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You can find the current article at its original source at https://www.theguardian.com/politics/live/2017/mar/03/royal-brompton-hospital-paediatric-heart-unit-children-live
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| Why is this children's heart unit facing closure? A day on the NHS frontline - live updates | Why is this children's heart unit facing closure? A day on the NHS frontline - live updates |
| (35 minutes later) | |
| 3.06pm GMT | |
| 15:06 | |
| Nearly a quarter of NHS trusts declared themselves unsafe since December, figures reveal | |
| Sarah Marsh | |
| New NHS data has been released today, and the figures make for sobering reading: more than 60% of trusts have had to declare high-level alerts since December. | |
| Almost one-quarter of these trusts (37) reported an ‘Opel 4’ alert, which means they were so overcrowded safety could not be assured. Another 93 reported Opel 3s, which indicated that they were under major pressure. | |
| Sarah Marsh and Pamela Duncan crunch the numbers in the full story. | |
| 2.52pm GMT | |
| 14:52 | |
| Explainer: what are the issues involved in the planned NHS closures? | |
| Denis Campbell | |
| There is agreement at the top levels of the NHS that an unprecedented centralisation of services needs to take place across England, for two main reasons. | |
| First, the belief that quality of care will improve and lives will be saved; and second, that staff working in bigger teams, albeit in fewer places, will help overcome the serious and growing shortages in many NHS areas. The latter has been exacerbated by the Brexit vote and flatlining real-terms pay. | |
| Many of the 44 STPs (if you don’t know what this means, see the 12.01pm post) involve reducing the number of A&E and maternity units, and also the number of hospitals providing acute stroke care, and even certain kinds of cancer treatment. These proposals have generated a huge outcry. | |
| However, much of this radical thinking will almost certainly not lead to dramatic rationalisation on the ground, for two reasons: | |
| 1) Theresa May has told Simon Stevens privately that she does not want bad news about hospital unit closures on newspaper front pages. NHS England’s chief executive can’t ignore that. Jeremy Hunt, the health secretary, shares those fears, though is more open-minded to the claimed virtues of NHS reconfiguration. | |
| 2) The public’s deep, emotional attachment to the bricks and mortar of their local NHS – hospitals much more than GP surgeries – makes it difficult to push through such changes. | |
| Most non-NHS staff are influenced most by emotion – “save our local hospital” – rather than data and evidence. Hospitals are where babies are born, operations are had, cancer care is delivered and, often, lives end. As such, they matter hugely. And that feeling prompts thousands of people to sign petitions, lobby MPs and attend protest marches. | |
| For example, in 2010 controversial plans to radically reshape the role of the Whittington hospital, a small district general hospital in north London, were shelved as a result of such people power. Local MPs affected – including Jeremy Corbyn, Emily Thornberry and David Lammy – joined a 5,000-strong protest march and that was that. The proposals disappeared. | |
| Six years on, it has to be said, the Whittington is still intact, has made improvements and is treating record numbers of patients, but is still facing questions about where it fits into the NHS landscape at a time when many hospital trusts, including those near it, are merging to become mega-trusts. | |
| 2.22pm GMT | 2.22pm GMT |
| 14:22 | 14:22 |
| 'Other parents know what you're going through' | 'Other parents know what you're going through' |
| Jessica Elgot | Jessica Elgot |
| Jack Gibson, 3, is running around the playroom, clutching his plastic toys and giggling. His chest is still bandaged from scheduled heart surgery, part of his treatment for the hole in his heart. | Jack Gibson, 3, is running around the playroom, clutching his plastic toys and giggling. His chest is still bandaged from scheduled heart surgery, part of his treatment for the hole in his heart. |
| His mother, Jemma, is pleased to see him looking lively, though he is anxious to find his favourite pirate ship toy. | His mother, Jemma, is pleased to see him looking lively, though he is anxious to find his favourite pirate ship toy. |
| He had a couple of problems in surgery so he’ll be here for another five days at least while they monitor him. It’s our first time here, the staff on the intensive care were just amazing. Talking to other parents helps, they do know what you’re going through. | He had a couple of problems in surgery so he’ll be here for another five days at least while they monitor him. It’s our first time here, the staff on the intensive care were just amazing. Talking to other parents helps, they do know what you’re going through. |
| Across the room, one-year-old Freddie Nash is mesmerised by the pink and green lights in the soft play’s “hurricane tube”. He is here for a rigorous number of tests, having first been treated at just three months. Now he has been transferred to Royal Brompton, where mum Becky hopes they finally get a diagnosis. | Across the room, one-year-old Freddie Nash is mesmerised by the pink and green lights in the soft play’s “hurricane tube”. He is here for a rigorous number of tests, having first been treated at just three months. Now he has been transferred to Royal Brompton, where mum Becky hopes they finally get a diagnosis. |
| “It’s even harder, not knowing what’s wrong with him,” she says. “Obviously I want to take him home soon as I can but more than that, I want to know what’s the answer. We were only supposed to be in for a night but now it looks like it will be a lot longer.” | “It’s even harder, not knowing what’s wrong with him,” she says. “Obviously I want to take him home soon as I can but more than that, I want to know what’s the answer. We were only supposed to be in for a night but now it looks like it will be a lot longer.” |
| Today is the first day Freddie is starting to act like a normal one-year-old, playing with his toy ambulance, and clapping his hands. | Today is the first day Freddie is starting to act like a normal one-year-old, playing with his toy ambulance, and clapping his hands. |
| “He has been quite distressed; he’s had 15 blood tests and he was really, really upset by them,” she said. “He loves it in the playroom though, I think we’ll be here a lot.” | “He has been quite distressed; he’s had 15 blood tests and he was really, really upset by them,” she said. “He loves it in the playroom though, I think we’ll be here a lot.” |
| 1.56pm GMT | 1.56pm GMT |
| 13:56 | 13:56 |
| '125 operations per surgeon [per year] to maintain skill levels is necessary' | '125 operations per surgeon [per year] to maintain skill levels is necessary' |
| Sarah Boseley | Sarah Boseley |
| Both the Royal College of Surgeons and the professional body, the Society of Cardiothoracic Surgeons, support the new NHS standards that may lead to the closure of children’s heart surgery units such as Royal Brompton. | Both the Royal College of Surgeons and the professional body, the Society of Cardiothoracic Surgeons, support the new NHS standards that may lead to the closure of children’s heart surgery units such as Royal Brompton. |
| “We very strongly support the idea of reconfiguration,” said Graham Cooper, the society’s president and college board member. “Obviously the implementation of this is NHS England’s job.” | “We very strongly support the idea of reconfiguration,” said Graham Cooper, the society’s president and college board member. “Obviously the implementation of this is NHS England’s job.” |
| They back the standards. “It is clear that 125 operations per surgeon [per year] to maintain skill levels is necessary and we are also quite clear that it will be four surgeons ultimately in a unit by 2021, for on-call and providing a service when people are sick or on holiday.” | They back the standards. “It is clear that 125 operations per surgeon [per year] to maintain skill levels is necessary and we are also quite clear that it will be four surgeons ultimately in a unit by 2021, for on-call and providing a service when people are sick or on holiday.” |
| Surgeons are increasingly specialised, operating only on neonates under one month old, for instance, which means more are needed. | Surgeons are increasingly specialised, operating only on neonates under one month old, for instance, which means more are needed. |
| They support having other children’s services on the same site too. “To ensure children get the very best care, co-location is very important.” | They support having other children’s services on the same site too. “To ensure children get the very best care, co-location is very important.” |
| But they are dismayed that it has taken 16 years to get this far. “Our members are very frustrated about the lack of progress with it. They see it as being important and the current limbo puts a lot of uncertainty in place for patients and families and all the staff working in cardiac surgery. We’d like to see it got on with and done.” | But they are dismayed that it has taken 16 years to get this far. “Our members are very frustrated about the lack of progress with it. They see it as being important and the current limbo puts a lot of uncertainty in place for patients and families and all the staff working in cardiac surgery. We’d like to see it got on with and done.” |
| 1.36pm GMT | 1.36pm GMT |
| 13:36 | 13:36 |
| NHS England chief Simon Stevens: 'We do need capital. We’ve said that from the get-go' | NHS England chief Simon Stevens: 'We do need capital. We’ve said that from the get-go' |
| Denis Campbell | Denis Campbell |
| Meanwhile, NHS England chief executive Simon Stevens has been speaking today at the annual summit of the health thinktank the Nuffield Trust. And will the NHS be getting more money in next week’s budget? No chance. | Meanwhile, NHS England chief executive Simon Stevens has been speaking today at the annual summit of the health thinktank the Nuffield Trust. And will the NHS be getting more money in next week’s budget? No chance. |
| Tellingly, Stevens was not even asked if he thought more cash was likely. That’s because everyone in “the system” – as health service bosses refer to it – knows that it’s not going to happen and that it’s a waste of time lobbying, pleading or arguing for it publicly. | Tellingly, Stevens was not even asked if he thought more cash was likely. That’s because everyone in “the system” – as health service bosses refer to it – knows that it’s not going to happen and that it’s a waste of time lobbying, pleading or arguing for it publicly. |
| Why? Because of Theresa May’s oft-stated, though widely-disputed, view that the NHS is already getting more money than it asked for between now and 2020. And her belief – first disclosed by the Guardian last October – that the NHS can learn useful lessons from her time as home secretary in cutting police budgets and seeing crime falling at the same time. | Why? Because of Theresa May’s oft-stated, though widely-disputed, view that the NHS is already getting more money than it asked for between now and 2020. And her belief – first disclosed by the Guardian last October – that the NHS can learn useful lessons from her time as home secretary in cutting police budgets and seeing crime falling at the same time. |
| Stevens publicly challenged both opinions in evidence to the Commons public accounts committee on 11 January. | Stevens publicly challenged both opinions in evidence to the Commons public accounts committee on 11 January. |
| However, since last year Stevens has instead repeatedly made the case for more money to prop up England’s ailing social care system and also extra cash for NHS capital spending. | However, since last year Stevens has instead repeatedly made the case for more money to prop up England’s ailing social care system and also extra cash for NHS capital spending. |
| Philip Hammond, the chancellor, looks likely to deliver on social care at least. Though there is growing speculation he will provide between £700m and £1bn of genuinely new government money in the budget. | Philip Hammond, the chancellor, looks likely to deliver on social care at least. Though there is growing speculation he will provide between £700m and £1bn of genuinely new government money in the budget. |
| But capital funding for the NHS? That’s money to build new premises and maintain existing ones and buy new equipment, such as scanners. That’s the pot of NHS funding that’s been raided by the health secretary Jeremy Hunt to the tune of £1.2bn this year, to help keep struggling hospitals going, amid the huge pressures they are under. | But capital funding for the NHS? That’s money to build new premises and maintain existing ones and buy new equipment, such as scanners. That’s the pot of NHS funding that’s been raided by the health secretary Jeremy Hunt to the tune of £1.2bn this year, to help keep struggling hospitals going, amid the huge pressures they are under. |
| Another £1bn is expected to disappear again from that pot in the new financial year starting next month, just when Stevens’s bold plans to “transform” how the NHS works through STPs means NHS organisations need more money for capital than before, not less – to build, for example, new community health centres and the like as care is shifted out of hospitals. | Another £1bn is expected to disappear again from that pot in the new financial year starting next month, just when Stevens’s bold plans to “transform” how the NHS works through STPs means NHS organisations need more money for capital than before, not less – to build, for example, new community health centres and the like as care is shifted out of hospitals. |
| On that, though, Stevens conceded defeat. “I’m not expecting the capital question to be resolved at this juncture,” Stevens told the 140 NHS bigwigs, doctors and policy wonks at the Nuffield Trust event. “The critical events on this are in November [when Hammond delivers his second autumn statement]. And this is a matter for the chancellor and the prime minister.” | On that, though, Stevens conceded defeat. “I’m not expecting the capital question to be resolved at this juncture,” Stevens told the 140 NHS bigwigs, doctors and policy wonks at the Nuffield Trust event. “The critical events on this are in November [when Hammond delivers his second autumn statement]. And this is a matter for the chancellor and the prime minister.” |
| But, he added: “We do need capital. We’ve said that from the get-go.” | But, he added: “We do need capital. We’ve said that from the get-go.” |
| 1.21pm GMT | 1.21pm GMT |
| 13:21 | 13:21 |
| In the playroom with 'the pink doctors' | In the playroom with 'the pink doctors' |
| Jessica Elgot | Jessica Elgot |
| Maxine Ovens and her team have enviable job titles: they are play specialists. Their domain is the soft pastel-lit playroom on the ward, with adult-sized Darth Vader models, flashing toy ambulances, paints and a soft play pen. | Maxine Ovens and her team have enviable job titles: they are play specialists. Their domain is the soft pastel-lit playroom on the ward, with adult-sized Darth Vader models, flashing toy ambulances, paints and a soft play pen. |
| They are recognisable across the ward in their pink polo shirts – one child calls them “the pink doctors”. In the playroom, medical talk is banned, it’s an escape for children and parents. | They are recognisable across the ward in their pink polo shirts – one child calls them “the pink doctors”. In the playroom, medical talk is banned, it’s an escape for children and parents. |
| “For a child, even a simple procedure can be very invasive and distressing: putting on a gown, going under anaesthetic, waking up with tubes, it’s distressing,” she said. “Our jobs is to help children get through their procedures, distract them so nurses can take blood tests, and help their recovery,” | “For a child, even a simple procedure can be very invasive and distressing: putting on a gown, going under anaesthetic, waking up with tubes, it’s distressing,” she said. “Our jobs is to help children get through their procedures, distract them so nurses can take blood tests, and help their recovery,” |
| Today, toddlers are painting pictures of pigs, or building toy houses sat on their parents’ knees, with few taking any note of their portable oxygen or bandaged hands to protect the tubes. There will be magicians, musicians and beat boxing sessions here. | Today, toddlers are painting pictures of pigs, or building toy houses sat on their parents’ knees, with few taking any note of their portable oxygen or bandaged hands to protect the tubes. There will be magicians, musicians and beat boxing sessions here. |
| “Whatever a kid wants, if they want a party, and if they’re here for a long time, we will make it happen for them,” says Maxine. She is planning to be on the march against the closures, but until then she says she does not want to let the threat distract her. | “Whatever a kid wants, if they want a party, and if they’re here for a long time, we will make it happen for them,” says Maxine. She is planning to be on the march against the closures, but until then she says she does not want to let the threat distract her. |
| “I can’t imagine how anyone could ever come in here and think this place should close. I can’t understand it. Whatever they decide, I don’t have power over that. My power is in here, and meanwhile, there are children who need our help.” | “I can’t imagine how anyone could ever come in here and think this place should close. I can’t understand it. Whatever they decide, I don’t have power over that. My power is in here, and meanwhile, there are children who need our help.” |
| 1.13pm GMT | 1.13pm GMT |
| 13:13 | 13:13 |
| The Kidderminster case study: what happens when an MP appears to oppose the local NHS | The Kidderminster case study: what happens when an MP appears to oppose the local NHS |
| As some of the stories in Sarah and Jessica’s reporting make clear, there’s a weighty emotional argument against closing any hospital service. Royal Brompton says its case is far from merely emotional, and enlists powerful, rational arguments on their side; but there are powerful, rational arguments on the other side, too. | As some of the stories in Sarah and Jessica’s reporting make clear, there’s a weighty emotional argument against closing any hospital service. Royal Brompton says its case is far from merely emotional, and enlists powerful, rational arguments on their side; but there are powerful, rational arguments on the other side, too. |
| So how should the people who genuinely believe that it is in patients’ best interests to close the unit make their case? | So how should the people who genuinely believe that it is in patients’ best interests to close the unit make their case? |
| If history is any guide, the answer is: with extreme difficulty. In January, the Observer’s chief leader writer, Sonia Sodha, made a documentary for BBC Radio 4 that offered the view that public affection for the NHS was holding back progress. One of the people she spoke to was David Lock, a Labour MP who backed controversial attempts to move some services from Kidderminster general hospital in the late 1990s. | If history is any guide, the answer is: with extreme difficulty. In January, the Observer’s chief leader writer, Sonia Sodha, made a documentary for BBC Radio 4 that offered the view that public affection for the NHS was holding back progress. One of the people she spoke to was David Lock, a Labour MP who backed controversial attempts to move some services from Kidderminster general hospital in the late 1990s. |
| Lock told Sodha he supported the changes because “the results for my constituents under the existing arrangements were appalling”. But the public took a different view, and Lock was insulted and screamed at in public, he says. | Lock told Sodha he supported the changes because “the results for my constituents under the existing arrangements were appalling”. But the public took a different view, and Lock was insulted and screamed at in public, he says. |
| In 2001 he lost his seat to Richard Taylor, a former consultant physician at Kidderminster general who campaigned on restoring its A&E – even though the data showed that since the changes the death rates for high risk vascular surgery had dropped. | In 2001 he lost his seat to Richard Taylor, a former consultant physician at Kidderminster general who campaigned on restoring its A&E – even though the data showed that since the changes the death rates for high risk vascular surgery had dropped. |
| Lock says: “I had numerous conversations with numerous individuals, all of whom were persuaded on the head case – and then they would go away and talk to somebody else about how appalling it is, and the heart would take over again.” | Lock says: “I had numerous conversations with numerous individuals, all of whom were persuaded on the head case – and then they would go away and talk to somebody else about how appalling it is, and the heart would take over again.” |
| You can listen to Sonia’s documentary here. | You can listen to Sonia’s documentary here. |
| 12.41pm GMT | 12.41pm GMT |
| 12:41 | 12:41 |
| Readers' views: 'It is necessary to close services sometimes' | Readers' views: 'It is necessary to close services sometimes' |
| Here are a few more responses from our readers on the topic of NHS hospital closures and cuts. You can add more here. | Here are a few more responses from our readers on the topic of NHS hospital closures and cuts. You can add more here. |
| Anonymous nurse, 40, from south-west England | Anonymous nurse, 40, from south-west England |
| I worked for more than 10 years in the same trust which has closed beds. Community hospitals around it have also closed and services have been centralised on a background of different parties and health ministers. Has it made any difference? We always struggled with staff retention as not many people are up for the job. Regardless of agencies filling the gaps there are not enough qualified staff. There are always escalation beds open (as we are usually running above the 85% capacity). We are always fire fighting which can’t be productive in health service. It means unpredictable fluctuations are not catered for. The plan to centralise is going to fail if there is no financial support and a plan. The problem is that planning never exceeds more than two to three years. Where is the new system getting the staff from? Where is the training? If you’re mechanic is not trained properly your engine will fail eventually. | I worked for more than 10 years in the same trust which has closed beds. Community hospitals around it have also closed and services have been centralised on a background of different parties and health ministers. Has it made any difference? We always struggled with staff retention as not many people are up for the job. Regardless of agencies filling the gaps there are not enough qualified staff. There are always escalation beds open (as we are usually running above the 85% capacity). We are always fire fighting which can’t be productive in health service. It means unpredictable fluctuations are not catered for. The plan to centralise is going to fail if there is no financial support and a plan. The problem is that planning never exceeds more than two to three years. Where is the new system getting the staff from? Where is the training? If you’re mechanic is not trained properly your engine will fail eventually. |
| Janine Brown Jones, NHS operational care staff | Janine Brown Jones, NHS operational care staff |
| It is necessary to close services sometimes. We know that to maintain the best care and most importantly safety, specialities have to have a critical mass of activity to ensure properly trained and experienced staff are delivering the care. Too little activity means poor skills. | It is necessary to close services sometimes. We know that to maintain the best care and most importantly safety, specialities have to have a critical mass of activity to ensure properly trained and experienced staff are delivering the care. Too little activity means poor skills. |
| Stroke services for instance – it has been shown that traveling a little further to a specialist stroke unit leads to better outcomes than admission to a local general unit. Maternity services also need to have at least 2,000 births a year to be viable, but more to ensure better obstetric care. But in this case it’s important to remember that the majority of births don’t need obstetric care. In fact for a “normal” labour, midwifery led care has better outcomes. Don’t get me wrong, I’m in grief about what’s happening in our NHS right now, but I can’t jump on the bandwagon of “we must keep all services open everywhere”. | Stroke services for instance – it has been shown that traveling a little further to a specialist stroke unit leads to better outcomes than admission to a local general unit. Maternity services also need to have at least 2,000 births a year to be viable, but more to ensure better obstetric care. But in this case it’s important to remember that the majority of births don’t need obstetric care. In fact for a “normal” labour, midwifery led care has better outcomes. Don’t get me wrong, I’m in grief about what’s happening in our NHS right now, but I can’t jump on the bandwagon of “we must keep all services open everywhere”. |
| In my career (started as a nurse, worked my way up in operational care) I was involved in difficult decisions about centralising services, but always in the interests of improving outcomes for patients and with real public involvement and consultation. | In my career (started as a nurse, worked my way up in operational care) I was involved in difficult decisions about centralising services, but always in the interests of improving outcomes for patients and with real public involvement and consultation. |
| Updated | Updated |
| at 12.43pm GMT | at 12.43pm GMT |
| 12.26pm GMT | 12.26pm GMT |
| 12:26 | 12:26 |
| 'Babies look so fragile, but they are tough, so so tough' | 'Babies look so fragile, but they are tough, so so tough' |
| Jessica Elgot | Jessica Elgot |
| Mason Jay Nastor underwent his first open heart surgery when he was just six days old. His mother Rupinder, 36, was 20 weeks pregnant when she got the diagnosis that her baby son would have hypoplastic left heart syndrome, and that he would be spending his first months in the Royal Brompton. | Mason Jay Nastor underwent his first open heart surgery when he was just six days old. His mother Rupinder, 36, was 20 weeks pregnant when she got the diagnosis that her baby son would have hypoplastic left heart syndrome, and that he would be spending his first months in the Royal Brompton. |
| She gave birth at Chelsea and Westminster hospital, and the family were transferred immediately over. | She gave birth at Chelsea and Westminster hospital, and the family were transferred immediately over. |
| “Your brain is going at 100 miles an hour, people are telling you what to expect and it is hard to process,” her husband Benson, 27, said. “I don’t know much about the medical terminology, but having it explained, coming here before he was born, that was such a help. At least you can imagine the place you’re going to be. He’s a Brompton baby,” Rupinder said. | “Your brain is going at 100 miles an hour, people are telling you what to expect and it is hard to process,” her husband Benson, 27, said. “I don’t know much about the medical terminology, but having it explained, coming here before he was born, that was such a help. At least you can imagine the place you’re going to be. He’s a Brompton baby,” Rupinder said. |
| Now just over two weeks old, Mason’s chest is still open and bandaged from the surgery. The new parents had cuddles before he went under, but now all they can do is watch, and stroke his eyelids. | Now just over two weeks old, Mason’s chest is still open and bandaged from the surgery. The new parents had cuddles before he went under, but now all they can do is watch, and stroke his eyelids. |
| “He didn’t open his eyes after he was born,” Benson said. “We really wanted him to look at us before he went into surgery and just the day before he opened them. We were so grateful for that, you look into his eyes, you can see into their soul. Babies look so fragile, but they are tough, so so tough.” | “He didn’t open his eyes after he was born,” Benson said. “We really wanted him to look at us before he went into surgery and just the day before he opened them. We were so grateful for that, you look into his eyes, you can see into their soul. Babies look so fragile, but they are tough, so so tough.” |
| If recovery goes well, Mason will need surgery again when he is two to four months old, and again when he is two years old. The parents are keeping their fingers crossed that the unit will still be open for them to return to. “I can’t understand at all why they would be thinking of closing this place.” | If recovery goes well, Mason will need surgery again when he is two to four months old, and again when he is two years old. The parents are keeping their fingers crossed that the unit will still be open for them to return to. “I can’t understand at all why they would be thinking of closing this place.” |
| 12.24pm GMT | 12.24pm GMT |
| 12:24 | 12:24 |
| 12.01pm GMT | 12.01pm GMT |
| 12:01 | 12:01 |
| What are sustainability and transformation plans (STPs)? | What are sustainability and transformation plans (STPs)? |
| It is impossible to talk about the closure of NHS services without quickly hearing the initials STP. Sustainability and transformation plans are the controversial engine by which the NHS is trying to manage its costs and build a service with a stable future by 2020. | It is impossible to talk about the closure of NHS services without quickly hearing the initials STP. Sustainability and transformation plans are the controversial engine by which the NHS is trying to manage its costs and build a service with a stable future by 2020. |
| It is important to note the critical difference from what’s going on at Royal Brompton; STPs are explicitly related to making the NHS more financially sustainable and making the £22bn of necessary cuts. The mooted changes at Royal Brompton and elsewhere are, the NHS says, an argument about the best clinical outcome for patients. | It is important to note the critical difference from what’s going on at Royal Brompton; STPs are explicitly related to making the NHS more financially sustainable and making the £22bn of necessary cuts. The mooted changes at Royal Brompton and elsewhere are, the NHS says, an argument about the best clinical outcome for patients. |
| If STP doesn’t mean a lot to you, read Denis Campbell’s excellent explanatory piece about the plans here. | If STP doesn’t mean a lot to you, read Denis Campbell’s excellent explanatory piece about the plans here. |
| 11.35am GMT | 11.35am GMT |
| 11:35 | 11:35 |
| The case for closure: 'We need to go for a world-class service' | The case for closure: 'We need to go for a world-class service' |
| When the closure of some children’s heart surgery units was first mooted, in the wake of the unnecessary deaths of babies in Bristol, the rationale was safety. | When the closure of some children’s heart surgery units was first mooted, in the wake of the unnecessary deaths of babies in Bristol, the rationale was safety. |
| Today, every unit is safe, says Prof Huon Gray, the NHS national clinical director for heart disease, who argues that the closures at Brompton and in Leicester are necessary because the ambition is “to future-proof the service” by making it as good as it can be. | Today, every unit is safe, says Prof Huon Gray, the NHS national clinical director for heart disease, who argues that the closures at Brompton and in Leicester are necessary because the ambition is “to future-proof the service” by making it as good as it can be. |
| “We need to go for a world-class service, as opposed to one that is satisfactory or adequate.” | “We need to go for a world-class service, as opposed to one that is satisfactory or adequate.” |
| NHS surgeons need to be operating regularly to keep up their skills, as ever more complex operations on babies become possible. By 2021, says NHS England, there must be a minimum of four cardiac surgeons in a unit, to allow for a proper on-call rota. They must perform between them at least 500 operations a year, which is about three each every week. That is a minimum, says Gray. | NHS surgeons need to be operating regularly to keep up their skills, as ever more complex operations on babies become possible. By 2021, says NHS England, there must be a minimum of four cardiac surgeons in a unit, to allow for a proper on-call rota. They must perform between them at least 500 operations a year, which is about three each every week. That is a minimum, says Gray. |
| Also important is having all the support services on the same hospital site. Many babies born with heart defects also have other health problems. It has to be possible to diagnose and treat the whole child in one place, Gray argues. | Also important is having all the support services on the same hospital site. Many babies born with heart defects also have other health problems. It has to be possible to diagnose and treat the whole child in one place, Gray argues. |
| The Royal College of Paediatrics and Child Health as well as the Royal College of Surgery agree co-location is key. “If I were a parent sitting beside the bed with a child who needed other specialist input, I would feel much more comfortable knowing that it was two floors down,” Gray says. | The Royal College of Paediatrics and Child Health as well as the Royal College of Surgery agree co-location is key. “If I were a parent sitting beside the bed with a child who needed other specialist input, I would feel much more comfortable knowing that it was two floors down,” Gray says. |
| The standards that set this out have been discussed and consulted on since 2013. Everybody who could have an interest, from patients to families to nursing staff and doctors and charities has had their say. “I find it difficult to know how much more one could do to involve everyone who has an interest in the topic,” said Gray. | The standards that set this out have been discussed and consulted on since 2013. Everybody who could have an interest, from patients to families to nursing staff and doctors and charities has had their say. “I find it difficult to know how much more one could do to involve everyone who has an interest in the topic,” said Gray. |
| He understands, he says, the upset at the Brompton and in Leicester. “Their services, as judged by mortality data, are safe.” But, he says, “that is a different argument from saying do we think in the future we could do better when children are born with a complex cardiac disease where treatment previously would not have been thought feasible.” | He understands, he says, the upset at the Brompton and in Leicester. “Their services, as judged by mortality data, are safe.” But, he says, “that is a different argument from saying do we think in the future we could do better when children are born with a complex cardiac disease where treatment previously would not have been thought feasible.” |
| Updated | Updated |
| at 11.35am GMT | at 11.35am GMT |
| 11.16am GMT | 11.16am GMT |
| 11:16 | 11:16 |
| War-gaming emergencies with dummies that bleed | War-gaming emergencies with dummies that bleed |
| Jessica Elgot | Jessica Elgot |
| Dr Margarita Burmester, a paediatric intensive care consultant, specialises in plastic patients. | Dr Margarita Burmester, a paediatric intensive care consultant, specialises in plastic patients. |
| She and a team of staff from across departments, from surgeons to doctors, anaesthetists and healthcare assistants have developed a unique emergency simulation, with life-like patient dummies who bleed when surgeons open their chests. | She and a team of staff from across departments, from surgeons to doctors, anaesthetists and healthcare assistants have developed a unique emergency simulation, with life-like patient dummies who bleed when surgeons open their chests. |
| The simulation, called Sprint, runs once a week, role-playing emergency scenarios to help doctors and nurses identify the pitfalls for when emergencies occur for real. | The simulation, called Sprint, runs once a week, role-playing emergency scenarios to help doctors and nurses identify the pitfalls for when emergencies occur for real. |
| “Often the problem in emergency isn’t the skills, it’s the system,” she says. Filming a healthcare assistant going through the rigmarole of collecting blood from the a lab, while a dummy patient was experience catastrophic haemorrhaging, meant doctors could see for the first time how the process worked – and how slow it could be. “Now we have cut down the process from four minutes to eight seconds – that can be absolutely crucial.” Working across departments has also been key. | “Often the problem in emergency isn’t the skills, it’s the system,” she says. Filming a healthcare assistant going through the rigmarole of collecting blood from the a lab, while a dummy patient was experience catastrophic haemorrhaging, meant doctors could see for the first time how the process worked – and how slow it could be. “Now we have cut down the process from four minutes to eight seconds – that can be absolutely crucial.” Working across departments has also been key. |
| “This is an intense environment, it is common for emergency scenarios to lead to conflict. And in a real emergency, no one has time to think afterwards how this could be done better,” she says. “This gives you time for you to do just that.” | “This is an intense environment, it is common for emergency scenarios to lead to conflict. And in a real emergency, no one has time to think afterwards how this could be done better,” she says. “This gives you time for you to do just that.” |
| The simulation has been clinically proven to improve patient safety, and Burmester’s close-knit team now educate other medical staff nationally. She is extremely worried about the implications for the system, developed over a decade, if the unit was to close. | The simulation has been clinically proven to improve patient safety, and Burmester’s close-knit team now educate other medical staff nationally. She is extremely worried about the implications for the system, developed over a decade, if the unit was to close. |
| This kind of simulation can take three to five years to become part of the culture, once staff have bought into the idea. Culture in places can be very different and there can be resistant. Yes if the unit closed I could go elsewhere, but this team wouldn’t be together any more, and it would take years to replicate what we have built here. | This kind of simulation can take three to five years to become part of the culture, once staff have bought into the idea. Culture in places can be very different and there can be resistant. Yes if the unit closed I could go elsewhere, but this team wouldn’t be together any more, and it would take years to replicate what we have built here. |
| 11.08am GMT | 11.08am GMT |
| 11:08 | 11:08 |
| The Royal Brompton views the threat to decommission its heart services with mystification, because it rests on one failed standard – “co-location” – out of 470 that does meet. | The Royal Brompton views the threat to decommission its heart services with mystification, because it rests on one failed standard – “co-location” – out of 470 that does meet. |
| This standard requires that certain children’s services are all in the same place. But the Royal Brompton says that it works seamlessly with the nearby Chelsea and Westminster for these linked services, and that there is no evidence that co-location ensures better performance. | This standard requires that certain children’s services are all in the same place. But the Royal Brompton says that it works seamlessly with the nearby Chelsea and Westminster for these linked services, and that there is no evidence that co-location ensures better performance. |
| It also says that the data shows it’s among the biggest, best and safest congenital heart disease services in the world – and that the changes wouldn’t improve standards. | It also says that the data shows it’s among the biggest, best and safest congenital heart disease services in the world – and that the changes wouldn’t improve standards. |
| Families, patients and doctors share the same strong view. Parents are supremely loyal – like Steve Marwood, who credits Brompton’s paediatric intensive care unit with saving his daughter Honor. He fears that her life will be more difficult if outpatient services close and is trying to raise £40,000 for the hospital. On March 18, there’ll be a public demo against the plans. | Families, patients and doctors share the same strong view. Parents are supremely loyal – like Steve Marwood, who credits Brompton’s paediatric intensive care unit with saving his daughter Honor. He fears that her life will be more difficult if outpatient services close and is trying to raise £40,000 for the hospital. On March 18, there’ll be a public demo against the plans. |
| And many supporters share the view of the pioneering surgeon Prof Sir Magdi Yacoub: | And many supporters share the view of the pioneering surgeon Prof Sir Magdi Yacoub: |
| It hurts me a lot to see centres of excellence being shut for convenience, for planning purposes, because it doesn’t fit on a piece of paper somewhere in the ministry. When you have a tradition of excellence in one place, please don’t destroy it. It’s very sad to see so-called planners wanting to have ‘optimised services’, saying they don’t like this here and they might put it there. | It hurts me a lot to see centres of excellence being shut for convenience, for planning purposes, because it doesn’t fit on a piece of paper somewhere in the ministry. When you have a tradition of excellence in one place, please don’t destroy it. It’s very sad to see so-called planners wanting to have ‘optimised services’, saying they don’t like this here and they might put it there. |
| Updated | Updated |
| at 11.12am GMT | at 11.12am GMT |
| 11.01am GMT | 11.01am GMT |
| 11:01 | 11:01 |
| Child heart units: the picture across England | Child heart units: the picture across England |
| Sarah Boseley | Sarah Boseley |
| Royal Brompton isn’t the only hospital facing a loss of services. After some 200 standards governing care were set out in 2013, hospitals providing heart surgery were assessed across the country. NHS England decided that four did not meet the standards: Royal Brompton in London; the Glenfield hospital in Leicester; Newcastle; and Manchester, which only does adult surgery. | Royal Brompton isn’t the only hospital facing a loss of services. After some 200 standards governing care were set out in 2013, hospitals providing heart surgery were assessed across the country. NHS England decided that four did not meet the standards: Royal Brompton in London; the Glenfield hospital in Leicester; Newcastle; and Manchester, which only does adult surgery. |
| Newcastle has been given more time to meet the criteria because of the specialised work it carries out. The other three units are slated to close under proposals published in February. The University Hospitals of Leicester NHS trust missed two standards – it carried out 326 operations in 2015-16, when the minimum number to ensure high quality was 375, and like Royal Brompton, it did not have all the children’s services it needed on one site. | Newcastle has been given more time to meet the criteria because of the specialised work it carries out. The other three units are slated to close under proposals published in February. The University Hospitals of Leicester NHS trust missed two standards – it carried out 326 operations in 2015-16, when the minimum number to ensure high quality was 375, and like Royal Brompton, it did not have all the children’s services it needed on one site. |
| Neither hospital is going quietly. Just as Royal Brompton is organising a demonstration in a fortnight’s time, a thousand people were reported as marching for the Glenfield heart unit in Leicester, and nearly 25,000 have signed a petition calling for it to be saved. | Neither hospital is going quietly. Just as Royal Brompton is organising a demonstration in a fortnight’s time, a thousand people were reported as marching for the Glenfield heart unit in Leicester, and nearly 25,000 have signed a petition calling for it to be saved. |
| You can read our story from July last year about the announcement of plans to close the units here. | You can read our story from July last year about the announcement of plans to close the units here. |
| 10.53am GMT | 10.53am GMT |
| 10:53 | 10:53 |
| 'For a boy with only one working lung he’s amazing' | 'For a boy with only one working lung he’s amazing' |
| Sarah Boseley | Sarah Boseley |
| Two-year-old Ieuan from Little Hampton has been treated for a collapsed lung since he was 7 months old. He is in hospital to assess the problem and if the doctors are not happy with his progress then he may have a lobectomy. | Two-year-old Ieuan from Little Hampton has been treated for a collapsed lung since he was 7 months old. He is in hospital to assess the problem and if the doctors are not happy with his progress then he may have a lobectomy. |
| “He’s like a little tornado,” says his mother, Lisa Barnard. “For a boy with only one working lung he’s amazing. Absolutely amazing. He’s going into theatre soon and I can go for a coffee!” | “He’s like a little tornado,” says his mother, Lisa Barnard. “For a boy with only one working lung he’s amazing. Absolutely amazing. He’s going into theatre soon and I can go for a coffee!” |
| Updated | Updated |
| at 10.54am GMT | at 10.54am GMT |
| 10.42am GMT | 10.42am GMT |
| 10:42 | 10:42 |
| Sarah Marsh | Sarah Marsh |
| We have been hearing from our readers on the question of whether hospital closures are ever necessary to improve patient care. Lots of you have been sending over your stories. Here are two interesting perspectives. Add your views here. | We have been hearing from our readers on the question of whether hospital closures are ever necessary to improve patient care. Lots of you have been sending over your stories. Here are two interesting perspectives. Add your views here. |
| Anonymous, 55, NHS operating theatre technician | Anonymous, 55, NHS operating theatre technician |
| There is a case for concentrating some services, much as I hate to admit it. This is especially true in areas of the country that have quite a few hospitals close to each other. From my front door, there are four hospitals within 10 miles, not to mention a few smaller hospitals with minor injury units. | There is a case for concentrating some services, much as I hate to admit it. This is especially true in areas of the country that have quite a few hospitals close to each other. From my front door, there are four hospitals within 10 miles, not to mention a few smaller hospitals with minor injury units. |
| Having said that nobody wants their local hospital downgraded and in more rural areas it’s a different matter. My local A&E (which is under threat) is also currently treating patients in corridors due to high demand so it’s difficult to see how it could close. | Having said that nobody wants their local hospital downgraded and in more rural areas it’s a different matter. My local A&E (which is under threat) is also currently treating patients in corridors due to high demand so it’s difficult to see how it could close. |
| Kirsty Davies-Duddy, assistant headteacher, 36, from Surrey | Kirsty Davies-Duddy, assistant headteacher, 36, from Surrey |
| Our son, now aged three, had emergency open heart surgery at The Royal Brompton at 13 weeks old. The level of expertise, knowledge, care and dedication shown by the staff is incredible. The comfort we take from knowing that if our son needs more surgery, it will be undertaken at the Royal Brompton can not be taken for granted. Knowing that the hospital that saved our son’s life (and could potentially save it again) could close is unsettling. | Our son, now aged three, had emergency open heart surgery at The Royal Brompton at 13 weeks old. The level of expertise, knowledge, care and dedication shown by the staff is incredible. The comfort we take from knowing that if our son needs more surgery, it will be undertaken at the Royal Brompton can not be taken for granted. Knowing that the hospital that saved our son’s life (and could potentially save it again) could close is unsettling. |
| Updated | Updated |
| at 10.50am GMT | at 10.50am GMT |