Royal Brompton Hospital wins review into heart unit closure

Royal Brompton Hospital in London The heart unit is located at Royal Brompton Hospital's Sydney Street site

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The Royal Brompton Hospital has won its High Court judicial review into the decision to close its children's heart surgery unit.

The move was part of wider consolidation of moving surgery to fewer sites across England.

The west London hospital challenged the way the consultation was carried out by NHS bosses, who now plan to appeal.

As a result of the ruling being upheld, the wider consultation will almost certainly have to be carried out again.

The court bid - brought by the Royal Brompton and Harefield NHS Foundation Trust - represented the first time that one NHS organisation has taken legal action against another.

Mr Justice Owen rejected most of the trust's complaints against the consultation but upheld the claim that the Joint Committee of the Primary Care Trusts (JCPCT) had failed to meet the hospital's expectation that its capacity for research and innovation would be assessed fairly.

This had "seriously distorted" the consultation process, he said.

The judge said the unfairness was "of such a magnitude as to lead to the conclusion that the process went radically wrong".

The Royal Brompton in Chelsea argued in court that the future of the whole hospital would be at risk if the child heart surgery unit closed.

Analysis

Judicial reviews are not uncommon. But what sets this one apart was that it was NHS v NHS.

The Royal Brompton's legal team contested the way the consultation had been carried out.

By winning, it does not mean the unit is saved. Instead, the most likely scenario is that the consultation will have to be re-done, delaying what many experts say is a necessary change.

The Royal Brompton is one of several units earmarked for closure as there is widespread agreement specialist care like child heart surgery is best provided at fewer sites.

This has wider implications for the NHS. Up and down the country the health service is being re-organised. A&E units are closing and maternity services are being moved.

In short, it could pave the way for more challenges to NHS decision-making.

The team behind the "Safe and Sustainable" consultation told the court it did not accept the allegations made by the Royal Brompton and said there was widespread support for its proposals, including from independent experts.

Chief executive of the Royal Brompton Hospital, Bob Bell, said: "It is the culmination of a struggle that has lasted many months and has at times been both unpleasant and deeply stressful.

"It has been an upsetting time for many people and one of our greatest concerns has been the needless anxiety that has been caused to patients, their families and our staff.

"It would have been so much easier to simply accept the plans of the Joint Committee of PCTs back in February, but we felt the stakes were simply too high.

"We could not sit back and watch while flawed plans to dismantle our specialist children's services at Royal Brompton were drawn up by bureaucrats, plans which we knew would have a harmful effect on patient care.

"The real tragedy is that the judicial review could and should have been avoided."

Sir Neil McKay, chairman of the JCPCT, said: "I am disappointed that the judge decided to quash the consultation on an obscure technical point that had no material bearing on the JCPCT's choice of consultation options.

"We respectfully intend to appeal the judge's decision based on his misunderstanding of the review process.

"I am, however, pleased that the judge rejected most of the grounds on which the RBH based their claim."

'Vital process delayed'

The consultation exercise proposed to reduce the number of children's heart surgery centres in London from three to two.

It favoured keeping the Evelina Hospital, which was part of Guy's and St Thomas' Hospital Trust, and the Great Ormond Street Hospital.

But the recommended options did not include the Royal Brompton, which was one of two centres in the country which met the criterion for achieving the stated goal of the review, lawyers told the court during a hearing in September.

The judge found that the JCPCT's process for assessing the Royal Brompton's compliance with research and innovation standards was flawed. The consultation had found it to be 'poor'.

But the court rejected the other claims against the JCPCT, including the hospital's claims that the JCPCT had made its decision to keep two child heart surgery centres in London as far back as 2010, before the consultation began.

The court also rejected the allegation that the consultation document was fundamentally flawed and had misled the public and the hospital's argument that the closure of the heart unit would have an impact on its respiratory services.

The judge also rejected claims that the Safe and Sustainable Steering group, which carried out the consultation, was biased as it had clinicians from Great Ormond Street Hospital for Children and the Evelina Children's Hospital.

Sir Neil added: "I am genuinely saddened that this court action has delayed a process that will deliver vital changes needed to improve outcomes for children across the country."

Later Sir Neil announced on behalf of the JCPCT that a final decision on the future configuration of services would be made next spring.

Tory health minister Simon Burns said: "The review of children's congenital heart services is a clinically-led NHS review, independent of government. It is now for the JCPCT to consider the court's ruling."

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