NHS England accelerates national reviews of vital specialist services for children – Dr Jonathan Fielden

Welcome to the first of what I hope will be a series of regular blogs, keeping you updated about the progress being made in NHS England’s work to secure sustainable specialist surgical and critical care services for children.

Today we have formally announced more details of our accelerated national reviews of both paediatric critical care, and specialised surgery for children.

Good progress has been made since the reviews began earlier this year, and some positive engagement has already taken place with a number of professional organisations.

It is clear that, from the discussions held so far, there is an appetite amongst those working in these service areas to engage with our review process, plus some tangible support for working collaboratively to develop workable solutions for the future delivery of services. This is very encouraging.

Reviews such as these would usually take up to two years to complete, but we are accelerating the paediatric critical care, and children’s specialised surgery reviews, as both of these services are inextricably linked with another critical piece of work.

In July this year, we announced our ‘minded’ proposals for the future delivery of congenital heart disease services for both adults and children. We have stated from the outset that final decisions about the future of these services need to be understood in the light of any potential changes to a number of other services on which congenital heart disease care depends.

Paediatric critical care and specialised children’s surgery are just two such services. Our reviews will also look at (paediatric) Extra Corporeal Membrane Oxygenation (ECMO), which delivers care to children with life-threatening respiratory and cardiac conditions, and paediatric transport – vital road and air services, which provide children with a mobile critical care service whilst transferring them between hospitals ensuring we can always get children to the right specialists at the right time.

The care currently provided by these services is good, and young lives are being saved every single day, thanks to the work of NHS staff in these areas.

However, as NHS England’s Director of Specialised Services, and Deputy National Medical Director, I need to think not just about the ‘now’, but about the future. We need to be sure that in years to come, children are able to access high-quality, safe and effective care, in the most appropriate setting, and as close to their homes and families as possible – Care that keeps up with the ever improving evidence of how best to achieve world class outcomes.

We know that the current configuration of many of our specialist children’s services varies across the country, which means that we are unable to guarantee consistent standards of care, regardless of where our patients live. We know, for instance, that children are sometimes looked after in the wrong setting, and are being treated in specialised intensive care units, when they could be treated closer to home, if there were suitable services or support in more local settings. Similarly we know that some children are transferred to specialist hospitals for surgery, when they could have their operations nearer home, if only their local acute hospital was supported in a different way.

We also know from our early discussions that there are a number of potential solutions to the problems I have outlined, and our review process will explore all of those in more detail. We will be directly engaging with colleagues who are working in these services, as well as with those patients and families who have first-hand experience of specialist children’s surgery and/or critical care.

We are also establishing an Expert Stakeholder Group, which I will chair, to oversee the work. We are currently recruiting to this group, but anticipate that it will include colleagues from organisations such as the Paediatric Intensive Care Society, the Royal College of Anaesthetists, the Academy of Medical Royal Colleges, the Children’s Alliance and the Royal College of Paediatrics & Child Health, as well as other key experts and representatives from patient organisations/expert users.  Membership of this group will be posted on the NHS England website shortly, but the Terms of Reference for the reviews has been published.

We expect to see some early findings from the reviews this winter, in particular regarding demand and capacity. This work will, in turn, inform the public consultation on our proposals for congenital heart disease services, which we expect to launch in mid-December.

I hope you have found this blog useful in bringing you up to date on progress so far. Over the next few weeks, my team will be developing plans for engagement with key stakeholders, as part of the service reviews. I will update you about opportunities for you to get involved in this work as soon as I can, the aim being to ensure that all children in England, their families and carers, achieve the best outcomes and experience within the resources available.

Jonathan FieldenDr Jonathan Fielden is the Director of Specialised Commissioning at NHS England. He leads the national specialised commissioning directorate within NHS England reporting to Simon Stevens and the development of the national strategy for specialised services. He also serves as a Deputy National Medical Director to Sir Bruce Keogh. Dr Fielden was previously Medical Director at University College London Hospitals NHS Foundation Trust and Royal Berkshire NHS Foundation Trust, Secondary Care Specialist and Governing Board Member at Aylesbury Vale Clinical Commissioning Group and has also worked on numerous national bodies. He is a consultant in anaesthesia and intensive care medicine by background and currently a Board Trustee at Nuffield Trust.

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  1. ian appleby says:

    Can you provide a single piece of clinical evidence that the Brompton is not providing exceptional care for children – in paediatric cardiology,congenital heart disease, respiratory medicine etc or is their “minded” decommissioning just because they dont work in a horizontal model like GOSH (who seem to be able to dictate how all paediatric services in this country are formulated ) Indeed, there is very good evidence (from a GOSH source) that the loss of patients when they transition to seperate adult services is up to 40% – a figure many times in excess of that at the Brompton.
    Why shut a centre of excellence just to have more average centres?

    • Anonymous says:

      Dear Ian

      You will be aware that NHS England has published a series of proposals relating to congenital heart disease services. These proposals will be the subject of formal public consultation, starting in December. Feedback received during this consultation will be considered by NHS England before any commissioning decisions are made, in spring 2017 at the earliest.

      Our proposals do not involve the closure of any centres, rather the moving of surgery and interventional cardiology to those centres which are able to meet the CHD standards within the required timeframe.

      NHS England is currently working with all CHD providers to better understand the impact of our proposals on related services, and will be taking this information into consideration, before any commissioning decisions are made.



  2. Debra Chambers says:

    I believe that the full impact of ECMO has not been fully realised or utilised yet. Glenfield Hospital, formally Groby Road hospital was and still is the leader in the international field. My husband who is Assistant Chief Perfusionist and myself as a retired ITU Sister and Cardio Thoracic Nurse Tutor have seen ECMO evolve and become expert over the last 30 years. We have had numerous interrupted nights sleep when he has been called out for emergency transport for critically ill patients both paediatric and adult when hospitals have not got the required skill or capacity to deal with these life threatening conditions. Many of the Perfusionists at Glenfield have been invited as guest speakers in ECMO and transport all over the world including the USA as they are recognised internationally as the very best in their field. I find it incredibly sad and somewhat disconcerting that this is not recognised by NHS England because if this was the case they would not even be considering this

    • Anonymous says:

      Dear Debra

      We absolutely acknowledge the significant amount of work Glenfield has done to develop its ECMO service, and the expertise and expert knowledge and skills displayed by all those working in, and supporting, the ECMO service there.

      However, Glenfield is not the only provider of ECMO services in England, and we need to look at how this vitally important, national service is provided, so that we can ensure its sustainability for the future.

      The national review of paediatric critical care includes ECMO in its scope, and will look at the current provision of ECMO across the country. We will be directly engaging with stakeholders as part of this review, and hope to make details of how you can get involved available shortly, via this blog.