Royal Brompton loses fight to keep child heart unit

The Royal Brompton, London, the UK's largest heart and lung centre (Susannah Ireland)

A London hospital has lost its legal bid to save a children’s heart unit after the Court of Appeal ruled that the national review recommending its closure was in fact lawful.

The Royal Brompton Hospital had temporarily derailed NHS plans to concentrate children’s heart surgery in fewer hospitals after a judge found the ‘Safe and Sustainable’ review was unfair because of a “flawed” assessment of the hospital’s research and innovation programme.

But three Court of Appeal judges yesterday overturned the November decision, ruling that the process was fair, lawful and proper.

This paves the way for the Joint Committee of Primary Care Trusts (JCPCT), which runs the review, to decide which four or five of England’s 11 paediatric heart surgery units will close. The JCPCT today promised to make its decision, which could still save the Royal Brompton, with an “open mind”.

But the final decision on 4 July will undoubtedly prove controversial, despite widespread agreement that concentrating specialist medical expertise in fewer, larger centres improves safety and quality of care for patients.

The Safe and Sustainable review was launched in 2008 following the scandal at Bristol Royal Infirmary in the 1990s, where as many as 35 babies and children died because of substandard care.

Sir Roger Boyle, former heart disease and stroke tsar, said: “This is a landmark judgment for future NHS reconfigurations. The Court of Appeal has recognised that the process of public consultation – not costly litigation – is the most appropriate way for public bodies to express their views on proposed changes. The NHS must ensure that the clinical benefits for children and other patients come first – not the vested interests of individual hospitals.”

The consultation has led to bitter debates and local tensions, even though all 11 hospitals ‘signed-up’ to the process. In particular the “preferred option” put forward by the JCPCT outraged the Royal Brompton as it was the only one of three units in London earmarked for closure. The review recommended that its unit should be merged into Great Ormond Street and Guy's and St Thomas's.

The hospital sued the JCPCT, the first time one NHS organisation has taken action against another, claiming the decision was a “classic backroom stitch-up”. The judge rejected those claims but upheld that the consultation had been unfair to the Trust because of a “flawed” assessment of its research and innovation.

The judges yesterday dismissed the original ruling, but also spoke of the Trust’s excellent reputation.

They said: “A member of the public might well find it difficult to understand why a centre of the standard of the Royal Brompton should cease to be a centre for paediatric cardiac surgical services under the configuration exercise.”

The Brompton, which is the UK’s largest specialist heart and lung centre, last night said it was “disappointed” by the decision. They remained convinced that closing the cardiac unit could make its world class children and adult’s respiratory service unviable.

But medical experts said the proposed changes were in the best interest of patient safety.

Professor Norman Williams, President of the Royal College of Surgeons said: “It’s desperately sad for high performing units and their patients when they are transferred elsewhere, but in the long term this may be best for patients and that is the most important point. Simply condemning change as bad without looking at the evidence is not serving the interests of patients.”

The Royal Brompton said: “We regret that resources have had to be diverted to this legal case, but when serious assaults are made on patient care, when internationally acclaimed clinical teams are effectively put on notice, when groundbreaking research teams who may be on the cusp of a significant breakthrough in cystic fibrosis tell us their research will not be possible under the Safe and Sustainable proposals, then drastic measures are called for. What better cause is there than the health of vulnerable children?”