Fewer and bigger - shape of NHS services to come

 
Children's heart surgery The reorganisation of children's heart surgery will lead to fewer, bigger centres

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Politicians are usually quick to speak out about changes that should lead to improved services for patients. But ministers will leave it to surgeons and health officials to champion the proposed changes to children's heart surgery.

This is not surprising given that the entire process was free of ministerial input and the decision given to a Joint Committee of Primary Care Trusts.

Ministers, whatever their political party, know the perils of being associated with the loss of hospital services.

It has taken more than a decade for children's heart surgery to be reorganised. The Bristol heart surgery inquiry concluded as far back as 1991 that surgery be concentrated in fewer, larger centres.

There have been several reviews since then and all have reached similar conclusions. So why did it take 11 years for today's announcement? Lack of political will and opposition from within the NHS are among the factors. I've written about the background to the changes before.

Today's decision means there will be seven surgical centres at the Freeman Hospital, Newcastle, Alder Hey Hospital, Liverpool, Birmingham Children's Hospital, Bristol Royal Hospital for Children, Southampton General, and in London at Great Ormond Street Hospital and Evelina Children's Hospital (at St Thomas').

The three surgical centres to close are at Leeds General Infirmary , Glenfield Hospital in Leicester and the Royal Brompton Hospital in London.

If you want to read about the proposed changes in details, my colleague Nick Triggle's report can be read here.

Shutting hospital services is politically risky. This was highlighted when a retired doctor provided the biggest shock of the 2001 election by trouncing a Labour minister to win the seat of Wyre Forest. Dr Richard Taylor had been campaigning against the downgrading of Kidderminster Hospital.

Within the health service there was broad consensus that fewer surgical units were needed, but often bitter in-fighting over which should be chosen.

Most recently the Royal Brompton hospital in London launched a legal challenge to the whole consultation process when it emerged that it was not included in any of the preferred options.

The hospital initially won its judicial review but then lost on appeal. It argues that its world-class respiratory service would be irreparably damaged if it no longer carried out children's heart surgery.

This is because the hospital's paediatric intensive care unit would close, and mean that some complex procedures for patients with Cystic Fibrosis and other conditions would have to be transferred elsewhere.

Dr Duncan Macrae, director of children's services at the Royal Brompton said: "What is genuinely shocking about this proposal is the failure of NHS managers to acknowledge or understand the adverse impact that the proposed changes will have on our highly specialised services for children with severe lung and heart conditions."

But there is no argument about the need for change in children's heart surgery. Study after study in Britain and overseas has accepted that hospitals with bigger caseloads have better results. The Safe and Sustainable review team point to reviews of paediatric heart surgery in Sweden, Canada, Australia, the Netherlands and Germany.

There will be many parents who will be distraught at the prospect of their local hospital losing its surgical unit. These are families who build up strong relationships with the surgeons and staff - often their children have several operations over a number of years.

It will mean that many families will have to travel much further distances for surgery. But the review team stress that all the current hospitals will keep their cardiology units so most day to day care will remain where it is.

Professor Sir Ian Kennedy, who led the Bristol inquiry is adamant that the changes will benefit patients. He told me: "What we've got to do is replace mediocrity with excellence. When this reconfiguration goes through we can be confident that we are bedding in excellence."

Sir Ian described it as a landmark moment which would point the way to the consolidation of other services.

A review of adult congenital heart services is underway, and another looking at children's neurosurgery.

Several Accident and Emergency units could shut in north-west London as part of a review of trauma services and specialists want to see an overhaul of maternity services.

Perhaps the best example of "fewer, bigger, better" is provided by the stroke service in London. Eight "super" units provide treatment which previously was done by 30 hospitals. It was initially controversial but has now been deemed a success and is expected to save around 400 lives a year.

Those responsible for changing children's heart surgery seem confident that - in years to come - their re-organisation will be seen in a similar light.

' Fewer, bigger, better' is the new mantra in the NHS regarding specialist services.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
    0

    Comment number 16.

    Craig. As I understand it, cost of transtion will be 11 - 12 million. More than the care costs now! Would have been better to use this money to improve services we already have

  • rate this
    +1

    Comment number 15.

    A careful balance is needed. In most cases a larger hospital provides better outcomes but on the other hand when people have to travel further for healthcare then their own outcomes are worse (e.g. greater chance of missed appointments). If centralisation occurs then help should ALSO be given to people living far from these centralised facilities.

  • rate this
    -3

    Comment number 14.

    Yorkshire the biggest county in the country but no specialist unit - where is the sense in this?

    Everybody wants the best care for their children but does that mean you have to travel hours to get it? All you hear talk of is centralise this, restructure that and have no actual resource at local level.

    People need local services - not some great huge , faceless corporate company.

  • rate this
    +1

    Comment number 13.

    It hard for the patients of the units closing but if as in the case of strokes, the no. of lives saved goes up this is the right way to go. Medicine is increasingly complex & patient outcomes are determined by not only speed of treatment, but the quality & type of treatment. If it's my child I'd want them transferred to the best centre ASAP, even if it's 3 hours away.

  • rate this
    +1

    Comment number 12.

    A dark day for NHS Paediatric Cardiac services. Watched the live video feed of the meeting yesterday - what a farce! The committee just sat in silence agreeing with everything. No one raised any questions or challenged any findings. Of course people are emotional when it comes to the care of their children. But that doesn’t mean their feelings should be discounted in favour of cold bureaucracy.

  • rate this
    +2

    Comment number 11.

    My wife had a double lung transplant at the Freeman Hospital in Newcastle, which is a 3 hour journey from our home in Glasgow. For all the hours travelling, I wouldn't change a thing. What matters is the expertise of the surgeons and doctors and therefore the life or death of a loved one. In my experience, larger numbers of patients, means bigger medical teams and more combined experience.

  • rate this
    +1

    Comment number 10.

    As a patient I would not be happy if my local unit closed but children deserve the best possible care with the latest research based treatments and equipment. Smaller units although valuable to the locale do not have enough throughput to remain at the top of their game. Bigger more specialised units will offer better care and treatments. This isn't a question of cash, its a question of quality.

  • rate this
    +1

    Comment number 9.

    Show the full reasoning behind the decisions. People are clearly emotional about their service. There must be transparency in order for people to make sense of it all.
    On the surface, it looks odd. How can say, Leeds, expect to keep staff on just to do "pre & post" ? Where does continuity if care fit in? Will transfers between hosps have an impact on vulnerable patients?

    There are many questions

  • rate this
    0

    Comment number 8.

    I was in Glenfields Hospital for three months with my baby daughter, I had a room on the ward as my wife was not well after giving birth, I have two more daughters 5+4 years old both at school. All the hospitals need more staff not fewer units.

  • rate this
    +2

    Comment number 7.

    It does make sense to have fewer units so the teams are more experienced, but why have two in London and none in Yorkshire? It's a very long way to Newcastle, and in bad weather conditions this would be an nightmare.

  • rate this
    0

    Comment number 6.

    I think it's a damm disgrace closing any childrens Heart Units there more needed then ever you say it's down to cost so why don't the Government do something about money the likes of Footballers, Actors, Actresses Models etc get paid stupid amount of money weekly why not cut that down and money saved there could go towards Heart Units as more Important

  • rate this
    0

    Comment number 5.

    So have they said how much it is going to cost to close these units, move the specialist equipment with its trained staff to operate this equipment or train new staff, and make these bigger centres? Compared to training more surgeons and nurses to work at the under staffed centres. Isn’t that what they want, more surgeons working closer together?

  • rate this
    0

    Comment number 4.

    I do not think they shoud not have closed Leeds Childrens Unit,as it is central for all of yorkshire

  • rate this
    0

    Comment number 3.

    I tHink they have made a bad decision to shut Leed

  • rate this
    0

    Comment number 2.

    Eggs and baskets come to mind. Where do you stop with this process?
    I giant Hospital? If you get a disease/bug outbreak in one hospital it puts more at risk.

  • rate this
    +2

    Comment number 1.

    Frontline service GPs is extremely important - good GPS whose salaries reflect our respect. A good GP is the person who makes decision on what service is needed next e.g. diagnostic tests. S/he makes referral accordingly. Thereafter comes conclusion: surgery or no surgery, more treatment or less treatment. But what makes system work is Pyramid: several GPs at bottom, few specialists at top.

 

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