We are today making a statement on the decisions taken by NHS England at its Board meeting on 30 November 2017 regarding future commissioning arrangements for adults’ and children’s CHD services in England, following its Review of and full public consultation on these services.
CHD services are a specialised service currently commissioned by NHS England. There have been concerns about these services, especially children’s congenital heart surgery, which date back to the early 1990s and which have been the subject of a number of reviews.
Heart surgery is becoming ever more complex and technically demanding. Surgeons now operate on babies that may be only hours old and will in the future be able to operate on babies before they are born. This demands a highly skilled and experienced team of doctors and nurses able to operate on sufficient numbers of patients to maintain and improve their skills. It also requires that a wider range of other specialist children’s services are also present on the same hospital site. This determines what medical care is available by the bedside for a child in a critical condition, which is important because many children with CHD have multiple medical needs.
The New Congenital Heart Disease Review was established in July 2013, and on 23 July 2015 the NHS England Board agreed the standards – almost 200 in total that cover the entire patient pathway. These standards were collaboratively developed over a two year period by patients and their families and carers, clinicians, commissioners, and other experts. They were the subject of extensive public consultation, and all the views put forward were considered before the standards were finalised.
Patients and their families told NHS England that while it was a good thing to have standards, they only really mattered if they ensured that they were met. Following a self-assessment of providers against these standards, NHS England announced in July 2016 that it was minded to make a number of changes in the way it commissions CHD services. NHS England set out proposals to implement the standards, and asked for views in a full, formal, public consultation that ran between 09 February 2017 and 17 July 2017.
With this Review, NHS England has been asking how we can take the good service we have today across the country and turn it into a truly great service for the long-term; a service fit for the 21st century. When its proposals are implemented, patients and their families can be confident that they will be able to access the very best CHD services in the world, regardless of where they live.
Having noted the results of the consultation, and in order to support the full implementation of the standards, NHS England agreed a number of recommendations regarding future commissioning arrangements for CHD services in England at its Board meeting on 30 November 2017. It also agreed proposals for full implementation of all the standards, and confirmed its support for recommendations regarding better information, funding for formal CHD networks and the development and delivery of a rolling peer review programme that will cover all of the standards at all Trusts.
The following recommendations were considered and agreed by the NHS England Board at its meeting on 30 November 2017:
- for Liverpool Heart and Chest Hospital NHS Foundation Trust to provide level 1 adult CHD services in the North West, with Manchester University Hospitals Foundation Trust providing the full range of level 2 adult CHD services as an integral part of a North-West CHD Network;
- to continue to commission level 1 CHD Services from University Hospitals of Leicester NHS Trust, conditional on the Trust achieving full compliance with the standards in line with its plan to do so and demonstrating sufficient progress within required timescales;
- to note the outline proposal presented by the Royal Brompton and Harefield NHS Foundation Trust for how full compliance against the standards might be achieved; to confirm that NHS England should work with RBH and other potential partners on the full range of options for delivering a solution that could deliver full compliance with the standards and ensure the sustainability of other connected services; and to continue to commission level 1 CHD services from the Trust, conditional on the Trust demonstrating sufficient progress within required timescales;
- to continue to commission level 1 CHD services from The Newcastle upon Tyne Hospitals NHS Foundation Trust until at least March 2021, with NHS England to consider further the future commissioning of both the Trust’s advanced heart failure and transplant services and its level 1 CHD services;
- to cease to commission level 2 CHD services, including cardiology interventions in adults with CHD, from the following Trusts: 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 (note, this Trust has now merged with Central Manchester University Hospitals NHS Foundation Trust to form Manchester University NHS Foundation Trust, which will be providing level 2 adult CHD services under the recommendations).
This will mean that in future level 1 CHD services in England will be provided by the following hospitals:
- Alder Hey Children’s Hospital NHS Foundation Trust (children’s services) and Liverpool Heart and Chest Hospital NHS Foundation Trust (adult service) – subject to the conditions described by NHS England;
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust (children’s services) and University Hospitals Birmingham NHS Foundation Trust (adult service);
- Great Ormond Street Hospital for Children NHS Foundation Trust (children’s services) and Barts Health NHS Trust (adult service);
- Guy’s and St Thomas’ NHS Foundation Trust (children’s and adult services);
- Royal Brompton & Harefield NHS Foundation Trust (children’s and adult services) – subject to the conditions described by NHS England;
- Leeds Teaching Hospitals NHS Trust (children’s and adult services);
- Newcastle Hospitals NHS Foundation Trust (children’s and adult services) – subject to the conditions described by NHS England;
- University Hospitals Bristol NHS Foundation Trust (children’s and adult services);
- University Hospitals of Leicester NHS Trust (children’s and adult services) – subject to the conditions described by NHS England; and
- University Hospital Southampton NHS Foundation Trust (children’s and adult services).
And that in future level 2 CHD services in England will be provided by the following hospitals:
- Brighton and Sussex University Hospitals NHS Trust (adult service)
- Manchester University NHS Foundation Trust (adult service)
- Norfolk & Norwich University Hospitals NHS Foundation Trust (adult service)
- Oxford University Hospitals NHS Foundation Trust (children’s and adult services)
- Papworth Hospital NHS Foundation Trust (adult service)
The commissioning of CHD services in England is a matter for NHS England. The Government will continue to hold NHS England to account as NHS England takes forward the recommendations of its Review. Full details of NHS England’s recommendations, including its implementation proposals, are available on its public website.
This statement has also been made in the House of Lords: