Children’s Heart Federation (CHF) accepts that in order to achieve the highest possible clinical standards in children’s heart surgery, there needs to be a reorganisation of the national paediatric heart care service that results in fewer, larger surgical units, each of which would have a team of at least four surgeons working together performing, as a unit, at least 400 operations a year. This means that some of the specialist heart care units currently offering surgery will no longer do so in the future.
We have confidence that the expert panel chaired by Sir Ian Kennedy, which reviewed every surgical unit earlier this year, adopted a rigorous and impartial approach. We also accept the logic that patient flows to units would work well even if Oxford were not part of the national configuration of surgical units. CHF therefore accepts the recommendation that Oxford should not be included in the set of options presented for public consultation next year as part of the NHS Safe and Sustainable Children’s Heart Surgery programme.
At the same time, we fully support the right of any CHF member group to lobby on behalf of the unit or units with which they have a close relationship. We understand that parents who are members of the Oxford Group (Young Hearts) feel very strongly that the Oxford Unit has provided excellent care to their children. The culture of recognition and support for family members’ needs has obviously been strong at Oxford – and is something all units should work hard at, as excellence depends both on clinical performance and the quality of the service user’s experience.
It appears from close inspection of the Oxford unit that working practices and equipment were out of date and fell well behind best practice elsewhere. A small surgical team (one or sometimes two surgeons) is not sufficiently large to cope every day, all year round, with planned and emergency surgery and give the surgeon enough time away from the unit to stay refreshed and up to date with the latest techniques.
From the point of view of safety, efficiency (fewer cancellations) and sustainability longer term, larger surgical teams are better placed to respond to the paediatric cardiac caseload. As a national organisation, CHF does not lobby on behalf of any particular unit, but rather presses for all those units that provide surgery to meet the consensus standards and be geographically placed to ensure fair access to care, so that no family has a disproportionate distance to travel for surgery.
CHF welcomes the assurances we have received from the NHS throughout the lifetime of the Safe and Sustainable programme that although surgery will be consolidated into fewer centres, the network of cardiology services that provide ongoing support should grow and be strengthened, so that they will be better developed at local level. We hope that this will reassure parents that travelling will be kept to a minimum.
We appreciate that hearing of poor results from a surgical unit can be disorientating for parents, but trust that greater openness about performance will enable weaknesses in the system to be addressed in order to drive up standards, and that this is a better approach than turning a blind eye to problems.
Whatever the challenges of changing the children’s heart care system to achieve consistently high quality results, CHF strongly urges politicians, clinicians, support groups, service planners and parents to back the implementation of the Safe and Sustainable standards, for the sake of the babies and children who will need life-saving heart surgery in the future.
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Notes for editors:
Approximately 5000 babies in the UK are born with a heart condition each year, with a further 1000 developing a serious heart problem after birth.
The Children`s Heart Federation (CHF) is an umbrella body with 21 member organisations that support children and young people with heart defects from birth or acquired in childhood and their families in the UK and Ireland. CHF provides information and support through its freephone helpline 0808 808 5000, open Monday to Friday and its websitehttps://www.chfed.org.uk
The NHS is currently reviewing services related to children’s heart surgery across England. This reconfiguration programme, known as Safe and Sustainable Children’s Heart Surgery in England, is expected to lead to fewer, larger centres that provide surgery, after the publication of recommendations early next yearhttp://www.ncg.nhs.uk/safe_sustainable/childrens-congenital-cardiac-services