Health: Congenital Heart Disease

Baroness Finlay of Llandaff Excerpts

Thursday 20th July 2017 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this important debate, secured by my noble friend Lady Boothroyd, has raised an issue much wider than simply the hospital, and that is the role of standards. They are a means to an end, and that is what patients want—good outcomes.

The services at the Royal Brompton care for 12,500 patients and undertook 1,288 congenital heart disease procedures in 2015-16, of which 814 were paediatric surgical and interventional catheter procedures. For such interventions, the well-established and skilled multidisciplinary teams have a 30-day survival rate of 98.3%, against a predicted survival rate of 97.7%. The data from 2012 to 2015 suggest that Brompton ranked third in the UK in its outcomes. That is what patients want—good outcomes.

What is the evidence for closure? We have heard about the Chelsea and Westminster hospital being located five minutes away on foot. In 2016, an audit of the arrangement showed that 100% of emergency attendances occurred within the agreed response times and no patient has ever been known to suffer because of the current locations of the general paediatric services, and there seems no evidence from anywhere around the world that this standard of same-site co-location will provide better outcomes for patients.

Apart from this single standard, all other standards are more than met by the Royal Brompton. NHS England does not dispute this. So where is NHS England’s transition plan for this proposal? If the services were closed, the patients would be scattered, as we have heard, between Great Ormond Street, Bart’s, Guy’s and St Thomas’ for surgery and other procedures. Up to 100 healthcare professionals currently can be involved in any one patient at the Royal Brompton. These teams will be broken up, compromising continuity of patient care and, more importantly, compromising future patient care because it takes years to build them up again.

The NHS’s own assessment shows that, if the proposals are implemented, there will be a significantly detrimental impact on the paediatric intensive care unit, known as PICU. That is because congenital heart disease accounts for 86% of admissions to PICU at the Royal Brompton so it is dependent on providing these services. Without them, the unit would be forced to close, resulting in a reduction of PICU in London of one-sixth or possibly more. Children requiring PICU services are already being sent out of London because there are not enough PICU beds. On 1 December last year, a lack of such beds meant that three children had to be sent far away for care. That is not good for clinical outcomes, and it is certainly disastrous for them and their families psychologically, even if they survive the experience.

Closure of the Brompton PICU would result in a cascade of loss of skills. The absence of PICU and on-site anaesthetists will further jeopardise complex specialist treatments such as cardiac extracorporeal membrane oxygenation, known as assisted ventilation, for children, as well as cardiac and respiratory ECMO for adults.

An independent review published in 2013 in the International Journal of Cardiology rated the Royal Brompton as the most influential research unit in the world, with a cumulative research impact factor that was 50% higher than any other centre in London. The research facilities provide advanced cardiac magnetic imaging, echocardiographic work and a catheter laboratory. Its genetics laboratory is looking at new genes linked to congenital heart disease, with diagnostic and prognostic markers for disease and surgery outcomes. Novel right ventricular assist devices and valve replacement procedures are currently being trialled, along with new treatment modalities for pulmonary arterial hypertension. Closure of the clinical congenital heart disease services will have a destructive effect on this world-leading research facility. Again, these services have taken decades to build up. This is not something that can be replicated overnight.

The holistic approach taken in the care of sick children and their families means that every child with complex needs, particularly in palliative care when it is clear that they are not going to survive, is dealt with by a team with its own lead nurse and consultant helping parents to participate fully in care and with a staff focus on quality of life for the child and their family. The hospital has a unique feature of integrating paediatric and adult services so that teenagers can transition seamlessly and learn how to look after themselves. They are given help in planning their future careers and guidance on healthy living, including knowing who to contact if there is a problem.

Closure of services at the Brompton goes against the interests of patients and their families. It will disrupt vital research, and I would suggest that it also seems to have no evidence base behind it.