Agenda item

A review of paediatric cardiac surgical services in England began in 2008 in response to long-standing concerns around the sustainability of the current service configuration. It was considered that surgeons were spread too thinly across surgical centres (31 congenital cardiac surgeons spread over 11 surgical centres), leading to concerns around lack of 24/7 cover in smaller centres and the potential for sudden closure or suspension of smaller centres.

The review is being led by the National Specialised Commissioning Team (NSC Team) on behalf of the 10 Specialised Commissioning Groups (SCGs) in England and their constituent Primary Care Trusts. It was planned that proposals for change should go to public consultation in 2011. However, in October 2010 it was decided that the eventual options for reconfiguration to be put out for public consultation would not include the children’s heart surgery service at the John Radcliffe Hospital.

However, at the same time, the Trust was told that “not being included in options for consultation does not mean that the JCPCT [Joint Committee of Primary Care Trusts] has made any decision about the future of the service at the John Radcliffe Hospital.

The purpose of this item will be to broaden understanding of this issue and how the John Radcliffe Hospital could be included in the future consultation on changes to the service. Also, to hear from the Oxford Radcliffe Hospitals NHS Trust about the development of a proposal to establish an integrated service with Southampton University Hospitals NHS Trust that would enable a robust paediatric cardiac service to be provided at Oxford.

Speakers will include representatives of the ORH Trust; the Director for the NSC Team “Safe and Sustainable Services” programme and representatives of the “Young Hearts” a local charity that supports children with heart disease and their families.

The following papers are attached:

A letter from the Chair of the Joint Committee of Primary Care Trusts to the Chief Executive of the Oxford Radcliffe Hospitals NHS Trust

A letter from the Chairman of the HOSC to the Secretary of State for Health

The reply from the Secretary of State

Young Hearts briefing to MPs

A review of paediatric cardiac surgical services in England began in 2008 in response to long-standing concerns around the sustainability of the current service configuration for paediatric cardiac services. It was planned that proposals for change should go to public consultation in 2011. However, in October 2010 it was announced that the Joint Committee of Primary Care Trusts(JCPCT) would be advised that eventual options for reconfiguration to be put out for public consultation would not include the children’s heart surgery service at the John Radcliffe Hospital. At the same time, the Trust was told that “not being included in options for consultation does not mean that the JCPCT has made any decision about the future of the service at the John Radcliffe Hospital”.

Members wishes to address the apparent inconsistencies around consultation and to ascertain what the future consultation arrangements would be. The following speakers attended:

Jeremy Glyde – NHS Specialised Services Programme Director

Simon Jupp – South Central Specialised Services Director

Andrew Stevens – Director of Planning and Information at the Oxford Radcliffe Hospitals Trust

Dr Nick Archer – Lead Paediatric Cardiologist at the Oxford Radcliffe Hospitals Trust

Caroline Langridge }

Kim Holmwood } Young Hearts

Jude Kelly }

Jeremy Glyde started the discussion by explaining some of the background to the review and the decision to exclude the Oxford Radcliffe Hospitals Trust from the consultation.

There are long held concerns about the safety and sustainability of paediatric cardiac surgical services. It was considered that surgeons were spread too thinly across surgical centres (31 congenital cardiac surgeons spread over 11 surgical centres), leading to concerns around lack of 24/7 cover in smaller centres and the potential for sudden closure or suspension of smaller centres. The long-term aim would be to:

1.      Reduce the number of centres

2.      Implement new quality standards

3.      Develop new cardiac networks

The review is being led by the National Specialised Commissioning Team (NSC Team) on behalf of the 10 Specialised Commissioning Groups (SCGs) in England and their constituent Primary Care Trusts.

No paediatric centres would be closed but some would lose specific functions such as surgery. If surgery were to be removed from Oxford, it is proposed that all other core non-interventional paediatric services would be retained. A key standard for future viability is that a surgical centre must undertake a minimum of 400 paediatric surgical procedures a year and have a minimum of 4 surgeons co-located on the same site. The review team will recommend to the JCPCT that the ORH Trust is unlikely to be able to meet these and other standards based on an assessment of the John Radcliffe (and all other surgical units) by an independent panel of experts led by Professor Sir Ian Kennedy. As only viable options can be put forward for consultation, it will be recommended to the JCPCT that the inclusion of the John Radcliffe in any option would make that option un-viable. Mr Glyde further explained that nothwithstanding the  concerns about the Trust’s ability to meet the standards the national review team had undertaken further analysis to test whether the inclusion of the John Radcliffe in potential options would improve access for children and families. However, this analysis suggested that this was not the case. It also suggested that the John Radcliffe Hospital could only meet the necessary critical mass of patients by removing heart surgery from both the Bristol and Southampton units; there was no confidence that the John Radcliffe Hospital would be able to manage a paediatric cardiology network covering such geography.

On behalf of the ORH Trust Andrew Stevens and Dr Archer commented that the Trust recognises the need for safety and sustainability. They also accept that the size of the set up at the John Radcliffe could be a problem. However the Trust considers that services should be looked at in the round and the review should recognise the importance of the wider paediatric services and the services provided for adult cardiac patients. Children grow into adults and the seamless transfer from one part of the service to the other is very important.

The ORH is in talks with Southampton University Hospital to develop proposals for a fully rounded integrated service with a larger surgical capacity.

Mr Stevens and Dr Archer contended that it would not be necessary to close heart surgery at Southampton and Bristol. There were other options that could be considered that would leave those hospitals and the JR with the ability to perform heart surgery. Other small, isolated hospitals could be closed and patients could be cared for in Oxford or Southampton.

The Young Hearts representatives stressed their support for the John Radcliffe and pointed out that parents are very satisfied with the service. They appreciated the importance and benefits of the “cradle to grave” service available in Oxford and expressed concern over the amount of travel that could be involved for patients and their families if Oxford were to be closed.

A lengthy discussion ended with Jeremy Glyde explaining that the consultation document would contain a number of options with the expert committee’s preferences being expressed. The consultation will allow consultees to explain how other possible configurations, not included in the consultation document, could be appropriate.

Members AGREED that the consultation should form part of the agenda for the March HOSC meeting. In addition to the consultation document, they would expect to see the scoring system and total scores for each option and those excluded from the options.