It has taken a dozen years, involved one of the worst scandals in the NHS’s history and involved five reports. But today, the national plan to concentrate children’s heart surgery in fewer centres for safety reasons was torn up and its architects sent back to the drawing board.
The Health Secretary, Jeremy Hunt, announced in the Commons that he was suspending the controversial reform, which would have seen the number of hospitals providing surgery reduced from 10 to seven, following the latest of the five reports which said it was based on a “flawed analysis”.
Children’s heart charities reacted angrily. Anne Keatley-Clarke, the chief executive of the Children’s Heart Federation, said: “For the past 12 years, ever since the Bristol baby tragedy, we’ve been campaigning to ensure that another crisis in the care of vulnerable children can never be allowed to happen. It has been really disappointing to see the implementation of the necessary improvements delayed. We want all heart-children, wherever they live in England, to have access to an excellent service.”
Professor Norman Williams, the President of the Royal College of Surgeons, said: “We are extremely disappointed that the reform plans aimed at providing the best possible heart surgery for very sick children will be suspended. We understand that there were flaws in the process; however, no process will ever satisfy everyone.”
The controversial plans to shut three of the 10 units were drawn up by the Safe and Sustainable Review, on behalf of NHS commissioners, which began examining children’s heart surgery provision in 2008. That followed the 2001 inquiry by Sir Ian Kennedy into the Bristol children’s heart surgery disaster in which scores of babies died or were maimed by sub-standard treatment. The report concluded that lives had been sacrificed to maintain the hospital’s status as a specialist heart unit.
A follow-up report by Sir Ian, published in 2011, ranked the units according to the quality and safety of the service they provided. The Safe and Sustainable Review proposed the closure of the Royal Brompton hospital, London, Glenfield hospital in Leicester, and Leeds General Infirmary, but it provoked fury among doctors and patients and led to the first legal clashes between NHS bodies.
Last month a High Court judge quashed the decision to stop surgery in Leeds saying the consultation was “flawed and ill judged”.
Mr Hunt had earlier ordered an independent review of the closure decisions – the fifth examination of the issue – in response to protests from MPs. The report by the Independent Reconfiguration Panel, published today, backed the need for change saying heart surgery should “only be provided by specialist teams large enough to sustain a comprehensive range of interventions, round the clock”.
But it said the plans were “incomplete” and left “too many questions” because they failed to take account of adult cardiac surgery and the need to consider the “whole pathway” of patient care.
Mr Hunt said “This is clearly a serious criticism of the Safe and Sustainable process. I therefore accept their recommendation that the proposals cannot go ahead in their current form and am suspending the review today.” But he added that it was “not a mandate for the status quo or for going back over all the ground already covered over the last five years” because the original argument for improving care was unchanged.
It has been recognised for years that hospitals must carry out a minimum number of operations a year to ensure that doctors and surgeons maintain their skills. This number is put at around 500 for children’s heart surgery. With such 3,600 operations annually in the UK, the arithmetic dictates a maximum of seven children’s cardiac surgery units.
Mr Hunt set a deadline of the end of July for NHS England, which took over responsibility for the Safe and Sustainable Review in April, to come up with the next steps in the process.
Fit for purpose? Reprieved
Royal Brompton, London
Ending children’s heart surgery here would have meant closing the paediatric intensive care unit. As Europe’s leading centre for cystic fibrosis, the Brompton attracts complex cases where children may require treatment in intensive care. The knock-on effects were not fully assessed, the report said.
Leeds General Infirmary
The big concern of families served by the Leeds centre was the extra travelling time to Newcastle. The report said the extra travel time involved had been underestimated and there would be a “disproportionate” impact on families in Yorkshire, Humberside and Lincolnshire.
Glenfield Hospital, Leicester
The same surgeons carry out adult and paediatric heart surgery – so the closure of children’s services would threaten the future of adult services and risk continuity for adolescents. The report said a single review of adult and children’s heart surgery would have enabled “better solutions”.