Councillors from the Royal Borough of Kensington and Chelsea tore into NHS England’s proposals to withdraw vital heart and lung services from Royal Brompton Hospital on Tuesday evening (11 July), and demanded they produce evidence that so-called ‘co-located’ services produce better outcomes for patients.
NHS England’s plans to decommission congenital heart disease (CHD) centre on one disputed claim: that Royal Brompton Hospital does not provide certain other services on-site, despite a formal working arrangement with neighbouring Chelsea and Westminster Hospital which ensures these services are available at patients’ bedsides 24 hours a day, 365 days a year.
Stopping the hospital’s CHD services will also result in the closure of Royal Brompton’s paediatric intensive care unit and other heart and lung services for thousands of patients, including the country’s largest paediatric cystic fibrosis and difficult asthma services. Despite this, NHS England is still unable to provide any evidence, from anywhere in the world, that ‘co-located’ services produce better outcomes for patients.
At a meeting of the borough’s Adult Social Care and Health Scrutiny Committee, councillors called the plans “bizarre” and accused NHS England of not “coming clean” about their reasons for withdrawing the services.
Changing the rules
Councillor Will Pascall challenged the NHS England panel, Dr Michael Marsh, Regional Clinical Director Specialised Commissioning (London), and John Stewart, Acting Director of Specialised Commissioning, saying: “Co-location by the larger [clinical reference] group originally which came forward with these standards was put down as 30 minutes access time; there was then a change by a smaller group. We don’t have any explanation as to who that smaller group was, what evidence they used and why they changed it from 30 minutes to being physically on the same site.
“What we need as a scrutiny committee is actually some chapter and verse of what this is, because if you want to close something that’s going to have such a serious effect as this is going to have, I think it warrants some serious evidence… We’ve asked for the further information before, through the Chairman, and we haven’t got it.”
Echoing a question patients, families and staff at the hospital have been asking since NHS England launched the review process a year ago, Councillor Pat Healy asked: “Are you able to give us evidence from other trusts that have co-location have better patient outcomes?”
“Looking for an excuse”
Councillor Robert Freeman added: “There is a wide suspicion that NHS England have looked for the answer, which is to close Royal Brompton, and then look for the justification for it afterwards.
“Effectively, you have got co-location…Chelsea and Westminster Hospital are confident that in fact co-location is provided. The strong suspicion is that you are looking for an excuse in order to close Royal Brompton.
“What is the clinical evidence that, because of the failure of not having a consultant within the walls but actually a few yards away, mortality and outcomes have been worse? I’ve seen absolutely no evidence that mortality and outcomes are adversely affected.”
“Bizarre”
After admitting that mortality data for CHD at Royal Brompton is “fine”, John Stewart was told by Councillor Freeman: “Excuse me saying so, but that’s bizarre. You’ve got a hospital that is working well, you’ve got provision of consultant support … available within a very short time, you have patient outcomes, you have standardised mortality all of which are at a satisfactory if not leading level and you say, ‘well look there’s some doctrinaire view that we have that they must not actually be within easy distance but must be actually on the same site, otherwise we’re going to close you down.’ That does seem bizarre to me.”
Royal Brompton teams currently have a 30 day survival rate for congenital heart surgery of 99%.
“De facto co-location”
Councillor Robert Atkinson told the panel from NHS England: “We’ve got de facto co-location – your paper is patronising and is repeating what we were told before. We asked you to give us detail and you haven’t.”
In a presentation to the committee, Dr Jan Till, consultant in Paediatric Electrophysiology at Royal Brompton, reassured councillors: “We care very much about co-located services… for many years we have worked with our colleagues at Chelsea and Westminster; it’s not a new thing: we’ve been doing it for a long time. We have built services around what children need so we can call on a general surgeon, a gastroenterologist, an endocrinologist, a neurologist, we have developed those services. It’s all contracted and we know those services are in place 24/7."
Asking why clinicians who have joint contracts with Royal Brompton and Chelsea and Westminster hospitals were not seen as ‘co-located’, Councillor Fenella Aouane suggested to NHS England that providing “two broom cupboards” as office space for them at Royal Brompton would mean the hospital was compliant with the standard.
Holistic care
Dr Jan Till continued:“These days you can transfer images digitally, if a child becomes unwell on our PICU, we’re in immediate contact, sending them X-ray images – “We think there’s a problem, can you come up?” and they will say “Get the theatre ready” – they operate on-site at Royal Brompton, not only emergency work, but also routine operations.”
Jan added that the team have audit data to prove they are one hundred per cent compliant in providing specialist support in an emergency, across all the specialties, within 30 minutes whenever a child has needed it.
An “act of vandalism”
During the meeting, NHS England were again unable to produce any clinical evidence that having other children’s services co-located on the same site produces any additional benefits for patients, let alone any that would outweigh the disruption caused by dismantling Royal Brompton’s leading cardiac, research, and respiratory teams.
Councillor Adrian Berrill-Cox told the delegation from NHS England: “This is an act of vandalism, destroying a service that has taken generations to build."
Councillor Will Pascall told the panel: “I find it insulting that this is the level of debate. Is this a serious analysis or an excuse? Come clean… this does not stand up to sensible, rigorous scrutiny.”