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Three hospital trusts set to lose specialist heart surgery

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NHS England has announced decisive changes to which hospitals carry out congenital heart disease surgery – and faced immediate challenge from some of the trusts that are set to lose the service.

The national commissioning body this morning announced the results of its review of congenital heart disease services, against minimum standards which were decided last year.

As a result of the decision, such surgery looks set to cease at Central Manchester University Hospitals NHS Foundation Trust, University Hospitals of Leicester NHS Trust and Royal Brompton and Harefield NHS Foundation Trust.

However, at least two of the NHS providers are already challenging NHS England’s plans to strip them of specialist heart services under the proposals.

Detailing its decision, NHS England said:

  • Central Manchester will no longer carry out the most specialised level one CHD work, with this moving to Alder Hey Children’s Hospital and Liverpool Heart and Chest Hospital foundation trusts.
  • University Hospitals of Leicester and Royal Brompton and Harefield will stop CHD surgical and interventional services. NHS England said the trusts did not meet its standards and they were “extremely unlikely” to be able to.
  • The following trusts will no longer be allowed to perform “occasional and isolated practice” in less specialised “level two” medical services: Blackpool Teaching Hospitals, University Hospital of South Manchester, and Papworth Hospital foundation trusts; and Nottingham University Hospitals and Imperial College Healthcare trusts.
  • The following trusts do not meet NHS England’s standards but will receive “support” to help them do so: University Hospitals Bristol NHS Foundation Trust, Leeds Teaching Hospitals Trust, University Hospitals Birmingham NHS Foundation Trust, Barts Health Trust, Guy’s and St Thomas’ NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust.

Two of the providers set to lose surgery have reacted strongly to the decision.

University Hospitals of Leicester NHS Trust chief executive John Adler said he would “not sit by whilst they destroy our fabulous service”. Royal Brompton and Harefield Foundation NHS Trust also said it would challenge NHS England’s decision.

NHS England’s statement on its decision said it would take “enforcement action” if Central Manchester did not stop carrying out some procedures.

“We have waited 15 years to arrive at a solution which delivers quality and consistency”

Ian Kennedy

There have been successive calls for and efforts at reconfiguration of congenital heart disease services, particularly children’s heart surgery, over several decades.

The last major set of proposals made by the NHS nationally were taken to the High Court in 2011 by the Royal Brompton, which would have lost children’s congenital heart surgery. The plans were eventually abandoned in 2013, with intervention by health secretary Jeremy Hunt and criticism from the Independent Reconfiguration Panel.

Since then NHS England has carried out a long running review which has come to a head over the past few months.

Today’s announcement is good news for Birmingham Children’s Hospital and Great Ormond Street Hospital for Children foundation trusts, which NHS England said would “continue to be commissioned, with ongoing monitoring, as they currently meet all or most of the standards”.

It is also good news for Leeds Teaching Hospitals Trust, which was involved in a row with Newcastle and NHS England over CHD surgery in 2013.

Its chief executive Julian Hartley said: “We have a high quality integrated CHD service at Leeds with excellent outcomes and our team have done an outstanding job demonstrating their enthusiasm and ability to comply with the rigorous new national standards.”

NHS England

Three trusts set to lose specialist heart surgery

Jonathan Fielden

Dr Jonathan Fielden, NHS England’s director of specialised commissioning and deputy national medical director, said in a statement: “There has been a great deal of uncertainty over the future of congenital heart disease services over the past 15 years.

“We owe it to patients, families and staff to end that uncertainty, and to provide clear direction for the safety and quality of this specialist area of medicine going forward,” he said.

“A great deal of work has gone into achieving consensus across the board on the standards that providers should meet,” he said. “We are determined to take all actions necessary to ensure that those standards are met, so that patients get the high quality and safe services that they expect and deserve.”

Sir Ian Kennedy, who chaired a public inquiry into child deaths at Bristol Royal Infirmary in 2001, and which led to previous attempts at reform, said: “These are vital services and we have waited 15 years to arrive at a solution which delivers quality and consistency for current and future generations.

“It is good news for patients that there is finally a clear consensus on the standards that need to be met, and that we are now seeing decisive action to make those standards a reality for every patient in every part of the country,” he added.

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