Hello, and welcome to my latest blog, which I hope will provide you with an update on where we are up to in terms of our engagement about proposals for improving congenital heart disease services in England.
I want to remind you about the reasons for us doing this work, and also inform you about developments in specific parts of the country.
The driver for NHS England’s work is simple – we want to ensure that every patient, who requires care for congenital heart disease, can be confident that that care is delivered from a centre that meets the national standards.
These standards were developed by clinicians, patients, and other key stakeholders, and were the subject of rigorous public consultation, before being formally agreed by our Board in July 2015.
We know that implementation of these standards is critical if we are to provide the services our patients deserve. We know this, because stakeholders – including patient groups and families – have told us. We are strongly committed to ensuring that people with congenital heart disease have access to high quality, resilient services – achievement of the agreed national standards is the best way of securing this.
However, any potential change will not happen overnight. We are currently preparing for formal public consultation on our proposals. Commissioning decisions will not be made until spring, at the earliest, next year, and only after feedback received during that consultation has been considered. Any changes to current service provision will be carefully managed, and we will work with patients, and their clinical teams, to ensure that transition is as smooth as possible.
At the moment, we are meeting with providers across the country to discuss our proposals and their implications for individual hospital trusts. We have met with staff, patient groups and many others with an interest in the services, to answer questions; have visited existing facilities, to hear about plans for the future; and have sought to clarify some points where we needed further detail.
So far we have visited Great Ormond Street, the Evelina, University Hospitals Leicester, the Royal Brompton, Birmingham Children’s Hospital, and Barts. We also have visits lined up at Newcastle, Alder Hey, Liverpool Heart & Chest Hospital, and Central Manchester University Hospitals, with other hospital visits still to be arranged.
I would like to thank all of the providers who have hosted visits so far, in particular the clinical staff who have made time within their busy schedules to meet with us. We are in listening mode at the moment, and very open to debate and discussion. Since publishing our proposals in early July, we have dealt with almost 70 separate pieces of correspondence relating to our proposals, so if you do have any queries, please get in touch with us at firstname.lastname@example.org
The discussions currently taking place with CHD providers are critical as there is still opportunity for providers to produce evidence, or come up with solutions, which will enable them to meet the CHD standards in full by the required timescales. This would influence what we finally consult on.
University Hospitals Leicester NHS Trust
We know that University Hospitals of Leicester NHS Trust has put into the public domain correspondence sent to NHS England. The letter relates to a number of questions which we put to the Trust, after our visit there on 16 September.
In the interests of balance, it is important for people in Leicester, the wider East Midlands and beyond to understand the background to some of the questions we asked. There remain some fundamental areas where our assessment of the Trust’s current position – based on the information provided to us by the Trust – shows that Leicester does not currently meet the national standards, and which it needs to address.
The national standards require a minimum of three consultant surgeons, each undertaking a minimum of 125 operations per year, averaged over the three years leading up to April 2016. Leicester has reported carrying out 331 cases in 2015/16, well short of the minimum requirement for 3 surgeons of 375 cases. The Trust has told us that it has one substantive consultant surgeon and two locums.
The national standard further requires four consultant surgeons, each undertaking a minimum of 125 cases per year, averaged over the three years leading up to April 2021 – which would require an increase of over 50% on the numbers achieved last year. University Hospitals Leicester has not yet provided us with a plan setting out how they would achieve the 500 cases required.
This is a really important standard for patients. We want patients to be confident that their surgery is being delivered by an expert in this field, who has the back-up of a team of fellow surgeons, to cover periods of annual leave, sickness and out-of-hours cover. On the basis of the information provided so far, we cannot guarantee that this is the case in Leicester.
The national standards also have requirements for particular clinical services to be located together on the same site, so that patients and their families can benefit from treatment from a team who know each other well, and which is able to respond in a joined up way at very short notice when required. University Hospitals Leicester has not yet provided the information we require to demonstrate that these standards are met.
We will continue discussions with colleagues at University Hospitals Leicester, during this pre-consultation period, and will use this blog to share further information about any developments at Leicester or elsewhere as appropriate.