Agenda item

 

This item is to receive an update from South Yorkshire Cancer Alliance in relation to the success and impact of the Rotherham Hospital based Lung Clinic since its relocation as part of the non-surgical oncology transformation programme.

 

 

This item was to receive an update report and presentation in relation to the Non-Surgical Oncology Transformation Programme and resultant Joint Lung Clinic implementation serving both Rotherham and Barnsley patients from the Rotherham Hospital site.

 

Members had previously received information regarding the proposals for the Lung Clinic in May 2025, following a broader update provided to the South Yorkshire, Derbyshire and Nottinghamshire Joint Health Overview and Scrutiny Committee earlier that year.  Consideration of this item was augmented by a site visit to the facility undertaken by members of the Health Select Commission, along with their counterparts from Barnsley Council on 19 March 2026.  The Chair offered sincere thanks to all of the staff involved in supporting that valuable scrutiny activity.

 

The Chair welcomed Jo Evans, Improvement Director,Specialised Cancer Services at Sheffield Teaching Hospitals, Richard Maxted, Operations Director, Specialised Cancer Services at Sheffield Teaching Hospitals, Mark Tuckett, Chief Strategy Officer at Sheffield Teaching Hospitals and Julia Jessop, South Yorkshire and Bassetlaw Cancer Alliance Managing Director to the meeting and invited them to introduce the report and presentation.

 

The Chief Strategy Officer at Sheffield Teaching Hospitals explained that the purpose of the presentation was to report on progress since implementation of the Joint Lung Clinic, and noted their expectation that Members had had the opportunity to read and digest the report provided in the agenda pack ahead of the meeting, and noted that some members had visited the clinic.

 

They set out the intended flow of the presentation:

 

·       Context

·       What had been implemented

·       How it was operating

·       Next steps

 

The Improvement Director, Specialised Cancer Services at Sheffield Teaching Hospitals described their role in co-ordinating the work to open and embed the Joint Clinic.

 

They summarised the case for change which was a national shortage of Consultant Oncologists alongside rising demand driven by new treatments and increasingly complex pathways, compounded by regional variation that created uneven patient experiences and inconsistent service resilience.

 

The Improvement Director explained that these pressures had led to the Non-Surgical Oncology (NSO) Transformation Programme. Although this had started with outpatient redesign, it had broadened to consider end-to-end pathways, including how outpatient assessment and decision-making shaped the onward patient journey.

 

They outlined the programme’s aims which were:

 

·       To improve clinical safety and reduce clinical risk

·       Address inequalities in access and experience across the region

·       Strengthen workforce sustainability by planning around known workforce constraints.

 

They added that the programme had been organised into three phases and that the Joint Lung Clinic sat in Phase 1, the ‘Stabilisation’ phase.

 

The Improvement Director explained that the model for Barnsley and Rotherham patients had been shaped by patient, public and staff feedback.  There was the need to consolidate the number of sites providing face-to-face appointments, as the system did not have sufficient consultant capacity to run multiple separate clinics with the required resilience.

 

They explained that the change was expected to:

 

·       Increase consultant cover and senior oversight so clinics were less vulnerable to single-handed working and vulnerabilities through absence

·       To standardise pathways and reduce unwarranted variation so care felt consistent regardless of postcode

·       To minimise unnecessary travel and, where possible, offer appointments closer to home for patients needing face-to-face review.

 

The presentation then turned to Lung Outpatients specifically, describing that the service had historically relied on a single consultant providing outpatient support with one located in Barnsley and one in Rotherham.  That separate clinic model left little resilience. They explained that initially, telephone appointments had been increased where clinically appropriate, but when face-to-face review was required Barnsley patients had often travelled to Weston Park Cancer Centre, creating a level of travel that was inconsistent with arrangements elsewhere.

 

They described the Joint Lung Clinic as a measure intended to reduce variation and create a more robust outpatient model and outlined how an options appraisal had recommended locating the joint clinic in Rotherham, building on the existing Rotherham Clinic and consolidating Barnsley patients and the Barnsley consultant into a single combined service.

 

They outlined the establishment of a multidisciplinary working group that comprised of clinical and non-clinical colleagues from Sheffield, Barnsley and Rotherham that met weekly to prepare for launch ahead of the implementation and noted that the Sheffield involvement reflected the wider referral relationship with Weston Park Cancer Centre even though the outpatient clinic delivery for this cohort took place in Rotherham.

 

They confirmed that  the Joint Clinic had gone live on 27 November 2025. Operational readiness had centred on clear communication and standardisation.  Patient information leaflets had been designed and tested with a patient group and refined for clarity, and staff were supported with jointly developed Standard Operating Procedures and documentation to ensure consistent ways of working.

 

Reflecting on the early position since ‘go-live’, the Improvement Director noted that experiences shared indicated improved patient and clinical safety through increased resilience and senior cover, with a combined team in one location providing oversight if one consultant was unavailable, supporting continuity and reducing the risk of service disruption.

 

They clarified that the change related to Outpatient Clinics and that treatment continued to be delivered locally for both Barnsley and Rotherham patients, and added that the practical impact on Rotherham patients had been limited in terms of appointment day, location and process, whilst the system monitored whether the combined model created any detriment for either population.

 

They explained that an evaluation framework had been agreed drawing on patient engagement which focussed on what mattered to patients, staff engagement which focussed on workforce and operational issues, alongside feedback from forums such as the Health Select Commission which focussed on assurance and impact.

 

As the Joint Clinic had only operated since 27 November 2025, it was acknowledged that there were limitations to the available evaluation data, the offer to return after a 12-month evaluation to allow more robust assessment of trends and outcomes was reiterated. Nonetheless, it was noted that in that context early months showed a reduction in Barnsley referrals, which the team had reviewed and interpreted as likely natural variation influenced by fluctuation and seasonal effects which had reinforced the need for longer-term evaluation to validate assumptions made.

 

The Improvement Director summarised the information gleaned from the patient questionnaire. 52 patients had responded when the presentation was prepared, which had risen to 79 on the day of the meeting, but noted that the additional responses had not changed the themes identified in the report.

 

Feedback was largely positive about the care received at Rotherham, including staff interactions, reception welcome and the clinic environment with 93% of respondents said they had been informed about the change, although one person reported not feeling informed and had needed to ring for clarity.

 

They explained that there had been issues with appointment letters from the Sheffield side, but these were largely resolved. It was reported that the most consistent negative theme was parking at the Rotherham Hospital site.  The Improvement Director indicated that the question had been included deliberately because transport and travel had formed part of the considerations that had led to the identification of Rotherham Hospital as the preferred Joint Clinic site.  They confirmed that they had made TRFT aware of the feedback, whilst noting it was not within Sheffield Teaching Hospitals’ or the Cancer Alliance’s direct control to remedy.

 

The Improvement Director also outlined staff feedback, which reflected that the Clinic set-up and jointly developed SOPs had supported clearer expectations and more consistent processes. They identified IT and specifically WiFi connectivity as an ongoing operational challenge that was being addressed in conjunction with the relevant TRFT staff.  They particularly highlighted a positive cultural impact in that the Barnsley team had felt incredibly welcomed by Rotherham colleagues and in day-to-day practice, staff had worked cohesively, such that organisational boundaries were barely distinguishable.

 

The Chair invited questions and comments from members in relation to the report and presentation.

 

Councillor Brent queried the adequacy and reliability of communication methods with patients along the cancer pathway. They wanted to understand how standard communications operated before and after appointments or treatments, and how the service accounted for communication failures, particularly given increasing reliance on electronic patient records and the risks that poor communication could delay diagnosis or treatment.

 

Richard Maxted, Operations Director forSpecialised Cancer Services at Sheffield Teaching Hospitals explained that once a referral was received, the patient’s details were logged into the electronic patient record (EPR) and the patient was contacted by telephone to arrange an appointment. This phone call was used to ensure the patient had heard and understood the appointment details, which significantly increased attendance reliability. A written confirmation letter was then issued. Following appointments, letters summarising outcomes and next steps were issued both to patients and, where appropriate, clinicians and GPs.

 

They also described how communication failures were identified and explained that all cancer pathway patients were ‘tracked’ which meant their progress was monitored at every stage. If a patient failed to attend an appointment, the service contacted them to explore reasons.  Sometimes this was because of outdated contact details and sometimes due to disengagement related to the emotional burden of diagnosis. In the latter case, Clinical Nurse Specialists often telephoned patients to check on wellbeing and encourage re?engagement.

 

Councillor Brent raised sought reassurances regarding oncologist shortages particularly in the context of staffing gaps contributing to diagnosis and treatment delays.

 

The Operations Director provided broader context and clarified that the shortage stemmed partly from workforce planning issues arising from a reduced number of junior doctors choosing oncology, and partly from consultants retiring earlier than predicted during the pandemic. They noted a longstanding disparity between the north and south of England with respect to consultant numbers, with the north having fewer oncologists relative to population need but reassured members that significant efforts had been made to improve that position with recent indications of an improved position as a result of successful recruitment campaigns and other innovative approaches to retaining talent beyond training rotations. Those approaches included a focus on improving the appeal of the workplace, enhancing specialist registrar experiences to encourage them to stay, and workforce diversification. To qualify that they explained that whilst consultants remained essential for initial treatment planning, ongoing monitoring could often be conducted by advanced practitioners, junior doctors, and other staff. They described a shift to ‘consultant-led and team-delivered’ model which provided resilience amid both rising demand and workforce shortages.

 

Councillor Harper enquired about service resilience in the Joint Clinic, specifically, the response when one of the two consultants were absent.

 

The Operations Director explained that historically, lone consultants prepared  their teams in advance of leave however, the new joint working arrangement ensured that one senior consultant would always be present, as the two consultants coordinated leave. In cases of long?term absence, the service would seek locum support or redistribution of consultant cover across the region. Training junior and advanced staff to work across both consultants’ teams had further improved service resilience.

 

Councillor Harrison wanted to understand whether there were any factors under the Joint Clinic model that could compromise safe cover.

 

The Operations Director reiterated that planned leave was carefully coordinated, and whilst there was always the possibility of unexpected medium or long?term sickness, this would be mitigated through redeployment within the wider regional consultant pool or use of locums if required. No other factors were expressed as being considered to have the potential to compromise safe cover.

 

Councillor Harper wanted to understand long?term succession planning given recruitment difficulties cited.

 

The Operations Director explained the training pathway from medical school through foundation years and into specialty training.  They described how early interests developed and how Sheffield sought to create positive experiences for trainees entering oncology to encourage retention. The service monitored expected CCT (Certificate of Completion of Training) dates to anticipate future gaps and influence training rotations. The Chief Strategy Officer added that although recruitment remained challenging, the situation had improved compared with three or four years earlier, and highlighted recent successful consultant appointments where other centres had failed to recruit.

 

Councillor Clarke referred to concerns about transport and parking reflected in patient feedback. They welcomed efforts to review transport, particularly given that 13% of patients relied on taxis which represented an unwelcome additional financial burden that had the potential to further disadvantage cancer patients who may already be exposed to financial vulnerabilities. Of further concern was the low satisfaction rate with car parking at the hospital site and the effect of stress and anxiety caused by overcrowded and often dangerous parking conditions on cancer patients and their families who were undoubtedly already managing challenging personal circumstances.

 

The Operations Director acknowledged those concerns, and recognised the challenge across many hospital sites. They described a potential role for Western Park Cancer Charity, which operated minibus routes from several locations, although demand from Rotherham had been limited to date. There was the possibility of creating a combined Barnsley to Rotherham route, but only where sufficient patient demand emerged.

 

Bob Kirton, Managing Director of Rotherham Hospital acknowledged the parking issues at Rotherham Hospital. They outlined recent steps taking to improve parking organisation and availability which had included:

 

·       Creating 200 new staff parking spaces to free patient spaces

·       Implementing ANPR

·       Plans to introduce enforcement to address unsafe parking behaviours

 

They described that a new estates strategy was under development, with the potential to revisit a previous application for a multi?storey car park at the hospital site. They further noted ongoing discussions with the Council and South Yorkshire Transport, and in turn SYMCA (South Yorkshire Mayoral Combined Authority) about improving public transport access.

 

Councillor Tarmey commented that issues with parking at the hospital was a frequent cause of complaint to Ward Members, but emphasised the need to balance the enforcement response with the need for compassion carefully to not cause further distress. They suggested that the relevant Council Service could consider the sufficiency of the roads infrastructure and enforcement around the hospital site to consider whether anything could be done to help TRFT manage the issue given its impact on Rotherham residents.

 

The Chair agreed that a recommendation could be made to explore Councillor Tarmey’s suggestion.

 

The Councillor Clarke was concerned that the patient survey, notwithstanding the increased number or responses at the time of discussion, was too short-term and small to be considered a representative sample yielding meaningful data for analysis and asked whether there was scope to extend beyond the planned conclusion in March 2026.

 

The Improvement Director confirmed survey uptake was strong and aided by the simple in clinic delivery approach, and gave an undertaking to continue collecting responses as part of the 12?month evaluation.

 

Councillor Fisher queried whether there had been any unintended consequences, either positive or negative, from the establishment of the Joint Clinic.

 

The Improvement Director noted that staff had initially been apprehensive but found unexpected benefits, such as strong teamworking and a welcoming environment at Rotherham. A survey of staff experiences would be included in the evaluation which would seek to capture more detail regarding similar unintended consequences.

 

Councillor Brent wanted to know whether lessons learned from the experience of establishing the Joint Clinic and from the patient survey would be shared with TRFT, to allow dissemination of good practice and to further harness the power of collaborative working within the system. The Improvement Director confirmed that this was already being explored, as Rotherham Hospital had expressed interest in applying the insights elsewhere within the hospital’s operations.

 

Councillor Harrison was keen to understand whether the Joint Clinic had generated any efficiency savings and who would be responsible for commissioning a permanent solution for Non-Surgical Oncology in Rotherham.

 

The Operations Director confirmed that the Joint Clinic was cost?neutral excepting for travel expenses for Barnsley staff. The South Yorkshire and Bassetlaw Cancer Alliance Managing Director clarified that outpatient redesign was the responsibility of the Integrated Care Board, whilst specialised commissioning involved NHS England. They clarified that the aim of establishment of the Joint Clinic was improved patient experience and outcomes rather than cost reduction.

 

Councillor Thorp was concerned about the ratio of face?to?face versus telephone appointments, and in particular the variation between Clinics.

 

The Operations Director explained that distance and patient preference were key factors, particularly in the context of appointments in Sheffield. First appointments were usually face?to?face, but follow?up clinical checks could be conducted via phone where appropriate. The Improvement Director added that Barnsley numbers reflected a temporary backlog of telephone consultations due to earlier space constraints, and potentially a familiarity and comfort with the approach taken regarding telephone appointments prior to the Joint Clinic’s implementation.  The expectation remained that there would be gradual return to more balanced provision.

 

Councillor Harper reflected on the practical challenges experienced by clinicians, raising concerns shared with Members during the site visit in relation to the reliability of Wi?Fi connectivity in clinical spaces. The Improvement Director advised that they understood that this was a longstanding issue in that part of the hospital building and did not affect Joint Clinic staff in isolation. They were working with staff at TRFT to address the issue, with wired connectivity in clinical spaces one proposed solution. The matter was due for further review at the working group’s final meeting.

 

 

Resolved:

 

That the Health Select Commission:

 

1.    Noted the implementation and initial appraisal of the NSO joint Lung Clinic for Rotherham and Barnsley patients.

 

2.    Noted that a formal clinic evaluation would be undertaken 12-months post go-live, which would enable more meaningful data analysis to influence recommendations for future service provision.

 

3.    Requested that South Yorkshire and Bassetlaw Cancer Alliance provide the data and metrics requested by the Health Select Commission following the briefing received in May 2025 be provided following conclusion of the planned clinic evaluation, given that it had not been possible to provide the full detail at the time of the meeting.  The means via which this would be provided were to be agreed outside of the meeting.

 

4.    Requested that South Yorkshire and Bassetlaw Cancer Alliance considered the public and community transport needs, including the availability and infrastructure of onsite parking in conjunction with The Rotherham NHS Foundation Trust (TRFT), following the planned clinic evaluation.

 

5.    Requested that relevant Council Officers consider the roads network and transport infrastructure in the hospital’s immediate vicinity, including car parking restrictions and enforcement to seek to ensure that this supports traffic flow and actively contributes to reducing travel and parking frustrations for Rotherham residents accessing the hospital site.