Leeds heart unit battle: Judge tells NHS to think again

The judge acted today after ruling earlier this month that the process was legally flawed in relation to the decision to close the children’s heart unit at Leeds General Infirmary.

Mrs Justice Nicola Davies, sitting at London’s High Court, said aspects of the Leeds consultations, including a failure to make relevant information available to consultees, was “ill judged”.

But she stressed today she was only quashing “one part” of the decision by health chiefs so that there could be “re-consultation and reconsideration” over the Leeds closure.

The judge emphasised that she was not ordering that the whole consultation process had to return to the start.

Her decision was a qualified victory for campaigners from the Save Our Surgery campaign which has been battling to keep the Leeds unit open.

Youngsters from large parts of the region face a journey of up to three hours for life-saving heart surgery in Newcastle if the unit in Leeds closes.

The group challenged last July’s decision of the Joint Committee of Primary Care Trusts (JCPCT) to select seven specialist centres for the future delivery of paediatric cardiac surgery in England.

Leeds is one of three units facing closure in the Safe and Sustainable NHS review, which was triggered by the Bristol heart scandal in the 1990s in which 35 babies died and dozens more were left brain-damaged.

The aim of the review is to provide fewer but more efficient units round the country.

After today’s ruling SOS spokeswoman Sharon Cheng said: “We are thrilled that the unfair and flawed decision to stop surgery in Yorkshire & the Humber has been quashed.

“Today’s judgment vindicates our decison to pursue this case throught the courts.

“We brought this case on behalf of the families and patients of our region, whose genuine concerns about the review had been ignored by the NHS.

“The first line of the NHS constitution states ‘The NHS belongs to the people’ and we now call on the decison makers to reflect that by engaging with us to ensure the final outcome is the correct one for children across the country.”

The judge ruled that both the Leeds consultations and the subsequent decision-making process were flawed.

She described how the Kennedy Panel, a group of experts set up to advise the JCPCT, had produced “sub-scores” measuring the quality of service at each centre according to various criteria.

But the JCPCT chose only to look at the panel’s total scores, and did not take into account the sub-scores. It also did not disclose them to consultees until the consultation process was over.

In her judgment, the judge said “fairness required” disclosure of the sub-scores to enable Leeds to provide “a properly focused and meaningful response”.

The refusal by the JCPCT of a specific request for disclosure was “ill-judged”.

The judge also ruled that the sub-scores were “a material consideration” that the JCPCT itself should have taken into account, but failed to do so.

The judge ruled the JCPCT decision to reconfigure heart surgery services based on the option of closing the Leeds unit must be quashed and reconsidered because it was based on “a fundamental unfairness”.

She said the issue of closures was also being referred in a separate review process to another review body, the Independent Reconfiguration Panel (IRP), and a decision would subsequently be made by the Health Secretary.

But that should not deprive SOS of a quashing order in today’s case.

All parties recognised the “pressing need” for a change to the provision of heart surgery services in England and the need to limit any further delays, said the judge.

But, in reaching any further decision on unit closures, there would have to be “a process of reconsultation and reconsideration”.

Factors to be taken into consideration should include the sub-scores which were not taken into account by the JCPCT last July, as well as other changes that might have occurred since last July.

Sir Neil McKay, chairman of the JCPCT, said later: “Following today’s ruling, we are strongly considering our grounds for appeal.

“The NHS remains as determined as ever to reconfigure children’s heart services.

“The NHS will of course study the ruling carefully and its implications.

“The judge was very clear that she was not advocating a return to the start of the review process.

“I am pleased that the Judge has upheld our decisions in relation to the quality standards and the model of care.

“We will give due consideration to the judgment and will advise people of the next steps in the process at the beginning of April.

“We will aim to reach a final decision in June 2013, pending the outcome of the separate IRP process.

“The court and all the hospitals involved recognise the need for the NHS to continue in our important mission to improve services for children with congenital heart disease and the NHS remains absolutely committed to ensuring that services are safe and sustainable in the future.

“The case for the reconfiguration of children’s heart services remains strong and there continues to be a rare consensus amongst medical royal colleges, professional associations, NHS staff and national parent groups that the NHS needs fewer larger surgical centres and new national quality standards to improve outcomes for children. Safe and Sustainable will continue.

“The expert view remains that the longer vested interests delay this process, the greater the risk of safety concerns manifesting in the units.

“I never forget that the purpose of our work is saving lives and improving quality of life for children, and on behalf of the NHS I want to reassure families, patients and clinicians that we remain as determined as ever to reconfigure services for children with congenital heart disease in the interests of better outcomes and a more safe and sustainable service for children and their families.

“The decision we took in July last year will help save children’s lives, reduce co-morbidities and ensure ongoing care is provided closer to many families’ homes.”