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Congenital heart disease NHS England review

What you need to know

NHS England – the organisation that directs how the NHS works across England - have stated that they plan to decommission (stop paying for) congenital heart disease (CHD) services from Royal Brompton Hospital, subject to public consultation.

This would force Royal Brompton’s child and adult CHD services and our world-leading CHD research centre to close.
 
It would also potentially force the closure of a range of other services at the Trust, including the children’s intensive care unit and specialist children’s respiratory services such as those for cystic fibrosis, severe asthma and muscular dystrophy.



When will this happen and how will my/my child’s treatment be affected?


Is CHD care at Royal Brompton to close because it is not as good as it should be?


If the service is good, why do NHS England want to close it?


If this new requirement is about child services only, does that mean adult CHD care is unaffected by the plans?


Why was this proposal put forward?


Is Royal Brompton the only hospital not to meet all the standards?


Weren’t CHD services at Royal Brompton threatened with closure before?



When will this happen and how will my/my child’s treatment be affected?

 
The plan will be put to a public consultation (expected to begin in early 2017). A final decision is not expected until Summer 2017 at the earliest, and it is unlikely that any changes to patient care will take place before 2018 at the earliest. 

To be kept up to date with the public consultation and other activity around the decision-making process, visit our ‘How you can help’ page


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Is CHD care at Royal Brompton to close because it is not as good as it should be?

 
No – official data show Royal Brompton consistently has one of the biggest, best and safest CHD services in the UK (with UK CHD services as a whole being among the best in the world). Our adult CHD research output is also widely recognised as the best in the world.  
 
Although they plan to close the service, NHS England have expressed no concerns at all about the quality of CHD care at the Trust.


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If the service is good, why do NHS England want to close it?

 
NHS England recently stated that all hospitals offering CHD services must now also have certain other children’s services based on the same site – services such as general surgery and gastroenterology (treatment of digestive problems). Royal Brompton currently offers these services in partnership with Chelsea and Westminster Hospital.

Specialist trusts such as ours and the Royal Marsden have such partnerships so that clinical opinion across a number of specialties in addition to their own, is readily available. Our contract with Chelsea and Westminster (C&W) has been in place for several years, and means that expert opinion can be gained within a short timeframe across a number of areas both during and outside normal working hours.

The partnership with C&W works well; several consultants have joint contracts between our two hospitals and are key members of our multi-disciplinary teams, taking part in ward rounds and weekly meetings. Regular audits ensure that timely and appropriate medical opinion is achieved day and night.

The idea that all paediatric services need to be based on the same site has been opposed by a number of independent clinicians and has no basis in evidence.
 
NHS England have not disputed the effectiveness of our arrangement with Chelsea & Westminster. They also accept that there is no evidence that having all services on the same site improves patient care, and admit that many experts are opposed to this requirement. 


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If this new requirement is about child services only, does that mean adult CHD care is unaffected by the plans?

 
No – even though our adult CHD care meets all the standards required of it, both child and adult CHD services would end if NHS England’s plans were to go ahead.

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Why was this proposal put forward?

 
Reforming congenital heart disease services dates back to a 2001 report that investigated an unexpectedly high death rate among babies after heart surgery at one particular hospital – Bristol Royal Infirmary. The report made a number of broad recommendations about what the NHS needed to do to ensure such high death rates did not happen again.
 
Data from individual hospitals show a dramatic improvement in congenital heart disease standards in the early 2000s. There was a large increase in the number, and complexity, of the cases taken on, and death rates declined by nearly a third in the first half of the decade. By the end of the decade, studies showed that CHD care in the UK was among the best in the world.
 
Despite this improvement, central NHS management were still keen to introduce reforms that were linked to the recommendations of the 2001 report. The first attempt – ‘Safe and Sustainable’ – was published by NHS England in 2011, but was widely criticised and was abandoned two years later.
 
In 2015, a new set of around 470 new standards for CHD care was published to replace Safe and Sustainable.
 
It is one of these standards that states that all hospitals providing CHD services now need to have other named children’s services on site too. This standard exists even though, as NHS England have stated themselves, many medical professionals disagree with it, and there is no evidence showing it improves patient care.

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Is Royal Brompton the only hospital not to meet all the standards?

 
No – in fact, no hospital in the country meets all the standards. However, Royal Brompton’s CHD service is one of only three that is threatened with closure. CHD services at the remaining hospitals – including one hospital that also does not provide all services on one site – are not under threat.
 
It should be noted that there is no requirement in the standards for NHS England to commission CHD services from a set number of hospitals. So, if Royal Brompton’s CHD service remains open, it would not mean that services at another hospital would need to close.

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Weren’t CHD services at Royal Brompton threatened with closure before?

 
Yes – the ‘Safe and Sustainable’ review recommended the closure of children’s CHD services at Royal Brompton and other hospitals. However, after a series of protests, legal challenges and an independent review, the Secretary of State of Health, Jeremy Hunt, concluded that the plans were flawed and suspended them. He called for a new review of CHD services to replace Safe and Sustainable. The outcome of this new review is the proposal outlined above.


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