- Five out of 11 hospitals said they are working to meet the new standards in the agreed five year timescale
- Providers asked to submit a self-assessment of existing congenital heart disease services
- Proposals for future care models “fall significantly short” and “represent a real safety risk”
- St George’s has stopped all procedures for adult congenital heart disease
Half the hospitals that perform major children’s heart surgery do not currently meet all the new safety standards being implemented by NHS England.
Four of the 11 hospitals told HSJ they have assessed themselves as meeting the new specifications, while five said they are working to meet them within the five year timescale set down by NHS England. One did not respond, while another did not give a clear answer.
Earlier this year, providers were asked to submit a self-assessment of their existing congenital heart disease services, which are now in the process of being evaluated.
The new standards, which NHS England started monitoring this month and need to be met by 2021, include that congenital cardiac surgeons must work in teams of at least four surgeons, who each must be the primary operator in a minimum of 125 operations a year on adults and/or children.
Providers must immediately ensure surgeons are working in teams of at least three, with each centre performing at least 125 operations a year. According to audit data, all 11 centres meet this immediate requirement.
Who meets the new standards?
When contacted by HSJ, four providers said they already meet the new standards:
- Birmingham Children’s Hospital Foundation
- Royal Brompton and Harefield FT;
- London Harley Street Clinic; and
- Alder Hey Children’s Hospital Foundation Trust, which said it was “confident new standards were being met”.
Five trusts said they are working to meet all the standards within the agreed timescale:
- Guy’s and St Thomas’ FT;
- Leeds Teaching Hospitals Trust;
- University Hospitals Bristol FT;
- University Hospitals of Leicester Trust; and
- University Hospital Southampton FT.
Great Ormond Street Hospital for Children FT did not provide a clear answer, but appears to meet the new standards. Newcastle Upon Tyne FT did not respond.
Alongside the assessment of existing services, an ongoing review of future congenital heart disease service models is expected to demand that heart surgery for children and adults are delivered as part of the same service and concentrated on fewer sites.
NHS England proposed a three tier “network” of care last year, and told trusts to submit proposals for future service models in October.
However, an update in February said the proposals “fall significantly short of meeting the standards”, which a review panel said “represents a real safety risk”.
The national specialised services commissioning committee is now considering the next steps.
The review follows numerous attempts to centralise children’s heart surgery on fewer sites, following the public inquiry into the Bristol heart scandal, which reported in 2001.
The most recent attempt, under the Safe and Sustainable Review, had recommended that surgery at Leeds General Infirmary, Glenfield Hospital in Leicester and the Royal Brompton Hospital in London should be decommissioned, but this was abandoned in 2013 following legal challenges.
None of the major centres are planning to transfer or cease running their services, they told HSJ.
Leeds Teaching Hospitals and University Hospital Southampton said they plan to meet the standards within the required timescale.
Guy’s and St Thomas’ said it meets “almost all” the new standards, while University Hospitals Bristol and University Hospitals of Leicester said they meet the “vast majority”. All three have action plans in place.
As part of the recent self-assessment process, NHS England also wrote to 100 smaller hospitals where clinical coding suggested congenital heart disease procedures were possibly still being performed. They said the services must stop if the new standards were not being met.
HSJ contacted 20 of these centres, identified through a national audit, and many said their listed procedures were for atrial septal defects, which NHS England has said can be performed outside the main surgical centres.
However, St George’s University Hospital, which performed about 100 major procedures on adults between 2012 and 2015, said it withdrew its services this month as a result of the new standards. King’s College Hospital, which performs a small number of procedures for atrial septal defects, said it planned to phase these out from October.
The National Congenital Heart Disease Audit, published this month, showed the number of procedures (not just surgical) at each of the centres performing child heart surgery in 2012-15:
|Hospital||Number of procedures (children/adult)|
|Alder Hey, Liverpool||1,896 (1,843/53)|
|Birmingham Children’s||2,784 (2,665/119)|
|Bristol Royal Hospital for Children||2,278 (1,519/759)|
|Freeman Hospital, Newcastle||1,499 (1,098/401)|
|Great Ormond Street, London||3,110 (2,996/114)|
|Glenfield Hospital, Leicester||1,555 (1,123/432)|
|Evelina London Children’s Hospital||2,587 (1,967/620)|
|Harley Street Clinic, London||687 (588/99)|
|Leeds General Infirmary||2,391 (1,669/722)|
|Royal Brompton, London||2,786 (1,944/842)|
|Wessex Cardiothoracic Centre, Southampton||1,905 (1,420/485)|
- ALDER HEY CHILDREN'S FOUNDATION TRUST
- BIRMINGHAM CHILDREN'S HOSPITAL NHS TRUST
- East Midlands
- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
- GUY'S AND ST THOMAS' NHS FOUNDATION TRUST
- KING'S COLLEGE HOSPITAL NHS FT
- LEEDS TEACHING HOSPITALS NHS TRUST
- NHS England (Commissioning Board)
- North East
- Patient safety
- Royal Brompton & Harefield NHS Foundation Trust
- Service design
- South Central
- St George’s University Hospitals NHS Foundation Trust
- THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
- UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST
- UNIVERSITY HOSPITALS BRISTOL NHS TRUST
- UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST
- West Midlands
- Yorkshire and the Humber