Comment: Children’s heart surgery under threat

One in every 133 children is affected by congenital heart disease. Royal Brompton's children's heart surgery unit is threatened with closure under national plans for this specialist service, unless an upcoming judicial review can save it.

By Dr Duncan Macrae

"For all who attend or visit the children's wards it is clear that it is a place of excellence…you feel this as soon as you walk in the door and it is an example of what all hospitals should be like…Children deserve the best and the children's heart surgery services at Royal Brompton are the best."

A parent's comments conjure up a vivid picture of life on the children's wards at Royal Brompton. Many more have expressed similar feelings for the care they receive here, a commitment reinforced by plans to stop paediatric cardiac surgery at the hospital. It is these views which have propelled me and hundreds of other staff at the hospital to do everything in our power to protect our services for children.

The decision by Royal Brompton & Harefield NHS Foundation Trust to launch legal action against the Joint Committee of Primary Care Trusts (JCPCT) follows proposals to discontinue children's heart surgery at Royal Brompton. These follow a national review on the future of paediatric cardiac surgery in England.

We believe that the recommended options put to public consultation are fundamentally flawed, such that a consultation based on them is unlawful. Four options for the reconfiguration of paediatric cardiac services have been put forward. None include Royal Brompton. This is despite the hospital ranking joint-fourth out of all eleven children's cardiac surgery centres in England. Ours is the largest centre for the life-long care of adults and children born with heart defects, with four cardiac surgeons undertaking over 400 cardiac operations each year – criteria required by the national review to ensure the service is safe and sustainable.

Ruling on the trust's legal action in July, Mr Justice Burnett granted permission for the judicial review on all grounds advanced. This will be the first time one NHS body takes another to judicial review. It is a decision taken with great regret, but one which had to be taken knowing our patients have asked us to do everything in our power to protect the services we provide.

If children's heart surgery stops, this puts all our services for these patients under threat. Our paediatric intensive care unit and anaesthesia will immediately become completely unworkable, in turn threatening the future of our highly specialised children's services. They include services for patients with lung diseases such as cystic fibrosis and Duchenne muscular dystrophy and very severe asthma. These are delivered by clinical teams known throughout the world for their expertise. The impact on patients caused by the break-up of our expert teams and the impact of the proposed changes on the long-term financial health of the Trust would, I firmly believe, be hugely detrimental and have not been adequately considered.

As one patient's relative put it: "Closing down a highly successful unit when the capital is struggling to cope with patients seems unwise, unsafe and unsustainable."

The JCPCT have convened an expert panel to consider the knock-on effects of removing children's heart surgery from Royal Brompton. While we welcome this belated move, it is alarming that their terms of reference are very narrow. I believe this is a huge mistake which ignores the 360 degrees of wrap-around care which we offer heart and lung patients of all ages.

I have seen how the national review and JCPCT recommendations have created uncertainty and anxiety among some patients. We are singularly focused on doing everything to reassure patients and families that we will not sit back and allow the care we offer them to be downgraded or adversely affected in any way. We are continuing to invest in our paediatric facilities. We greatly regret the time and resource that is being spent dealing with the aftermath of the JCPCT's proposals. But the commitment of staff and the strength of feeling among patients and families is unequivocal. We have to protect children's heart surgery and paediatric services at Royal Brompton.

Dr Duncan Macrae, director of children's services, Royal Brompton & Harefield NHS Foundation Trust and president of the Paediatric Cardiac Intensive Care Society.

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