TWO of Scotland's three specialist child cancer centres would be "downgraded" to create a single super clinic under a controversial plan drawn up by health chiefs.
Key aspects of child cancer diagnosis, treatment, research and training would be withdrawn from Aberdeen and Edinburgh and concentrated in Glasgow under one option being considered.
A second option – contained in a draft report obtained by Scotlan
d on Sunday – says Aberdeen should be downgraded and two principal centres opened in the central belt.
Health chiefs say the move is vital to boost expertise in child cancer treatment and improve survival rates – not as high as in some European countries.
But parents' groups and health campaigners last night described the proposals as "appalling", warning they would result in hundreds of lengthy journeys each year for families already under huge stress.
If health bosses go ahead with either option they will almost certainly face a massive backlash from campaigners who have successfully opposed health centralisation plans elsewhere in Scotland, including the proposed closure of two accident and emergency units at Ayr hospital and Monklands in Lanarkshire.
Each year, Scotland's cancer centres treat 150 new cases of the disease in children under 16. Survival rates are generally high – around 70% overall – but lag behind those in some other European countries, although outcomes have improved dramatically in the last 20 years because of new treatments.
Currently, children with cancer and brain tumours can be treated at their nearest major hospital – Aberdeen, Edinburgh or Glasgow.
The drastic changes under consideration would, say experts, ensure all children were seen by the top specialists even if it meant families travelling hundreds of miles.
The options are revealed in a draft recommendation from the Scottish Government's National Steering Group for Specialist Children's Services.
The group, chaired by Malcolm Wright, chief executive of NHS Education Scotland, includes doctors, health officials and patients' representatives.
Under the first option, Glasgow would become Scotland's principal treatment centre for children's cancer, meaning both Aberdeen and Edinburgh ceasing treatments for brain tumours and some experimental drugs trials.
Under the second option, Glasgow and Edinburgh would operate as national centres with Aberdeen ceasing to treat brain tumours and some experimental drugs trials.
The report states: "One of the key outcomes of this review is to ensure that the future service provided for children and young people equals comparable European countries.
"There are real challenges currently in ensuring that children can access the full range of clinical trials available. This is likely to continue unless the service is developed appropriately."
Under the first option both Aberdeen and Edinburgh would operate as "Level 3" services – performing a number of procedures including chemotherapy and some diagnosis of common cancers.
Glasgow would operate as a "Level 4" service which includes all Level 3 services plus children's brain tumour treatment, academic training, diagnosis and early clinical trials of new drugs.
Under the second option, Aberdeen would provide Level 3 services, and Edinburgh and Glasgow would be Level 4.
However, Ella Pybus, spokeswoman for the charity Brain Tumour UK, said the prospect for some would be "appalling".
She said: "This means patients will have to travel further, and Scotland's geography makes this particularly difficult. The prospect for families in Aberdeen having to travel to Edinburgh or Glasgow hardly bears thinking about. Children with serious brain tumours might have to spend a considerable time a long way from home and if parents have other children to look after or jobs that they depend on it makes it extremely difficult."
Mike Rumbles, Liberal Democrat MSP for West Aberdeenshire and Kincardine, described the move as "outrageous".
He said: "Any attack on the services provided in Aberdeen is an attack on the whole system. There is no case to centralise services like this and it is simply not acceptable to centralise services to two cities in the central belt."
However a spokesman for NHS Grampian insisted last night that he did not anticipate the service would change. He said: "We currently do clinical trials and paediatric neurology and we will continue to do so. We believe we would provide the same level of service."
Dr Zoe Dunhill, clinical director of children's services for NHS Lothian, said: "We await with interest the outcomes of the ongoing national reviews which we know are intended to ensure best care for children with cancer across Scotland."
A Scottish Government spokeswoman said: "The report on children's cancer services will feed into the national delivery plan for specialist children's services which will be consulted on in the new year."
'We wanted family near as our son fought to beat cancer'WHEN Kieran Manson was diagnosed with a malignant brain tumour his devastated parents had to make some tough decisions.
The family, who live near Nairn, were offered treatment in Edinburgh, Glasgow or Aberdeen and had to consider which hospital would offer them and their son the best options.
Kieran's parents, Angie and Ryan, finally decided on Aberdeen, because that was where many of their relatives lived.
Despite the fact that doctors at the Royal Aberdeen Children's Hospital treat far fewer patients than their colleagues in the Central Belt, the couple wanted to remain close to their family during Kieran's treatment.
That decision, made when Kieran was diagnosed in 2003, paid off, and their son, now aged nine, has beaten the disease. He endured a gruelling regime of surgery, radiotherapy and chemotherapy which succeeded in treating the tumour.
Last night his father said the decision had been right for his family. The couple also have a 14-year-old son, Callum, and a 12-year-old daughter, Abby.
Manson, a 40-year-old facilities manager, said: "We chose Aberdeen because we had family there. They provided strength and support for us and him. That decision was right for our family. It would not have been good for us to go to Edinburgh. Kieran was in and out of hospital for 18 months."
But, according to the draft recommendations of Scotland's cancer experts, some families needing similar treatment from the north and north-east of Scotland will have to travel to the Central Belt in future.
And it remains a possibility that some children's cancer services performed at the Royal Hospital for Sick Children in Edinburgh will be lost, meaning dozens of families from Fife, Lothian, Borders and Tayside facing long trips to the 'Sick Kids' in Glasgow.
The Scottish Government's National Steering Group for Specialist Children's Services has effectively ruled out making the Royal Aberdeen Children's Hospital a so-called 'Principal' treatment centre for children with cancer.
Another group of experts will announce next year where a single centralised site for adult and child brain surgery will be located. If they plump for Glasgow, top-level children's cancer treatment will be concentrated there and Edinburgh will not have 'Principal' status. If they choose Edinburgh, that responsibility will be shared between the cities.
The centralisation of other specialist hospital services has already proved a controversial issue. Patients and their families do not want to travel miles for treatment.
However, cancer experts believe centralising treatment is the best way to ensure that all patients receive care from the best in their field.
They say this works best when it goes hand in hand with "shared care centres" – where local hospitals continue to provide ongoing "routine" treatment, such as chemotherapy – to cut down on the number of long-distance trips.
Currently doctors at the children's hospital in Aberdeen see 19 new cancer cases each year compared with 55 in Lothian and 76 in Glasgow.
Ellen Finlayson, the head of services for Scotland for the children's cancer charity, CLIC Sargent, said that at the heart of the plans to change Scotland's cancer services was the principle of treating as many patients as possible close to home, while focusing expertise in one or two centres.
She said: "Proposals to centralise primary treatment centres and increase the role of shared care centres for childhood cancer in Scotland will concentrate expertise and recourses. This will mean that children and young people can receive treatment as close to home as possible and in facilities that are appropriate to their needs."
But it is likely that local campaigners will not see the Steering Group's proposals as coming close to that.
And the new SNP Government will find itself on the horns of a dilemma. In June, one of the first steps the then-new Secretary for Health Nicola Sturgeon took was to overturn a deeply unpopular decision made by the previous Government to close accident and emergency departments in the west of Scotland. Sturgeon said health boards in those areas had failed to give enough weight to concerns from local people.
The full article contains 1452 words and appears in Scotland On Sunday newspaper.
