Agenda item

The Chairman welcomed those present to the meeting. 

Ms Claire McDonald, Engagement and Communications Lead, Specialised Commissioning – NHS England (NHSE) London Region, noted that she had last attending a Committee meeting to talk about this issue in 2017.  Congenital Heart Disease (CHD) standards had been consulted upon and agreed by the NHSE Board in 2015.  It had been noted that the Royal Brompton Hospital had not met the standard for paediatric colocation on the Chelsea site as the other specialist children’s services required for hospitals providing children’s CHD were not located on site.  In order to meet the standards, the Royal Brompton Hospital had proposed a partnership with Guys and St Thomas’ Hospital which was compliant with the CHD standards.  The proposal had been to move all paediatric services from the Chelsea site (children’s heart surgery (including CHD and intensive care), children’s respiratory services for children with cystic fibrosis, primary ciliary dyskinesia and other conditions and children who required long term ventilation in hospital and at home) as a ‘joint venture’.

Three proposals had been identified by the following organisations:

1.    Royal Brompton Hospital and Kings Health Partners - move all services from the Royal Brompton Hospital Chelsea site to new buildings on the Guys and St Thomas’ Westminster site as part of a joint venture.  Mr Piers McCleery, Director of Strategy and Planning at Royal Brompton and Harefield NHS Foundation Trust (RBH), advised that this collaborative proposal would not just meet the CHD standards but would also improve things like the estate, rotas and opportunities to fulfil academic potential.  Collaboration would provide RBH, Guys and St Thomas’ and Kings College with the opportunity to improve.  It was anticipated that all proceeds from the sale of the Royal Brompton Hospital would be reinvested in this proposal which would develop a network of care for 15m people.  Mr Nick Hunt, Director of Service Development at RBH, advised that this proposal was fit for mid-21^st century, was network driven and would provide modern care, making it easier to recruit new staff.

2.    Chelsea & Westminster and Imperial College Healthcare – move cystic fibrosis services from the Royal Brompton Chelsea site to the Chelsea & Westminster Hospital, cardiac (not adults or children’s CHD) and other respiratory services to Hammersmith Hospital and CHD and ECMO to Guys and St Thomas’ Hospital.

3.    NHSE – move paediatric CHD from the Royal Brompton site to another compliant CHD provider either in total or split along with adult CHD and associated services.  This had been the original proposition in 2017. 

Mr McCleery suggested that any proposal that sought to pick off services or sub sections of services would not work as well as RBH’s proposal which embraced wider collaboration.  He noted that taking the paediatric CHD services away from RBH would render other services at the Royal Brompton Hospital unsustainable. 

Ms Hazel Fisher, Programme Director Cardiac and Paediatrics Specialised Commissioning – NHSE London Region, advised that none of the proposals would change the services provided at Harefield Hospital and that the organisation was keen to ensure that non-congenital cardiac and respiratory services stayed in London.  However, it had been suggested that the proposals would have a knock on effect on the services provided at Harefield Hospital and its sustainability would depend on the option that was eventually chosen.  Ms Fisher reassured Members that clarity and support for the future of Harefield Hospital would be a key factor in moving forward.  She stated that she would be happy to attend a future meeting to talk to Members about the proposals and how they would address the sustainability of Harefield Hospital.

Ms Fisher noted that the different propositions were being worked through and capital costs and interdependent services were being investigated.  Members were advised that no service had been deemed so material that it would be prevented from being moved. 

Ms Fisher stated that 2.4% of activity at the Royal Brompton Hospital was in relation to Hillingdon patients.  Although consideration would need to be given to the wider referral geography, it had already been established that the proposed changes would have little effect on patient travel times.  It was noted that an assessment of travel issues would need to be undertaken before formal communication started with Transport for London (TfL) and the Mayor of London.  Consideration also needed to be given to building signage, communications out of hours, and appointment bookings irrespective of which change might be commissioned. 

Members were advised that the Royal Borough of Kensington and Chelsea was looking to establish a formal Joint Health Overview and Scrutiny Committee (JHOSC) to look at this issue in more depth.  A formal Committee in Common was being formed from the commissioning CCGs which would include the North West London CCG.  It was anticipated that the consultation would start towards the end of 2019.

When this issue had first arisen in 2017, Members had expressed concern regarding the impact that proposals would have on attracting and retaining experts.  To ensure that this was not impacted further, there was a need for a definitive timeline and certainty about the future.  Concern was also expressed that the removal of paediatric CHD would take away the foundation of services provided at the Royal Brompton Hospital. 

Ms Fisher advised that the benefits of each of the proposals were currently being investigated.  Consideration would need to be given to how each of the proposals: met the CHD standards; improved the quality of service; improved net care; offered value for money; and improved recruitment and retention.  Ms Fisher was aware that recruitment and retention would be a key component of the proposal that went forward.  She noted that a resolution was unlikely to be undertaken in one step and that the proposals needed to be deliverable. 

The NHSE Board had set timescales for the changes to paediatric CHD service in November 2017.  An outline business case to reconfigure paediatric services would need to be ready by November 2019 and consultation would need to be ready to start in January 2020.  Mr McCleery advised that RBH was keen to progress its proposal as soon as possible and to start the process of integrating services.  Whilst the Trust would like to work within the NHSE timescales, there were constraints.

RESOLVED:  That the discussion be noted.