Child heart unit decision likely to go against best practice

TODAY, in London, a committee meets to decide which children’s heart surgery units in England close. The likely decision for Leeds is the bigger whole of Yorkshire and Humber unit will close so the two smaller adjacent units, in Leicester and Newcastle, can thereby increase their workload, and only then meet the minimum required case volume to stay open.

The reason that will be given is that these two adjacent units do super-specialty work and, though the number of cases is small, it would pose too big a problem in terms of service delivery to close those units. However this goes against good health planning which is based on population size and density, future growth and giving patients a better service model.

In any health service reconfiguration, the patients should rule and the least number should be inconvenienced.

This means that smaller units should close and any super-specialty work transferred to the bigger unit in a particular geographic area.

This is possible as central authorities themselves say that service delivery is all about the health workers and not the bricks and mortar. In other words, move the doctors to the patients and not the patients to the doctors.

A recent patient travel survey confirms the principles of health planning. Yorkshire and Humber patients said they would not travel to Newcastle if Leeds closed but to a more convenient centre.

Patient choice is, of course, enshrined in the NHS constitution. Therefore Newcastle will never reach the minimum case volume necessary to stay open. Yorkshire contains one of the four big city centre conurbations in England, demonstrating its large population density. It has been a high growth area over the last decade and this is set to continue over the next 20 years, important in planning terms.

This means that Leeds can meet the case numbers in the near future independently. As well, fully a quarter of its surgical workload is on patients from ethnic minority groups.

Customer service models should also be important in health planning.

As an example, the unit in Leeds formerly was in an isolated, stand-alone situation.

In 1997, it was moved to the teaching hospital so that all the associated medical services that these patients sometimes need were immediately available under one roof. This will be of increasing importance in the future as ever smaller and increasingly complex patients are treated.

Indeed a mother with a high risk pregnancy can now deliver and have all services immediately available under the same roof, the ideal customer/patient service delivery model.

If the Leeds unit closes, the patients will be treated in stand-alone units again as in the past, not a good health planning model.

If good health planning principles trump health politics, Yorkshire, Humber and North Lincolnshire will keep its only children’s heart surgery unit.

The region is too big not to have one.