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Bombshell on heart surgery PDF Print E-mail
Written by Joan Davis   
Friday, 08 July 2016 21:38
The Community Voice has a long history of support for Harefield Hospital, which serves many of its members and their families.  Since Harefield Hospital is part of the Royal Brompton & Harefield FT we also take a keen interest in Royal Bormpton issues and we have long supported the Trust in its fight to retain the whole range of heart and lung services for which it is rightly famous.  At our meeting on 7th July 2016 we received advance information on the announcement by NHS England of its decisions on heart surgery, published on the following morning, and summarised below in Report 1 and Report 3.  Our members were aghast and we agreed to give Royal Brompton every possible support in its challenge of the NHS England decision with respect to its own services.  We also agreed that in view of us not having a mailing to members in July that we would update our website with any news on this issue and that those with email facilities would be updated by that route.  So, watch this page! 

 This introduction lists all reports and updates, with the first report at the bottom of the page.   All reports are slightly modified to aid ease of reading and to combat formatting  limitations within our web site.  The latest news will be inserted just below the list of reports:

Report 3:  The NHS England position (The section particularly relevant to Royal Brompton Hospital is in bold and bigger format)
Report 2:  The Royal Brompton and Harefield FT's response to Report 1 and Report 3
Report 1:  Three trusts set to lose specialist heart surgery
 
Report 3
Congenital Heart Disease: NHS England takes action to deliver consistent and high quality services now and for the future  
8 July 2016 -

Patients with complex, sometimes life-threatening congenital heart disease will benefit from action to ensure core standards of quality and sustainability apply across all specialist services announced today (Friday 8th July) by NHS England.

Congenital heart disease (CHD) services have been the subject of a number of reviews since the public inquiry at Bristol Royal Infirmary in 2001, with the outcome of a further review of a number of children’s heart surgery cases at Bristol published last week.

In 2015, NHS England published new commissioning standards for CHD services following extensive consultation with patients and their families, clinicians and other experts.

Since then, hospital trusts providing CHD services have been asked to assess themselves against the standards, which came into effect from April 2016, and report back on their plans to meet them within the set time frames.

As a result of these assessments, and following further verification with providers, NHS England intends – subject to necessary engagement and service change process in relation to this assessment – to take the following actions to ensure all providers comply with the set standards.

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.

Dr Jonathan Fielden, NHS England Director of Specialised Commissioning and Deputy National Medical Director, said: “Patients, families and staff need to be assured of sustainable, high quality services now, and into the future.

“There has been a great deal of uncertainty over the future of congenital heart disease services over the past fifteen years. We owe it to patients, families and staff to end that uncertainty, and to provide clear direction for the safety and quality of this specialist area of medicine going forward.

“A great deal of work has gone into achieving consensus across the board on the standards that providers should meet. We are determined to take all actions necessary to ensure that those standards are met, so that patients get the high quality and safe services that they expect and deserve.

“This is further proof that NHS England as the national commissioner of specialised care is stepping up decisively on behalf of patients now and to sustain quality care for the future.”

Professor Sir Ian Kennedy, who was the chair of the public inquiry at Bristol Royal Infirmary, 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.”

Miss Clare Marx, President of the Royal College of Surgeons, said: “Improvements to care for children undergoing heart surgery continue to be needed in spite of improvements since the Bristol Royal Infirmary public inquiry report in 2001. The Royal College of Surgeons strongly supports today’s plans and we hope these changes will now finally happen for the ultimate good of patients.

“Units need to be the right size to enable surgical teams to be familiar and skilled in all conditions, treating these patients on a regular basis to maintain their experience and expertise. It’s absolutely critical that teams are sufficiently staffed to provide secure on-call rotas, disseminate new techniques, and train the next generation of specialists.

“The proposals set out today represent a consensus view of what consistent, high quality care should look like across the country. As a profession we are confident these standards will help reduce variation in care and improve outcomes. Any further delay or obstruction by local parties will prolong uncertainty for the very ill patients who need this surgery.”

Congenital heart disease (CHD) affects up to 9 in every 1,000 babies born in the UK, with differing types of CHD and levels of severity. Some of the more common CHDs include:

  • septal defects, commonly referred to as a “hole in the heart”;
  • coarctation (or narrowing) of the aorta,
  • pulmonary valve stenosis, where the valve controlling blood flow to the lungs is narrower than normal, and;
  • transposition of the great arteries, where the pulmonary and aortic valves and the arteries they’re connected to have swapped positions.
Services and surgery – the provision of which is clustered in a small number of specialist centres across England – have progressed significantly over the last few decades, and around 80% of those born with a CHD now survive into adulthood.

However, there has been uncertainty over their future configuration. In an effort to address this uncertainty, in July 2013, after discussions with key stakeholders, NHS England established the New Congenital Heart Disease Review.

The Review had the following aims:

  • Securing the best outcomes for all patients – not just lowest mortality but reduced disability and an improved opportunity for survivors to lead better lives;
  • Tackling variation – ensuring that services across the country consistently meet national standards, and are able to offer resilient 24/7 care, and;
  • Improving patient experience – including how information is provided to patients and their families, and consideration of access and support for families when they have to be away from home.
On 23 July 2015 the NHS England Board received the review’s report and around two hundred new standards and service specifications which providers of CHD services should meet. These standards began in April 2016, with a five-year trajectory to full compliance.

In order to establish which providers do or can meet the standards in the set time frame, all providers were asked to complete a self-assessment process, the results of which have now been processed and form the basis of the actions set out today.

In 2014/15, the last year for which reliable data exists, the number of operations performed by CHD services was 4,354, and the number of interventional procedures was 3,793.

While some patients will have to travel further to access specialist services as a result of these changes, emergency admissions are rare, and ongoing work aims to ensure that more of a patient’s long-term care can be delivered closer to home, meaning fewer trips to specialist centres.

Where the transfer of services goes ahead, NHS England will work with the hospital trusts to ensure that staff are supported.

 



Report 2.  The Royal Brompton and Harefield FT's response to Report 1 and Report 3       8 JULY, 2016

In a statement in response to NHS England's announcement on congenital heart disease services Robert Craig, chief operating officer at Royal Brompton & Harefield NHS Foundation Trust, said:

“We find NHS England’s stated intention extraordinary. We are, however, reassured to see that the idea of removing congenital heart disease services from Royal Brompton is ‘subject to consultation with relevant Trusts and, if appropriate, the wider public’. We fail to see how any logical review of the facts will come to the same conclusion as this panel.  “While we understand the motivation of commissioners to show progress is being made with congenital heart disease services, threatening to withdraw services from one of the largest and most successful centres in the country seems an absurd approach.

“Teams at Royal Brompton Hospital carried out more congenital heart disease (CHD) procedures last year than any other centre in the country. For the past ten years, our experts have undertaken over 500 congenital surgical operations each year (paediatric and adult) and during this time our results have met or exceeded all the standards defined by the regulators. Since 2009 we have consistently been one of the five best-performing centres in terms of mortality rates.
“We are very concerned about where alternative capacity in other hospitals could be found if this ill-conceived proposal were to proceed and are surprised that this information has not been made available already.

 According to the national NICOR database
“Royal Brompton Hospital meets all current standards, with well-developed plans in place to meet the new standards introduced this year. Indeed, in the announcement of the panel’s intentions, the description of a high-performing unit offered by Clare Marx, president of the Royal College of Surgeons, describes Royal Brompton well:
“Units need to be the right size to enable surgical teams to be familiar and skilled in all conditions, treating these patients on a regular basis to maintain their experience and expertise. It’s absolutely critical that teams are sufficiently staffed to provide secure on-call rotas, disseminate new techniques, and train the next generation of specialists.”

“We are rightfully proud of the ground-breaking work of our congenital heart disease teams; many of our experts have achieved international recognition for their contribution to the field and are responsible for training large numbers of clinical staff, in the UK and abroad. Many thousands of patients have benefited from their innovative treatment and research and we have a duty to ensure they continue to experience ‘a lifetime of specialist care’.

“The process by which this decision has been made and announced has been deeply disappointing. In February the Trust submitted a self-assessment report on its CHD services, and added supplementary information at NHSE’s request in April. Having had no feedback from NHSE commissioners since then, our chief executive received a phone call on 30 June 30, followed up by a letter which stated that commissioners were ‘minded’ to stop commissioning specialist congenital heart disease services from the Trust. The letter requested additional evidence to support our position which we were given three working days to supply.

“After submitting detailed information late on 5 July, we were astonished to learn at lunchtime on 6 July that the final decision was being ‘communicated out to trusts’ that same day, giving little or no time for the panel to have reviewed the supplementary details. We were not surprised therefore to learn at 7.23pm that evening that there had been no change to the original decision.

“The consequences of this decision, should it be implemented, would be far-reaching and would affect not only congenital heart disease services for adults and children but also paediatric intensive care: if paediatric cardiac services were moved from Royal Brompton, our paediatric intensive care unit would no longer be viable
because of the drop in volume of patients needing such expertise.

In turn this would adversely affect our specialist respiratory services, many of which cannot be delivered without the back-up of a specialist intensive care service. Some adult services such as the nationally-designated pulmonary hypertension service would also be adversely affected because of their inextricable links with congenital heart disease services.

“It is a source of deep regret that once again, our patients and staff are faced with a period of uncertainty and anxiety. Of one thing they can be sure, we will be working closely with NHS England to ensure that full and frank discussions take place to determine what is behind this irrational and reckless announcement and to achieve our shared objective of high-quality services for patients with congenital heart disease.”

Report 1:  Three trusts set to lose specialist heart surgery - including Royal Brompton FT        8 JULY, 2016

  NHS England announces winners and losers in which trusts provide congenital heart defect services and a swathe of trusts to cease “occasional” procedures after NHS England sets out new standards. At least two NHS providers are already challenging NHS England’s plans to strip them of specialist heart services under the proposals – including Royal Brompton FT. Work follows 15 years of conflict between centres on where work should take place, after inquiry into Bristol child heart deaths.

The national commissioning body this morning announced the results of its review of congenital heart disease services, against minimum standards which were decided last year. Its decisions include:
  • Central Manchester University Hospitals Foundation Trust will no longer carry out the most specialised level one CHD work, with this moving to Alder Hey Children’s Hospital and Liverpool Heart and Chest Hospital foundation trusts.
  • University Hospitals of Leicester Trust and Royal Brompton & Harefield Foundation Trust will stop CHD surgical and interventional services.
NHS England said the trusts did not meet its standards and they were “extremely unlikely” to be able to.

The following trusts will no longer be allowed to perform “occasional and isolated practice” in less specialised “level two” medical services:
  • Blackpool Teaching Hospitals FT, 
  • University Hospital of South Manchester FT, 
  • Papworth Hospital FT, 
  • Nottingham University Hospitals Trust, 
  • Imperial College Healthcare Trust.
The following trusts do not meet NHS England’s standards but will receive “support” to help them do so:
  • University Hospitals Bristol Foundation Trust,  
  •  Leeds Teaching Hospitals Trust, 
  • University Hospitals Birmingham Foundation Trust,
  •  Barts Health Trust,        
  • Guy’s and St Thomas’ Foundation Trust, 
  • University Hospital Southampton Foundation Trust.
Two of the providers set to lose surgery have reacted strongly to the decision.
  •  University Hospitals of Leicester Trust chief executive John Adler said he would “not sit by whilst they destroy our fabulous service”.  
  • Royal Brompton and Harefield Foundation Trust also said it would challenge NHS England’s decision.
NHS England’s statement on its decision said it would take “enforcement action” if Central Manchester did not stop carrying out some procedures.

There have been successive calls for and efforts at reconfiguration of congenital heart disease services, particularly children’s heart surgery, over several decades. The last major set of proposals made by the NHS nationally were taken to the High Court in 2011 by the Royal Brompton, which would have lost children’s congenital heart surgery. The plans were eventually abandoned in 2013, with intervention by health secretary Jeremy Hunt and criticism from the Independent Reconfiguration Panel. http://www.hsj.co.uk/news/acute-care/nhs-england-to-rethinkchildrens-heart-surgery-plans/5059743.article. Since then NHS England has carried out a long running review which has come to a head over the past few months.

Today’s announcement is good news for Birmingham Children’s Hospital and Great Ormond Street Hospital for Children foundation trusts, which NHS England said would “continue to be commissioned, with ongoing monitoring, as they currently meet all or most of the standards”. It is also good news for Leeds Teaching Hospitals Trust, which was involved in a row with Newcastle and NHS England over CHD surgery in 2013.

NHS England’s director of specialised commissioning and deputy national medical director Jonathan Fielden said in a statement: “There has been a great deal of uncertainty over the future of congenital heart disease services over the past fifteen years. We owe it to patients, families and staff to end that uncertainty, and to provide clear direction for the safety and quality of this specialist area of medicine going forward. “A great deal of work has gone into achieving consensus across the board on the standards that providers should meet. We are determined to take all actions necessary to ensure that those standards are met, so that patients get the high quality and safe services that they expect and deserve.”

Sir Ian Kennedy, who chaired a public inquiry into child deaths at Bristol Royal Infirmary in 2001, and which led to previous attempts at reform, 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.”

 


Last Updated on Thursday, 04 August 2016 19:54
 
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