Creating a new NHS England: Health Education England, NHS Digital and NHS England have merged. Learn more.
Action on Congenital Heart Disease services
As NHS England announces moves to ensure core standards of quality and sustainability apply across all specialist services, Will Huxter explains how patients with complex, sometimes life-threatening congenital heart disease, will benefit:
In my recent blogs, I have provided updates on the self-assessment process which we have been undertaking with CHD providers, reviewing their compliance with the national standards agreed by the NHS England Board in July 2015.
We took the outcome of these self-assessments to the Specialised Services Commissioning Committee, a sub-committee of the NHS England Board, on 27 June 2016. Based on these assessments, and following subsequent factual checking with the providers, NHS England has identified a number of commissioning decisions that it is minded to take to ensure the provision of consistent, high quality services across the country now and for the future.
We are taking these steps because we believe that they are in the best interests of patients with congenital heart disease and their families, including those yet to be diagnosed who will need these services in future.
We believe that by ensuring that all patients across the country are able to benefit from services that meet agreed national standards, the quality of care they receive will be improved.
We hope that providers and other stakeholders will support us in these aims and that they will work with us in the interests of patients and their families to ensure that sound decisions are taken, and once taken that they are implemented effectively and efficiently.
As Professor Sir Ian Kennedy, who was the chair of the public inquiry at Bristol Royal Infirmary and co-author of the report into eight cases at Bristol released last week, said: “These are vital services and we have waited 15 years to arrive at a solution which delivers quality and consistency for current and future generations.
“It is good news for patients that there is finally a clear consensus on the standards that need to be met, and that we are now seeing decisive action to make those standards a reality for every patient in every part of the country.”
The action being taken by NHS England will involve a number of changes. With regard to providers of specialist surgical (Level 1) services:
- Subject to consultation with relevant Trusts and, if appropriate, the wider public, NHS England will also work with Alder Hey Children’s Hospital NHS Foundation Trust and Liverpool Heart and Chest Hospital NHS Foundation Trust to safely transfer CHD surgery from Central Manchester University Hospitals NHS Foundation Trust. Specialist medical services may be retained at Central Manchester.
- Subject to consultation with relevant Trusts and, if appropriate, the wider public, NHS England will also work with University Hospitals of Leicester NHS Trust and Royal Brompton & Harefield NHS Foundation Trust to safely transfer CHD surgical and interventional cardiology services to appropriate alternative hospitals. Neither University Hospitals Leicester or the Royal Brompton Trusts meet the standards and are extremely unlikely to be able to do so. Specialist medical services may be retained in Leicester.
- NHS England will work with Newcastle Hospitals NHS Foundation Trust to ensure progress is made towards meeting the standards and the strategic importance of the link of CHD surgery to the paediatric heart transplant centre is sustainable and resilient.
- NHS England will support and monitor progress at University Hospitals Bristol NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, University Hospitals Birmingham NHS Foundation Trust, Barts Health NHS Trust, Guy’s and St Thomas’ NHS Foundation Trust, and University Hospital Southampton NHS Foundation Trust to assist them in their plans to fully meet the standards. In the case of Bristol this will also include addressing specific recommendations set out in the independent report published last week.
- Birmingham Children’s Hospital NHS Foundation Trust and Great Ormond Street Hospital for Children NHS Foundation Trust will continue to be commissioned, with ongoing monitoring, as they currently meet all or most of the standards.
NHS England remains concerned as to the level of occasional and isolated practice in specialist medical (Level 2) services, and intends to take the following actions:
- NHS England will work with Blackpool Teaching Hospitals NHS Foundation Trust, University Hospital of South Manchester NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, Nottingham University Hospitals NHS Trust and Imperial College Healthcare NHS Trust to cease occasional and isolated specialist medical practices. Plans will be put in place to transfer services to other appropriate providers.
- NHS England will support and monitor progress at Liverpool Heart and Chest hospital to develop Level 2 and Level 1 services in line with standards and Oxford to assist them in their plans to fully meet the standards.
- Norfolk & Norwich University Hospitals NHS Foundation Trust and Brighton and Sussex University Hospitals NHS Trust will receive ongoing monitoring of their progress towards meeting the standards.
In addition, a small number of hospital trusts not recognised as a specialist centre, but which responded to the self-assessment that they undertook occasional practice/interventions, have been instructed to make arrangements for such patients to be cared for at a specialist centre in future. This process has now all-but eliminated occasional practice, with follow-up action to be taken against providers if they continue.
When will your blog be updated (12/7/16 last entry) as I have still not had any response as requested and assured following your attendance at meeting of the H&WB Leicester? At this meeting you undertook to provide information. Having checked with the Clerk to the Council a further request for the information was requested. This is still awaited .
At your recent mtng with LLR H&W Board,as a member of the public I posed some Q.which you confirmed you were happy to send a reply.Having checked with Clerk no reply has been rec’d.Please be courteous & show respect by giving full answers.
“Govt states requirement for openness & candor with PPI throughout change process,avoiding the serious flaws of S&S + the reccs.made by Lord Roberio(IRP).Please give the names of the PPI representatives on the panel,their experience, & what what steps they took to gain factual independent local PPI data.Why no apparent involvement of PPI in the changed speed the standards to be met.Who authorized the acceleration without 1st consulting & why?
Being involved with the National and regional mtngs including S&S,I am well aware of assurances given.Why have they been broken?
Please supply the format & phraseology of the Q’s.to be put for the Consultation period.Will Quality Stnds be included?You asserted the decision had NO £ basis is this still the case?
Decommissioning a service such as congenital heart surgery services from any existing centre clearly constitutes a substantial development or variation in service provision (as defined by Regulation 23 of the Local Authorty [Public Health, Health and Wellbeing Boards and Health Scrutiny] Regulations Regulations 2013). This regulation imposes on NHS England a duty to consult as the responsible commissioner of congenital heart disease services.
Whilst NHS England might argue that there was a previous consultation in 2014, the 2014 consultation was limited to the standards and specifications and does not excuse NHS England from full consultation on the application of those standards and specifications to particular centres.
Is NHS England prepared to comply with its legal obligations in accordance with the above regulations? If NHs England fails to consult, its failure clearly leaves it open to a local authority health overview and scrutiny committee to refer the matter to the Secretary of State for Health, who in all likelihood would initiate a full review by the Independent Reconfiguration Panel.
(2) Governance and Transparency
Is NHS England fully satisfied that it has made the decision transparently, and without any conflict of interest? When did the NHS England Board make the decision? Where in NHS England’s governance arrangements is Will Huxter given the authority to make these decisions, apparently without any reference to the NHS England Board?
So are you going to publish detailed supporting material of these agreed national standards and a comparative matrix of their attainment, both self-assessed and actually achieved, for each centre currently under review?
Similarly, a simple comparison of current service provision capacity versus current and projected (real terms) per capita expenditure would be more honest.
I can only see another wasted opportunity ending in multiple judicial reviews and dissatisfaction, uncertainty and despair for patients, carers and NHS staff alike.
Really it would really have been better to have curtailed Bristol RI alone at this time and made no national recommendations at all.
For the benefit of the patients and families can NHS England clearly state what hospitals have been announced as level 1 and level 2 services? The announcement just relates to trusts who will deliver the services which is clearly causing some confusion especially in the adult services. It is important for those patients at the hospitals which you are proposing to remove services to know the alternative hospitals which can offer various levels of treatment.
As I understand it, the announcement means that there are no level 2 children’s services as they were unsupported and unviable.
There appear to be 4 level 2 adult services at Oxford, Norfolk, Sussex and possibly Manchester Royal Infirmary which is being downgraded from level 1. Can you confirm this is the case?
As yet, no level 3 (local) services are affected by the announcement. However, the effect on those services is still unknown.
I agree with the 3 comment about Glenfield hospital they should leave it where is local and one of best hospitals for heart victims I was treated there by the team who do the scans can not fault then at all they do a good job on every service quality and very help full in every way
According to commissioning their will never be enough patients needing this kind of surgery to Glenfield viable why us that ?
Being a parent of a child with congenital heart disease I don’t see why the royal Brompton is put at risk yet again when clearly the Bristol hospital were the ones who failed these children not only that but you say these will be safer for these kids their parents and the adults who need this service if that was the plan where are all these patients going to go and why should we have to travel further for the care they need I find this totally unfair and I couldn’t sfford to send me child to for example Birmingham hospital for the care they need it’s going to b expensive and it will put my child in more danger what if something happens to her what r we going to do do a journey on blue light all the way to the Brompton u will be putting these kids and adults in more danger for u to say about standards how about the failing’s from Bristol hospital the royal Brompton is a great place safe and mostly a safe haven for our children and adults this would be a great loss and u r putting our children in more danger by doing this because other hospitals r over stretched as it is
You know absolutely nothing about Royal Brompton hospital. It is a world-class facility. Just ask any patient or their family members what they think of this wonderful place. Your reasons, as before, are completely perverse and can only indicate a hidden agenda, professional jealousies perhaps? As always the truth will out eventually, and I am sure that the true reasons for this relentless persecution of RBH will be revealed, hopefully sooner rather than later; because all the time this idiocy goes on, it is NHSEngland who is endangering patients’ lives and no-one else, certainly not the Brompton.
How can it be Good News to close a high performing world renowned centre of excellence?
The original safe and sustainable review was found to be flawed and illegal and without backing up your words with appropriate facts I worry this decision too is flawed at best, dangerous at worst.
I am extremely angry that this decision has been made. Leicester is working towards the standards and is highly likely to meet them in a very short space of time. I understand that Newcastle is in the same position but will be given support to meet the standards, based on the fact that they perform transplants and this cannot be moved. The Glenfield has the ECMO centre which would prove very difficult to move elsewhere, and were it to move, lives would be at risk, not least because staff are no more liley to relocate than they were years ago when a closure was first mooted. Closure of the unit at the Glenfield will leave a huge area of the country without a cardiac centre which again would put lives at risk. Additionally I have serious concerns about the knock on effects for adult services. I think this is a very dangerous and I am disgusted that this has been foisted upon the East Midlands with absolutely no consultation with patients and families.
(1) In the interests of transparency will the information provided by all the centres or networks as to how they proposed to meet the standards be published on the NHS England website?
(2) Can NHS England confirm if those with congenital heart defects, who unfortunately at some stage are listed for transplant, have now lost the option to be listed for transplant at the Manchester and Papworth hospital sites?
How can it possibly be regarded as “Good news for patients …..” that children’s heart surgery at Glenfield Hospital in Leicester is to be lost? Your blog states that “University Hospitals Leicester do not meet the standards and are extremely unlikely to be able to do so” The former statement is disputed, and the latter is simply ridiculous. Even if it were to be accepted that performance is below standard, if any location can operate to the required standard, there is absolutely no reason why Glenfield could not – with appropriate intervention and funding. Also, what does the phrase “appropriate alternative hospitals” mean? “Appropriate” in terms of safety, accessibility, location, cost-effectiveness, convenience, clinical expertise, facilities? – what exactly? – and to who would this be “appropriate”? – certainly not the local population of Leicester. How inappropriate a decision is it to assume that Glenfield could not be brought to a position considered “appropriate”?! I have enormous respect for the NHS (considerably more than I have for the decision making machinery of NHSE) and can assure you that this particular “decision” will not be accepted without significant and disruptive resistance.
Are the standards now published by NHS for the public? Without this information being available it is difficult for patients/parents to understand the measures of service that are being used