NHS England has reversed plans to close three of the country’s heart surgery units, including that of the Royal Brompton Hospital.
Proposals published by NHS England in July 2016 relating to future commissioning of congenital heart disease (CHD) services for adults and children had earmarked a number of units for closure.
Earlier this week, however, the NHS England board announced that units at the Royal Brompton, Leicester, and Newcastle would remain open, subject to certain conditions, a move welcomed by a number of Imperial staff and students.
The proposals, which stated that centres wishing to carry out CHD treatment would need a number of other services on-site, generated a large amount of controversy. Lord Darzi, holder of the Paul Hamlyn Chair of Surgery at Imperial, and Sir Magdi Yacoub, Professor of Cardiothoracic Surgery at Imperial’s National Heart and Lung Institute, said closure would be “a disaster” and “not in the best interest of our patients”.
Royal Brompton and Harefield NHS Foundation Trust currently do not provide all services required by the proposals on-site; instead, they work in collaboration with Chelsea and Westminster Hospital, which is located less than a mile away. The proposals also stated that centres would need three heart surgeons, carrying out 125 operations each year.
The Royal Brompton and Harefield NHS Foundation Trust have outlined a new proposal for meeting the standards, joining with King’s Health Partners, which comprises of a number of hospitals in south London. They plan to develop a purpose-built facility, as well as increase investment at other sites.
They will continue to offer CHD services as they work towards these new plans. NHS England has said that keeping the service open is “conditional on demonstrating convincing progress along the way”. Newcastle upon Tyne Hospitals and University Hospitals of Leicester NHS Foundation Trusts will also continue to offer CHD services.
In a statement, Bob Bell, the Trust’s chief executive, said they “welcome the opportunity to continue developing the benefits of a collaboration with King’s Health Partners across cardiac and respiratory medicine and research”.
He went on to say that “we are pleased to have been given the opportunity to shape our own destiny”, but that “any relocation of services…would involve consultation with many groups, including patients, staff, referrers, commissioners, and other key stakeholders”.
While the Royal Brompton will remain open, a number of centres across the country – including Imperial College Healthcare NHS Trust – will no longer offer certain CHD services.
Lisa-Jayne Edwards and Chris Eichhorn, presidents of ICSM Heart, a student society for those interested in cardiology, said they were “very pleased” by the decision. “The Royal Brompton Hospital, especially, is a centre of interest, study, and inspiration for our members who aspire to be cardiologists, cardiac surgeons, and cardiovascular scientists,” they told Felix, “This decision will certainly affect students’ exposure to the narrow field of congenital cardiology.”
They went on to say: “Our thoughts as a medical academic society, however, lie with the current and prospective patients. We are glad that a solution has been reached that benefits them overall whilst continuing to provide their future doctors with exceptional training and a solid evidence-base.”
The Royal College of Surgeons, in a joint statement with the Society for Cardiothoracic Surgery, said they supported raising standards, but “these changes should have happened decades ago”, and the “endless delays” have caused “great uncertainty to all the hospitals involved, their staff, and the children they care for.”
Plans to end CHD services at the Royal Brompton were fiercely opposed by the hospital, whose representatives claimed that it would cost the trust £47 million – 13% of their income – a figure NHS England disputed. The Royal Brompton also argued that cessation of CHD services would have a knock-on effect on other services they could provide, such as paediatric respiratory medicine.
The Royal Brompton Hospital is one of the best known centres in the world for cardiology and respiratory medicine. It was responsible for the UK’s first combined heart and lung transplant, and is closely linked with Imperial’s National Heart and Lung Institute, one of the largest respiratory departments in the world.