16 February 2011 (updated 1 March 2011)
At a meeting of the Joint Committee of Primary Care Trusts today, a report on the ‘Safe and Sustainable’ review into children’s heart surgery was published, which included a recommendation to discontinue children’s heart surgery at Royal Brompton Hospital.
Clinical teams from 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%). Over 9,000 procedures for children were carried out by our experts in 2010, with 453 cardiac operations undertaken – many of them complex procedures on newborn babies.
The Trust’s chief executive, Mr Bob Bell, commented: “Although we have been aware of rumours for some time, we believed that closing down such a high-performing children’s service would not be seen as a viable option.. Our weighted score of joint fourth out of ten, with Great Ormond Street, in Sir Ian Kennedy’s assessment report of all centres in England, suggests to us that our service is robust and fit for purpose.
“As part of the Safe and Sustainable review process, the three London centres submitted a joint plan for a formal networking arrangement to be explored, so that good working relationships could become better. Prior to that, in April 2009, a proposal to establish a national service for children with heart and lung disease was developed by ourselves and Great Ormond Street. Both proposals found a way of creating a more joined-up service without the need for major re-configurations with the significant disruption and cost that this would involve.
“Of major concern to the Trust is the effect that the removal of paediatric cardiac care would have on other services both for children and adults. Paediatric cardiac services do not exist in a vacuum. They are supported by other disciplines such as intensive care and anaesthesia.
“If paediatric cardiac services are moved from Royal Brompton, our paediatric intensive care unit would close because of the drop in volume of patients needing such expertise. In turn this would adversely affect our specialist respiratory services, many of which cannot be delivered without the back-up of a specialist intensive care service.
“The entire paediatric unit would be de-stabilised, with specialist respiratory care for children being untenable as a stand-alone service. Any re-configuration therefore must include a detailed plan for the break-up and re-distribution of services such as the Royal Brompton’s specialist paediatric cystic fibrosis service for children, one of the largest in the UK, and the dispersal and re-location of its expert teams of staff. The detrimental impact on Royal Brompton’s adult cystic fibrosis unit, acknowledged as one of the leading centres in Europe, would also soon be seen: 70-80% of adult patients progress from the paediatric service.
“Similarly, within one to two years, the effect of losing paediatric heart services would adversely impact on Royal Brompton & Harefield’s adult congenital heart disease (ACHD) service, which cares for more patients with congenital heart disease than anywhere else in the UK.
“The net effect will seriously affect the financial stability and clinical viability of the Trust, in turn putting all our specialist national services in jeopardy. We were briefed at the start of the Safe and Sustainable review that ‘It is likely that the rest of the country will take a view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable’. We feel sure now, as we have from the start of the process, that improved collaboration between the three expert centres, remains a better option for patients. We look forward to a full and frank public consultation on this issue.”
