Health: Congenital Heart Disease

Baroness Boothroyd Excerpts

Thursday 20th July 2017 Lords Chamber

Asked by

[Baroness Boothroyd]

To ask Her Majesty’s Government what clinical evidence they have that the proposed closure of congenital heart disease services at the Royal Brompton Hospital will lead to improved patient outcomes.

[Baroness Boothroyd (CB)]

My Lords, I hope this debate will persuade the Government to end the current crisis that threatens the future of the Royal Brompton Hospital. I hope also that it will convince NHS England, which funds Britain’s largest centre for the treatment of congenital heart and lung diseases, that its plans to decommission the hospital’s key services are mistaken and should be withdrawn. There is no justification for them. The NHS trust which runs the Royal Brompton is wholly opposed to them; on any rational basis, it is the last hospital one would expect to be treated in the way it has been by the national board of NHS England.

I deplore this crisis. It was entirely avoidable. Unless it is resolved in a way that benefits patients, it will have appalling consequences. It has already eroded the good faith that ought to exist between the hospital’s trust and NHS England, which appears to be determined to get its own way.

To make matters worse, the dispute between them is over a problem that actually does not exist. Perhaps the Minister will explain why it has been allowed to escalate in the way it has. I know that the Minister has strong feelings and will disagree with me, but I am delighted to be able to put my views in print, and I hope she will relay our dismay and alarm to her colleagues in senior government positions. If it ends in legal action, which has been talked about, the High Court will want to know a lot more about the way NHS England has behaved.

I declare an interest as a grateful long-term cardiac and respiratory patient at Brompton. From the information I have received, the national board has been high-handed, devious and secretive. It has constantly misunderstood and misrepresented the hospital’s position and dismissed its representations without proper consultation. In my opinion, which is shared by others, it has not behaved fairly, in the way its executive functions require and British justice expects.

Why, for example, did it demand the trust’s response within three days to its warning last year that it was minded to decommission Brompton’s procedures for treating congenital heart disease?

Why did it reject the hospital’s submission out of hand without explanation and announce the very next day that it was minded to cut Brompton’s funding? That was a breach of natural justice if ever I saw one.

Why was a small group of its advisers allowed at the last minute to overturn an independent review that had approved the way the Brompton worked in harmonious partnership with its near neighbour, Chelsea and Westminster Hospital? Other questions arise from its arbitrary decision to accept that U-turn.

How and where will Brompton’s 12,000 displaced patients be relocated? We all know that hospitals in London and the south-east are absolutely chock-a-block. What evidence do NHS England and the Minister have that the relocating of patients—whose interests must come first, or at least ought to—will lead to improved patient outcomes? Where is the evidence? That is the question that has to be answered today. A spokesman for NHS England told a public consultation recently that removing patients to other hospitals in London would be a formidable challenge. A patients’ representative asked, “Have you nothing better you could be doing?”. Evidently not. I say this to NHS England and to the Government too: I am minded to conclude that you are out of touch with public opinion and you have lost your way on this issue.

Is the Royal Brompton a failing hospital? No, its excellent performance ratings show otherwise. Is there some scandal we do not know about, like the 29 infant deaths from congenital heart disease in Bristol Royal Infirmary 20 years ago? No, there is not. So what is the problem? NHS England has changed tack on this. In June last year, it claimed that Brompton had failed to comply with seven of the board’s 14 requirements. NHS England dropped that charge when Brompton disproved it, but still rejected its submission out of hand. Its attitude throughout has been imperious.

No less a figure than Sir Magdi Yacoub, one of our surgeons of international repute, who performed Britain’s first heart and lung transplant and still oversees research work at the Heart Science Centre, which the Royal Brompton Trust runs, calls the effect of the plans to disrupt Brompton’s services “a crime”—a crime. Sir Magdi said:

“What are you doing? Why are you killing a centre of excellence? To me, it’s a crime”.


I want to know that too, as do many Members in both Houses of Parliament and several thousand families outside this House. We want Jeremy Hunt, the Secretary of State for Health, to stop this madness. He did so four years ago when the Brompton’s services were under threat; he should do so again and lose no more time and precious resources. Professional staff will move abroad.

Brompton’s fame and uniqueness stems from the results it achieves and the progressive treatments it generates. Its dedicated staff care for 8,000 adult patients and 4,500 children per year. Its out-patients receive lifelong care in a seamless stream from infant to senior citizen. It is the nation’s centre for treating babies and children from all around the UK with severe forms of cystic fibrosis, asthma, muscular dystrophies and other respiratory illnesses. Its research papers are widely published and students and academics study there, but that appears not to be good enough. It has to be decommissioned.

The controversy that threatens Brompton’s patients stems from NHS England’s regulation that from 2019 every hospital’s doctors should work under the same roof. This runs counter to Brompton’s agreement with its near neighbour Chelsea and Westminster, which is a different form of co-proximity but works just as well. If the Brompton needs a specialist with a differing discipline, Chelsea and Westminster provides one within half an hour, which used to be the national rule. I have personal experience of that procedure. Moreover, no patient has ever been put at risk. It has been 100% successful.

What does it take to convince the powers that be that the Brompton is an exceptional hospital and should be treated in a way that suits its patients best and not bureaucracy? NHS England talks about “future-proofing” congenital heart disease treatment, which the Brompton does every day. It alleges that the hospital has rejected an alternative proposal, which the hospital says has never been made.

The Brompton meets 469 out of NHS England’s 470 requirements. Even so, that is deemed not to be enough. Imagine any organisation being failed on a score of 469 out of 470. Parliament would have to shut up shop. What does it take to persuade the NHS moneybags that wrecking the Brompton risks more than they realise? This approach is not only unfair, it is quite unreasonable. NHS England demands optimal performance but only on its own terms. The Brompton’s performance is already optimal and risk-free.

The dire consequences of a forced relocation are already apparent. Brompton would lose 28% of its NHS income. The redundancies would cost more in professional and financial terms. The hospital’s respiratory services for asthma sufferers could not be sustained. I ask the Minister whether NHS England has forgotten the first principle of the Hippocratic oath that doctors must do nothing to harm their patients? It has certainly ignored the guidelines in its own Five Year Forward View published in 2014. It said then that,

“England is too diverse for a ‘one size fits all’ … model”.

Henceforth, it said, regulations were to be applied with “meaningful local flexibility” and it would back “diverse … and local leadership”. That seminal document went on to say:

“One of the great strengths of this country is that we have an NHS that—at its best—is ‘of the people, by the people and for the people’”.


There would be no more “factory models” of care and repair, with little engagement with the wider community and short-sighted attitudes to partnerships.

Is that not what is happening at the Brompton right now? If NHS England presses ahead and the Government do nothing to stop it, the health service will be the poorer, so will our country and others further afield. It would be a disaster if it succumbs to the diktat of bureaucracy.

The Royal Brompton must be allowed to get on with the job at which it excels.