[UPDATE] Pediatric heart surgery unit of Royal Brompton faces closure

By Dr. Ananya Mandal, MDMar 18 2011

A London NHS trust would challenge proposals to end child heart surgery at the Royal Brompton Hospital. The Royal Brompton and Harefield NHS Foundation Trust added that this would mean the loss of other services, which could call into question its viability.

This followed an NHS 'Safe and Sustainable' review into child heart units that proposed stopping operations at either four or five hospitals, including the Royal Brompton. But the trust has branded the recommendations “fundamentally flawed”. The Joint Committee of PCTs (JCPCT) has proposed four options - all of which involve stopping operations at either four or five hospitals.

At present a total 11 units are under review including services at three London hospitals – including the Evelina Children's Hospital, Great Ormond Street Hospital for Children and the Royal Brompton Hospital. A final decision will be made in the autumn following a public consultation.

The board is not convinced. They said that the recommended options put for consultation were so flawed that a consultation based on them would be “unlawful”. They also questioned the fact that the main body influencing the decision to reduce London's three centres to two included representatives from the other two London hospitals under review, but not any from Royal Brompton. It alleged that representatives from Great Ormond Street and the Evelina played an active role in the decision which favored their own centers at the expense of Royal Brompton.

In an understandable next step, the trust is now applying for judicial review, challenging the legality of the consultation. Two separate approaches have been made to the JCPCT in order to avoid legal action. The trust said that the first request to delay the start of the consultation was rejected and that the JCPCT failed to respond to a request to suspend the consultation while its concerns were heard. A spokesperson for the trust, said, “Although this is a decision we have taken with the greatest reluctance and regret, we feel we have no alternative but to act in the interests of our patients…What we cannot accept is that a large, successful centre like Royal Brompton is not even included as an option in the consultation process, despite it being of the required size and despite its impressive record.”

The Royal Brompton and Harefield NHS Foundation Trust is the largest specialist heart and lung centre in the UK and among the largest such centers in Europe.

[UPDATE 18th March] From the communications team for NHS Safe and Sustainable review of children’s heart services.

Teresa Moss, Director of the National Specialised Commissioning Team, said:

Safe and Sustainable is about improving outcomes for children with congenital heart disease and we do not see a reason to delay such an important consultation. We are also disappointed that the Royal Brompton & Harefield NHS Foundation Trust (RB&H) would seek to put a halt to the consultation. The inherent risks of the current system were brought to the public’s attention following the tragic deaths of children in Bristol. The landmark Bristol inquiry in 2001 and subsequent reports have highlighted the need for pooling surgical teams in fewer hospitals to improve the quality of care and survival rates for children. There is an obvious rationale behind the proposal for two London centres and we stand ready to defend the robust way in which the recommendations for public consultation have been reached.

 When developing the recommendations for change the Joint Committee of Primary Care Trusts was aware that if the Royal Brompton Hospital no longer carried out surgery there would be an impact on its paediatric intensive care unit. Due to the higher numbers of cardiac cases treated at the unit it was deemed less of a risk than those units that see higher numbers of non-cardiac cases. All information submitted by the Trust, including the impact to PICU and other services was considered by the JCPCT. Consultation provides the appropriate opportunity for further analysis on the impact to non-cardiac children who use the Brompton’s PICU and we have acknowledged this in the consultation document.

 As recently as 2009 the Royal Brompton & Harefield NHS Foundation Trust co-authored a very detailed report (with Great Ormond Street Hospital NHS Trust) where Board members and clinicians from the RB&H showed considerable support in principle for the proposal for two children’s cardiac centres in London. The report, entitled ‘A collaboration between Royal Brompton & Harefield NHS Trust (RB&H) and Great Ormond Street Children’s Hospital (GOSH) children’s heart and lung services’ explored the possibility of collaboration and integration of a national children’s cardiac and respiratory services on a single site at GOSH. The report highlights that the integration of services would optimise patient outcomes, quality of care and the quality of the service as well as improve the quality of working lives and training and development opportunities for staff. A Joint Steering Board which comprised clinicians representing each Trust also considered the re-location of other services. It was concluded that re-location and integration of these services was possible, and even favoured, including cystic fibrosis services.’

It is extremely disappointing that we find ourselves having to defend the integrity of senior NHS clinicians on the Steering Group who have provided only the most professional and impartial of advice to the Joint Committee of Primary Care Trusts (JCPCT). Allegations made by the Royal Brompton & Harefield NHS Foundation Trust (RB&H) that Steering Group members may have influenced the proposals recommended by the JCPCT are unfounded and a blow to esteemed colleagues. All members of the Steering Group represented their respective professional associations and were asked to advise from a national perspective on clinical issues, but never on particular hospital configurations.

No decisions on the future of the service at the Royal Brompton Hospital have been made. Safe and Sustainable continues to consult with parents, staff and hospitals to ask for their views on how many centres should continue to provide surgical services in London and which centres they should be. This consultation provides the NHS with a real opportunity to change the way children’s congenital heart services are delivered for the better and it is saddening that instead of taking this opportunity we find one NHS organisation taking another to court. However, NHS London and London Specialised Commissioning have expressed their willingness to pick up conversations with the three existing London centres following the Trusts’ agreement in principle for a network of care across the three providers based on two surgical sites.