Archived decisions

Appendix 5: Safe and Sustainable Children's Cardiac Surgery Services

Introduction

In September 2010 the Safe and Sustainable review will make recommendations for a reduced number of children's heart surgery centres in England. There are currently 11 centres in England (see Appendix A). The review is led by the National Specialised Commissioning Team on behalf of the 10 Specialised Commissioning Groups.

Professional and Lay Support

The review has support from the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the Society of Cardiothoracic Surgery of Great Britain, the British Congenital Cardiac Association and the Children's Heart Federation.

The Need for Change

The review is in response to concerns that the current configuration of services is not sustainable and does not provide all children in England with the same opportunity for excellent care:

· Not all centres can provide safe 24/7 cover

· Surgical expertise is spread too thinly across centres

· Risk of occasional practice around some complex procedures

· Risk that smaller centres may lead to less favourable outcomes for patients

· Smaller centres will experience recruitment difficulties; robust succession planning will be difficult, increasing the risk of unplanned and sudden closure of some centres

Likely Changes

The quality framework against which centres will be assessed for designation as specialist providers of children's heart surgery services in the future are likely to state that each centre must:

· Provide a 24/7 service

· Be staffed by a minimum of 4 consultant paediatric cardiac surgeons (current surgeon numbers are set out in Appendix B)

· Perform a minimum of 400 paediatric surgical procedures each year, and ideally a minimum of 500 paediatric surgical procedures each year (current procedure numbers are set out in Appendix C)

The assessment process will not just focus on surgeon numbers and procedure volumes. It will take a holistic assessment of each centre, in particular focusing on the degree to which they meet the standards for designation, and the ability of each centre to expand, grow, and take forward a world class service into the future. Other important issues will be taken into account, including travel times, geography and access for parents.

Implications of Reconfiguration

It is likely that the Safe and Sustainable review will recommend a reduction in the number of centres that provide children's heart surgery services. No key decisions have yet been made on the number or location of services in the future pending the outcome of a comprehensive assessment of each centre to be undertaken between May and June 2010, and pending the outcome of formal consultation between September and December 2010.

Although this will mean that some children and their families will have to travel a longer distance for surgery, they will not have to do this for other aspects of care (such as assessment, diagnostic tests, follow-up and ongoing management). The review will recommend a new `network model' of care that facilitates the delivery of all non-surgical and non-interventional paediatric cardiology care as locally as possible.

Benefits for Children and Families

The Safe and Sustainable review aims to develop a new national service that brings the following benefits for children and their families:

o Better clinical outcomes in the surgical centres (reduced mortality and reduced complications)

o Better follow up and other (non-surgical) treatment provided as close as possible to where the family lives

This will be achieved by the implementation of a quality framework that will be consistently applied in all surgical centres and that will achieve the following:

o Improved communication and planning between surgical centres and local services that links care in an effective network model

o A model of care that plans and deliver services around the needs of the child and which takes account of the transition to adult services

o Protocols between surgical centres and local maternity services that provides for early pre-natal screening and arrangements for delivery babies diagnosed with heart abnormalities

o Better access to surgical centres and local services, regardless of where the child lives

o An NHS workforce that is highly trained and expert in the care and treatment of children and young people

Progress to Date

· A Steering Group has been established, chaired by Dr Patricia Hamilton, Immediate Past President of the Royal College of Paediatrics and Child Health (see Appendix D for membership)

· Quality standards have been developed, providing a national quality framework for the future

· Stakeholders have been engaged, the outcome of which has fed into the development of the standards

Future milestones

· Local engagement events - from March 2010

· Centres to self assess against designation standards and submit plans for future expansion - March 2010

· Assessment of centres against designation criteria, including on-site visits - May to July 2010

· Recommendations for reconfiguration and the pre-consultation business case are put out for public consultation - September to December 2010.

· Outcome of consultation is considered - from January 2010

· Decision expected (dependent on outcome of consultation) - March 2011

The pre-consultation business case will set out:

· The objectives to be achieved

· The case for change in line with best clinical evidence

· Recommendations for the future configuration of the national service

· The appraisal of options, including the implications of no change

· The patient group affected by the recommendations and the benefits to service delivery and patient experience

· Other NHS services affected by the recommendations and a plan for addressing the implications of reconfiguration

· The workforce and training implications of the recommendations and how they will be addressed

· That the financial implications are affordable and how they will be addressed

· How stakeholders have been involved in developing the recommendations

· The outcome of Health Impact Assessments, Equality Impact Assessments and Travel Time Assessments

· An analysis of patient flows

· Cross boundary issues facing service provision for the devolved administrations that are affected by commissioning decisions in England

· An implementation plan

Engagement with Stakeholders

In October 2009 a national stakeholder event was held, attended by 200 clinicians, professional association and parent groups. 95% of attendees said that the event was well organised, relevant and provided plenty of opportunity for debate. A large part of the day was spent discussing the draft quality framework that had been circulated for comment in September 2009. Video excerpts of the day are available on the NSC Team website (www.specialisedcommissioning.nhs,uk). Further local engagement events are currently being developed for commencement in March 2010.

The NSC Team has issued two newsletters (summer and winter 2009) and has made available all relevant literature, including minutes of meeting, on its website.

Engagement with Health Overview Scrutiny Committees

The NSC Team has been working with the Centre for Public Scrutiny (CPS) to keep HOSCs informed of progress. The CPS has circulated relevant literature to HOSCs via existing networks.

In March 2010 the NSC Team, via the CPS, will ask HOSCs with an interest in this review to establish a statutory joint HOSC in time for formal consultation activities between September and December 2010.

END

Appendix A

Current NHS providers of children's heart surgery services in England

Freeman Hospital Newcastle

Leeds Teaching Hospital Leeds

Alder Hey Children's Hospital Liverpool

Glenfield Hospital Leicester

Birmingham Children's Hospital Birmingham

Oxford John Radcliffe Hospital Oxford

Bristol Royal Hospital for Children Bristol

Great Ormond Street Hospital for Children London

Royal Brompton Hospital London

Evelina Children's Hospital London

Southampton General Hospital Southampton

Appendix B

Number of consultant paediatric surgeons in England (forecast as at 1 April 2010)

Appendix C

Paediatric cardiac surgical procedures in England (2006/07)

Note:

2006/07 is the most recent year for which validated data is available

Data has been validated by the Central Cardiac Audit Database

Appendix D MEMBERSHIP OF THE STEERING GROUP ON SAFE AND SUSTAINABLE PAEDIATRIC CARDIAC SURGERY SERVICES (January 2010)