Radcliffe should stop doing children’s heart surgery, review recommendsBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5863 (Published 19 October 2010) Cite this as: BMJ 2010;341:c5863
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Dr Braithwaite is wrong to suggest that the NHS review of children's
congenital cardiac services has referenced a 'league table' of services
and he worryingly misunderstands the case for reconfiguration of services
All 11 surgical centres in England have been assessed against their
ability to meet new quality standards. The standards have been developed
and endorsed by the relevant professional associations including the Royal
College of Surgeons, the Royal College of Nursing, the Society for
Cardiothoracic Surgery in GB+I, the Royal College of Paediatrics and Child
Health, the British Congenital Cardiac Association and the Paediatric
Intensive Care Society. It is also endorsed by the Childrens Heart
The process has involved rigorous on-site assessments by an independent
expert panel chaired by Professor Sir Ian Kennedy together with an
evaluation of other relevant criteria.
There is overwhelming clinical support for the proposition that 11
children's congenital cardiac services in England is too many and that
fewer, larger surgical centres will lead to better quality of care,
including better outcomes, for children with congenital heart disease and
their families in the future. We recognise that reducing the number of
centres undertaking surgery will involve very difficult decisions but that
is the way forward.
Competing interests: I no longer undertake paediatric cardiac surgery
A National Health Service (NHS) review of children's heart surgery
has concluded that an Oxford hopsital should cease providing such
treatment. This decision appears to have been based largely on a league
table of all 11 centres in England, in which Oxford ranked the lowest.
This is a worrying omen for the future of the NHS. One service will
always be ranked the lowest in any league table. Using paediatric cardiac
surgery as an example, assuming that the ranking is updated annually, one
centre will have to be closed each year. Within a decade, there will be
only one cardiac centre operating on children in the whole of England. The
dilemma at that point will be whether to keep the centre open because it
is at the top of its league or close it because it is at the bottom. The
certainty is that children with congenital heart defects will suffer as a
The sooner league tables are scrapped in favour of meaningful
appraisals of services to help them improve, the better for patients.
Competing interests: No competing interests