Analysis: The debate over closing child heart surgery units

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27 September 2011 Last updated at 11:17 GMT By Jane Hughes Health correspondent, BBC News Nicolas Tompkins had surgery at 2.5 weeks Nicolas Tompkins' parents believe he wouldn't be with them if it wasn't for the doctors and nurses at the Royal Brompton Hospital in central London.

At just four weeks old, he's recovering from a 15-hour operation to correct a complicated and rare defect in his heart.

Surgeons effectively had to re-wire it, after discovering that his lungs weren't properly connected, and he wasn't getting enough oxygen.

He was lucky to be treated by a world expert in his condition.

His parents are incredulous at the thought that the team which saved his life could be about to be broken up.

"Everybody we meet here, every doctor, every nurse, is clearly at the top of their game," said his father, Andrew Tompkins. "There's nowhere like this in the world. How could they want to close it?"

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If we get centres of excellence, we can save money and still get better care”

End Quote Mike Farrar NHS Confederation Chief Executive The reason is that children's heart surgery across England is being reorganised. And, as one of three hospitals in London carrying out this kind of specialised paediatric treatment, the Royal Brompton was told it would have to scale down its children's heart unit and stop doing all operations.

Other units in Leeds, Southampton, Newcastle and Leicester are still waiting for a decision as to whether they will also stop doing operations. Ultimately, at least four will close across England.

The review does not affect patients in Scotland, who are all treated in Glasgow. Welsh patients are treated in England, while patients in Northern Ireland travel to Dublin for treatment.

Bristol scandal

The review of children's heart surgery came about as a result of the inquiry into the Bristol heart babies scandal in the 1990s, when a number of babies died needlessly during operations by surgeons with insufficient experience. It concluded that children would get better, safer care if there were fewer, larger, more specialised units.

"We know the best results can only be achieved by surgeons and units treating a lot of patients," said Professor Norman Williams, President of the Royal College of Surgeons. "And we also know that patients benefit from units with enough surgeons to give a round-the-clock service."

Yet, as the Royal Brompton's experience shows, reorganising services is not straightforward.

Without cardiac patients, it says its paediatric intensive care unit would no longer be viable. And without intensive care, it would no longer be able to offer its specialist children's lung services - treating children with cystic fibrosis and other conditions. It says its respiratory unit is second to none in the country, and many, many patients will lose out.

And so one part of the NHS is going head-to-head against another in the High Court. Watching around the country are not just the other units under threat, but NHS hospital trusts which know they must reorganise other hospital services to remain viable and provide the best possible patient care.

Tough challenge

The NHS Confederation has said the reconfiguration process will become increasingly necessary; not just because of a tougher financial climate, but also to improve care.

"At the moment, we're not getting the best outcomes we can because some services are distributed across too many sites," said NHS Confederation Chief Executive, Mike Farrar. "If we get centres of excellence, we can save money and still get better care."

Reorganising services is one of the hardest things the health service has to do, said Chris Ham, head of the health thinktank, the Kings Fund.

"But it is absolutely necessary at the present time," he said. "Not first and foremost because of the financial pressures but because we will only deliver world class standards of care if we grasp this nettle and take decisions that are long overdue by concentrating some of those services in fewer hospitals."

The fight over the future of the Royal Brompton may well be one of many more to come.

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Why closing hospitals is good for your health

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12 September 2011 Last updated at 12:56 GMT By Nick Triggle Health correspondent, BBC News Stroke services have been revamped in London Decisions about closing - or moving - hospital services are always controversial. But there is mounting evidence that such changes can actually improve care and save lives.

Every hour someone in London has a stroke - but in many ways they are the lucky ones.

It is now widely acknowledged that the city is probably the best place in the world to have one.

And it is all because some services were shut down.

The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".

It has meant patients get fast, 24-hour access to the best care and is expected to save 400 lives a year.

If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.

This allows medics to ensure the patients receive the right treatment in time.

For example, 15% of stroke patients need clot-busting drugs to restore blood flow to the brain within hours of the stroke. In London, virtually all of them get it.

Continue reading the main story

The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be”

End Quote Mike Farrar NHS Confederation Indeed, six of the eight units have been given the highest grade possible by inspectors. Across the rest of the country just one in 13 units have been given that rating.

Tom Greenwood, head of London operations for the Stroke Association, says: "I think there is evidence to suggest that the system in London is world-leading.

"Patients tell us they are amazed by how seamless and integrated it is - it really has made services better."

Risk for patients

But it is not just stroke care that can benefit from such a redesign.

The King's Fund has argued a whole host of specialities would benefit from being delivered from fewer sites.

In a report published earlier this year, the think-tank highlighted A&E, maternity, neonatal and heart services in particular.

Researchers said without such measures, patients could be put at risk.

The argument has been put forward by other bodies too.

A wave of new hospital developments have happened in the past decade

The Royal College of Surgeons has said emergency departments should not be providing services to population of less than 300,000 to ensure expertise is not spread too thinly.

At the moment the north east has an emergency department for every 150,000 people. The north west and London fair little better.

Similar arguments have been put forward for maternity care by the Royal College of Obstetricians and Gynaecologists and child heart surgery during an official NHS review by local health bosses.

But these steps come at a price - the closure of individual hospital departments or, sometimes, entire centres.

'Attachments'

For example, the review of child heart surgery said between four and five units needed to stop doing surgery to ensure doctors carried out enough operations to keep their skills up.

This suggestion has ignited local campaigns to save the threatened units, with one even winning the right to challenge the proposals through the courts.

It is this sort of backlash which makes overhauling hospitals such a difficult step.

Despite the strong case that can be often put forward, the public feel attached to their local hospital.

And, as a result, politicians have shied away from publicly backing the case for change - even though centralisation of services often saves money by making the health service more efficient.

Hospitals have been the visible face of the NHS ever since it was created. This was cemented in the 1960s which saw the network of district general hospitals expanded to every corner of the country.

And it has been further reinforced by the use of PFI since the 1990s which has used private money to build or refurbish over 100 hospitals.

But Mike Farrar, chief executive of the NHS Confederation which represents health managers, says this attachment to hospitals can often get in the way.

He had experience of two major reconfigurations when he was head of the North West Regional Health Authority - one involving the closure of an A&E unit and the other the overhaul of maternity care in the Greater Manchester.

"The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be.

"It means we spend years going though the arguments for change and sometimes can't do the very thing that will benefit patients."

View the original article here

Peliculas Online

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Why closing hospitals is good for your health

AppId is over the quota
AppId is over the quota
12 September 2011 Last updated at 12:56 GMT By Nick Triggle Health correspondent, BBC News Stroke services have been revamped in London Decisions about closing - or moving - hospital services are always controversial. But there is mounting evidence that such changes can actually improve care and save lives.

Every hour someone in London has a stroke - but in many ways they are the lucky ones.

It is now widely acknowledged that the city is probably the best place in the world to have one.

And it is all because some services were shut down.

The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".

It has meant patients get fast, 24-hour access to the best care and is expected to save 400 lives a year.

If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.

This allows medics to ensure the patients receive the right treatment in time.

For example, 15% of stroke patients need clot-busting drugs to restore blood flow to the brain within hours of the stroke. In London, virtually all of them get it.

Continue reading the main story

The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be”

End Quote Mike Farrar NHS Confederation Indeed, six of the eight units have been given the highest grade possible by inspectors. Across the rest of the country just one in 13 units have been given that rating.

Tom Greenwood, head of London operations for the Stroke Association, says: "I think there is evidence to suggest that the system in London is world-leading.

"Patients tell us they are amazed by how seamless and integrated it is - it really has made services better."

Risk for patients

But it is not just stroke care that can benefit from such a redesign.

The King's Fund has argued a whole host of specialities would benefit from being delivered from fewer sites.

In a report published earlier this year, the think-tank highlighted A&E, maternity, neonatal and heart services in particular.

Researchers said without such measures, patients could be put at risk.

The argument has been put forward by other bodies too.

A wave of new hospital developments have happened in the past decade

The Royal College of Surgeons has said emergency departments should not be providing services to population of less than 300,000 to ensure expertise is not spread too thinly.

At the moment the north east has an emergency department for every 150,000 people. The north west and London fair little better.

Similar arguments have been put forward for maternity care by the Royal College of Obstetricians and Gynaecologists and child heart surgery during an official NHS review by local health bosses.

But these steps come at a price - the closure of individual hospital departments or, sometimes, entire centres.

'Attachments'

For example, the review of child heart surgery said between four and five units needed to stop doing surgery to ensure doctors carried out enough operations to keep their skills up.

This suggestion has ignited local campaigns to save the threatened units, with one even winning the right to challenge the proposals through the courts.

It is this sort of backlash which makes overhauling hospitals such a difficult step.

Despite the strong case that can be often put forward, the public feel attached to their local hospital.

And, as a result, politicians have shied away from publicly backing the case for change - even though centralisation of services often saves money by making the health service more efficient.

Hospitals have been the visible face of the NHS ever since it was created. This was cemented in the 1960s which saw the network of district general hospitals expanded to every corner of the country.

And it has been further reinforced by the use of PFI since the 1990s which has used private money to build or refurbish over 100 hospitals.

But Mike Farrar, chief executive of the NHS Confederation which represents health managers, says this attachment to hospitals can often get in the way.

He had experience of two major reconfigurations when he was head of the North West Regional Health Authority - one involving the closure of an A&E unit and the other the overhaul of maternity care in the Greater Manchester.

"The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be.

"It means we spend years going though the arguments for change and sometimes can't do the very thing that will benefit patients."

View the original article here

Peliculas Online

Read More