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Reconfiguring children ’ s congenital heart services in England

Reconfiguring children ’ s congenital heart services in England. Public Health ’ s role in major service reconfiguration. Matthew Day North of England Specialised Commissioning Group (Feb 2011-Feb 2012) School of Public Health Regional Conference 2012. Congenital Heart Defects.

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Reconfiguring children ’ s congenital heart services in England

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  1. Reconfiguring children’s congenital heart services in England Public Health’s role in major service reconfiguration Matthew Day North of England Specialised Commissioning Group (Feb 2011-Feb 2012) School of Public Health Regional Conference 2012

  2. Congenital Heart Defects • Defect in structure of the heart present at birth • 8/1000 prevalence • Surgery rare • Approx 3’600 operations per year Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010

  3. Background • 2001 : The Bristol Royal Infirmary Inquiry Report (the Kennedy Report) recommended the need for Children to have heart surgery performed in fewer specialist centres. • March 2011 the NHS led review ‘Safe and Sustainable’ consultation document proposing options for the future delivery • Proposal to reduce the number of centres which currently performed these complex operations from ten centres, to six or seven.

  4. 3600 Operations • >30 surgeons specialising in England • 10 centres doing surgery

  5. Magic numbers

  6. Option A • Option A • Seven surgical centres at: • Freeman Hospital, Newcastle • Alder Hey Children’s Hospital, Liverpool • Glenfield Hospital, Leicester • Birmingham Children's Hospital • Bristol Royal Hospital for Children • 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

  7. Option B • Option B • Seven surgical centres at: • Freeman Hospital, Newcastle • Alder Hey Children’s Hospital, • Liverpool • Birmingham Children's Hospital • Bristol Royal Hospital for Children • Southampton General Hospital • 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

  8. Option C • Option C • Six surgical centres at: • Freeman Hospital, Newcastle • Alder Hey Children’s Hospital, Liverpool • Birmingham Children's Hospital • Bristol Royal Hospital for Children • 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

  9. Option D • Option D • Six surgical centres at: • Leeds General Infirmary • Alder Hey Children’s Hospital, Liverpool • Birmingham Children's Hospital • Bristol Royal Hospital for Children • 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

  10. The politics!

  11. Public Health Role!

  12. Public Health Role: The Science • Regional Health Impact Assessment (HIA) of the proposed consultation options • Regional ‘information group’ established

  13. Health Impact Assesment • Epidemiology • Patient flows • Network configuration • Travel and access • Patient experience • Fetal cardiology • Financial • Staffing Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010

  14. Epidemiology: Surgical procedure rates Knowledge of available data + Building ‘Trust’ trust + Really basic number crunching Table 1 Shows surgical procedures performed at LTHT by age-group and PCT 2009/10.

  15. Epidemiology / Network configuration: Multiple health needs 75% patients with multiple health needs > 25% Respiratory related Knowledge of available data + clinical network advice + analytical support + Complexity to ‘essentials’

  16. Travel and access / patient experience Patient flows Understanding evidence / pathways + clinical network advice + narrative

  17. Patient / Family Experience “Some {surgical} centres may not provide services that are culturally specific to the current community.... If communities aren’t able to access culturally sensitive services the quality of care may suffer” Source: Interim Health Impact Assessment Draft Appendices - Bradford Event Feedback. Available at: http://www.specialisedservices.nhs.uk/library/30/Health_Impact_Assessment_Interim_Report_Draft_Appendices.pdf

  18. Y&H HIA ‘science’ Influence • Regional Commissioner and Provider CXs • Presenting and representing NHS at Regional Joint OSC • Providers • National Safe and Sustainable Team • Joint Committee of PCTs (decision making body) • Circulated nationally as exemplar • Advised PWC / MM for National HIA / Patient Flow work

  19. Public Health (dark) ‘Arts’ • Relationships • Communication • Written – complexity to essentials • Non-verbal • Conflict

  20. Lessons for Public Health role in major service reconfigurations • Professional leadership • Technically astute • Complexities to essentials • PH ‘Communicators’ • PH as ‘Honest brokers’

  21. Safe and sustainable Timeline • Largest Ever NHS Consultation - >75,000 responses • Y&H petition > 600,000 signatures • Royal Bromptom Vs JCPCT (Sept 2011). Consultation unlawful • JCPCT Appeal - verdict overturned. Consultation lawful.

  22. The decision “The 4th of July will be a milestone for the future of children’s congenital heart services” Sir Neil McKay, Chair JCPCT • More options now on the table…..

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