The review of children's heart surgery in England and Wales was motivated by a desire to improve congenital cardiac services across the country. The Bristol baby tragedies of the late 80s and early 90s, where a cardiac unit had covered up poor surgical results and deaths ensued, was another major influence. This brought about the Kennedy Report of 2001 which suggested a reduction in the number of NHS hospitals performing complex children's heart surgery.
Motives Behind NHS Children's Heart Review
One of the main arguments of the NHS review is that concentrating specialist medical units, such as heart patients, into fewer centres would have a favourable impact on the ability to treat the maximum number of patients with a greater pool of expert surgeons to hand. The Royal Brompton Hospital is one of three London specialist centres along with Great Ormond Street and the Evelina Children’s Hospital in Guy’s and St. Thomas. The Safe and Sustainable Review team suggested that London only needs two units and that Brompton's current services should be merged with these two larger centres to condense paediatric services for the capital. The Royal Brompton argues that a three centre London network should be favoured.
Royal Brompton's Case Against Closure of Child Heart Surgery
The Royal Brompton insists that there is no medical reason or clinical evidence which supports the closure or cutting down of its services. It does not argue that change is unnecessary, but is at a loss to understand why such a unit is under threat, especially as it is respected and relied upon by organisations and clinicians around the world, and possesses some of the country's lowest mortality rates. Indeed, the hospital rates joint fourth (alongside Great Ormond Street) in the overall ratings as gathered by Sir Ian Kennedy's latest report on all eleven paediatric heart centres in England. The Royal Brompton actually meets all of the original consultation criteria in terms of surgeons and cases but was bizarrely left out of the original options. The reconfiguration of heart services would also have a negative impact on adult heart services at Brompton and the treatment of respiratory patients who would have to seek care elsewhere. The Brompton carries out ground-breaking research on cystic fibrosis in particular.
Credit: R Sones
Royal Brompton Judicial Review
The Royal Brompton Trust was so incensed by the proposals that they asked for a judicial review, arguing that the criteria used in the consultation was fundamentally flawed. They won the initial case in November 2011, but lost the appeal in April 2012. However, even the judges praised the centre for its excellence, going so far as to say: "A member of the public might well find it difficult to understand why a centre of the standard of the Royal Brompton should cease to be a centre for paediatric cardiac surgical services under the configuration exercise."
The Brompton Trust insisted that in the initial consultation only surgeons from Evelina and Great Ormond Street were approached for their views and that political motives were contributing towards a London unit - namely, the Brompton - having to shut down.
Aim to Make Children's Heart Surgery National
The Safe and Sustainable team insisted that they were keeping "an open mind" and that a three centre London option was still possible up until their final decision which was made on July 4. However, even though the Review team set up the controversial Pollitt Report and a last minute respiratory exercise on the knock-on effects of the heart reconfiguration, it appears that the decision had already been made. It is difficult to understand how shutting down the Royal Brompton children's heart unit can ostensibly improve national outcomes when the hospital is already an example of what the review aspires to.