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Tough new standards for congenital heart disease care unveiled

Hospitals unable to meet them must either show how they will, or stop providing treatment, says NHS England

Caroline White

Friday, 01 December 2017

All children with heart disease are to be treated in hospitals where all the specialists and services they need are on-site, so that they can receive the best care without the need for either the patient or the doctor to travel to another hospital, NHS England (NHSE) has announced.

Hospitals currently unable to fulfil these standards, which have been developed by specialists and patients, must either show how they intend to do so, and meet strict milestones, or stop providing treatment, says NHSE.

Patients with congenital heart disease (CHD) have already benefited from full out-of-hours, seven-day cover across the country and safer practice as procedures are only carried out by specialists, says NHSE.

But clinicians and professional bodies, including the Royal College of Paediatrics and Child Health, British Congenital Cardiac Association, British Heart Foundation and the Royal College of Anaesthetists, have all said that “isolated children’s services are unacceptable and children’s cardiac services must be co-located within a hospital providing a broad range of paediatric specialties and services.”

Every operation or interventional procedure for congenital heart disease patients will be carried out by specialist doctors whose volume of practice is sufficient to develop and maintain their skills, working in centres that are more resilient, with bigger teams, and providing full 24-hour seven-day specialist care.

Consultant heart surgeon and former president of the British Congenital Cardiac Association, Professor David Anderson, has previously stated that 125 procedures, equivalent to three operations a week, per surgeon, is the minimum requirement

While some procedures only materialise once or twice a year, a minimum standard is required to ensure that a surgeon has an acceptable level of skill that can be refined and maintained through regular practice, he said.

NHSE has clarified which hospitals will provide these services for adults and children.

Liverpool Heart and Chest Hospital NHS Foundation Trust will provide level 1 adult CHD services in the North West, with Manchester University Hospitals NHS Foundation Trust providing the full range of level 2 adult CHD services as an integral part of a North-West CHD Network.

University Hospitals of Leicester NHS Trust will continue to provide level 1 CHD services, provided that it achieves full compliance with the standards set out in their own plans to do so and can demonstrate convincing progress along the way.

NHSE is also backing the Royal Brompton and Harefield NHS Foundation Trust’s new outline proposal for achieving full compliance with the standards. The trust will continue to provide level 1 services in the meantime, conditional on demonstrating that convincing progress is being made.

Newcastle upon Tyne Hospitals NHS Foundation Trust will continue to provide level 1 CHD services until at least March 2021, with further consideration to be given, by NHS England, to the future commissioning of both its advanced heart failure and transplant service and its level 1 CHD service.

But Blackpool Teaching Hospitals NHS Foundation Trust, Imperial College Healthcare NHS Trust, Nottingham University Hospitals NHS Trust, and University Hospital of South Manchester NHS Foundation Trust will no longer provide level 2 CHD services, including cardiology interventions in adults.

In each case, NHSE will closely monitor progress towards each of the standards, and take appropriate action, if it becomes clear that the standards will not be met within the specified timescale.

Professor Huon Gray, national clinical director for heart disease, NHS England, said: “Every patient should be confident that their care is delivered by a hospital that meets quality standards, which have been developed after long consultation with patients, their families and specialist clinical staff.

“These standards, agreed in 2015, are intended to ensure that the care received by those with congenital heart disease is consistent, of the highest quality, and maintained in future years. These objectives have always been at the forefront of our proposals.”

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