Editorial: A bad decision on heart surgery

The problems at the Bristol Royal Infirmary in the 1990s provides the clearest possible evidence of the dangers of spreading expertise too thinly

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Anyone involved in the past dozen years of the fraught negotiations over the future of children’s heart surgery will be holding their heads in wonder this morning. Worse, so too will anyone who will ever have cause to use the NHS – and that means all of us.

The problems at the Bristol Royal Infirmary in the 1990s, which resulted in the death and injury of scores of babies cared for by surgical teams that lacked the necessary skills, provided the clearest possible evidence of the dangers of spreading expertise too thinly. The case for change was as clear as it was urgent. Surgeons must perform a minimum number of operations in order to maintain their skills – and there were simply not enough children with congenital heart defects to sustain so many specialist units. Some would have to close.

But which ones? It took no fewer than three separate reports to identify the three most suitable candidates, and even then opposition was so intense that the current Health Secretary finally bowed to pressure and ordered yet another review – this time from the Independent Reconfiguration Panel. Unbelievably, the panel’s conclusions, published yesterday, have derailed the plans once again – even though further delay means continuing, avoidable, risks to children.

The process must be restarted and the closures must go ahead with all possible speed. But the episode is dismaying for deeper reasons, too. The closure of services, units and, in some cases, entire hospitals is essential to concentrate expertise, raise standards and respond to demographic changes. The survival of the NHS depends upon it.

The lessons from the experience with children’s heart surgery are deeply discouraging, however. If rationalisation is too difficult even for a single specialty where the case for change was overwhelming and agreed on all sides, it is difficult to see how it will ever be possible on a wider scale. If ever there was a need for some strong leadership, it is now.

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