Health: Congenital Heart Disease
Debate between Lord Darzi of Denham and Baroness Chisholm of Owlpen
Baroness Chisholm of Owlpen (Con)
I thank the noble Baroness, Lady Boothroyd, for tabling this debate, and I pay tribute to her for her tireless work in this matter. I do feel quite lonely in here today—but, luckily, I have my noble friend Lady Sugg beside me, so I have one mate.
The future of congenital heart disease services is of utmost importance and I understand why, for many people, it is a concern. I am of course happy to facilitate a meeting with the noble Baroness, Lady Boothroyd, and anybody else who would like to join us, alongside NHS England. That could be an important thing to do.
With this review, NHS England is asking how we can take the good service we have across the country and turn it into a truly great service for the long term—a service fit for the 21st century. This is not about closing the Royal Brompton Hospital or stopping it providing CHD services. NHS England is proposing instead to continue to commission specialist medical services, which make up much of the care required by people with congenital heart disease. The proposal is that NHS England ceases level 1 children’s surgical services from the Royal Brompton Hospital. NHS England has also asked the Royal Brompton to consider providing an adult level 1-only surgical service.
Heart surgery is becoming ever more complex and technically demanding. Surgeons now operate on babies who may be only hours old. They will in future be able to operate on babies before they are born. This demands a highly skilled and experienced team of doctors and nurses able to operate on sufficient numbers of patients to maintain and improve their skills, as well as access to the very latest technology. The noble Lord, Lord Darzi, mentioned that the number of procedures is arbitrary—but 125 is not an arbitrary number. That number of operations was agreed by CHD surgeons as the minimum required to maintain a certain level of competence in the operating theatre.
NHS England’s approach to commissioning these very specialised services is proactive and future-focused. If the proposed changes are implemented, patients and their families can be confident that they will be able to access the very best CHD services in the world, regardless of where they live. It is worth emphasising that the consultation which closed on Monday considers the implementation of an agreed set of common standards, developed more than two years ago by clinicians, other experts and patients, which were subject to full public consultation and which the Royal Brompton, along with other centres, helped to develop.
The standards include the requirement that specialist children’s cardiac services are delivered only in settings where other children’s services are collocated on the same site. There are several reasons why collocation is essential for a world-class service. Managing the complex needs of very sick children demands close co-operation between many specialist doctors, nurses and other experts. Collocation allows much closer working relationships to develop between paediatric cardiology specialists and other paediatric teams. The interaction between these teams on a daily basis, when collocated, is considered by NHS England’s clinical advisers to be of significant benefit to patients. Follow-up and rehabilitation for recovering children often require intermittent access to a wide range of specialists, which is far easier to provide at a centre supporting a full range of services.
The noble Baroness, Lady Boothroyd, and the noble Lord, Lord Darzi, talked about collocation, and I would like to read a couple of quotes. Professor Michael Birch, head of clinical service, cardiology, at GOSH, said:
“Paediatric collocalisation is crucial to provide optimal clinical care at the specialist children’s surgical centre. In the UK early post-operative mortality has reduced, but morbidity remains a concern. The co-dependencies are essential, not only to maintain results with regard to mortality, but also with regard to morbidity”.
Lord Darzi of Denham
I suggest that the last person I will ask about their experience is the person who is conflicted.
Baroness Chisholm of Owlpen
I understand, but this is a time-limited debate. I have only 12 minutes to speak and if interrupted, I cannot. I am very sorry. I shall continue the quote:
“In … one year, a formal transfer of care was required to 18 different specialties … These specialties included urology, renal medicine, metabolic medicine, general surgery, respiratory medicine, plastics, neurosurgery, neurology and haematology”
Having those all in one location obviously makes a huge difference. This way of working brings paediatric cardiac care into line with expectations in other specialist children’s services. Collocation of specialist children’s services is the accepted international norm, and this is why the standard requires collocation on the same hospital site.