Fewer hospitals in England should perform children’s heart surgery

Public consultation starts later this month on four newly published options to reduce the number of hospitals in England providing children’s heart surgery from 11 to six or seven.

Safe and Sustainable—the NHS review into the future of children’s congenital heart services in England—put forward the proposals on 16 February. New quality standards are also proposed to ensure better care and survival rates.

While specialist surgical care would be centralised, the NHS would like more expert assessment and ongoing care services closer to families’ homes. The four month consultation launches on 28 February and a final decision will be made later this year.

All centres would need at least four consultant congenital heart surgeons treating the ideal minimum of 500 children each year. Rather than closing, surgical centres that do not provide children’s heart surgery would provide children’s cardiology instead, the review added.

All children’s congenital heart services would be coordinated by congenital heart networks, managed and led by clinicians. According to the review, this would “provide better coordination of the existing fragmented services as well as strengthened local services, meaning that many children would no longer need to travel long distances for cardiology services.”

In line with an interim recommendation made last October (BMJ 2010;341:c5863; doi: 10.1136/bmj.c5863), the review recommends that the lowest ranking centre—the John Radcliffe Hospital in Oxford—should not be considered viable in any of the four options. It recommends that London should be served by two—not three—surgical centres. The preferred configuration in London is that Great Ormond Street Hospital and the Evelina Children’s Hospital would remain surgical centres, with the Royal Brompton Hospital envisaged as a children’s cardiology centre. All other centres are included in at least one of the options.

The recommendations in the review have been agreed by a committee of NHS specialist commissioners from across England, known as the Joint Committee of Primary Care Trusts. Leslie Hamilton, vice chairman of the Safe and Sustainable steering group and immediate past president for the Society for Cardiothoracic Surgery, said: “These changes are about saving lives—not saving money.”

In a joint response, the Royal College of Surgeons and the Society of Cardiothoracic Surgery said they support the plans, but they emphasised the importance of wide public consultation. Condensing expertise in fewer units, with the critical number of staff to support each other, disseminate new techniques and train the next generation of specialists, would provide a better service, the response concluded.

The Royal Brompton and Harefield NHS Foundation Trust said it was disturbed to learn that the proposed London re-configuration recommends it should cease to provide children’s heart services. The trust said that clinical teams from the Royal Brompton are “recognised internationally for the quality of their specialist paediatric care, the trust’s congenital heart service has an excellent safety record and mortality rates are less than half the national average (0.9% versus 2%).”

Deputy policy director of the NHS Confederation Jo Webber said: “This is not about cuts to services or indeed the closure of centres because they are failing to do the best they can. It is about concentrating the very best skills and experience in a smaller number of locations, where a truly world class level of care can be provided for every patient.”