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Committee says high-performing national centre must close children's heart unit


4 July 2012 - 6.50pm

Third largest centre also loses children’s intensive care


A committee of NHS Primary Care Trust chief executives today approved a plan to end children’s heart surgery at one of the best performing and largest centres in England. The Joint Committee of Primary Care Trusts (JCPCT) approved a plan to reduce the number of centres offering children’s heart surgery in London from three to two, with specialist heart and lung centre Royal Brompton Hospital, losing out to the Evelina Children’s Hospital and Great Ormond Street Hospital for Children. The decision came as part of a national review of paediatric heart services in England.


As part of the proposals, Royal Brompton will also lose its children’s intensive care unit which will in turn destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of other severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, Royal Brompton clinicians will not be able to undertake the more complex specialist treatments they do now, because they consider it unsafe to do so.


Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. The research they undertake can only be carried out at a specialist hospital, where the combination of clinical expertise, the type of patients seen and the number of patients seen, provide the necessary conditions. Without a children’s intensive care unit and on-site anaesthetists, Royal Brompton hospital cannot offer the type of specialist respiratory care it does now and its respiratory consultants will seek work elsewhere. As a result, the expert teams that are responsible for both clinical care and research programmes will be broken up.


“It is very difficult to know what to say at times like these,” commented Royal Brompton & Harefield NHS Foundation Trust chief executive, Bob Bell, “but it is even more difficult to try and understand how this committee could have come to such a decision. Over the past 18 months we have seen respiratory charities like the Cystic Fibrosis Trust and Asthma UK, independent clinicians from around the world, and many anxious parents, highlighting time and time again the damaging effects on specialist respiratory care for children if Royal Brompton’s paediatric intensive care unit is closed.


“Even Safe and Sustainable’s own ‘Pollitt’ review panel concluded that bronchoscopy for patients with severe asthma will need to be undertaken elsewhere, complex bronchoscopies needing intensive care support will have to be referred elsewhere, complex cystic fibrosis cases ‘may have to go elsewhere for specific aspects of their management’, our long-term ventilation service cannot continue to be delivered at Royal Brompton, and the decision to take away intensive care “may affect the motivation of personnel … and could also have implications for the successful research programme”. Yet there is no plan, no recommendation, no public consultation and no analysis of spare capacity to show how our work will be undertaken at other centres that was disclosed by the JCPCT.


“I will now discuss this decision with the Trust’s Board and Governors’ Council to determine our next steps. One thing is certain – I will not be asking them for the mandate to manage the destruction of a highly valued and respected children’s unit.”


Dr Duncan Macrae, director of children’s services, added: “Anyone who has worked in the NHS for any length of time is familiar with reviews, reorganisations and reconfigurations. What is genuinely shocking about this proposal is the failure of NHS managers to acknowledge or understand the adverse impact that the proposed changes will have on our highly specialised services for children with severe lung and heart conditions.  For instance, our leading children’s lung disease service and its world class research programme will in my view be fatally wounded. How can this NHS reorganisation be an improvement, if services such as these are destroyed in the process?”


Bob Bell concluded: “Royal Brompton has never argued for no change, just the right change. Safe and Sustainable should be about raising the bar of quality, protecting specialist skills and providing the best possible care, without question, for patients. But with this review, the steering group set criteria, and then ignored them when considering Royal Brompton’s fate. Our service fulfils the set criteria, with four surgeons undertaking over 400 procedures each year. It is the third largest centre for children’s heart surgery in the country, with very low mortality rates and an international reputation. Surely the NHS can do better than this?


“Our position remains that the number of patients referred into London warrants a collaborative network system comprising the three current centres. There are enough patients in London and the South East to support this approach and it would avoid the need for significant expenditure on expanding one of the two other centres to deal with Royal Brompton’s patients. It would also protect respiratory care and research – a win-win solution for everyone.”


Notes to editors:

  1. Professor J Stuart Elborn, president, European Cystic Fibrosis Association, Dr Neil Gibson MD FRCPCH consultant in paediatric respiratory medicine, Royal Hospital for Sick Children, Glasgow (who sat on the review ‘Pollitt’ panel), Professor Gunilla Hedlin MD, PhD and Professor Sven-Erik Dahlén MD, PhD, directors of the Karolinska Institutet, Asthma UK, the Cystic Fibrosis Trust, the Muscular Dystrophy Campaign and the PCD Family Support Group are among those who have stated publicly that the damage to Royal Brompton’s respiratory care for children will be significant if intensive care is not available on site.
    Dr Neil Gibson MD FRCPCH consultant in paediatric respiratory medicine, Royal Hospital for Sick Children, Glasgow:

    “It is absolutely imperative that before cardiac surgical services are withdrawn from the Royal Brompton Hospital that a very detailed piece of work is done to ensure that a sensible, safe and sustainable plan is made for paediatric respiratory services. My own personal professional view is that the models of care that we suggested in the Pollitt Report could be made safe but they are certainly not necessarily the best way to provide a sustainable service.

    “My other big concern is the research, innovation and development of our specialty that is given a terrific impetus by the clinicians and researchers at the Royal Brompton Hospital…There is a significant potential for irreparable damage to be made to the only world class Paediatric Respiratory Research Unit in the United Kingdom.

    “The unit at the Royal Brompton Hospital from a paediatric respiratory point of view is truly one of the world’s leading centres with an already impressive track record and a current set up that is likely to be part of delivering some fundamentally important research findings and treatment innovations for relatively common conditions. I fear there is a very real threat to that work from the implications of removing cardiac surgical services...There is a much, much bigger piece of work that requires to be done about the future of Respiratory Services at the Brompton once the decision to remove cardiac surgery is finalised. Failure to do that may actually result in significant damage to specialist clinical services and to research and innovation for children with paediatric respiratory disease.”

    Professor J Stuart Elborn,
    president, European Cystic Fibrosis Association:
    “The quality of the current paediatric respiratory research programme at RBH is outstanding. It is one of very few centres with sustained internationally competitive programmes in the UK or mainland Europe. The investigators at RBH have published primary research which has resulted in changes in medical practice and the understanding of fundamental mechanisms of chronic lung diseases. The report by the panel of independent experts chaired by Adrian Pollitt clearly articulated the potential for adverse effects on the Royal Brompton’s research programme if the PICU became unviable as a result of the cessation of paediatric cardiac surgery.”

    Asthma UK, Cystic Fibrosis Trust, Muscular Dystrophy Campaign, PCD[1] Family Support Group:

    “Because of concerns … you appointed a panel headed by Mr Adrian Pollitt to examine the impact which de-designation as a cardiac surgery centre would have upon the Royal Brompton’s respiratory services. It is our collective view that the report of Mr Pollitt’s panel does not lay to rest those concerns. Instead, we see the Pollitt report as giving rise to a number of questions which need to be addressed and answered robustly. At the heart of those questions is a concern, which we all share, that the clinical and financial viability of the sort of changes contemplated by Mr Pollitt’s panel, and the consequences of those changes for respiratory research and clinical trials, should be established robustly before any final decision is taken …. The report also gives rise to concerns about clinical governance …We also believe that it is imperative that there is a public consultation on alternative models of respiratory service delivery before the JCPCT makes a decision which would otherwise effectively pre-empt the outcome of any such consultation.

    "We have explicitly mentioned respiratory research because it is an issue of fundamental importance to each of our charities because of the excellence of the Royal Brompton’s paediatric respiratory research and clinical trials programmes and the importance of that work for improving patient outcomes in the future. The possibility of adverse consequences for respiratory research or clinical trials programmes, which is acknowledged in the Pollitt report, is also an issue which goes to the heart of our concerns for the future sustainability of the clinical services, for the reasons explained incompelling terms by Professor Stuart Elborn of Queen’s University, Belfast in his letter to you dated14 November 2011...

  2. For further information:

    Mark Fenwick                             Jo Thomas
    Head of media relations                  Director of communications
                                                            and public affairs
    0207 351 8672                                0207 351 8850
    07866 536 345                                07813 025 256

[1] PCD – Primary Ciliary Dyskinesia, is a rare disease that affects tiny, hair-like structures that line the airways. This can cause breathing problems, infections, and other disorders. PCD mainly affects the sinuses, ears, and lungs.


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Visit our Safe and Sustainable section to read about:
  • The background to the review
  • The Trust's response to the public consultation
  • UK and international comments of support
  • The effects on respiratory care and treatment