Cecilia Yardley: Ignore the scare tactics over child heart care

THE Children’s Heart Federation has been following the campaign supporting children’s heart care at Leeds with respect and admiration for the passion, commitment and organisational skills of the parents, combined with a deep concern that important issues are being ignored.

Over the last two years of the national review (Safe and Sustainable Children’s Congenital Heart Services), we have heard the following views expressed many times, most recently in Leeds. They are always along the lines of “it’s disgusting they should even think of closing any units” and “they should be ashamed to be slashing services for the sickest children to save money”.

These views, based on misinformation and gut instinct, have been played on by some doctors, nurses and managers across the country. It seems that while the majority of clinicians recognise that the direction of the review is absolutely right in theory, some are prepared to put the defence of their own workplace and jobs in front of the safety of heart children nationwide.

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All the paediatric cardiac units sent representatives to a summit in 2006 and signed up to the principles on which the current review is based, and which came from recommendations after the Bristol Baby Tragedy. They were fully aware that some units would probably have to stop doing surgery.

As part of the current review, the professional bodies for surgeons, cardiologists, nurses, intensive care specialists, as well as CHF, which represents the interests of heart families, have signed up to a rigorous set of national standards for children’s heart care. When implemented, these should raise the overall standard of surgery, increase cardiology services and reduce waiting times and cancelled operations.

With scaremongering about units “closing”, which is not part of the proposals, some clinicians and managers are diverting attention from the significant improvements this review can deliver. This is not to deny that families whose children have the most complex conditions need to be at the centre of detailed and sensitive planning to meet their ongoing needs.

When emotions are highly charged, those careful and constructive discussions cannot take place, leaving many parents feeling that no one is listening and their family’s needs are being ignored. The logic of applying the standards does not fit neatly into a soundbite and modern medical best practice can be counter-intuitive. It cuts across our instincts to hear that it is safe to transport critically ill children to surgical centres in properly equipped vehicles with highly trained staff.

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Parents say they “know” their child would have died if they had been transported to Newcastle in that way. Families have knowledge no other group brings to the planning of a health service – expertise by experience about their child – and they must be major players in the design of services alongside all the other experts, including those who have detailed specialist medical knowledge about transporting very sick children.

The problem for families in Leeds, just as in Southampton, Leicester, London, Newcastle and Oxford, is that this review has to take a national perspective; it cannot focus on the needs of one area to the exclusion of all the rest.

There are hard choices in many areas. For example, if Leeds keeps surgery, heart transplantation will move from Newcastle and a very special kind of life support will move from Newcastle and Leicester. People who take the national view are not the enemy, as it can seem to those who feel embattled. Their responsibility is to look at the bigger picture for the good of children wherever they live. In many cases, the information available to parents is very partial.

At a national level, clinicians, managers and support groups, like CHF, are aware that there is a significant variation between surgical units in the quality of life experienced by children who have undergone surgery. At the moment only death rates are published but senior consultants, including some from Leeds, are aware that this is a crude measurement and are trying to find ways of accurately measuring and recording quality of life data. Where units operate beyond their competence in a procedure, children can die and suffer harm.

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The bottom line is that to drive up standards everywhere you have to concentrate surgery into fewer units with larger teams of surgeons.

Making these changes requires nerve – twice in the past 20 years, politicians have pulled back, presumably from fear of a backlash from the public. The children’s heart care system is not as safe as it could be today and is not sustainable into the future.

The Leeds petition is an amazing demonstration of public support for a highly valued hospital and for local heart families. The desire to protect goes to the crux of the current review, which has to work on a national scale to embrace all our heart children.

The children’s heart care system is a work in progress – to be properly constructed, it needs honest input from all those directly affected. CHF urges everyone with a concern in these matters to dig beneath the soundbites, respond to the consultation and, as you do so, call to mind those quietest voices.

Cecilia Yardley is communications manager of the Children’s Heart Federation.