On 4 July, a committee of primary care trust chief executives made the extraordinary decision to end children’s heart surgery and intensive care at one of the best performing and largest centres in England: Royal Brompton hospital, a specialist heart and lung hospital that treats children and adults from all over the country who have some of the most severe forms of heart and lung disease. It was quite a surprise for the doctors and other staff at Royal Brompton to find out last year that they were earmarked for closure. The national review panel that made the recommendation, in February 2011, had previously specified that for children’s heart surgery centres to be viable they must have four surgeons each doing at least 100 operations every year, and they must offer round-the-clock care.
Royal Brompton has four surgeons, each undertaking more than 100 operations every year and it offers round-the-clock care. It also has a safety and outcome record of which any centre would be proud. Rates of patient satisfaction at the hospital are exceptionally high.
The national review of paediatric heart surgery set out to reduce the number of hospitals offering children’s heart surgery, because it was felt that in some areas surgeons did not have enough cases to maintain their skills in the longer term. London has three centres, although two of them, Royal Brompton and Great Ormond street, are recognised national specialist centres and treat patients from all over the country. The decision was made to close a London centre, and divert its patients to the
remaining two, once their facilities are improved and extended, at significant cost to the taxpayer. A proposed solution to develop a network in London that would mean closer collaboration between the three existing centres, but no closures, was ignored.
Time prevents me from going into detail about why Royal Brompton drew the short straw of closure; it came down to a complicated scoring mechanism that eventually ended up in the High Court. I must stress, because it is of utmost importance, that there was never any suggestion that Royal Brompton’s clinical services for children are anything other than first rate. A better insight may be provided by the comments of a civil servant at a meeting of the London specialised commissioning group on 26 April:
“It is likely that the rest of the country will take the view that London should take its share of the pain of closures and will seek to make one closure in the capital in order to make closures elsewhere more palatable.”
Removing children’s surgery and intensive care from Royal Brompton will have devastating consequences, and not just for the young patients who value the hospital’s cardiac care so highly. Losing its children’s intensive care unit will destroy Royal Brompton’s world-class paediatric respiratory service, which specialises in the treatment of children with cystic fibrosis, severe asthma and a number of severe and complex respiratory conditions. Without the back-up of intensive care and on-site anaesthesia, doctors will not be able to undertake the more complex specialist treatments they do now, because they will consider it unsafe to do so.
Royal Brompton’s respiratory teams also undertake groundbreaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. That research can be carried out only at a specialist hospital, where the combination of clinical expertise and the type and number of patients seen provides the necessary conditions. Without an intensive care unit and provision for anaesthesia, research will simply not be possible.