A nationwide plan to concentrate children's heart surgery in fewer hospitals for safety reasons was temporarily derailed yesterday after a London hospital won a High Court action to prevent the closure of its paediatric cardiac surgery unit.
NHS officials pledged yesterday that the plan would go ahead, despite the victory of the Royal Brompton Hospital in Chelsea, west London, which had described the proposed closure of its unit as "an act of bureaucratic vandalism". They warned that the bitterly fought case highlighted the difficulty of closing NHS services to ensure the remainder provided the highest standard 21st century care.
There are 31 surgeons across 11 paediatric heart surgery units in England and experts agree that children will be safer if the surgery is concentrated in fewer, larger units. A review was launched in 2008 following the scandal at Bristol Royal Infirmary in the 1990s in which children died because of substandard care.
However the plans put forward by the Safe and Sustainable NHS review, run by a joint committee representing NHS primary care trusts (JCPCT), outraged the Royal Brompton, which was the only one of the three units in London earmarked for closure. The review said its unit should be merged into those at Great Ormond Street and Guy's and St Thomas's.
The hospital sued the JCPCT, the first time one NHS body has taken action against another, claiming the decision was "irrational" and the result of a "classic backroom stitch-up". The judge rejected those claims but upheld one point that the consultation had been unfair to the Trust because of a "flawed" assessment of its research and innovation.
Sir Neil McKay, chair of the JCPCT said it would appeal the "disappointing" decision but gave an "absolute reassurance" that, whatever the outcome, the committee would make a final decision on which units would close in the spring. In a sign of how the court battle has strained relations, which will make future working relationships difficult, Sir Neil accused Bob Bell, chief executive of the Royal Brompton, of making "serious allegations of impropriety" against members of the review and called on him to apologise.
Mr Bell said the struggle had been "unpleasant and deeply stressful", adding: "We could not sit back and watch as flawed plans to dismantle our specialist children's services were drawn up by bureaucrats."
Leslie Hamilton, a member of the steering group for the review and a former president of the Society of Cardiothoracic Surgeons, said local tensions had emerged across the country over threatened units which would take "time to heal". But the national recommendations were backed by patients and professionals. "This time we are going to see it through," he said.
Mr Hamilton said the bruising experience raised urgent questions about the reconfiguration of NHS services. "I have been staggered by the number of hurdles we have had to cross. Everyone agrees services must close but no one wants it to be them. We have to come up with a more streamlined process."