Doctors attack plan to close children’s heart unit at the Royal Brompton hospital. Can 216 specialists be wrong?

Chris Smyth reports in the Times 28th July 2017: Doctors attack plan to close children’s heart unit at the Royal Brompton hospital

Image result for heart surgery cartoon

Doctors from around the world have condemned plans to close the biggest NHS children’s (The Brompton) heart surgery unit, in a battle that highlights how the NHS struggles to make life-saving reforms.

Thousands of children would suffer if the Royal Brompton’s congenital heart disease unit was closed and care for adults would also be put at risk, according to 216 specialists in cardiology and paediatrics.

NHS England said last year that the unit was one of three hospitals that must no longer operate on children or adults with inherited heart problems in an attempt to improve standards by centralising care.

The move dates back to the Bristol heart scandal in the 1990s and the principle of restricting complex care to a smaller number of specialist centres is widely supported. However, disputes about the evidence and which units should close have derailed such plans.

In a letter to The Times, doctors say that the Brompton’s results are excellent and “it is difficult to identify where any patient benefit would accrue” by closing the unit.

NHS England said: “We all want to ensure that patient care is as good as it can possibly be.”

Letters to the Times 28th July 2017:

HEART SURGERY PLEA

Sir, As medical professionals working in cardiovascular, respiratory and paediatric care, we urge the health secretary to block plans to decommission congenital heart disease (CHD) services at Royal Brompton Hospital. This plan would affect more than 14,000 patients and 400 staff and would cost tens of millions of pounds, yet it is difficult to identify where any patient benefit would accrue. Official data show that Royal Brompton’s CHD service is the largest in the UK, with excellent patient outcomes. The Royal Brompton & Harefield NHS Foundation Trust’s adult CHD research team is independently rated as the most influential in the world.

NHS England’s plan will result in the closure of Royal Brompton’s paediatric intensive care unit (PICU), losing a sixth of London’s PICU beds at a time when there is already a widely publicised shortage in London and the south. The lack of a PICU would in turn occasion the loss of other heart and lung services treating thousands of patients, including the country’s largest paediatric cystic fibrosis and difficult asthma services.

Dr David Ross, Consultant Paediatric Cardiac Surgeon, University of Alberta Hospital; Dr Gary Webb, Consultant Cardiologist, Cincinnati Children’s Hospital; Professor Ju Le Tan, Senior Cardiology Consultant, National Heart Centre Singapore; Professor Paul Khairy, Director, Adult Congenital Heart Centre, Montreal Heart Institute; Professor Tal Geva, Professor of Paediatrics, Boston Children’s Hospital / Harvard Medical School; Dr Lisa Hornberger, Professor of Paediatrics and Consultant Cardiologist, University of Alberta / Stollery Children’s Hospital; Professor Barbara Mulder, Cardiologist, Academic Medical Centre Amsterdam; Dr Susan Etheridge, Professor of Paediatrics, University of Utah; Professor Jolien Roos-Hesselink, Consultant Cardiologist, Erasmus Medical Center Rotterdam; Professor Dipen Shah, Director, Cardiac EP, University Hospitals Geneva; Professor Wayne Tworetzky, Consultant Attending, Boston Children’s Hospital; Dr Puja Banka, Consultant Cardiologist, Boston Children’s Hospital; Dr Anne Marie Valente, Cardiologist, Boston Children’s Hospital; Dr Andrew Powell, Chief, Cardiac Imaging Division, Boston Children’s Hospital; Dr Alexander Opotowsky, Assistant Professor, Boston Children’s Hospital / Brigham and Women’s Hospital / Harvard Medical School; Professor Douglas L. Packer, Director Translational Electrophysiology / Clinical Consultant Electrophysiology, Mayo Clinic / Mayo Foundation; Professor Luc Mertens, Consultant Cardiologist, The Hospital for Sick Children, Toronto; Professor Edgar Jaeggi, Director, Fetal Cardiac Program, The Hospital for Sick Children, Toronto; Dr Elizabeth Stephenson, Consultant Cardiologist, The Hospital for Sick Children, Toronto; Professor Vivek Reddy, Director of Electrophysiology, Mount Sinai Hospital, New York; Professor Mats Mellander, Consultant Paediatric Cardiologist, Queen Silvia Children’s Hospital, Sweden; Dr Vasu Venkanna Burli, Clinical Fellow Children’s Acute Transport Service, Great Ormond Street Hospital; Dr Evangelia Papathanasiou, Clinical Fellow in Paediatric Cardiology, Great Ormond Street Hospital; Professor Peter Schwartz, Director, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano; Dr Riyan Sukumar Shetty, Consultant Paediatric ITU and Head of ECLS, Narayana Institute of Cardiac Sciences, India; Dr Aranzazu Gonzalez Posada, PICU Consultant, 12 de Octubre Hospital, Madrid; Mr Michael Heuer, Managing Director Europe, Acutus Medical, Belgium; Dr Kelly Straka, PICU Fellow, Aghia Sophia Children’s Hospital, Greece; Professor George Giannakoulas, Consultant Cardiologist, AHEPA University Hospital, Greece; Dr Fulvio Gabbarini, Consultant Cardiologist & Chief of Grown Up Congenital Heart Center, AOU Città della Salute e della Scienza di Torino, Turin University; Dr Sumanaru Dorin, Paediatrics, AP-HP Paris; Dr Prabhat Maheshwari, Head of Paediatric Intensive Care, Artemis Hospital, Gurgaon, India; Professor Karl-Heinz Kuck, Head of Cardiology Dept., Asklepios Klinik St. Georg, Germany; Dr Michael Schlüter, Scientist, Asklepios Proreseach, Germany; Dr Hani Mahmoud, Associate Consultant Cardiologist, Aswan Heart Centre, Egypt; Dr Massimo Stefano Silvetti, Cardiologist, Bambino Gesù Children’s Hospital, Rome; Dr Fabrizio Drago, Paediatric Cardiologist & Chief of Paediatric Cardiology, Bambino Gesù Children’s Hospital, Rome; Dr Ramaratnam Ramanan, Consultant Paediatrician, Basildon Hospital; Dr Tosin Otunla, Consultant Paediatrician, Ashford & St Peter’s Hospital; Dr Anita Mittal, Consultant Paediatrician, Bedford Hospital; Mr Nimrod Hershco, Field Clinical Specialist, Belinson, Israel; Professor Cristiane Martins, Consultant Cardiologist, Biocos Hospital, Brazil; Mr Bjarne Larsen, Clinical Development Manager, Biosense Webster, Denmark; Dr Farhana Khalil, Consultant Paediatrician, Bradford Teaching Hospitals; Dr Martin Hosking, Consultant Cardiologist, British Columbia Children’s Hospital; Dr Raghavan Nair Mahesh Babu, Consultant Paediatrician, Broomfield Hospital; Mr Lars Retzlaff, Senior Field Clinical Specialist, Bsc, Germany; Professor Jia L, Professor, Capital Institute of Paediatrics, China; Dr Jelena Radojevic Liegeois, Paediatric and Adult Congenital Cardiologist, Strasbourg; Dr Junaid Zaman, Electrophysiologist, Cedars Sinai Medical Center, US; Dr Joachim Hebe, Co-Chair, Center for Electrophysiology Bremen, Germany; Professor Christos Ouzounis, formerly Professor & Chair, King’s College London, CERTH, Greece; Professor Stefan Willich, Director, Charite University Medical Center, Germany; Dr Sam Kaddoura, Consultant Cardiologist, Chelsea and Westminster Hospital; Dr Bikash Bhojnagarwala, Consultant Neonatolgist, Chelsea and Westminster Hospital; Dr Jonathan Penny, Consultant Paediatrician, Chelsea and Westminster Hospital; Dr Martin Stocker, Consultant PICU/NICU, Children’s Hospital Lucerne, Switzerland; Dr Jose Pedro Da Silva, Peadiatric Cardiothoracic Surgeon (Attending), Children’s Hospital of Pittsburgh of UPMC; Professor Gil Wernovsky, Senior Consultant in Paediatric Cardiology and Cardiac Critical Care, Children’s National Health System, US; Dr Marie Bosman, Consultant Anaesthetist, Christian Barnard Mem Hospital, South Africa; Dr Marko Gujic, Consultant Electrophysiologist, CHU Charleroi, Belgium; Professor Julian Villacastin, Director Cardiovascular Institute, Clínico San Carlos. Madrid, Spain; Dr Radu Vatasescu, Consultant Cardiologist, Head EP Lab, Clinic Emergency Hospital Bucharest; Dr Miguel Ventura, Cardiologist Electrophysiologist, Coimbra University Hospital, Portugal; Dr Theo Fenton, Consultant Paediatrician, Croydon University Hospital; Dr Dinakaran Rengan, Consultant Paediatrician, Croydon University Hospital; Dr Nazma Chowdhury, Consultant Paediatrician , Croydon University Hospital; Professor Hans-Heiner Kramer, Director, Department of Congenital Heart Disease and Paediatric Cardiology, Kiel; Professor Annalisa Angelini, Associate Professor of Cardiovascular Pathology, University of Padua, Italy; Professor Ingo Daehnert, Head of Paediatric Cardiology, Heart Center, University of Leipzig; Professor Gaetano Thiene, Professor of Cardiovascular Pathology, Università degli Studi di Padova, Italy; Dr Alexandra Galloway, Consultant Paediatrician, East and North Hertfordshire NHS Trust; Miss Elia Heraclio Doya, Internist and Cardiologist, Ernst von Bergmann Klinikum, Germany; Dr Judit Llevadias, Paediatric Cardiac Intensive Care Consultant, Freeman Hospital, Newcastle; Professor Jochen Weil, Consultant Paediatric Cardiologist, German Heart Center Munich; Professor Isabel Deisenhofer, Head of Department, German Heart Center Munich; Professor Gabriele Hessling, Consultant Paediatric Cardiologist, German Heart Center Munich; Dr Oktay Tutarel, Consultant Cardiologist, German Heart Centre Munich; Mrs Jenni Syrjaenen, Clinic Manager, German Heart Centre, United Arab Emirates; Professor Christof Stamm, Consultant Surgeon, German Heart Institute Berlin / Charite Universitaetsmedizin; Mrs Miriam García San Prudencio, Consultant Paediatrician, Gregorio Marañón Hospital, Spain; Professor Yves Ville, Professor of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, France; Professor Simcha Yagel, Consultant Obstetrician/Gynecologist, Hadassah-Hebrew University Medical Center, Israel; Dr Roman Gebauer, Consultant Paediatric Cardiologist, Heart Centre, University of Leipzig; Dr Fernando Moraes, Consultant Cardiac Surgeon, Heart Institute of Pernambuco, Brazil; Dr Britta Weidtmann, Consultant Cardiologist, Helios Berlin; Dr Michele Cruwys, Consultant Paediatrician, Hillingdon Hospital; Professor Mélèze Hocini, Consultant Cardiologist, Hopital Haut Leveque, France; Dr Elena Montañes, Consultant Cardiologist, Hospital 12 Octubre, Madrid; Ms Rosa Maria Calderon Checa, Consultant PICU, Hospital 12 Octubre, Madrid; Professor Cleonice de Carvalho Mota, Consultant Paediatric Cardiologist, Hospital das Clínicas/ Federal University of Minas Gerais, Brazil; Dr Patrícia Barrios, Consultant Paediatric Cardiologist, Hospital de Clínicas de Porto Alegre (UFRGS), Brazil; Dr María del Carmen Gutiérrez, Paediatric Pathologist, Hospital Pereira Rossell / University of Uruguay; Dr Joaquim Bartrons Casas, Consultant Fetal and Paediatric Cardiologist, Hospital Sant Joan de Deu, Spain; Professor Jose Luis Merino, Chief Robotic EP Laboratory, Hospital Universitario La Paz, Spain; Mrs Ana María Marcos Oltra , PICU Consultant, Hospital Virgen de la Arrixaca, Murcia, Spain; Professor Josef Kautzner, Head of Department, IKEM, Czech Republic; Dr David Inwald, Consultant Paediatrician with Expertise in Cardiology, Imperial College Healthcare NHS Trust; Dr Jayanta Banerjee, Consultant Neonatologist, Hon Consultant, Paediatric Cardiology, Hon Senior Clinical Lecturer, Imperial College Healthcare NHS Trust / Imperial College London; Dr Aubrey Cunnington, Clinical Senior Lecturer in Paediatric Infectious Diseases, Imperial College London; Dr William Aaron Kay, Medical Director, Adult Congenital Cardiology Program, Indiana University; Miss Renate Oberhoffer, Director, Institute of Preventive Paediatrics, Technical University Munich; Professor Carina Blomström Lundqvist, Consultant Cardiologist, Institution of Medical Science, Sweden; Dr Raul I. Rossi Filho, Consultant Pediátrica Cardiologist, Instituto de Cardiologia, Brazil; Dr Estela Suzana Horowitz, Consultant Cardiologist, Instituto de Cardiologia, Brazil; Professor Vera Aiello, Cardiovascular Pathologist, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo; Professor Peter Schwartz, Director, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Italy; Dr Koby Sheffy, Chief Scientist, Itamar Medical, Israel; Professor Cecilia Linde, Consultant Cardiologist, Karolinska University Hospital, Sweden; Dr Haitham Sakr, Consultant Cardiologist, King Saud Medical City, Saudi Arabia; Dr Spyridon Zidros, Echocardiography Fellow, King’s College Hospital; Dr Philip Knight, PICU fellow, King’s College Hospital; Dr Laura Vitali Serdoz, Head of the Arrhythmia and Electrophysiology, Klinikum Fuerth, Germany; Professor Alpay Celiker, Consultant Cardiologist, Koc University Hospital, Turkey; Dr Akiko Ueda, Cardiologist, Kyorin University Hospital, Japan; Dr Hamish Walker, Consultant Cardiologist, Leeds General Infirmary; Professor Katja Zeppenfeld, Prof. Cardiology, Leiden University Medical Centre, Netherlands; Dr Lyn Ventilacion, Consultant Paediatrician, Lister Hospital; Dr Jan Reiser, Consultant Paediatrician, Lister Hospital; Dr Prathiba Chandershekar, Consultant Neonatal Paediatrician, Lister Hospital; Dr Kanimozhi Tamilselvan, Consultant Paediatrician, Lister Hospital; Dr Anshoo Dhelaria, Paediatric Consultant, Lister Hospital; Dr Sharmishtha Sarkar, Consultant Community Paediatrician, Lister Hospital; Dr Amanda Williams, Consultant Paediatrician, London North West Healthcare NHS Trust; Dr Khadija Ben-Sasi, Consultant Neonatologist, London North West Healthcare NHS Trust; Dr Wolfgang Muller, Consultant Paediatrician, London North West Healthcare NHS Trust; Dr Gerald Hanson, Consultant Paediatrician with cardiology expertise, London North West Healthcare NHS Trust; Dr Nilanjana Ray, Consultant Paediatrician, London North west Hospitals NHS Trust; Dr Krishnan Balasubramanian, Consultant Paediatrician, Maidstone and Tunbridge Wells NHS Trust; Dr Burkhard Hügl, Chief of Cardiology Department, Marienhaus Neuwied, Germany; Dr Job Cyriac, Paediatric Consultant with Cardiology Interest, Mid Essex Hospitals NHS Trust; Dr Michele D’Alto, Consultant Cardiologist, Monaldi Hospital, Italy; Dr Ali Zaidi, Director of Adult Congenital Heart Disease Program, Montefiore Medical Center, Albert Einstein College of Medicine, US; Dr Peter G. Guerra, Chief of Medicine and Cardiology, Philippa and Marvin Carsley Chair in Cardiology, Montreal Heart Institute; Professor Jan Janousek, Consultant Paediatric Cardiologist, Motol University Hospital, Czech Republic; Dr Mithuna Urs, Consultant Paediatrician, Maidstone and Tunbridge Wells NHS Trust; Dr Shreesha Maiya, Consultant Paediatric Cardiologist and Electrophysiologist, Narayana Health, India; Dr Ganesh Sambandamoorthy, Consultant CICU , Narayana Institute of Cardiac Sciences, India; Professor Marek Malik, Professor of Cardiac Electrophysiology, National Heart and Lung Institute, UK; Dr Alice Maltret, Paediatric Cardiologist, Necker-Enfants Malades, France; Dr Barbara Deal, Consulting Cardiologist, Northwestern Hospital, US; Dr Kerry Day, Consultant Paediatrician, Northwick Park Hospital; Dr Sheana Wijemanne, Paediatric Consultant, Northwick Park Hospital; Dr Richard Nicholl, Consultant Paediatrician, Northwick Park Hospital; Dr Thais Lins Pedersen, Resident Cardiologist, Odense University Hospital; Dr Tom De Potter, Staff Cardiologist, OLV Hospital, Belgium; Professor Seshadri Balaji, Paediatric Cardiology, Oregon Health & Science University; Dr Craig Broberg, Consultant Cardiologist, Associate Professor, Oregon Health and Science University; Miss Silvia Scansani, Cardiac Physiologist Echo, Policlinico Ospedale Maggiore, Italy; Dr Deane Yim, Consultant Paediatric Cardiologist, Princess Margaret Hospital Perth; Dr Catarina Cavalcanti, Paediatric Cardiologist, PROCAPE University Hospital / University of Pernambuco, Brazil; Dr Monther Obeidat, Fellow in Paediatric Cardiology, Queen Alia Heart Institute, Jordan; Professor Stephanie Ware, Professor of Paediatrics and Medical and Molecular Genetics, Riley Hospital for Children at Indiana University; Professor Yves d’Udekem, Consultant Cardiac Surgeon, Royal Children’s Hospital, Australia; Dr Sainath Raman, Paediatric Intensive Care Fellow, Royal Children’s Hospital, Australia; Dr Safeena Afzal, Anaesthetic Registrar, Royal Free Hospital; Dr Ana Martinez Naharro, Clinical Research Fellow, Royal Free Hospital; Dr Mark Spence, Consultant Cardiologist, Royal Victoria Hospital; Dr Mariutzka Zadinello, Consultant Paediatric Cardiologist, Saúde Santa Mônica Medical Center, Brazil; Dr Fredy Prada, Consultant Cardiologist, Sant Joan de Deu Hospital, Spain; Dr Amish Vora, Senior Consultant Paediatric Intensivist, SRCC NH Children’s Hospital, India; Dr Sandeep Shetty, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Donovan Duffy, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Nasreen Aziz, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Cliona Murphy, Consultant Cardiologist and Electrophysiologist, St Luke’s Hospital, University of Missouri Kansas City, UK; Dr Alison Groves, Consultant Paediatrician & Cardiology Lead, St Peter’s Hospital, UK; Dr Anay Kulkarni, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Maxim Didenko, Head of Department, Associate Professor, St. Petersburg Paediatric State University, Russia; Professor Sanjiv Narayan, Professor of Medicine, Stanford University, Palo Alto, California, US; Dr Venkata Krishna Kishore Jayanthi, Consultant Paediatric Intensivist, Star Hospital, India; Professor Evgeny Pokushalov, Head of Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Russia; Mr Bart Wittevrongel, Director Clinical Adoption EMEA & ROW, Stereotaxis, Belgium; Ms Dustie Butteiger, Research and Clinical Affairs Manager, Stereotaxis Inc., US; Dr Paul Brathwaite, Vice President of Research and Development, Stereotaxis, Inc., US; Mr Nathan Kastelein, Medical Systems Engineer, Stereotaxis, Inc., US; Dr Adil Dingankar, Cardiac Critical Care Research Fellow, Stollery Children’s Hospital, Canada; Dr Claire Scudder, GP, The Chelsea Practice, UK; Professor Jack Rychik, Robert and Dolores Harrington Endowed Chair in Paediatric Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine; Dr Andrew Davis, Paediatric Cardiologist and Electrophysiologist, The Royal Children’s Hospital, Australia; Dr Daniel Tobler, Staff Cardiologist, University Hospital Basel, Switzerland; Dr Ans Wiesfeld, Cardiologist / Electrophysiologist, University Hospital Groningen, Netherlands; Professor Gerhard-Paul Diller, Consultant Cardiologist, University Hospital of Münster, Germany; Dr Maria Grazia Bongiorni, Director of Cardiology Department, University Hospital of Pisa; Dr Matthias Greutmann, Director Congenital Heart Disease Unit, University Hospital Zurich; Dr Fernando Amaral, Consultant Adult Congenital Heart Disease, University Hospital, Ribeirão Preto, Brazil; Dr Mohammad Zoha, Consultant Paediatric Transport, University Hospitals of Leicester; Dr Julia Vujcikova, Consultant Paediatric Intensivist, University Hospitals of Leicester; Professor Isabelle Van Gelder, Cardiologist, University Medical Center Groningen, Netherlands; Professor Ian Adatia, Consultant Paediatric Pulmonary Hypertension Specialist and Paediatric Cardiologist, University of Alberta / Stollery Children’s Hospital / Glenwood Paediatric Cardiology Clinic, Canada; Dr Julia Indik, Professor of Medicine, Division of Cardiology, University of Arizona, Sarver Heart Center, US; Professor Nassir Marrouche, Professor of Medicine, University of Utah; Professor Jeanne Poole, Consultant Cardiologist-Electrophysiologist, University of Washington; Professor Haran Burri, Staff Physician, University Hospital of Geneva; Dr Ferran Rosés-Noguer, Lead of Paediatric Cardiology Department, Vall d’Hebron University Hospital, Spain; Dr Sunil Raga, Consultant Paediatrician; Professor David L Wessel, Executive Vice President and Chief Medical Officer, Washington; Dr Sankara Narayanan, Paediatrician with Cardiology Interest, Watford General Hospital; Dr Emmanuel Quist-Therson, Consultant Paediatrician/Local PEC, West Hertfordshire Hospitals NHS Trust; Dr Eleanor Hulse, Consultant Paediatrician, West Middlesex University Hospital; Trudie Lobban MBE FRCP (Edin), Expert Patient Representative, Arrhythmia Alliance, UK; Dr Anil Garg, Consultant Paediatrician – PECSIG, Western Sussex Hospitals Foundation NHS Trust; Dr Anna Mathew, Consultant Paediatrician, Western Sussex Hospitals NHS Foundation Trust; Dr Jonathan Mervis, Consultant Paediatric and Interventional Cardiologist, Westmead Children’s Hospital, Australia; Dr Rachael Cordina, Cardiologist, Royal Prince Alfred Hospital, Clinical Senior Lecturer, University of Sydney; Dr Coralie Blanche, Hôpitaux Universitaires de Genève; Dr Riikka Rydman, Karolinska Institutet, Sweden; Dr Annette Schophuus Jensen, Department of Cardiology, Rigshospitalet, Copenhagen; Professor Alex Davidson, Cardiologist, Children’s Hospital of Philadelphia; Mrs Maria Cristina Bembom, Consultant Cardiologist, Hospital de Clinicas Gaspar Vianna, Brazil; Professor Maiy El Sayed, Consultant Paediatric and Adult Congenital Cardiologist, Ain Shams University Hospitals, Egypt; Professor Lars Sondergaard, Consultant Cardiologist, Rigshospitalet, Denmark; Professor Paul Volders, Cardiologist / Professor of Genetic Cardiology, Maastricht University Medical Centre; Mr Charles E. Juvin, Cardiovascular Surgeon, Hôpital Universitaire Pitié-Salpêtrière, France; Professor William Yip, Adjunct Professor, National University of Singapore; Dr Trong Phi Le, Klinikum Links der Weser, Germany; Dr Tiffany Ng, Junior Doctor, Chelsea and Westminster Hospital

Peers from across political spectrum unite to support our CHD service

Thousands march to save Royal Brompton services from closure … (March 2017)

and The Guardian: Why is this children’s heart unit facing closure? A day on the NHS …Jessica Elgot

For our last appointment of the day, we meet Robert Craig, the chief operating officer at Royal Brompton. NHS England’s plans to close the unit might be emotionally distressing for staff and patients, but if giving other hospitals more consultants, doing regular complex work in bigger hospitals and closing smaller ones improves outcomes, isn’t that the best way to “future-proof” the NHS?

Craig firmly disagrees with that proposition. Instead, he says he believes there are clear-headed clinical arguments against closure.

Yes it’s an emotional, almost visceral thing for people who work here,” he says. “It was the first adult congenital unit in the country; it’s one of the biggest in the country; our outcomes are among the best and they compare well with the rest of the world. But no, it isn’t just an emotional issue. It’s a logical, clinical question too. Why seek to fragment the biggest centre in the country?”
The Guardian asked Craig to read arguments made earlier on the blog by Prof Huon Gray, the NHS national clinical director for heart disease – and respond directly to his case forclosing the unit.

NHS surgeons … must perform between them at least 500 operations a year, which is about three each every week. That is a minimum.”

.We absolutely agree with that, we do more than the standards require,” says Craig.
“There is an argument being made that small, specialist hospitals are outdated. The argument I always make is that there used to be a hospital specifically for skin diseases, which got taken over by St Thomas’s and became a dermatology ward. And we don’t yet have a cure for psoriasis. I’m not saying that’s cause and effect, but I don’t know if something might have been different if we still had a specialist skin hospital. Because you lose the focus that clinicians can identify. Our services are different to the cardiac wards at Hammersmith or or St George’s hospital.

Their services, as judged by mortality data, are safe … [But] that is a different argument from saying do we think in the future we could do better when children are born with a complex cardiac disease where treatment previously would not have been thought feasible?

Craig says things are already improving. “The number of people now surviving through to adulthood is vastly more than 20 years ago,” he said.

“The challenge now is thinking of this as a predominantly adult service to manage, because of survival rates. And we’re in the perfect position to do that. We see people transition through. There is a risk as a teenager, and frankly getting fed up with treatment plans and hospitals. And at that exact moment, they have to be taken away from the team they’ve known all their lives to a new adult hospital. Lots of US evidence suggests that people get lost to follow-up, and our setup enables that to be much rarer.”

Co-location is Gray and NHS England’s key argument:

If I were a parent sitting beside the bed with a child who needed other specialist input, I would feel much more comfortable knowing that it was two floors down.

“I would say, has he asked the patient or parents?” Craig responds. “Surgeons are timetabled to work at both hospitals, they have to be flexible but that is what doctors do.

“Gastroenterologists are here when we need them, surgeons are here when we need them. They can be here every half an hour, they can be here every day of the week. So it does become a bit emotional yes, because it’s like, ‘why don’t you get this?’ This feels like such a matter of an interpretation of standard, the paranoid among us think there’s something else going on.

“The number of people you need for a 1,000 bed hospital means it can be impersonal. You pick up the phone to talk to the labs here and you know who they are. Would it be better to build a brand new hospital with everything under one roof? Where’s the money to do that? And what’s the benefit? It’s the theoretical risk, which hasn’t happened, that the surgeon might not be there when we want him. What actually happens is one of his colleagues covers. Even in bigger hospitals, there’s no guarantee the paediatric surgeon is immediately available either. We have done this for decades with outcomes which are the envy of the world.”

That’s all from today’s liveblog. A huge thank you goes out to the staff and patients at Royal Brompton hospital, and to you of course for reading.

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This entry was posted in A Personal View, NHS managers, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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