1. 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

2. 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 2010 2

3. 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

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

5. Magic numbers 5

6. 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. 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. 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. 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

10. The politics! 10

11. Public Health Role! 11

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

13. 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 2010 13

14. 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

15. 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

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

17. Patient / Family Experience 17 Source: Interim Health Impact Assessment Draft Appendices - Bradford Event Feedback. Available at: http://www.specialisedservices.nhs.uk/library/30/Health_Impact_Assessment_Interim_Report_Draft_Appendices.pdf “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”

18. 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

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

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

21. 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

22. 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