9 February 2017
Today (09 February) , NHS England launched its much-delayed public consultation on the national congenital heart disease (CHD) review, which includes proposals to end CHD services at Royal Brompton Hospital.
Commenting on the consultation, Dr Richard Grocott-Mason, medical director at Royal Brompton & Harefield NHS Foundation Trust, said:
“As a doctor, I cannot understand how this plan would result in patients receiving better care. It makes no sense to try and improve care by closing one of the biggest, well-performing services, or by destroying research teams that are leading the way in finding new treatments for the future. To do this without a sound basis in evidence is nothing short of foolhardy.”
Official figures show that Royal Brompton operates the UK’s largest CHD service, and consistently has among the best patient outcomes in the country. Clinical teams help over 14,000 patients, treating many from birth through childhood, adolescence and adulthood. It also has exceptionally high patient satisfaction levels, with over 98% of patients saying that they would recommend the cardiology service. The UK’s CHD services as a whole are already considered to be among the best in the world.
If the plans went ahead, Royal Brompton would be forced to withdraw all CHD services, requiring both child and adult patients to find another hospital to provide their care. The plans would also dismantle Royal Brompton’s world-leading adult CHD research team – responsible for publishing more papers than any other centre in the world – and would force the closure of its children’s intensive care unit.
Without intensive care the Trust’s paediatric cystic fibrosis and difficult asthma services, both of which are the largest service of their kind in the UK, would also have to close. NHS England’s consultation document does not include any plan for dealing with these, and other, wider consequences.
Dr Grocott-Mason continued: “We have held many meetings with NHS England, and provided evidence showing how we already achieve excellent outcomes for congenital heart disease patients. It is therefore regrettable that they have moved ahead with an expensive public consultation without addressing the key issues we and others have raised with them repeatedly over the last few months.
“This consultation document still does not explain how NHS England expects these plans to improve the care patients with congenital heart disease receive throughout their life. It fails to address how NHS England will counteract the damage that will be done to future care standards by the destruction of our world-leading research team, and astonishingly, despite our requests, does not provide an impact assessment of how other services such as those for children with cystic fibrosis, difficult asthma and complex lung disease will be affected by these plans. The damage to our work in genetics and high risk pregnancy and to our inherited cardiac conditions service is similarly ignored.
“This public consultation gives patients and medical professionals alike the opportunity to make their views known. I hope that NHS England use the consultation to genuinely take note of these views and to develop more sensible plans. We know the cost of this unnecessary reconfiguration would run to many millions of pounds and when resources are so stretched it seems impossible to understand why they are being used in this way.”
NHS England plans to withdraw CHD services because it considers the Trust not to meet a new standard around ‘co-location’. This requires certain paediatric services – gastroenterology, nephrology (kidney) and general surgery – to be permanently ‘co-located’ in the same building as the CHD service. As Royal Brompton is a specialist heart and lung hospital, these additional services are based at the neighbouring Chelsea & Westminster Hospital, just a few minutes’ walk away.
Staff from both hospitals have worked seamlessly together for years under a formal Service Level Agreement, with joint rotas, ward rounds, meetings and shared systems. The Trust has a 100 per cent record of ensuring that any patient in need of these additional services receives them at their bedside, whenever are needed, day or night.
Despite several requests, NHS England has not explained what else would be achieved through co-location, or how services at Trusts that are already co-located are in any way better as a result. They have admitted that there is no evidence showing any clinical benefits of co-location, and state that many clinicians were opposed to its inclusion as a compulsory standard.