Reconfiguring children ’ s congenital heart services in England

Reconfiguring children’s congenital heart services in

England

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Public Health’s role in major service reconfiguration

Matthew DayNorth of England Specialised Commissioning Group

(Feb 2011-Feb 2012)

School of Public Health Regional Conference 2012

Congenital Heart Defects Defect in structure of the

heart present at birth 8/1000 prevalence Surgery rare Approx 3’600 operations

per year

Slides on the Safe and Sustainable Review of Paediatric Congenital

Cardiac Services in England, October 2010

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Background 2001 : The Bristol Royal Infirmary Inquiry

Report (the Kennedy Report) recommended the need for Children to have heart surgery performed in fewer specialist centres.

March 2011 the NHS led review ‘Safe and Sustainable’ consultation document proposing options for the future delivery

Proposal to reduce the number of centres which currently performed these complex operations from ten centres, to six or seven.

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3600 Operations

>30 surgeons specialising in England

10 centres doing surgery

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Magic numbers

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Option A

Option A Seven surgical centres at: • Freeman Hospital, Newcastle • Alder Hey Children’s Hospital,

Liverpool • Glenfield Hospital, Leicester• Birmingham Children's Hospital • Bristol Royal Hospital for Children• 2 centres in London 

Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

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Option B

Option B Seven surgical centres at: • Freeman Hospital, Newcastle • Alder Hey Children’s Hospital,• Liverpool • Birmingham Children's

Hospital• Bristol Royal Hospital for

Children• Southampton General

Hospital• 2 centres in London 

Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

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Option C

Option CSix surgical centres at:• Freeman Hospital, Newcastle • Alder Hey Children’s Hospital,

Liverpool• Birmingham Children's Hospital • Bristol Royal Hospital for Children• 2 centres in London

Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

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Option D

Option D Six surgical centres at:• Leeds General Infirmary • Alder Hey Children’s Hospital,

Liverpool • Birmingham Children's

Hospital• Bristol Royal Hospital for

Children • 2 centres in London

Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

The politics!

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Public Health Role!

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Public Health Role: The Science

Regional Health Impact Assessment (HIA) of the proposed consultation options

Regional ‘information group’ established

Health Impact Assesment

Epidemiology Patient flows Network configuration Travel and access Patient experience Fetal cardiology Financial Staffing

Slides on the Safe and Sustainable Review of Paediatric Congenital

Cardiac Services in England, October 2010

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Epidemiology: Surgical procedure rates

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PCT Total Paediatric Rate/10,000 pop

Bradford and Airedale 51 4.73

Leeds 52 4.17

North East Lincolnshire 11 3.88

Wakefield District 21 3.77

Sheffield 31 3.55

Barnsley 13 3.28

East Riding of Yorkshire 17 3.22

Calderdale 11 2.92

Doncaster 15 2.90

Kirklees 22 2.81

Rotherham 11 2.41

Hull 10 2.28

North Lincolnshire 6 2.18

North Yorkshire and York 24 1.92PCTs Outside Region 21 -

Total 316 3.5

Table 1 Shows surgical procedures performed at LTHT by age-group and PCT 2009/10.Knowledge of

available data+

Building ‘Trust’ trust+

Really basic number crunching

Epidemiology / Network configuration: Multiple health needs

Knowledge of available data +

clinical network advice +

analytical support+

Complexity to ‘essentials’15

75% patients with multiple health

needs

> 25% Respiratory related

Travel and access / patient experience Patient flows

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Understanding evidence / pathways

+clinical network

advice+

narrative

Patient / Family Experience

17Source: Interim Health Impact Assessment Draft Appendices - Bradford Event Feedback. Available at: http://www.specialisedservices.nhs.uk/library/30/Health_Impact_Assessment_Interim_Report_Draft_Appendices.pdf

“Some {surgical} centres may not provide services that are culturally specific to the current community.... If communities aren’t able to access culturally sensitive services the quality of care may suffer”

Y&H HIA ‘science’ Influence Regional Commissioner and Provider

CXs Presenting and representing NHS at

Regional Joint OSC Providers National Safe and Sustainable Team Joint Committee of PCTs (decision

making body) Circulated nationally as exemplar Advised PWC / MM for National HIA /

Patient Flow work

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Public Health (dark) ‘Arts’

RelationshipsCommunication

Written – complexity to essentials

Non-verbal

Conflict

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Lessons for Public Health role in major service reconfigurations

Professional leadershipTechnically astuteComplexities to essentialsPH ‘Communicators’PH as ‘Honest brokers’

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Safe and sustainable Timeline Largest Ever NHS

Consultation - >75,000 responses

Y&H petition > 600,000 signatures

Royal Bromptom Vs JCPCT (Sept 2011). Consultation unlawful

JCPCT Appeal - verdict overturned. Consultation lawful.

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The decision

“The 4th of July will be a milestone for the future of children’s congenital heart

services” Sir Neil McKay, Chair JCPCT

More options now on the table…..

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