News

‘No plans’ to reconfigure congenital heart disease specialists

NHS England is not planning any changes to the configuration of specialist Congenital Heart Disease (CHD) providers “at this time”, but does plan to introduce new wide-ranging standards. 

At this week’s Board Meeting, members are being invited to agree on the proposals in the final report on the ‘New Congenital Heart Disease Review’, which sets out the standards to deliver a three-tier model with clear roles and responsibilities for each tier. 

Under the proposals, networks will help local services to work closely with specialist centres, to ensure that patients receive the care they need in a setting with the right skills and facilities, as close to home as possible. 

The paper, prepared by Ian Dodge, national director for commissioning strategy at NHS England, says: “The main recommendations of the review will be accomplished through commissioning. We are working with clinicians and managers from hospitals to design ways of working that will ensure the standards are met. We have set a target go-live date of 1 April 2016 for contracts against the new standards. 

“Our commissioning decisions will need to take into account and balance all the main factors, including affordability, impact on other services, access, and patient choice, and not treat the standards as though they exist in isolation.” 

It added that after considering the “deliverability of proposals” the proposals were “affordable”, that we can be “cautiously optimistic” that staff with the right skills will be available to deliver the standards, and that major reconfiguration of specialist services, with the associated risk and upheaval, can “probably be avoided”. 

However, Dodge noted that implementation of the proposals will “be complex but we believe it is deliverable”. 

NHS England said the future CHD service must evolve from one that is largely focused on children, to one that sees a growing number of young people and adults with continuing health needs. Otherwise, it will become difficult for the specialist surgical centres alone to manage the demand, so we must develop new ways of working to future-proof the service. 

The three tier model would include: 

Specialist Surgical Centres (level 1): Each network will have at least one (often more) Specialist Surgical Centre. All surgery and most cardiological interventions will be undertaken at these level 1 centres. These centres will provide the most highly specialised diagnostics and care. 

Specialist Cardiology Centres (level 2): Not all networks will necessarily include level 2 centres, but because of the increasing number of adults living with CHD, Specialist Adult CHD (ACHD) Centres are expected be more common. The need for level 2 centres will be determined by each network taking account of local circumstances, including the opportunity to improve local access, the need for additional capacity, and the availability of appropriately skilled staff.

Local Cardiology Centres (level 3): Local children’s cardiology centres will employ a paediatrician with expertise in cardiology (PEC) to provide ongoing monitoring and care, and run outpatient clinics alongside specialists from the Specialist Surgical Centre. This will mean that more care can be given locally, so children and their families will have less need to travel long distances for their ongoing monitoring and care. 

It was noted that there is a proposal that all hospitals providing CHD care must work as part of regional, multi-centre networks, bringing together fetal, children’s and adult services. 

Networks would be hosted by one of the surgical centres involved. Individual surgeons will be based at each surgical centre, as now, with arrangements in place for 24/7 cover. Additionally, surgeons and interventionists will need to work in teams of at least four. 

Dodge added that where “occasional practice” still exists, that is, small volumes of surgery and interventional cardiology being undertaken in institutions that do not offer specialist expertise in this field. “This kind of practice is explicitly ruled out by the standards as it is not in the best interests of patients. Networks will work with the relevant local and regional commissioners to identify and tackle occasional practice”. 

The paper also proposes that specialist children’s cardiac services should only be delivered in settings where a wider range of other specialist children’s services are also present on the same hospital site. “This is recognised in the specific requirements in the standards for co-location of paediatric CHD care with paediatric surgery (D6); paediatric renal (D7); and paediatric gastroenterology (D9). Some centres do not currently have paediatric CHD co-located with other tertiary paediatric services”. 

Dodge wrote that while changes to the configuration of the service are not planned, if this were to result from the introduction of new standards, a joint approach to managing staff affected by change would be “sensible and helpful”. 

“We are not making any proposals for changes to the configuration of specialist providers at this time,” he said. “The precise configuration of specialist services will be the result of commissioning the CHD service against the proposed new standards and service specifications.” 

The new proposals follow a consultation process launched last year and the ‘Safe and Sustainable’ review, which said three centres providing children’s heart surgery should close – those at Leicester’s Glenfield Hospital, Leeds General Infirmary and the Royal Brompton in London – but that review was scrapped following a judicial review, which said the consultation was flawed.