NHS to cut children's heart surgery at local unit

As part of a national review of services the authority have plans to reduce the number of specialist heart surgery hospitals in favour of concentrating on fewer, more specialist centres as they say the Glenfield heart hospital in Leicester does not meet all the new clinical criteria standards.

Will Huxter, Regional Director for NHS Englands says it is “in the best interests of patients.”

The hospital is used by heart patients and their families from across the Lincolnshire area, with the next nearest set to be Birmingham instead - almost double the travelling time.

The hospital trust is disputing the decision, saying that it disgrees with the conclusions of the review.

John Adler, chief executive at Leicester’s Hospitals, said: “Over the last 18 months we have made excellent progress, with the support of our charities and partner organisations, to meet the standards set by NHS England through the New Congenital Heart Disease Review. We have expanded the number of beds, improved our outcomes, invested in staffing and briefed architects to create a new single site children’s hospital which will meet the co-location standard.

“We are confident that our clinical outcomes are now amongst the best in the country so we strongly disagree with NHS England’s decision and will not sit by whilst they destroy our fabulous service.”

Mr Adler continued: “This progress has all been achieved against a backdrop of many years of uncertainty following the ‘flawed’ decision four years ago to stop Level 1 CHD services in Leicester. It does make me wonder what this service could achieve if NHS England backed these clinicians.”

Mr Adler said the decision could not in any way be in the best interests of patients with congenital heart disease and their families.

The East Midlands Congenital Heart Centre supports 12 Paediatric Intensive Care Unit, (PICU) beds

at Glenfield Hospital which will be lost if NHS England ceases to commission surgical services.

Mr Adler said the viability of the PICU at the Leicester Royal Infirmary would also be compromised as paediatric experts work across both units in Leicester attracted by the diverse caseload. He said the the children’s intensive care would cease to be as attractive a place for clinical teams to work, making it harder to attract and retain staff.

“More children and their families will have to travel further to support one another in a time of crisis,” he said.

With a national crisis in PICU capacity, he said the decision to remove beds from the system and destabilise the remaining Leicester PICU seems “at best misguided and at worst, reckless”. 
He went on: “Without a suitably sustainable children’s intensive care service there will be an inevitable domino effect on other specialist paediatric services which require intensive care capacity to function safely. These include include: children’s general surgery, ear nose and throat surgery, metabolic medicine, fetal and respiratory medicine (for long term ventilated children), children’s cancer and finally our neonatal units. In addition, those neighbouring hospitals currently supported by the specialist teams in Leicester will no longer be able to look for support for their more complex patients from their nearest specialist trust. These include hospitals in Burton, Coventry, Kettering, Northampton and Peterborough.

“You are essentially undermining the vast majority of other specialist services for children in the East Midlands,” Mr Adler warned in his letter to NHS England’s regional director Will Huxter.

He said: “Leicester’s paediatric respiratory ECMO service is the largest in the country accounting for 50 per cent of all capacity nationally. As NHS England is aware, Leicester pioneered ECMO in the UK and as a

consequence there are many children and adults alive today who have our clinicians to thank for a second chance of life. (In fact, survival following respiratory ECMO treatment in Leicester last year was 15 per cent higher than for patients treated elsewhere).

“The EMCHC ECMO unit is also the only unit providing a national transport service which stabilises patients at their local hospital before transporting them to a specialist centre. Obviously the decision to close the Leicester surgical service would also result in the closure of the ECMO service, as the doctors working in one also work in the other. This would mean that decades of experience, knowledge and innovation would be lost.

“When assessing our surgical service NHS England stressed the importance of achieving a certain critical mass of patients. It therefore strikes us as either peculiar or convenient for those making the decisions on our future that this same principle does not apply when considering ECMO.”

He said: “We have invested in our people and our infrastructure and we have a vision to take the service to the next level within a new children’s hospital.”

He questioned why children in Northamptonshire were not treated in their nearest specialist hospital instead of being referred to a centre in Southampton. This would help in achieving the Glenfield achieve the necessary number of cases to reach standards.
He said to Mr Huxter: “For the avoidance of doubt, we reject your stated intention to cease commissioning level 1 CHD services from us and we will use all the means at our disposal to reverse this intention.

Mr Huxter, in informing the hospital trust said there would be local engagement before a change in the service at the hospital.

He said: “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.