Trusts to keep heart surgery but must fulfil 'ambitious' promises

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Neither Royal Brompton nor Leicester hospitals to lose congenital heart surgery despite threat of closure
Service stability uncertain as NHS England reliant on trusts meeting “ambitious” promises to meet national standards
“Further discussions” about Newcastle’s future needed, which may see it lose transplant and CHD services after 2021

Three hospital trusts will no longer lose their congenital heart disease surgery despite the services facing the threat of closure for over a year, NHS England announced on Thursday.

None of the centres threatened with closure – at University Hospitals of Leicester Trust, Royal Brompton and Harefield Foundation Trust, and Newcastle upon Tyne Hospitals FT – will lose their services. Central Manchester University Hospitals FT had already accepted in July that its adult surgery was no longer sustainable.

However, the stability of the service is still not guaranteed as all three centres are threatened with future decommissioning of congenital heart surgery if they cannot deliver on the promises made to NHS England in their consultation responses.

Sir Bruce Keogh opened the debate at NHS England’s board meeting by admitting the ongoing reviews of CHD services, begun in 2001 after the investigation into the Bristol children’s heart surgery scandal, had “been counterproductive for people working” in the speciality. He said over the “the last 17 years… it has pitted unit against unit, clinician against clinician, and parents against parents, if [the decision] is prolonged the only losers will be unborn babies”.

He added: “We are reaching crunch time. [Service reviews have] been going on since 2001 we need a solution, and we need to be clear that this solution is not about the past or present, it is about future proofing the service.”

However, in next few years all three centres will still not meet key national safety standards. All three will not be able to co-locate paediatric services on the same site as CHD surgery and all but one, Brompton, will not be able to ensure a team of at least four surgeons operates on a minimum of 125 patients a year.

Continued commissioning of CHD surgeries at UHL and Royal Brompton is reliant on each trust meeting these two conditions within a defined timeline.

Newcastle has been made exempt from meeting the standards until at least 2021 but it may lose both CHD and transplant services beyond that point.

John Stewart, acting director of specialised commissioning at NHS England, said UHL had submitted a “convincing plan” for achieving co-location standards and a “detailed growth plan on how to meet surgical activity standards in full”. He added that the trust must “make convincing progress” to ensure commissioning continues. The trust has been building relationships with others in the region and submitted letters from other hospitals that assured future referral numbers to the hospital.

UHL chief executive John Adler said: “The future is now in our hands and this decision means that the clinical team can now focus on building a world class congenital heart service for people across the East Midlands and beyond.”

Royal Brompton presented a joint proposal to collaborate with Guy’s and St Thomas’ FT that would bring together the CHD services of the two trusts. Children’s cardiac services will move to Evelina Children’s Hospital and a specialist heart and lung centre for adults opened on the St Thomas’ Westminster bridge campus. NHS England board papers said the proposal was “ambitious and would require a great deal of money… which would probably need to be found by the trusts themselves”. It said if the “solution cannot be put in place within a reasonable timescale” CHD services would be decommissioned.

Bob Bell, chief executive of Royal Brompton and Harefield, said the new planned centre could become the “most advanced cardiovascular and respiratory health system in Europe”. While he welcomed the “opportunity to shape [its] own destiny” he said relocation of services would “take time [and] for now, our focus remains on continuing to provide the best possible specialist care for patients with heart and lung disease”.

As outlined in the original consultation proposal, Newcastle will keep CHD surgeries until at least March 2021 as removing them would make paediatric cardiothoracic transplant surgeries unfeasible. Along with Great Ormond Street Hospital, Newcastle is the only other centre in England to offer this service.

However, the review concluded NHS England needs to “further consider” whether to commission both CHD and advanced heart failure and transplant services at the trust from April 2021. The board papers said this review may result in the “potential for moving [services] to another provider” or maintain services at Newcastle but with the trust allowed to “permanently” not meet the surgical activity standard.

The trust will also not meet the paediatric co-location standard before 2021 and NHS England has advised the trust to hold off building reconfiguration plans until it decides on the future of its transplant services.

NHS England approved plans for Manchester to retain level two adult CHD services, which includes obstetric care for women with CHD. Liverpool Heart and Chest Hospital Foundation Trust will now provide all adult and children’s congenital heart disease surgeriesin the region.