre.

At the decision-making meeting, leaders from NHS England (London and South East Regions) looked at all the evidence available to them, including feedback from the public consultation, as well as other evidence such as the integrated impact assessment, environmental assessment, evidence from the Trusts and other relevant information.

This was in order to meet our legal obligations.

Both Evelina London and St George’s Hospital met all the criteria and wanted to provide the service.

Leaders for NHS England (London and South East regions) chose the option for the future Principal Treatment Centre that gave them the greatest confidence that it will deliver the best quality care for children with cancer in the future.

This followed a robust process over many months involving clinical cancer specialists, children with cancer and their parents, NHS staff, local communities and their representatives, a 12-week public consultation, and very careful consideration of all the evidence, including feedback from the public consultation. The decision makers considered the need to provide care for children across the entire catchment area (south London and much of the south east).

Feedback received through the consultation was reviewed by an independent organisation appointed for this purpose. They analysed it by theme of what people said, and by group of who said it, such as, parents and carers, children and young people and staff. They prepared a consultation report which is published on this website, and was shared with NHS England leaders who reviewed and considered all the feedback included in the report.

NHS England leaders also considered a document called a decision-making business case that set out, among other things, how we have taken account of the feedback received. This included suggestions for alternative solutions which were carefully considered by NHS England leaders.

There will be no sudden changes to how children and young people receive care. The future Principal Treatment Centre will not be ready until late 2026 at the earliest. The move will be carefully planned with the full involvement of current teams and clear information for parents and families. We recognise, as with any move of service, there will be risks we need to manage, and planning for that is already underway.

We will work closely with staff in the current service, patients and their families, all the Trusts involved, the cancer network, the Institute of Cancer Research, and other partners to ensure that the move to Evelina London Children’s Hospital is as smooth as possible.  All staff involved in the service will have the opportunity to be part of this work. Patients and parents will also be able to help design the new service – the Evelina London team will make sure that people from different groups and communities have the chance to get involved.

As with any change, there will be things we need to focus on managing, however, all the Trusts involved in this consultation are committed to making a success of this for children with cancer, and to working together to achieve it.

The change is to meet the national service specification for Children’s Cancer Principal Treatment Centres, which is firmly underpinned by clinical guidance and evidence developed by national bodies. This guidance is clear about the critical importance of Principal Treatment Centres for children with cancer having immediate access to children’s intensive care services.

For example:

• National Institute for Health and Care Excellence (NICE) cancer service guideline (CSG7) Improving Outcomes in Children and Young People with Cancer (PDF) (2005) states that at Principal Treatment Centres for children “there should be immediate access to paediatric intensive care.” This guidance was developed through a formal process with representation from The Royal Marsden, Great Ormond Street Hospital, Kingston Hospital, Bristol Children’s Hospital, Children’s Hospital for Wales and others on the Guidance Development Group.
• Commissioning Safe and Sustainable Specialised Paediatric Services (PDF) (2008) is a framework that shows which other services specialised paediatric services need to be located with to deliver safe, high quality and sustainable care. It states there is “absolute dependency, requiring co-location”, between children’s cancer services and paediatric critical care, and also between bone marrow transplantation and paediatric critical care. The framework was produced by clinicians, supported by the Department of Health, and endorsed by the Royal College of Paediatrics and Child Health (and other medical colleges).
• NICE guidance on Improving Outcomes for Haematological Cancers (PDF) (NG47, 2016) confirmed that the previous NICE guidance (Improving Outcomes in Children and Young People with Cancer (PDF)) should be used to guide the facilities required for children undergoing chemotherapy.

After three further reports, including one which looked at the service delivered by the current Principal Treatment Centre and one which suggested an approach to cancer care for London, a draft service specification for Children’s Cancer Principal Treatment Centres in England was drawn up.

This did not require co-location for Principal Treatment Centres with a level 3 children’s intensive care unit, though it was clear that one should be on the same site. However, a public consultation in summer 2019 about the draft service specification was subject to significant criticism from cancer specialists, children’s cancer charities and NHS Trusts. For example:

• The Royal College of Paediatrics and Child Health’s response to the consultation (PDF) said: “We would suggest that the Principal Treatment Centres where treatment risks must be at their highest, inherent both in the intensive oncology treatment and, potentially, new more exploratory regimens, must be co-located with NHS England level 3 units. If the service plans to give high intensity treatment to a child on a site, then that site should have a paediatric intensive care unit service in [sic] the same site that can be accessed without the need of a transport team or ambulance transfer.”
• Children’s Cancer and Leukaemia Group, an affiliated specialty group of the Royal College of Paediatrics and Child Health which brings together those working on children’s cancer in the UK and Ireland, and is also a leading cancer charity, stated that the requirement for co-location of level 3 intensive care and other defined services at all Principal Treatment Centre sites was “strongly endorsed at all the engagement events, involving professionals working in children’s cancer service across the whole country.” It added: “The fundamental drive for this clarification was patient safety and survival but also patient experience…it is a widely held view in the profession…that providing services without critical co-dependencies in place is to compromise patient safety and experience.”

To help it address this and other feedback to the 2019 consultation, NHS England commissioned the former National Cancer Director, Professor Sir Mike Richards, to undertake a review on the co-location question. His conclusion was that Children’s Cancer Principal Treatment Centres must be on the same site as a level 3 intensive care unit which can give life support. This led to the development of the revised service specification, published in 2021, which the reconfiguration will deliver.

We recognise that parents and families are worried about travelling by public transport with a severely ill or immunosuppressed child. They are also worried about driving into London, with the costs, the congestion, and difficulties parking.

To work out the impact of the move on children and families’ travel times, an independent travel analysis looked at journey times. It was based on anonymised addresses for the patients who were admitted to hospital as inpatients in 2019/20. The analysis found both options would be very similar or faster to get to by public transport than the current Principal Treatment Centre at The Royal Marsden and St George’s Hospital for the vast majority of people. By road, for many people going to St George’s and most going to Evelina London, it would be slower.

To understand the impact on travel times of our proposal to move conventional radiotherapy services from The Royal Marsden to University College Hospital, an independent analysis was carried out. It compared travel times to The Royal Marsden and University College Hospital by car and by public transport for all children across the catchment area.

The analysis found University College Hospital would be faster to get to by public transport and slower by road than The Royal Marsden for most children in the catchment area.

An assessment of travel times formed part of our evaluation criteria.  Some concerns about how travel times were assessed and scored were raised with us. In response to this we ran checks which assumed more children came by car and fewer by public transport, to see what effect that had on the scores. It reduced the scores for both options but, even if we assumed all families drove, the overall result stayed the same. If you would like to know more, please see our information on how travel times were assessed and scored for this consultation.

The group advising on our impact assessment has looked at help with travel for children and families. Guy’s and St Thomas’ NHS Foundation Trust, which runs Evelina London Children’s Hospital, confirmed there will be:

• at least the same number of parking spaces as at the Oak Centre for Children and Young People at The Royal Marsden (four accessible spaces for Blue Badge holders and four dedicated spaces for Principal Treatment Centre patients). These are most likely to be in the St Thomas’ car park.
• free parking for patients who regularly attend hospital (more than three times a month). It will either be free on entry or reimbursed the same day
• hospital volunteers to help families get from the car park to their appointment in the hospital
• drop-off zones outside or near the entrance to the children’s hospital

The Trust said it will bring in a system for managing parking spaces and will also look at allocating spaces in a nearby car park. It will aim to improve parking provision for all patients.

The group advising on the equality assessment has also made recommendations for the future Principal Treatment Centre on how to reduce the impact of this change on families. These include:

• help for patients and families to plan their journeys to hospital, including easy to understand information in different languages
• getting their travel costs paid quickly. Help to access other financial support
• improving non-emergency transport services for patients and their families
• space for families to stay
• easy arrangements at the site, including for dedicated parking and drop-off
• convenient appointment times, more care closer to home, strong communication between different health and social care teams, and online or phone appointments
• an excellent plan to support patients during the move, with a named care coordinator (such as a specialist cancer nurse) for each child and family.

Evelina London will need to act on these recommendations. Everyone involved is committed to doing so.

Staff have told us that travel to work is important. As part of our evaluation criteria, we therefore looked at the change in travel times for staff. The independent analysis was based on the anonymised addresses of actual members of staff at The Royal Marsden and St George’s who would transfer to the future centre. The options appraisal looked at travel times by public transport. It found both options are very similar or faster to get to by public transport than their current workplace for most staff.

We recognise that the vast majority of staff at The Royal Marsden currently drive, walk or cycle to work and this is unlikely to be possible after the move.

We analysed average travel times for staff who drive to work at The Royal Marsden and found it is 32 minutes. Travel times to work by public transport would increase to 70 minutes to Evelina London.

Members of staff transferring will be eligible to receive support for excess travel costs for up to four years under TUPE regulations. They will also receive inner London high cost area supplement.

We involved key stakeholders in developing our plans for pre-consultation and consultation. These stakeholders included our Stakeholder Group of parents and local and national charities, NHS Trust and Integrated Care Board communications and engagement colleagues, and Overview and Scrutiny Committees within the service catchment area as well as children and young people themselves.

Pre-consultation period

• targeted online surveys – tailored to specific groups with specific questions on travel and access for those directly providing or experiencing the current service
• on the ward surveys – visits to wards at The Royal Marsden, St George’s Hospital and Evelina London to directly engage with children and young people and their families.
• face to face events and focus groups for staff
• online on-demand briefing sessions
• attendance at meetings (by invitation)
• meetings with Overview and Scrutiny Committees which deemed this change as substantial for their populations – formal meetings open to members of the public
• meetings with MPs whose constituents may be affected
• meetings with our Stakeholder Group of parents and local and national charities
• attending a Teenage and Young Adults Forum at the Royal Marsden Hospital
• a session with children’s cancer shared care unit staff and patient representatives

In total, we had 739 responses to this phase of engagement, which included 27 engagement sessions, 313 responses to online surveys and seven ward visits.

Consultation period

The 12-week public consultation ran from 26 September to 18 December 2023, activities included:

• targeted questionnaire (both online and paper copies)
• onsite visits to The Royal Marsden and children’s cancer shared care units outpatient areas to directly engage with children and young people and their families, and record their views
• play therapy sessions with children and young people with cancer
• three online public events to provide more information about our proposals and to seek feedback
• focus groups for families with/without direct experience of cancer, staff at all three Trusts and wider NHS staff (e.g. staff at other Principal Treatment Centres, staff working in children’s cancer shared care units)
• attendance at meetings and forums with equalities groups such as families with children with learning disabilities and ethnic minority forums
• targeted efforts to reach equalities groups and requests to them to spread the word to their members and networks
• 1:1 interviews as requested
• meetings with Overview and Scrutiny Committees
• meetings with MPs whose constituents may be affected
• paid for social media campaign – to raise awareness of the consultation and encourage people to share feedback.

Staff have been involved throughout this process. Our early engagement took place during 2020-2021.

A small number of staff were involved in two working groups for the programme, shaping the fixed points and hurdle criteria for assessing the potential options, and the evaluation criteria for assessing the two proposals, working alongside other independent experts.

The groups were:

• a clinical advisory group involving clinicians from St George’s, Evelina London, King’s College Hospital NHS Foundation Trust, and The Royal Marsden. They considered and commented on the fixed points, hurdle criteria and evaluation criteria. Representatives from the children’s cancer and strategic paediatric network for south London and South East region attended the meetings. Both networks supplied written submissions to the chair of the clinical advisory group
• a group of senior managers and clinicians from the same four Trusts who considered the impacts of the change on staff and what would be needed to deliver it (in terms of capacity and activity).

There was also a workshop with staff from The Royal Marsden, St George’s and Evelina London Children’s Hospital to capture their views on what the future Principal Treatment Centre could deliver. Discussions highlighted concerns about support to staff during the change process.

This led to more in-depth work with staff at The Royal Marsden, which found that staff wanted to:

• be reassured that the benefits (such as childcare and opportunities for staff learning and development) they currently receive at The Royal Marsden would be maintained or improved upon by the future Principal Treatment Centre, wherever it is
• to understand the likely difference to their travel times to work for both of the shortlisted options.

Both these points were incorporated into the ‘impact on staff’ element of the evaluation criteria as a result of this feedback.

During the pre-consultation engagement period between mid-April 2023 and the end of August 2023, we held briefing sessions and undertook surveys with staff at Evelina London, St George’s and The Royal Marsden.  At the briefing sessions, we provided an overview of our work to date and gathered feedback from staff.

A summary of their feedback was then shared with them, along with a survey to give staff who were unable to attend the engagement sessions an opportunity to share their thoughts and raise any questions they had.

During the consultation period (26 September to 18 December 2023), all three Trusts shared letters from NHS England with their staff to encourage them to respond to the consultation and share their views. Staff were encouraged to share their feedback via the questionnaire, for instance by being given time during working hours to do this. Feedback sessions were held at each of the Trusts where staff were invited to share their views. Staff were also encouraged to share any feedback via email. During site visits and on demand, there were opportunities for staff to share their feedback on a 1:1 basis.

We will continue to engage with staff as we move through the different stages of this reconfiguration process.

In the run up to consultation, we engaged with the London and South East Clinical Senates, the London Mayor, MPs, Overview and Scrutiny Committees, including Joint Health Overview and Scrutiny Committees for south west London and Surrey, and south east London, Integrated Care Boards for south London and much of the south east, and NHS England assurance experts. All gave us helpful feedback from their different perspectives on different aspects of our work.

Since the start of our public consultation, we have continued to:

• engage with the Mayor of London and his team to support their review of our proposals against the mayoral six tests for major health and care service reconfigurations affecting Londoners
• further consider recommendations made by the London and South East Clinical Senates
• consult and work closely with the Joint Health Overview and Scrutiny Committees (which considered our changes substantial) and engage with Health Overview and Scrutiny Committees for the rest of the catchment area
• liaise with and update MPs, and the Integrated Care Boards across the catchment area.

You can read more about this in our decision-making business case (PDF).

We worked closely with parents and other stakeholders who advised us on our pre-consultation activity and helped to plan our consultation activities. This is covered in our pre-consultation feedback report.

During the twelve week consultation we received more than 2,660 formal responses including 379 from children affected by cancer and their families, 562 from affected NHS staff and 601 from other NHS staff. This was through several means, including play specialists working with children, engagement with families in more deprived areas, our questionnaire, meetings, interviews, and direct responses that people sent to us. Feedback from the public consultation was reflected in the independent consultation feedback report (PDF) and has since been carefully considered. Themes identified through consultation form a key part of the decision-making business case, which also includes information about the proposals, the pre-consultation options evaluation process, the latest integrated impact assessment, and other evidence.

All this feedback was carefully assessed and considered in the decision making business case.