Uncertainty over children's heart surgery

Every review into children's heart surgery has recommended fewer, bigger units

I still remember the 29 tiny black coffins - each with a white cross - laid out in front of the General Medical Council. That was 1998 and the start of the disciplinary hearing into failures of two surgeons at Bristol Royal Infirmary.

The Bristol heart scandal led to a wide-ranging inquiry which concluded in 2001 that dozens of babies had died needlessly. It recommended that children's heart surgery should be carried out in fewer specialist centres.

At least two further reviews - one by the Royal College of Surgeons in 2007 - backed that key proposal. The following year the "Safe and Sustainable" review was set up.

This was seen as a template for reconfiguring NHS services. Rather than ministers facing the unpopular task of shutting down units, the process of reorganisation would be left to an independent specialist group.

Five years on and more than £6m later and the review - the biggest of its kind in the NHS - has been suspended.

So what went wrong? The Independent Review Panel appointed by the Health Secretary to reassess the whole process concluded that the proposals to stop surgery at three hospitals in England - were flawed, leaving too many questions about sustainability unanswered.

In particular, the IRP review found that there was a lack of coordination with a review of adult heart services. The "single issue mission" of reducing the number of surgical centres has "ignored the impact on other specialist services."

This included the specialist respiratory service at the Royal Brompton. Ending children's heart surgery would have meant the closure of its paediatric intensive care unit.

The Royal Brompton is Europe's leading clinical and research centre for Cystic Fibrosis, and some complex cases where children may require access to intensive care would have had to be transferred elsewhere. Such knock-on effects were not fully assessed.

More travel

The need to travel further for surgery was a major concern among families in Yorkshire - whose surgical unit at Leeds was recommended to shut.

The IRP said the proposal put forward by Safe and Sustainable underestimated the number of times that families would have to travel to centres like Newcastle.

It said there would be a "disproportionate" impact on families in Yorkshire and the Humber in terms of increased travel times.

So what does this mean for the future? One thing has been made crystal clear by the IRP. It's review is "not a mandate for the status quo or going back over all the ground in the last five years. There is a case for change that commands wide understanding and support."

NHS England has until next month to decide what to do next. The IRP says that the review of children's services must be joined up with the review of adult cardiac care - something that the Safe and Sustainable review failed to do adequately.

So this is not the end of the matter. Given that all parties agree that fewer specialist centres will improve standards, then a new battle may commence in due course over the next plan to streamline services.

But the Health Secretary has made it clear that no change was no option.

He told the Commons: "There is overwhelming consensus that we cannot stick with the model of care we have now.

"To do so would be a betrayal of the families who lost loved ones in Bristol who want nothing more than the NHS to learn the lessons from their personal tragedies."