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Royal Brompton & Harefield NHS Foundation Trust issues legal proceedings




Thursday 17 March 2011


Royal Brompton & Harefield NHS Foundation Trust today issued legal proceedings against the Joint Committee of PCTs (JCPCT) in respect of the proposal to end paediatric cardiac surgery at Royal Brompton Hospital, as part of the ‘Safe and Sustainable’ review. The Trust’s board believes that the recommended options put to public consultation are fundamentally flawed, such that a consultation based on them would be unlawful. Two separate approaches have been made to the JCPCT in order to avoid legal action. The JCPCT rejected the first request to delay the start of the consultation to enable discussions to take place, and failed to respond to the second request to suspend the consultation while the Trust’s concerns were heard. The Trust is now applying for judicial review, challenging the legality of the consultation.


Commenting, 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. We have always supported the principle that all babies and children who undergo heart surgery deserve the best possible care, and that this is likely to be in larger centres. But 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 hospital was highly rated in Sir Ian Kennedy’s national assessment.”


The Trust’s legal challenge identifies a number of issues relating to the review process and the corresponding public consultation. It provides evidence to show that the consultation’s exclusion of Royal Brompton from the available options is not rational, that a decision to close a London site was taken in Spring 2010 based on PCT commissioners’ subjective views rather than clinical reasons, and that the analysis of the pre-consultation business case is flawed, failing to take into account the impact of the closure of paediatric cardiac surgery on other services at Royal Brompton & Harefield NHS Foundation Trust. 


The Trust also questions the fact that the safe and sustainable steering group, the main body influencing the decision to reduce London’s three centres to two - at Great Ormond Street and the Evelina, included representatives from both those London hospitals, but not from Royal Brompton. Representatives from Great Ormond Street and the Evelina played an active role in the decision which favoured their own centres at the expense of Royal Brompton.


The JCPCTs failure to take into consideration the full impact of the removal of children’s heart surgery from Royal Brompton has far-reaching consequences for the Trust.


Loss of the paediatric cardiac surgery services would:

  • Render Royal Brompton’s Paediatric Intensive Care Unit (PICU) unsustainable, because heart surgery accounts for 90 per cent of cases that go through the PICU.

  • Make it impossible for the Trust to maintain a paediatric anaesthetic service – taking away surgery would mean activity levels would not warrant keeping the expertise on site. 

  • Mean that interventional cardiology would become unsustainable because it depends on the ability to undertake surgery on certain cases and often requires the presence of paediatric anaesthesia and PICU.

  • Mean that paediatric respiratory services, including those for cystic fibrosis, would also be unsustainable, because these depend upon the presence of paediatric anaesthesia and PICU. Although not accountable for enough activity to support an entire PICU or a team of anaesthetists, several respiratory procedures cannot be undertaken without anaesthesia (e.g. bronchoscopy) and are fundamental to, and commonplace in, the treatment of paediatric cystic fibrosis (e.g. the fitting of gastronomy feeding tubes).

  • Cripple the Trust’s adult congenital cardiac surgery service because those operations are also performed by the paediatric surgeons who specialise in these diseases.


The loss of all of these services would potentially call into question the viability of the Trust.


The spokesperson for the Trust concluded: “Royal Brompton & Harefield NHS Foundation Trust recognised the opportunity for a new approach to the provision of children’s heart and lung services in London in 2009, and developed plans for an extensive collaboration with Great Ormond Street. The report ‘A Proposal to Establish A National & International Service for Children with Heart & Lung Disease’ was discussed at a joint Board-to-Board meeting on July 1st, 2009.  The proposed Children’s Heart and Lung Service would deliver clinical care for children (aged 0-16) with congenital and acquired cardiac and respiratory disease, integrating the best practices of Royal Brompton and Great Ormond Street hospitals with supportive referral and follow up networks of shared care. The Trust strongly believes that a collaboration and network agreement between the three existing London centres, based on such a model, will deliver the best care for patients.[1]  The present JCPCT-recommended options for consultation are poles apart from the proposed collaboration – they will be destructive of other services rather than providing a platform on which all centres can work to enhance the treatment and care of children.”



Notes to editors

  1. Royal Brompton & Harefield NHS Foundation Trust is the largest specialist heart and lung centre in the UK and among the largest such centres in Europe. It operates two sites, Royal Brompton Hospital (the “Royal Brompton”) in Chelsea, West London and Harefield Hospital near Uxbridge. Royal Brompton has an international reputation for specialist paediatric services. Its performance is rated ‘excellent’ by the Care Quality Commission, and its record in children’s heart services is particularly strong. It is the third largest UK centre for paediatric cardiac surgery and the largest UK centre for congenital heart services.

  2. Our experts promote the principle of ‘shared care’ and are involved in an expanding programme of outreach clinics, at which they see patients with paediatric colleagues at 30 hospitals across the South East, covering Essex, Sussex, Surrey, Hertfordshire and Middlesex. A complete range of paediatric services is also provided in collaboration with Chelsea and Westminster Hospital and Imperial College Healthcare NHS Trust, and collaboration with colleagues is supported by a series of ‘virtual’ telemedicine clinics through which expert opinion is available when needed, around the clock. Royal Brompton is also a partner in the Children’s Emergency Transport Service (CATS) with St Mary’s and Great Ormond Street.

  3. Responding rapidly to critically ill children is part of the daily work of the paediatric team, which is a national specialist referral centre for children with heart and lung disorders – the largest in the country for those with heart rhythm problems.  Children come to us from all over the UK. Our multi-disciplinary team approach, involving cardiologists, surgeons, intensive care specialists, anaesthetists, specialist nurses, physiotherapists and other health professionals, ensures our younger patients get the best possible care in a clean, safe environment. Our record in infection prevention and control is one of the best in the country.

  4. The Trust is the largest centre in Europe for adult congenital heart disease and is a significant provider of fetal cardiology services, covering 10 per cent of all babies born in England.  The majority of these babies are referred by maternity hospitals across the UK, from the routine “20 week” ultrasound scan. Our clinicians work with experts in fetal medicine units at partner hospitals, to provide the best possible care for pregnant woman. Thus, the hospital offers a seamless transition of patients from fetal life through infancy, into childhood, adolescence and adulthood, providing the highest standards of care through all stages of life.

  5. Royal Brompton experts sit on, and chair, international advisory panels and professional bodies, are keynote speakers at conferences throughout the world and share their knowledge through teaching both in the UK and abroad. They raise awareness of their profession, and of the high standard of paediatric care and expertise available in the NHS. Their research collaborations cross international boundaries.

  6. The JCPCT was established in September 2010 by and on behalf of the 10 Specialised Commissioning Groups (“SCGs”) for England and their constituent Primary Care Trusts (“PCTs”).It was established as the body to conduct formal consultation in respect of the proposed reconfiguration of the provision of paediatric cardiac services in England. At the end of the consultation period, the JCPCT is due to make a final decision on the national reconfiguration of paediatric cardiac services in England.


For further information please contact:

Jo Thomas                                                                                                           Director of Communications  

Royal Brompton & Harefield NHS Foundation Trust

Tel: 020 7351 8850 or 07813 025256

Email: j.thomas@rbht.nhs.uk


Jessie Mangold

Head of Media Relations

Royal Brompton & Harefield NHS Foundation Trust

Tel: 0207 351 8672 or 07866 536345

Email: j.mangold@rbht.nhs.uk


[1] As part of the ‘Safe and Sustainable’ process, the three London centres also submitted a joint plan (‘A proposal for a London, South and East England Children’s Cardiac Network’) for more formal networking arrangements to be developed, in November 2010. 




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Read about the Safe and Sustainable review of children's cardiac services in England and its impact on services at Royal Brompton.