Children's heart surgery review shatters confidence in NHS reconfiguration: Jeremy Hunt, the health secretary, hears of a failure to recommend a safe, sustainable and accessible way forward.
The Independent Reconfiguration Panel's demolition of proposals for reconfiguring children's heart services has set the benchmark for all future service reviews.
The panel told the health secretary, Jeremy Hunt, that the review of children's heart services had failed in its objective of recommending a safe, sustainable and accessible way forward.
While it had no criticism of the underlying aim to concentrate services in fewer centres, it accused the review team of a flawed analysis of incomplete proposals that left many questions unanswered.
These included issues at the centre of the debate, such as the minimum number of operations that should be carried out by surgeons and teams, and even what services would be where. It damned the review for "a paucity of basic information" about the clinical needs of patients. The panel didn't even have confidence in the financial viability of what had been proposed.
The review's remit was flawed the panel concluded and the proposal for children's services was undermined by a lack of co-ordination with a parallel review of adult services for congenital heart disease. It is often the same clinical staff providing the service and patients move between the two as they get older.
One of the panel's most striking statements was that "people told us that being listened to was something they valued". It is clear that parents who object to the proposals are far more than knee-jerk "save our hospital" banner wavers. On the contrary, they have read widely and developed a deep understanding of the issues and evidence.
Forcing such well-informed and passionate campaigners to resort to freedom of information requests to get hold of data and meeting minutes was arrogant and foolish. So was issuing press statements accusing them of "putting lives at risk".
The reputational damage to the NHS by this reverse is considerable. To still be struggling with the process – never mind the outcome – 12 years after the Kennedy report into deaths at Bristol Royal Infirmary and five years after the Safe and Sustainable review was established to examine the provision of paediatric cardiac services in England makes the service look ineffectual. The risk is that it will undermine public and political confidence in future reviews and encourage anti-closure campaigners to launch legal challenges.
One notable feature of the collapse of the Safe and Sustainable review is the crucial role played by councils in its downfall. The review team allowed a climate of distrust to develop and it was evidently obstructive towards councils in Yorkshire and the Humber who were trying to get more information.
As NHS England begins to restore confidence in the reconfiguration process, it needs to spend a lot of time talking with local government and MPs to ensure future consultations have political support in the way they are conducted.
Although the panel's review again puts back a final decision on children's heart surgery, more positively it sets out a robust, clear and comprehensive approach to future reconfiguration consultations on which NHS England can build.
There needs to be a clear understanding of patients' needs and how they use services. The interrelationships between different services needs to be considered. The evidence underpinning the criteria to be used must be clear. Reviews must be far more open in the way they conduct their affairs – really listening to people and considering their opinions and evidence, not just "communicating" with them.
The whole of the care pathway needs to be given proper consideration, rather than just prominent aspects such as surgery. Important issues for patients such as geography and transport cannot be ignored. And the team conducting the review need to be seen to be impartial in membership and open-minded about how they will achieve their objective.
If future consultations follows this guidance closely, recommendations will be far more likely to withstand judicial scrutiny, and ministers will find it more difficult to avoid taking the tough but necessary decisions required to secure a safe and sustainable NHS. Guardian Professional.
The Independent Reconfiguration Panel's demolition of proposals for reconfiguring children's heart services has set the benchmark for all future service reviews.
The panel told the health secretary, Jeremy Hunt, that the review of children's heart services had failed in its objective of recommending a safe, sustainable and accessible way forward.
While it had no criticism of the underlying aim to concentrate services in fewer centres, it accused the review team of a flawed analysis of incomplete proposals that left many questions unanswered.
These included issues at the centre of the debate, such as the minimum number of operations that should be carried out by surgeons and teams, and even what services would be where. It damned the review for "a paucity of basic information" about the clinical needs of patients. The panel didn't even have confidence in the financial viability of what had been proposed.
The review's remit was flawed the panel concluded and the proposal for children's services was undermined by a lack of co-ordination with a parallel review of adult services for congenital heart disease. It is often the same clinical staff providing the service and patients move between the two as they get older.
One of the panel's most striking statements was that "people told us that being listened to was something they valued". It is clear that parents who object to the proposals are far more than knee-jerk "save our hospital" banner wavers. On the contrary, they have read widely and developed a deep understanding of the issues and evidence.
Forcing such well-informed and passionate campaigners to resort to freedom of information requests to get hold of data and meeting minutes was arrogant and foolish. So was issuing press statements accusing them of "putting lives at risk".
The reputational damage to the NHS by this reverse is considerable. To still be struggling with the process – never mind the outcome – 12 years after the Kennedy report into deaths at Bristol Royal Infirmary and five years after the Safe and Sustainable review was established to examine the provision of paediatric cardiac services in England makes the service look ineffectual. The risk is that it will undermine public and political confidence in future reviews and encourage anti-closure campaigners to launch legal challenges.
One notable feature of the collapse of the Safe and Sustainable review is the crucial role played by councils in its downfall. The review team allowed a climate of distrust to develop and it was evidently obstructive towards councils in Yorkshire and the Humber who were trying to get more information.
As NHS England begins to restore confidence in the reconfiguration process, it needs to spend a lot of time talking with local government and MPs to ensure future consultations have political support in the way they are conducted.
Although the panel's review again puts back a final decision on children's heart surgery, more positively it sets out a robust, clear and comprehensive approach to future reconfiguration consultations on which NHS England can build.
There needs to be a clear understanding of patients' needs and how they use services. The interrelationships between different services needs to be considered. The evidence underpinning the criteria to be used must be clear. Reviews must be far more open in the way they conduct their affairs – really listening to people and considering their opinions and evidence, not just "communicating" with them.
The whole of the care pathway needs to be given proper consideration, rather than just prominent aspects such as surgery. Important issues for patients such as geography and transport cannot be ignored. And the team conducting the review need to be seen to be impartial in membership and open-minded about how they will achieve their objective.
If future consultations follows this guidance closely, recommendations will be far more likely to withstand judicial scrutiny, and ministers will find it more difficult to avoid taking the tough but necessary decisions required to secure a safe and sustainable NHS. Guardian Professional.
No comments:
Post a Comment