Brompton wins heart surgery case

 
Royal Brompton Hospital The Royal Brompton has an international reputation for heart and lung treatment

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The Royal Brompton hospital in west London has won the first round of its legal battle against the review team which sought to close its children's heart surgery unit.

It is an extraordinary case - some reports suggest this is the first time one NHS body has taken action against another. It certainly must be costing a small fortune, money which all concerned would rather see spent on patient care.

There is general agreement that children's heart surgery should be confined to fewer units. This argument dates back a decade to the Bristol heart inquiry led by Professor Ian Kennedy. Earlier this year the "Safe and Sustainable" national review team for England proposed that 11 surgical units be reduced to 7. It put forward a number of different potential re-configurations, but in none of these did the Royal Brompton figure.

Unfair

It's worth pointing out that the judge was not asked to decide on the wisdom of the review team's proposals. Rather, Mr Justice Owen was asked to determine whether the review process was fair to the hospital. Most of the grounds put forward by the hospital were rejected.

But the judge said - on one key point relating to assessing the quality of research - it was so unfair to the hospital as to be "radically wrong".

As a result he ruled that the consultation exercise was unlawful and must be quashed.

This ruling does not ensure the future of all current children's services at the hospital. But it may mean the consultation process has to be re-run.

For the Royal Brompton, there is a lot riding on the outcome. If it loses children's heart surgery, it is inevitable that its paediatric intensive care unit will close.

Cystic Fibrosis

This would have an impact on its respiratory services. The hospital runs Europe's biggest Cystic Fibrosis unit and cares for a range of rare and complex lung disorders. If it does not have a paediatric intensive care unit, then a small proportion of serious cases will have to be treated elsewhere.

The hospital argues it would lead to the eventual break-up of its world-class respiratory team, and the loss of the research programme. This is strongly rejected by the review team which argues that the vast majority of services at the hospital could continue.

Appeal

So what happens next? Sir Neil McKay, chairman of the review team made clear that there would be an appeal. He said he was disappointed that the consultation was quashed "on an obscure technical point", adding the judge's decision was based on a "misunderstanding of the review process".

Whatever the outcome of the appeal, the review team says it plans to make a final binding decision by spring next year at the latest.

Amalgamating or axing any hospital service is contentious, and in this case the national decision was delegated to a joint committee of primary care trusts. Many see this as a blue-print for the future. Rather than ministers making the unpopular decision to close a casualty department, hospital, or specialist unit, it could be left to an independent committee.

This legal battle shows how difficult it is to re-configure the NHS, even when there is broad agreement with the underlying objectives.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
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    Comment number 7.

    @5 when working 108/168 true (1992)
    when working 64/168 hours not true. (1999)
    Prior 2000 new consultant surgeon operating hours approx 30000
    Current 2011 new consultant surgeon operating hours approx 5000
    Ignorance & inexperience now a bigger killer than tiredness.
    You are right than enough ongoing experience is needed for rare procedures
    Shutting units will kill by distance for time critical

  • rate this
    0

    Comment number 6.

    National decision was delegated to a joint committee of primary care trusts. This may be: blue-print for the future?
    Rather than ministers making the unpopular decision to close a casualty department, hospital, or specialist unit, it could be left to an independent committee.
    This seems rather distant, uninvolved, i.e. HEARTLESS, to me.

  • rate this
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    Comment number 5.

    @3 - tired doctors = bad doctors who are more prone mistakes.

    Smaller units mean surgeons perform less operations and so harder to maintain and develop their skills and teach the next cohort of consultants.

    I would much prefer a surgeon doing operations to do sufficient numbers so that they do them well rather than one who does only a small number but badly because of small patient numbers.

  • rate this
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    Comment number 4.

    "Specialised services are usually best delivered through centres of excellence."A comment on NHS Specialised Services own website.
    It is quite remarkable that in process of wanting to specialise one area of paediatric care, they are happy to break another to pieces and put children's lives at risk. And this is without consulting the patients or experts in respiratory ilnesses! Definately unfair.

  • rate this
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    Comment number 3.

    @2. Well said

    The reduction in units has nothing to do with quality of care.
    It is about fighting for scarcer funding.
    It is about sustaining rotas of juniors at big units filled currently with locums because of junior doctor hour reductions by the European working time directive means more are needed.
    The same applies to the idea of shutting 70 paediatric wards in the UK.
    This will Kill Kids.

  • rate this
    0

    Comment number 2.

    Please could I make the suggestion that the comments section for this part of BBC Health is not closed so quickly each time. Unless you read the page every single day, it is easy to miss the small window of opportunity in which to comment. It would make more sense for the comments to be left open until a new subject is posted which can be 10 days or more later. Thank you.

  • rate this
    0

    Comment number 1.

    I cannot believe the judge did not uphold the argument that the reduction of units from 11 to 7, of which the Royal Brompton was not included, as being unfair. The committee has members on it's panel that serve Great Ormand street and St Thomas in London but none from the Brompton and what do you know? any outcome from will definitely see the cardiac services at the Brompton being closed.

 

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