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Judge rules that decision to close three children’s heart units was unfair

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1575 (Published 08 March 2013) Cite this as: BMJ 2013;346:f1575
  1. Clare Dyer
  1. 1BMJ

Campaigners fighting the decision to close the children’s heart surgery unit in Leeds as part of an exercise to concentrate operations in fewer but larger centres have scored a comprehensive victory at the High Court in London.

Mrs Justice Nicola Davies ruled that the “Safe and Sustainable” consultation that recommended closing three units was flawed by procedural unfairness and a failure to take into account material considerations.

The success for the campaigning group, Save our Surgery Limited, on both grounds of its challenge is a significant setback for the plans to concentrate surgery at only seven sites: Bristol, Birmingham, Southampton, Liverpool, Newcastle, and two in London. Units in Leeds and Leicester and at London’s Royal Brompton Hospital in London would be axed under the consultation recommendations.1

The judge ruled that the consultation process was unlawful in the first instance because the Joint Committee of Primary Care Trusts, which took the decision, had refused to disclose the sub-scores that an expert committee had given in a scoring exercise. Units were given only the overall scores.

“I am satisfied that fairness did require disclosure of the sub-scores to enable Leeds to provide a properly focused and meaningful response,” said the judge, who described the committee’s refusal to hand over the sub-scores as “ill judged.”

In addition, the joint committee also failed to take into account the sub-scores when carrying out the consultation, although the overall scores were acknowledged to be close, she said. The sub-scores provided the basis for what was ultimately the difference of one point in the critical quality scoring between Leeds and Newcastle.

“In my view, and commensurate with their duty to properly scrutinise and assess all relevant evidence, the JCPCT [the joint committee] should have considered the sub-scores,” she said.

At a further hearing on 27 March to decide what remedy should be granted, the Leeds campaigners are expected to argue that the decision on 4 July 2012 to concentrate children’s heart surgery at the seven sites should be quashed. The joint committee is expected to seek an appeal.

The Royal Brompton initially succeeded in a High Court challenge to the plans but lost on appeal.2

If the decision is quashed, the Leeds campaigners would argue that surgery should continue at Leeds and Newcastle, the judge said.

Last October the health secretary, Jeremy Hunt, referred the decision to close the three units to the independent reconfiguration panel, which advises on contested changes to health services in England. The panel was expected to deliver its decision by the end of March.3

The units earmarked for closure have argued in submissions to the panel that the consultation, which began in 2008, has been working with outdated figures and that current and projected demand provides a case for retaining all the units.

Neil McKay, chairman of the joint committee, said that patients had already waited too long for the changes. “I am very disappointed with the court’s decision. The pressing need to reform children’s heart services is long overdue, and experts have cautioned that further delay in achieving the necessary change would be a major setback in improving outcomes for children with heart disease.”

Sharon Cheng of Save our Surgery said, “This judgment is a victory for the people who fought to keep children’s heart surgery services in Yorkshire and to challenge what they knew to be a flawed and unjust process.”


Cite this as: BMJ 2013;346:f1575