On Thursday, 9 February, NHS England launched its delayed public consultation on the national congenital heart disease (CHD) review, which includes proposals to end CHD services at Royal Brompton Hospital. The only CHD consultation event in London is due to take place on 7 March between 6pm and 8pm at the Coin Street Neighbourhood Centre, London.
The consultation is due to run until 5 June this year.
Official figures show that Royal Brompton operates the UK’s largest CHD service, and consistently has among the best patient outcomes in the country. Clinical teams help over 14,000 patients, treating many from birth through childhood, adolescence, and adulthood. It also has exceptionally high patient satisfaction levels, with over 98% of patients saying that they would recommend the cardiology service. The UK’s CHD services as a whole are already considered to be among the best in the world.
If the plans went ahead, Royal Brompton would be forced to withdraw all CHD services, requiring both child and adult patients to find another hospital to provide their care. The plans would also dismantle Royal Brompton’s world-leading adult CHD research team – responsible for publishing more papers than any other centre in the world – and would force the closure of its children’s intensive care unit.
Without intensive care the Trust’s paediatric cystic fibrosis and difficult asthma services, both of which are the largest service of their kind in the UK, would also have to close. NHS England’s consultation document does not include any plan for dealing with these, and other, wider consequences.
NHS England plans to withdraw CHD services because it considers that the Trust does not meet a new standard around ‘co-location’. This requires certain paediatric services – gastroenterology, nephrology (kidney) and general surgery – to be permanently ‘co-located’ in the same building as the CHD service. As Royal Brompton is a specialist heart and lung hospital, these additional services are based at the neighbouring Chelsea & Westminster Hospital, just a few minutes’ walk away.
Staff from both hospitals have worked seamlessly together for years under a formal Service Level Agreement, with joint rotas, ward rounds, meetings and shared systems. The Trust has a 100 per cent record of ensuring that any patient in need of these additional services receives them at their bedside, whenever are needed, day or night.
The Trust asserts that, despite several requests, NHS England has not explained what else would be achieved through co-location, or how services at Trusts that are already co-located are in any way better as a result. The Trust also states that NHS England has admitted that there is no evidence showing any clinical benefits of co-location, and state that many clinicians were opposed to its inclusion as a compulsory standard.
Commenting on the consultation, local Member of Parliament for Chelsea & Fulham, Greg Hands, said: “As the Member of Parliament for Royal Brompton Hospital since 2010, I have taken a great interest in the Hospital, including in 2011 when the “Safe and Sustainable” review was published threatening children’s CHD services, and was subsequently abandoned.
“I have raised this issue in person with the Secretary of State for Health, and with NHS England. I am in the process of organising a meeting with the Minister of State for Health, Philip Dunne MP – within whose purview this issue falls – with representatives of Royal Brompton Hospital, other concerned MPs, and representatives of the Royal Borough of Kensington and Chelsea.”
Commenting on the consultation, Dr Richard Grocott-Mason, medical director at Royal Brompton & Harefield NHS Foundation Trust, said: “As a doctor, I cannot understand how this plan would result in patients receiving better care. It makes no sense to try and improve care by closing one of the biggest, well-performing services, or by destroying research teams that are leading the way in finding new treatments for the future. To do this without a sound basis in evidence is nothing short of foolhardy.
“We have held many meetings with NHS England, and provided evidence showing how we already achieve excellent outcomes for congenital heart disease patients. It is therefore regrettable that they have moved ahead with an expensive public consultation without addressing the key issues we and others have raised with them repeatedly over the last few months.
“This consultation document still does not explain how NHS England expects these plans to improve the care patients with congenital heart disease receive throughout their life. It fails to address how NHS England will counteract the damage that will be done to future care standards by the destruction of our world-leading research team, and astonishingly, despite our requests, does not provide an impact assessment of how other services such as those for children with cystic fibrosis, difficult asthma and complex lung disease will be affected by these plans. The damage to our work in genetics and high risk pregnancy and to our inherited cardiac conditions service is similarly ignored.
“This public consultation gives patients and medical professionals alike the opportunity to make their views known. I hope that NHS England use the consultation to genuinely take note of these views and to develop more sensible plans. We know the cost of this unnecessary reconfiguration would run to many millions of pounds and when resources are so stretched it seems impossible to understand why they are being used in this way.”
Details on NHS England’s consultation can be found here, and for further information on NHS England’s CHD consultation – including the event on 7 March – please Nicola Humberstone on 07789 770037 or at england.congenitalheart@nhs.net.
