Child heart surgery reform suspended

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Controversial plans to reform children's heart surgery in England have been suspended as the decision was based on a "flawed analysis", Health Secretary Jeremy Hunt has announced.

The NHS had planned to concentrate care in fewer, bigger centres.

There was opposition to ending surgery at Leeds General Infirmary, Glenfield Hospital in Leicester and the Royal Brompton in London.

Mr Hunt ordered an independent review of the decision.

Repairing the hearts of children born with congenital defects is one of the most complex procedures in the NHS. About 3,700 such operations take place each year.

Start Quote

The Safe & Sustainable review was based on a flawed analysis of the impact of incomplete proposals, and leaves too many questions about sustainability and implementation.”

End Quote Jeremy Hunt Health Secretary

Ten hospitals currently perform the delicate surgery required, but last year the "Safe & Sustainable review" performed by the Joint Committee of Primary Care Trusts ruled expertise was spread too thinly.

It said surgery should be concentrated in seven specialist centres by 2014 in order to improve safety. They were:

  • Great Ormond Street, London
  • Evelina Children's Hospital, London
  • Newcastle's Freeman Hospital
  • Birmingham Children's Hospital
  • Alder Hey, Liverpool
  • The Royal Children's Hospital, Bristol
  • Southampton General

Campaigners were concerned at a loss of local services and a High Court judge quashed the decision to stop surgery in Leeds saying the consultation was flawed and "ill judged".

Amid the tension, Mr Hunt asked the Independent Reconfiguration Panel (IRP), an advisory body, to assess the decision.

Watch Jeremy Hunt's statement on child heart surgery in full

'Serious criticism'

He told the Commons: "The IRP report also concludes that the outcome of the Safe & Sustainable review was based on a flawed analysis of the impact of incomplete proposals, and leaves too many questions about sustainability and implementation.

"This is clearly a serious criticism of the Safe & Sustainable process. I therefore accept their recommendation that the proposals cannot go ahead in their current form and am suspending the review today."

Analysis

Shutting services and hospitals is never a popular decision, there is nearly always a huge amount of support for a local hospital.

And yet there is evidence that creating fewer specialist centres saves lives.

In London, stroke care was moved from 30 hospitals to just eight.

The move is thought to save 400 lives a year.

This suspension by Jeremy Hunt does not change the underlying principle of fewer, bigger and better.

This is a reprieve for the three hospitals which were set to lose their child heart surgery teams.

But in the future there will be fewer hospitals providing this care and there is likely to be similar campaigns to save local units when a final decision is eventually made.

He said the consultation, which has already cost more than £6m, did not have the confidence of the public with some feeling the decision was predetermined.

He said choosing which hospitals provided surgery was one of the most flawed areas of the review, but added "we need to get on with this" as the original argument for improving care was unchanged.

The IRP's report said: "The Panel's advice addresses the weaknesses in the original proposals, but it is not a mandate for either the status quo or going back over all the ground in the last five years."

Lord Ribeiro, the chairman of the IRP, said access to services was one of the panel's main concerns.

"Many of the relatives said to us, 'Of course, we would travel to the Moon to have our daughter or son treated,'" he said.

Case study

Lyall

Lyall Cookward, aged four, has been treated repeatedly in Leeds.

He was born without one of the walls which separate the chambers of the heart - an atrial septal defect.

Surgeons had to create a new septum and heart valves for him and he had emergency surgery at just four weeks old.

Further operations followed and there will be more in the future.

His family want him to continue being treated at Leeds General Infirmary, but would have been forced to travel to Newcastle if the reforms went ahead.

One of his parents, Steph Ward, said: "We're absolutely delighted, everything that we said was wrong with the review has been vindicated.

"The review has been conducted in a manner which is absolutely disgusting and betrays the parents and patients it was set up to look at services for."

"But, for them, it is also about the quality of care that can be provided for the whole family, and many of them do have to travel long distances, with great cost, and, therefore, if they could see the changes that were being provided for them would provide a service which, for them - and this is what we were told - for them, appeared to be no better than what they had locally, then they had concerns about that."

Mr Hunt set NHS England, which has taken over the responsibilities of the Joint Committee of Primary Care Trusts, a deadline of the end of July to come up with the next step in the process.

The fate of children's heart surgery will also be considered alongside changes to adult heart surgery.

Prof Sir Bruce Keogh, the medical director for NHS England, said: "We welcome the review, and NHS England will now study its recommendations in full to learn from them.

"We will institute a new process that recognises the very strong case for redesigning services to meet the demands of the future whilst addressing the legitimate concerns in our local communities."

'Re-start'

Prime Minister David Cameron said: "We have to be frank with people that we can't expect really technical surgery, like children's heart operations, to be carried out at every hospital in the country."

He said it was clear the original review had not been conducted properly, "so we need to make a re-start".

Lord Ribeiro: 'Our recommendations are not a panacea for doing nothing - it is not a mandate for rolling the clock back'

Sharon Cheng, of the group Save Our Surgery, which has campaigned in Leeds, said: "[Mr Hunt's] comments about the Safe & Sustainable process and outcome completely vindicate the action that we took to challenge this, and demonstrate that exposing the flaws in the review was the right and necessary thing to do."

She called for the new review to be "fully open and accountable".

Meanwhile the chief executive of Newcastle Hospitals Sir Leonard Fenwick, who had been told the hospital would keep its unit, said the decision was "a little surprising".

The Shadow Health Secretary Andy Burnham said: "When it was published, while I fully support the reduction in sites, I expressed concerns about the distribution of the seven sites, skewed towards the western half of England and leaving a large swathe of the east, from Newcastle to London, without a surgical centre.

"For a family in Hull or Lincoln, already at their wits' end with worry, the wrench of leaving home to travel hundreds of miles with the cost of accommodation and time off work would add to high levels of stress and anxiety."

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