An NHS England review into congenital heart disease services has called for a major shake-up of how they are provided, proposing a ‘three tier’ model of care.

  • NHS England review calls for “three tier” care model for congenital heart disease
  • Latest in a series of reviews into children’s heart surgery, stemming from concerns about raised at Bristol Royal Infirmary in 1980s and 1990s
  • Submissions for proposed new service models expected by October, decision by November

The commissioning body started the review in June 2013. It was a the latest in a series of reviews into the children’s heart surgery, following concerns raised about children receiving complex cardiac surgery at the Bristol Royal Infirmary between 1984 and 1995.

Cardiac surgery

Concerns about children’s heart surgery were first raised at Bristol in the 1980s

The most recent report, published ahead of NHS England’s board meeting on Thursday, says there “have been subsequent reviews each making a series of recommendations, but no coordinated programme of change, and concerns have remained”. The first report was published in 2001.

It also says: “The failure to implement recommendations created uncertainty within the specialty, damaged relationships between centres, harmed recruitment and retention and reduced the resilience of services.

“A number of centres could not meet NHS England’s service specification for paediatric congenital heart disease services, and occasional practice was widespread.”

Under the “three tier” model recommended by NHS England, all hospitals providing congenital heart disease care would work within “regional, multi-centre networks, bringing together foetal, children’s and adult services”.  

Each network would have at least one specialist surgical centre as the first tier.

Some networks would have a second tier specialist cardiology centre. However “because of the increasing number of adults living with CHD, specialist adult CHD centres are expected be more common”, the report says.

Local cardiology centres, which form the final tier, would employ a paediatrician with expertise in cardiology and run outpatient clinics.

NHS England said it expects to receive formal submissions for its proposed new service models from October. It will review and decide whether to continue with its current commissioning approach in November.

Congenital heart services are directly commissioned by NHS England, and account for 1 per cent of its specialised commissioning budget.