Choosing the centre

Prepared 4 September 2026 by Kya for her partner and the patient. It sets out the case both ways, what the evidence does and does not say, and the questions that should decide it. Evidence is in research thread 07. It is not a recommendation to delay; whichever unit, the priority is tissue.

What is settled

• Derriford (University Hospitals Plymouth) is the commissioned neurosurgery centre for Cornwall. Per the discharge summary, the Derriford neuro-oncology MDT discussed her on 3 September; outcome: Mr Muquit to see her in clinic. The family was not told this before leaving. DISPUTED (27 Sep full read): RCHT's notes, p34, 4 Sep 15:28, say "MDT Discussion informed to pt & Husband DD - Clival Chordoma, Sinonasal tumor, metastasis (less likely). Plan to see Mr. Muquit in clinic". Her partner's own voice note of that meeting (em-evidence/2026-09-04_1530) records the same three differentials being given. So the differentials were told on 4 Sep at the self-discharge meeting. Whether the MDT itself and the Muquit clinic plan were explained is her partner's account against the note. The verbatim re-transcription of that voice note (27 Sep, em-evidence/2026-09-04_1530_mark-voice-note-discharge-meeting.verbatim.txt) contains the differentials but no mention of an MDT, of Mr Muquit or of a clinic plan, and her partner says "that's the term that was on there" and "I'm guessing these are the things they're thinking", which suggests terms read off a document rather than a plan explained. Source: em-evidence/2026-09-27_rcht-records-full-read.md.
• Southampton (Wessex Neurological Centre) has been requested under NHS Constitution patient choice in the complaint email, on the ground that both families are nearby.
• Since April 2026 there is a National Chordoma and Chondrosarcoma Skull Base MDT (Northern Care Alliance, Manchester, fortnightly, referral through the proton beam portal). Either unit can and should refer her to it.
• Proton beam therapy, if chordoma is confirmed, is at The Christie (Manchester) or UCLH (London). They run as one national service and the referring unit does not choose the centre.

What the evidence does not say

Neither unit has published outcomes for skull base chordoma or chondrosarcoma. Both contribute anonymously to the same national datasets (the CRANIAL endonasal study; the national proton cohort). Inspection ratings do not separate them: both trusts are Requires Improvement overall with surgery rated Good. Annual skull base chordoma numbers for either unit could not be found. So "which is better" cannot be answered from published data. It can be answered by asking.

The one evidence-backed predictor of a complete removal in the UK is unit volume. In the national cohort (Glancz 2024, BMJ Oncology, 230 patients from 18 units), each extra case a unit sent for protons raised the odds of complete removal by about a third, and volume was the only significant factor. GIRFT 2018 recommends chordoma be concentrated in fewer, higher-volume centres for the same reason.

The case for Southampton

• A designated neurosurgery centre with a skull base MDT and an ENT and neurosurgery endonasal team, with the longer skull base pedigree of the two.
• Family nearby. Months of treatment with young children need a support base close to the hospital. This is a legitimate factor and is the ground the patient-choice request rests on.
• Closer to London. If UCLH is the proton centre, Southampton to London is about 1h20 by train against 3 hours or more from Plymouth.

The case for Derriford

• Time. Her ptosis and double vision are progressing, and cranial nerves recover better the less time they are compressed. A transfer between trusts means a new referral, a new MDT cycle and possibly repeat imaging, which can add one to three weeks. Derriford is the pathway Treliske already runs and is the fastest route to tissue.
• Choice is a request, not a right, for a tertiary inpatient referral. Treliske can decline or delay. Days spent arguing are days not spent on biopsy.
• No evidence Southampton is higher volume. Its skull base MDT chair's own profile emphasises spinal surgery. Reputation is not data.
• The national chordoma MDT and the proton centre are identical whichever unit holds her. The expert review that matters most does not depend on this choice.
• Travel is repeated, not once: pre-op assessment, surgery, post-op review, any complication. About 1 hour to Derriford; about 3h40 by car or 5h30 by rail to Southampton, unless the family relocates for the duration.
• Continuity. Treliske and Derriford share images, transfer routes and a neuro-oncology nurse network. Southampton starts from a blank sheet.

The questions that decide it

Ask both units, in writing if possible:

1. How many skull base chordomas and chondrosarcomas do you operate on each year?
2. How many have you referred for proton beam therapy since 2017?
3. Who would do the operation (neurosurgeon and ENT surgeon by name), and how many endoscopic endonasal skull base cases do they do a year?
4. Will you refer her to the National Chordoma and Chondrosarcoma Skull Base MDT, and when?
5. What is your earliest date for MDT discussion and for biopsy?

Choose on the answers to 1, 2 and 5. If Southampton's numbers are clearly higher and the delay is short, the choice is well founded. If the numbers are similar, or the transfer adds weeks while her eye signs progress, Derriford with a national MDT review is the safer path, and a Southampton second opinion can run alongside.

One line for the ward or the complaints team

"We would like the Derriford referral to proceed without delay, the case referred to the National Chordoma and Chondrosarcoma Skull Base MDT, and a parallel referral to Southampton under patient choice, with both units asked their annual skull base chordoma volume and earliest biopsy date so that the family can make an informed decision."

Sources

• Glancz et al 2024, BMJ Oncology: national UK chordoma cohort, unit volume and gross total resection. https://pmc.ncbi.nlm.nih.gov/articles/PMC11347697/
• GIRFT Cranial Neurosurgery 2018: regional model for rare tumours including chordoma.
• CRANIAL study 2022, Frontiers in Oncology: UK endonasal skull base outcomes, per-centre results unpublished.
• NHS England proton beam therapy service pages; The Christie PBT FAQs.
• CQC reports: Derriford (Feb 2026), Southampton General (Jul 2023).
• Unit and consultant profiles: University Hospitals Plymouth; University Hospital Southampton.
• Full detail and links: research thread 07, em-research/07-derriford-vs-southampton.md.