NHS England outlines future of congenital heart disease services

NHS England has today set out plans to implement exacting new standards that will ensure patients with congenital heart disease (CHD) receive the best possible care.

Hospitals that do not currently fulfil these standards, which have been developed by specialists and patients, must either show that they have a programme to do so and meet strict milestones, or stop providing treatment.

NHS England’s work has already seen patients with congenital heart disease benefiting from these standards, including full out of hours, seven day cover across the country and safer practice as procedures are only carried out by specialists.

However, in future all children with heart disease will receive inpatient care in a place where all the specialists and services they need are on-site, so that they can receive the best care without either the patient or the specialist having to travel to another hospital.

Clinicians and professional bodies, including the Royal College of Paediatrics and Child Health, British Congenital Cardiac Association, British Heart Foundation and the Royal College of Anaesthetists have said that “isolated children’s services are unacceptable and children’s cardiac services must be co-located within a hospital providing a broad range of paediatric specialties and services.”

Every operation or interventional procedure for congenital heart disease patients will be carried out by specialist doctors whose volume of practice is sufficient to develop and maintain their skills, working in centres that are more resilient, with bigger teams, and providing full 24 hour seven day specialist care.

Professor David Anderson is a Consultant Heart Surgeon and former President of the British Congenital Cardiac Association (BCCA) has previously said: “125 really is a minimum number. It equates to three operations a week, per surgeon. Practice makes perfect. Some of the operations we do only come up once or twice a year… we must set a minimum standard in order to ensure that a surgeon has an acceptable level of skill refined and maintained through regular practice.”

The plan unveiled today, which follows extensive consultation on NHS England’s proposals, will ensure that in future all hospitals will meet the new standards.

Patients and their families provided feedback that it was important to have the standards, but that only mattered if they were being met. The decisions reached by the NHS England Board will further support compliance by:

  • Commissioning Liverpool Heart and Chest Hospital NHS Foundation Trust to provide level 1 adult CHD services in the North West, with Manchester University Hospitals NHS Foundation Trust providing the full range of level 2 adult CHD services as an integral part of a North-West CHD Network;
  • Continuing to commission University Hospitals of Leicester NHS Trust to provide level 1 CHD services, conditional on achieving full compliance with the standards in line with their own plan to do so and demonstrating convincing progress along the way;
  • Backing the Royal Brompton and Harefield NHS Foundation Trust’s ambitious new outline proposal for achieving full compliance with the standards and continuing to commission level 1 services from them in the meantime, conditional on demonstrating convincing progress along the way;
  • Commissioning Newcastle upon Tyne Hospitals NHS Foundation Trust to provide level 1 CHD services until at least March 2021, with further consideration to be given, by NHS England, to the future commissioning of both its advanced heart failure and transplant service and its level 1 CHD service; and
  • Ceasing to commission level 2 CHD services, including cardiology interventions in adults with CHD, from Blackpool Teaching Hospitals NHS Foundation Trust, Imperial College Healthcare NHS Trust, Nottingham University Hospitals NHS Trust, and University Hospital of South Manchester NHS Foundation Trust.

In each case, NHS England will work with providers on their plans and closely monitor progress towards each of the standards, and take appropriate action, if it becomes clear that the standards will not be met according to the timescale set.

NHS England also signalled its support for further action to implement all the standards at all of the hospitals providing CHD services. There will be support for networks to promote closer working between hospitals, steps to improve the information available on how well the service is performing and a national programme to assess each centre against the remaining standards and to share best practice.

Professor Huon Gray, National Clinical Director for Heart Disease, NHS England said: “Every patient should be confident that their care is delivered by a hospital that meets quality standards, which have been developed after long consultation with patients, their families and specialist clinical staff. These standards, agreed in 2015, are intended to ensure that the care received by those with congenital heart disease is consistent, of the highest quality, and maintained in future years. These objectives have always been at the forefront of our proposals.

“Progress made towards meeting the standards so far is encouraging, and we know that the Brompton and Leicester have gone to great lengths to develop plans to meet the standard. However, we have been clear that there is further work to do and where necessary, action must be taken to achieve this within the specified timescales.”