Reconfiguring children’s congenital heart services in England 1 Public Health’s role in major service reconfiguration Matthew Day North of England Specialised Commissioning Group (Feb 2011-Feb 2012) School of Public Health Regional Conference 2012

Congenital Heart Defects  Defect in structure of the heart present at birth  8/1000 prevalence  Surgery rare  Approx 3’600 operations per year Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October

Background  2001 : The Bristol Royal Infirmary Inquiry Report (the Kennedy Report) recommended the need for Children to have heart surgery performed in fewer specialist centres.  March 2011 the NHS led review ‘Safe and Sustainable’ consultation document proposing options for the future delivery  Proposal to reduce the number of centres which currently performed these complex operations from ten centres, to six or seven. 3

3600 Operations  >30 surgeons specialising in England  10 centres doing surgery 4

Magic numbers 5

6 Option A Seven surgical centres at: Freeman Hospital, Newcastle Alder Hey Children’s Hospital, Liverpool Glenfield Hospital, Leicester Birmingham Children's Hospital Bristol Royal Hospital for Children 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

7 Option B Seven surgical centres at: Freeman Hospital, Newcastle Alder Hey Children’s Hospital, Liverpool Birmingham Children's Hospital Bristol Royal Hospital for Children Southampton General Hospital 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

8 Option C Six surgical centres at: Freeman Hospital, Newcastle Alder Hey Children’s Hospital, Liverpool Birmingham Children's Hospital Bristol Royal Hospital for Children 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

9 Option D Six surgical centres at: Leeds General Infirmary Alder Hey Children’s Hospital, Liverpool Birmingham Children's Hospital Bristol Royal Hospital for Children 2 centres in London Slides on the Safe and Sustainable Review of Children’s Congenital Heart Services in England, March 2011

The politics! 10

Public Health Role! 11

Public Health Role: The Science  Regional Health Impact Assessment (HIA) of the proposed consultation options  Regional ‘information group’ established

Health Impact Assesment  Epidemiology  Patient flows  Network configuration  Travel and access  Patient experience  Fetal cardiology  Financial  Staffing Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October

Epidemiology: Surgical procedure rates 14 Table 1 Shows surgical procedures performed at LTHT by age-group and PCT 2009/10. Knowledge of available data + Building ‘Trust’ trust + Really basic number crunching

Epidemiology / Network configuration: Multiple health needs Knowledge of available data + clinical network advice + analytical support + Complexity to ‘essentials’ 15 75% patients with multiple health needs > 25% Respiratory related

Travel and access / patient experience Patient flows 16 Understanding evidence / pathways + clinical network advice + narrative

Patient / Family Experience 17 Source: Interim Health Impact Assessment Draft Appendices - Bradford Event Feedback. Available at: “Some {surgical} centres may not provide services that are culturally specific to the current community.... If communities aren’t able to access culturally sensitive services the quality of care may suffer”

Y&H HIA ‘science’ Influence  Regional Commissioner and Provider CXs  Presenting and representing NHS at Regional Joint OSC  Providers  National Safe and Sustainable Team  Joint Committee of PCTs (decision making body)  Circulated nationally as exemplar  Advised PWC / MM for National HIA / Patient Flow work 18

Public Health (dark) ‘Arts’  Relationships  Communication Written – complexity to essentials Non-verbal  Conflict 19

Lessons for Public Health role in major service reconfigurations  Professional leadership  Technically astute  Complexities to essentials  PH ‘Communicators’  PH as ‘Honest brokers’ 20

Safe and sustainable Timeline  Largest Ever NHS Consultation - >75,000 responses  Y&H petition > 600,000 signatures  Royal Bromptom Vs JCPCT (Sept 2011). Consultation unlawful  JCPCT Appeal - verdict overturned. Consultation lawful. 21

The decision “The 4 th of July will be a milestone for the future of children’s congenital heart services” Sir Neil McKay, Chair JCPCT  More options now on the table….. 22