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| NHS plan to shut child heart surgery units causes outcry | NHS plan to shut child heart surgery units causes outcry |
| (about 2 months later) | |
| Two large hospitals, the Royal Brompton in London and Glenfield hospital in Leicester, have defied plans from NHS England to close their heart surgery units for children. | Two large hospitals, the Royal Brompton in London and Glenfield hospital in Leicester, have defied plans from NHS England to close their heart surgery units for children. |
| NHS England has tried to settle a bitter 15-year argument following the deaths of babies at the Bristol Royal Infirmary, whose heart surgeons were not as skilled as others elsewhere. The 2001 Kennedy review into the tragedy said some units had to close so that the remaining surgeons operated on enough tiny hearts to be as good as they could be at the complex procedures. But nobody can agree which units these should be. | NHS England has tried to settle a bitter 15-year argument following the deaths of babies at the Bristol Royal Infirmary, whose heart surgeons were not as skilled as others elsewhere. The 2001 Kennedy review into the tragedy said some units had to close so that the remaining surgeons operated on enough tiny hearts to be as good as they could be at the complex procedures. But nobody can agree which units these should be. |
| The new review by NHS England says the units at Royal Brompton and Glenfield must shut down. Both fought judicial reviews against earlier closure proposals and they appear prepared to do so again. The third hospital trust named was Central Manchester, which operates on children and adults born with heart defects. | The new review by NHS England says the units at Royal Brompton and Glenfield must shut down. Both fought judicial reviews against earlier closure proposals and they appear prepared to do so again. The third hospital trust named was Central Manchester, which operates on children and adults born with heart defects. |
| Every attempt to rationalise children’s heart surgery by closing units to ensure the surgeons in those that remain treat enough children to stay highly skilled, has caused a huge outcry, beginning with the hospital management and consultants and spreading to families and local politicians. | Every attempt to rationalise children’s heart surgery by closing units to ensure the surgeons in those that remain treat enough children to stay highly skilled, has caused a huge outcry, beginning with the hospital management and consultants and spreading to families and local politicians. |
| Both the Royal Brompton and Leicester came out fighting. “We are confident that our clinical outcomes are now among the best in the country, so we strongly disagree with NHS England’s decision and will not sit by whilst they destroy our fabulous service,” said John Adler, chief executive at University Hospitals of Leicester NHS trust. | Both the Royal Brompton and Leicester came out fighting. “We are confident that our clinical outcomes are now among the best in the country, so we strongly disagree with NHS England’s decision and will not sit by whilst they destroy our fabulous service,” said John Adler, chief executive at University Hospitals of Leicester NHS trust. |
| The Royal Brompton signalled that it would rally the sort of support it had from campaigners last time its service was under threat. | The Royal Brompton signalled that it would rally the sort of support it had from campaigners last time its service was under threat. |
| “We find NHS England’s stated intention extraordinary. We are, however, reassured to see that the idea of removing congenital heart disease services from Royal Brompton is ‘subject to consultation with relevant trusts and, if appropriate, the wider public’. We fail to see how any logical review of the facts will come to the same conclusion as this panel,” said Robert Craig, chief operating officer at Royal Brompton & Harefield NHS foundation trust. He added that threatening to withdraw services from one of the “largest and most successful centres in the country” seemed “an absurd approach”. | “We find NHS England’s stated intention extraordinary. We are, however, reassured to see that the idea of removing congenital heart disease services from Royal Brompton is ‘subject to consultation with relevant trusts and, if appropriate, the wider public’. We fail to see how any logical review of the facts will come to the same conclusion as this panel,” said Robert Craig, chief operating officer at Royal Brompton & Harefield NHS foundation trust. He added that threatening to withdraw services from one of the “largest and most successful centres in the country” seemed “an absurd approach”. |
| The new plan also seeks to rationalise cardiology services offering medical treatment, but not surgery, to patients with heart defects. Services at five hospitals – in Blackpool, South Manchester, Papworth, Nottingham, and at Imperial in London – will be moved elsewhere. | The new plan also seeks to rationalise cardiology services offering medical treatment, but not surgery, to patients with heart defects. Services at five hospitals – in Blackpool, South Manchester, Papworth, Nottingham, and at Imperial in London – will be moved elsewhere. |
| NHS England took on the work after the last attempt to rationalise children’s heart surgery collapsed amid lawsuits and recriminations. Hospital trust managers, consultants, parents and local politicians have always united to block closures. The worst of the fighting in recent years was over Leeds, which keeps its children’s heart surgery unit under the NHS England plans. | NHS England took on the work after the last attempt to rationalise children’s heart surgery collapsed amid lawsuits and recriminations. Hospital trust managers, consultants, parents and local politicians have always united to block closures. The worst of the fighting in recent years was over Leeds, which keeps its children’s heart surgery unit under the NHS England plans. |
| NHS England’s team, working with the hospitals, doctors and patient groups, developed and published a detailed set of standards that children’s heart surgery units must meet in order to be commissioned and paid to do the work. Crucially, every surgeon has to carry out at least 125 operations a year to ensure that they remain sufficiently skilled; and each hospital team must have at least four surgeons on the rota. | NHS England’s team, working with the hospitals, doctors and patient groups, developed and published a detailed set of standards that children’s heart surgery units must meet in order to be commissioned and paid to do the work. Crucially, every surgeon has to carry out at least 125 operations a year to ensure that they remain sufficiently skilled; and each hospital team must have at least four surgeons on the rota. |
| Central Manchester, which has just one surgeon for congenital heart defects, “does not meet the standards and is assessed as not being able to within the foreseeable future”, said NHS England. Surgery would be transferred to Alder Hey children’s hospital and the Liverpool heart and chest hospital. | Central Manchester, which has just one surgeon for congenital heart defects, “does not meet the standards and is assessed as not being able to within the foreseeable future”, said NHS England. Surgery would be transferred to Alder Hey children’s hospital and the Liverpool heart and chest hospital. |
| University Hospitals of Leicester NHS trust and the Royal Brompton and Harefield also failed to meet the standards and were “extremely unlikely to be able to do so”, said the statement. NHS England will work with Newcastle to help it meet the standards, because of the importance of keeping the children’s heart transplant unit there viable. | University Hospitals of Leicester NHS trust and the Royal Brompton and Harefield also failed to meet the standards and were “extremely unlikely to be able to do so”, said the statement. NHS England will work with Newcastle to help it meet the standards, because of the importance of keeping the children’s heart transplant unit there viable. |
| Only two of 13 hospitals met most or all of the standards; these were Birmingham children’s hospital, and Great Ormond Street in London. | Only two of 13 hospitals met most or all of the standards; these were Birmingham children’s hospital, and Great Ormond Street in London. |
| Out of nine NHS hospital trusts that have cardiology services where children and a small number of adults born with heart defects are diagnosed and given medical treatment but not surgery, five will have their services transferred elsewhere. Those that remain will be Liverpool, Oxford, Norfolk and Norwich, and Brighton and Sussex. | Out of nine NHS hospital trusts that have cardiology services where children and a small number of adults born with heart defects are diagnosed and given medical treatment but not surgery, five will have their services transferred elsewhere. Those that remain will be Liverpool, Oxford, Norfolk and Norwich, and Brighton and Sussex. |
| Huon Gray, NHS England’s national clinical director for heart disease, said this was the last chance to bring about the changes that were needed to ensure an excellent children’s heart service for the future. “I know for a fact that we have lost key consultant staff moving abroad over the last few years because they weren’t convinced we were able to grasp the nettle, because it is a really difficult issue. If we don’t grasp this opportunity, I think we will have to accept that adequate is good enough.” | Huon Gray, NHS England’s national clinical director for heart disease, said this was the last chance to bring about the changes that were needed to ensure an excellent children’s heart service for the future. “I know for a fact that we have lost key consultant staff moving abroad over the last few years because they weren’t convinced we were able to grasp the nettle, because it is a really difficult issue. If we don’t grasp this opportunity, I think we will have to accept that adequate is good enough.” |
| The review had taken three years and engaged all parties, from management to clinicians to parents and patients. Gray said that without enough support to put the proposals into effect, he could not see that “anybody [would] have the appetite to hold a similar review in the future”. | The review had taken three years and engaged all parties, from management to clinicians to parents and patients. Gray said that without enough support to put the proposals into effect, he could not see that “anybody [would] have the appetite to hold a similar review in the future”. |
| Jonathan Fielden, director of specialised commissioning at NHS England, said he believed they had followed due process and hoped they could work with the relevant organisations to implement the proposals “rather than redirect resources into a protracted judicial review process, which would limit our opportunity to give good-quality services now and into the future”. | Jonathan Fielden, director of specialised commissioning at NHS England, said he believed they had followed due process and hoped they could work with the relevant organisations to implement the proposals “rather than redirect resources into a protracted judicial review process, which would limit our opportunity to give good-quality services now and into the future”. |
| The Royal College of Surgeons said it strongly supported the proposals, while Sir Ian Kennedy, who chaired the Bristol review, said: “These are vital services, and we have waited 15 years to arrive at a solution which delivers quality and consistency for current and future generations.” | The Royal College of Surgeons said it strongly supported the proposals, while Sir Ian Kennedy, who chaired the Bristol review, said: “These are vital services, and we have waited 15 years to arrive at a solution which delivers quality and consistency for current and future generations.” |