Children's Heart Surgery
This has been an emotive issue across Yorkshire and the Humber for several years, generating considerable public interest and much activity for Councillors and Members of Parliament.
In the UK, about 1 in 145 babies is born with some form of congenital heart disease. That is over 4,600 new cases each year, most of whom will require surgery. Nowadays most affected children can be successfully treated and they grow up to lead a normal adult life. Sadly, for a small minority with the most severe conditions the death rate is still around 20%.
Practice makes perfect. In all branches of medicine and surgery, provision for the most difficult cases is now being concentrated into fewer, larger hospitals, where the doctors see enough patients to perfect their techniques. For the simpler, more common conditions size is less important, and most units get close to 100% success.
Very big units have their own problems. It takes a long time for many patients to get there, and the children are at risk when in transit. A few may die on the way to specialist treatment. Big units are also very disruptive for families, who need to find affordable accommodation, maybe for several weeks or even months while their child is being treated. Large units can become inconvenient and bureaucratic, making it difficult for people to visit and support the child.
The ideal size of unit for treating congenital heart disease is now reckoned to be four surgeons jointly treating 400-500 cases per year. Treatment is probably safe with half this number, but with fewer surgeons on the rota it is more difficult to cover holidays and study leave, satisfy the European Working Time Directive and offer full 24x7 emergency care.
None of this presents a problem for Leeds, whose catchment includes the whole of Yorkshire and North Lincolnshire, about 5.5 million people in total. We have good access by road and rail. In fact, most of the big UK conurbations could easily support a children's hospital offering children's congenital cardiac surgery.
What is more, at Leeds, and at several of the top children's hospitals, children's services are co-located with maternity services, so if a mother is known to be carrying a baby with a congential heart problem, she can still have a normal delivery. Both mother and baby will receive expert care.
Nowadays, ante-natal ultrasound scans mean that many congenital problems are recognised long before the baby is born. But even if the heart problem is a surprise, expert help is available in Leeds, just down the hospital corridor. Leeds has well developed clinical networks and specialist ambulance teams, so that wherever families live in Yorkshire and the Humber they can get quick and easy access to the specialist treatment they require.
If the Leeds unit is working well, how come that NHS bosses want to close it?
The problem has never been in Leeds. The problem comes from some of the smaller towns and cities in more remote parts of the UK. There simply aren't enough patients in these thinly-populated areas to justify a children's heart unit in every town. As a result, some of the smaller cities are jockeying for position, and many of the problems stem from this.
In Scotland there aren't enough Scottish babies to merit a full size unit, so their unit at Yorkhill Hospital in Glasgow is slightly smaller than optimum, but it still works OK, and the Scots are happy with it. There is no way that the devolved Scottish government will ship its poorly kids off to England for heart surgery, and we can quite understand how they feel about this.
Unfortunately, in England we sometimes lack such common sense. There are three big problem areas where the train has come off the tracks:
Royal Brompton: This famous London hospital has specialised in heart surgery, and currently treats both adults and children with good success. Unfortunately, there are just too many excellent hospitals in London, compared with the rest of the UK. Great Ormond Street Children's Hospital (GOSH) and the Evelina Children's Hospital may have a stronger claim. There aren't enough patients to go round, particularly if Southampton heart unit stays open and collects patients along the south coast. London hopitals are very expensive to keep running half-empty, and some units will have to close.
Leicester: This hospital developed the technique of extra-corporeal membrane oxygenation (ECMO) which can be life-saving for a minority of babies with lung and heart problems. Unfortunately, after working hard to develop the technique, many other hospitals are adopting ECMO because it works really well. Birmingham has a much bigger children's hospital which is fairly close at hand. If the target is 400 operations per year, it is difficult to justify keeping every unit open, when there are not enough patients to fill them all. People in Leicester are fed-up about this, but it is difficult to see what else can be done.
Newcastle: The Freeman Hospital has been a heart and lung transplant centre for over twenty years. It is a standalone cardiac unit treating adults and children. There are relatively few transplants each year, so the transplant service is only viable if the hospital also provides general cardiac surgery as well. Unfortunately the Newcastle area has a relatively small population, so there aren't enough local patients to keep Newcastle children's cardiac surgery unit busy at the desired level of 400 operations per year. This is the reason that NHS bureaucrats want to close the successful Leeds cardiac unit, and force Yorkshire patients to travel up to Newcastle to solve the problems there.
This "solution" is so daft that we marvel who could think of it. It is a long way from Leeds to Newcastle, and quite often the route is closed by flooding and adverse weather. Newcastle is a small hospital, Leeds is a big one, so hundreds of Yorkshire patients and their families would be forced to travel long distances and suffer major expense and inconvenience to solve a problem affecting a handful of transplant patients, who could in fact be treated elsewhere.
The children's service available at Newcastle is much worse than Leeds. Newcastle doesn't have a dedicated children's hospital like we have in Leeds: the maternity unit and the heart hospital are several miles apart. In Leeds, a mother expecting a baby with a heart problem can have a normal delivery with the neonatal / paediatric team standing by to treat the baby as soon as it is born. Both mother and baby receive expert care because the two units are next to each other. In Newcastle the mother would be forced to have a caesarian section in the "wrong" hospital, where it is more difficult to provide a high standard of maternal care.
Last updated 24 June 2013 at 00:07. Back to the top
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