Radcliffe should stop doing children’s heart surgery, review recommends

An NHS review of children’s congenital heart services in England has made an interim recommendation that cardiac surgery should no longer be carried out at the John Radcliffe Hospital in Oxford.

The recommendation was made after a meeting on Friday 14 October of the steering group of the NHS safe and sustainable review team, which is considering how to deliver high quality children’s congenital cardiac services. It is chaired by Patricia Hamilton, president of the Royal College of Paediatrics and Child Health.

The team had considered an independent assessment led by Ian Kennedy, emeritus professor of health law at University College London, of all 11 hospitals in England that provide children’s heart surgery services.

Heart operations on children were suspended at John Radcliffe Hospital earlier this year after four babies died within a few months of a new surgeon starting work there. An independent review of paediatric cardiac surgery and clinical governance at the Oxford centre was published this July. It concluded that the newly appointed consultant surgeon, Caner Salih, was not to blame but said that a lack of effective clinical management and poor mentoring contributed to the infants’ deaths (BMJ 2010;341:c4157, doi:10.1136/bmj.c4157).

In a press statement NHS Specialised Services, the body responsible for commissioning specialised services for children and adults with rare conditions, said that the steering group had made its interim recommendation after “robust consideration” of the assessment carried out by Professor Kennedy and his panel of experts.

The statement added: “The service at the John Radcliffe Hospital received the lowest ranking assessment of the current 11 centres by a significant margin. Oxford is therefore the least likely of the 11 surgical centres to meet all the new quality standards for children’s heart surgery.

“Therefore the NHS review will recommend that it should not be included in any potential configuration option for surgery.” It is, however, proposed that the Oxford centre will continue to offer specialised cardiology services for children.

The NHS review team also looked at whether the hospital’s location could justify its inclusion in potential options on the grounds of access for children and families. According to the statement, the analysis had shown that this was not the case.

In the next few months the NHS will agree recommendations for pooling surgical expertise into fewer and larger surgical centres as part of a network of care for children’s congenital heart services. Recommendations will be published and will go to full public consultation in 2011. The statement from NHS Specialised Services said that a final decision about the future of all the centres will not be made until the outcome of the public consultation has been considered.

The John Radcliffe Hospital said in a statement that the closure was “very disappointing news for Oxford.” It added that although the centre is one of the smallest children’s heart surgery centres in the country, it had hoped that the safe and sustainable team would “recognise the potential that Oxford has in terms of geographical location and the presence of other connected clinical services on site.”

Patients, their families, and staff should stay involved in shaping the future of these services when the formal consultation begins in the New Year, said the statement. The Oxford Radcliffe Hospitals NHS Trust board would want to continue discussions with the safe and sustainable team about the future of specialist children’s heart services, it added.