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House of Lords Hansard
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NHS: Congenital Heart Disease
14 December 2016
Volume 777

Question

Asked by

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To ask Her Majesty’s Government how many hospitals have challenged NHS England’s recommendation that they cease to provide special surgical services for congenital heart disease.

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My Lords, the department has not received any formal challenges to NHS England’s proposals for changes to the way that congenital heart disease services are organised. I know that there are some concerns about NHS England’s proposals but we must remember that no final decisions have been made. A service-change process is now under way that will include public consultation. NHS England will announce further details in the new year.

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The Royal Brompton Hospital is one of the hospitals that has those concerns. NHS England said at a recent meeting in the Commons that there were no concerns over the quality of care provided by the hospital, yet the NHS England proposals for the Royal Brompton would remove a quarter of the paediatric care beds in London when there is already a growing shortage. They would also destroy the hospital’s world-leading adult congenital heart disease programme and cost a lot of money. Given all that, can the Minister say exactly what problem the Royal Brompton proposals are aiming to solve?

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I do not want to go into issues relating to specific hospitals but I emphasise that no decisions have been made. Where it is decided that changes need to be made, these will be managed carefully and will be carried out in partnership with current service providers, patient groups and advocates. Decisions are likely to be made in the summer but there will be no change on the ground until at least 2018. The public consultation will give everyone a chance to put forward their views and to discuss the plans further.

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My Lords, the noble Baroness says that she will not discuss individual hospitals but, in the end, Ministers are accountable. Will she confirm that the reason given by NHS England is that the Brompton does not meet its specification, which insists on same-site locations for all children’s services? Can she confirm that one of the hospitals not threatened with closure has multi-site locations, and will she also confirm that the Brompton has one of the best outcomes in the country?

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I am not going to be drawn into discussing specific hospitals and I have given my reasons for that. However, I will say that the statement made in July by the Royal College of Surgeons and the Society for Cardiothoracic Surgery said:

“We fully support these standards. NHS England must ensure that the standards are applied for the benefit of patients, by ensuring that expertise is concentrated where it is most appropriate. The proposals put forward by NHS England today should improve patient outcomes and help address the variations in care currently provided.

It is fundamentally important that specialist surgical centres are large enough and treat patients regularly enough to develop full expertise to treat all conditions. It’s vital they are properly staffed to provide on-call rotas and teams have the time to create a supportive environment where new techniques are shared and future specialists can learn”.

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My Lords, I declare an interest in that I was a member of the hospital board of the Brompton for some 15 or 17 years —a long time. You have to look at this case specifically because the Brompton has been quite outstanding and does not work in complete isolation. I am a cardiac patient under the Chelsea and Westminster Hospital, and the same consultants work at both these hospitals and work fairly closely together. However, I do not think that anywhere exceeds the Brompton in standards of care for congenital heart conditions. Indeed, there are Members of this House whose children have had very successful treatment there. We cannot ignore the very special circumstances of this world-famous hospital.

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I appreciate the concerns that noble Lords have raised and the concerns of the hospital trust. However, we must remember that no final decisions have been made and a public consultation will begin shortly. That is when all points can be raised and addressed.

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My Lords, will the Minister agree that NHS England should review the unfair and inconsistently applied standards that may force the closure of congenital heart disease services at the Royal Brompton Hospital, putting lives and life-saving heart disease research at risk?

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I want to share with noble Lords a little of what these standards are about. I feel quite strongly about this: it is so important, and it is the right way forward to determine where these operations should be done. The standards state:

“Each congenital cardiac surgeon must perform a minimum of 125 … congenital cardiac … surgical procedures … each year, averaged over a three-year period … Each consultant congenital interventionist must be primary operator in a minimum of 50 congenital procedures per year, averaged over a three-year period. There must be a designated lead interventionist who must be primary operator in a minimum of 100 procedures per year, averaged over a three-year period”.

This will ensure optimum outcomes for all patients.

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My Lords, does the Minister agree that this debate has gone on for a long time and the insecurity is very bad for patients and for staff, and that it is not just about the Brompton hospital but about other hospitals throughout the country?

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The noble Baroness makes a very good point. This has been fiercely debated since the publication in 2001 of the damning report into the high death rates among babies undergoing heart surgery at Bristol Royal Infirmary. The last time plans were put forward, in 2011, it led to a bitter fall-out, pitting hospitals against senior health bosses, and two years later the proposals were scrapped, with NHS bosses being told to look again. That is why we are now trying to go forward, so that we can cover both adult and children’s services.

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My Lords, may I offer some advice to the noble Baroness? It is quite clear that, in the end, the Government will not agree to the closure of the Brompton, because that has been the decision on numerous occasions since 2001. Why not just pull the consultation? It is not going anywhere, my Lords.

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We do not yet know that it is not going anywhere. A public consultation is coming forward, and the Brompton is not the only hospital concerned; it concerns a lot of hospitals all around the country. It is fair that it should go to a public consultation. Everybody will then have a chance to put their views, and that is going to be the way forward.

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My Lords, does the Minister agree that as well has having surgical expertise, part of the patient’s recovery depends on having access to their friends and their family? When the NHS is deciding these things, will someone please ensure that if a hospital is a long way away from where people live, the families are given funding for travel, because many people cannot afford to do so, and, if necessary, given accommodation in the hospitals where the operations take place?

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The noble Countess raises a good point. NHS England recognises that it may be difficult for the families involved having to travel further, which is why a number of standards will certainly address that point.