Hospital Dr News

Three units told to halt complex surgery on patients born with heart problems

Three of the 13 hospitals across England have been ordered to stop providing complex heart care amid concerns over standards.

NHS England has told three units to halt complex surgery on patients born with heart problems by April 2017; these include Central Manchester University Hospitals NHS Trust, University Hospitals of Leicester NHS Trust and the Royal Brompton and Harefield NHS Trust in London.

The sites affected are already promising to fight the decisions.

The services being targeted provide care to people born with congenital heart problems, such as holes in the heart, which affect nine in every 1,000 babies.

The announcement comes after attempts to reorganise services had to be abandoned three years ago following legal challenges by local campaigners and the hospitals themselves.

Last year NHS England established a set of standards that it wanted hospitals to meet to ensure both child and adult patients got high quality care.

These include the requirement that surgeons work in teams of four and see at least 125 patients a year each to ensure they keep their skills up-to-date.

NHS England has announced which trusts are not meeting the standards and which need to close services and transfer care elsewhere.

They have said:

  • Newcastle Hospitals NHS Trust will be allowed to keep doing surgery despite failing to meet key standards because it is the only unit in the region, so NHS bosses felt it would not be practical to stop surgery there. Instead the hospital will be given extra support.
  • Performance at Bristol Children’s Hospital will be monitored after the critical report last week, but it will still be able to provide complex surgery.
  • Blackpool Teaching Hospitals NHS Trust, the University Hospital of South Manchester, Papworth Hospital in Cambridgeshire, Nottingham University Hospitals NHS Trust and Imperial College Healthcare in London will have to stop providing complex medical care, which includes procedures such as widening the arteries and repairing holes in the heart.

Dr Jonathan Fielden, NHS England Director of Specialised Commissioning and Deputy National Medical Director, said: “There has been a great deal of uncertainty over the future of congenital heart disease services over the past fifteen years. We owe it to patients, families and staff to end that uncertainty, and to provide clear direction for the safety and quality of this specialist area of medicine going forward.

“A great deal of work has gone into achieving consensus across the board on the standards that providers should meet. We are determined to take all actions necessary to ensure that those standards are met, so that patients get the high quality and safe services that they expect and deserve.

“This is further proof that NHS England as the national commissioner of specialised care is stepping up decisively on behalf of patients now and to sustain quality care for the future.”

Carrying out surgery on children with congenital heart problems – some of them babies just born – is one of the most complex areas of care in the NHS.

There are fewer than 4,000 operations done each year with 80% of children born with these heart defects surviving into adulthood.

But how and where such surgery is carried out has been at the centre of a fierce debate since the publication in 2001 of a damning report into high death rates among babies undergoing heart surgery at Bristol Royal Infirmary.

Last time plans were put forward in 2011 it led to a bitter fallout, pitting hospitals against senior health bosses. Two years later the proposals were scrapped with NHS bosses told to look again.

Miss Clare Marx, President of the Royal College of Surgeons, said: “Improvements to care for children undergoing heart surgery continue to be needed in spite of improvements since the Bristol Royal Infirmary public inquiry report in 2001. The Royal College of Surgeons strongly supports the plans and we hope these changes will now finally happen for the ultimate good of patients.

“Units need to be the right size to enable surgical teams to be familiar and skilled in all conditions, treating these patients on a regular basis to maintain their experience and expertise. It’s absolutely critical that teams are sufficiently staffed to provide secure on-call rotas, disseminate new techniques, and train the next generation of specialists.

“The proposals represent a consensus view of what consistent, high quality care should look like across the country. As a profession we are confident these standards will help reduce variation in care and improve outcomes. Any further delay or obstruction by local parties will prolong uncertainty for the very ill patients who need this surgery.”

While some patients will have to travel further to access specialist services as a result of these changes, emergency admissions are rare, and ongoing work aims to ensure that more of a patient’s long-term care can be delivered closer to home, meaning fewer trips to specialist centres.

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