• Leicester and the Royal Brompton trusts dispute reconfiguration process
  • Trusts say recommendations from the Independent Reconfiguration Panel have been ignored
  • Specialised commissioning director Jonathan Fielden defends NHS England’s approach

Senior staff at the two congenital heart units threatened with closure by NHS England say the national body has failed to follow “due process” in arriving at its proposals.

According to figures at the Royal Brompton and Harefield Trust, and University Hospitals of Leicester Trust, NHS England’s decision making process was not transparent enough, and failed to take into account the knock-on effect it will have on related services.

Jonathan Fielden

Jonathan Fielden

Jonathan Fielden said the standards have ‘strong agreement from the specialists involved’

This was despite a commitment by NHS England to ensure “new levels of transparency and the highest levels of genuine participation” in the wake of the £8m Safe and Sustainable review, which unsuccessfully attempted to reconfigure children’s congenital heart services three years ago. The case for change had been based on flawed data and failed to follow due process.

NHS England announced plans to reconfigure congenital heart surgery last month, following a review of the quality and sustainability of existing services.

Leicester and the Royal Brompton immediately said they would challenge the outcome.

Jonathan Fielden, NHS England’s director of specialised commissioning, told HSJ “the process of getting the standards [which formed the basis for NHS England’s reconfiguration plans] took two years involving all the relevant people”, and they have the “strong agreement from the specialists involved and from the patients and the public”.

Aidan Bolger, consultant in congenital heart disease at UHL, said he had believed the consultation period between 2013 and 2015 was a “conversation” about best standards and how to reach them.

He said the trust had invested £1m in expanding wards at its Glenfield Hospital “on the basis that we would be providing services for years to come”.

Robert Craig, chief operating officer at the Royal Brompton, was also surprised that the consultation has resulted in reconfiguration plans. He said: “If you read the paper that went to the NHS England board last year, it says in black and white that ‘major reconfiguration of specialist services, with the associated risk and upheaval, can probably be avoided’.”

Mr Craig said the consultation period came to an abrupt end at the start of 2016 when NHS England “arbitrarily” picked out a subset of around 50 out of 450 clinical standards previously ratified by its board, and asked providers to submit a self-assessment on how they would work to achieve the standards they did not meet already.

NHS England’s national advisory panel then whittled these down to a few key criteria, which were used to decide which of England’s 14 specialist congenital heart units it intends to stop commissioning.

The criteria included the number of operations performed each year by individual surgeons; the number of surgeons per unit; and “co-location” – meaning other related services must also be present on the same site as congenital heart surgery.

The trusts affected by the proposed reconfiguration were excluded from the final decision about which criteria to use, and the Royal Brompton said it only found out about the results of the proposed reconfiguration the night before it was publicly announced.

This was despite the Independent Reconfiguration Panel’s insistence, when it reported on the previous reconfiguration attempt, that any reconfiguration of the services “must properly involve all stakeholders throughout”.

The trusts whose congenital heart units face closure also believe NHS England appears not to have followed the requirement to demonstrate proper planning with regard to where patients currently cared for by UHL and the Royal Brompton will be treated in future.

Dr Bolger said that based on informal conversations he had had with colleagues at his trust and other providers, “we understand it would be very difficult for other hospitals to accommodate all our patients”.

Asked if there are enough beds to accommodate patients from UHL and the Royal Brompton, Dr Fielden said: “All the potential receiving hospitals are in a place to work with us.”

NHS England has not looked at the effect the closures might have on co-dependent services such as paediatric intensive care, Mr Craig said. Sixteen paediatric intensive care beds at the Royal Brompton and 12 paediatric beds will close in Leicester if the proposals get the go-ahead.

The IRP also recommended that the future of respiratory ECMO should be taken into account when determining the reconfiguration of services.

This has not been done, Dr Bolger said, despite Leicester being home to the country’s busiest paediatric respiratory ECMO service “accounting for 50 per cent of all activity in the UK”.

Dr Fielden did not comment on how the proposed reconfiguration would affect ECMO.

He added that while NHS England is “minded” to follow the reconfiguration proposals, its decision is not yet final. “It will go through a regional consultation process to make sure that due process is done,” he said.

NHS England 'failed to follow due process' for heart surgery shake-up