LEEDS CHILDREN’S HEART SURGERY DECISION IGNORES PATIENT CHOICE

Earlier this week , at its decision meeting, the JCPCT chose Option B as the highest scoring option, which includes Newcastle serving the north instead of Leeds. The second highest scoring option was G which has Leeds instead of Newcastle serving the north. The scoring between B and G was very close. Patient Choice Ignored   The decision yesterday by the Joint Committee of Primary Care Trusts (JCPCT) to opt for Newcastle as the Unit serving Yorkshire, North Lincolnshire and the North East disregards patient choice, a key right under the new NHS Constitution.   A survey by PriceWaterhouseCooper of patients from the most populous parts of West and South Yorkshire clearly showed that they would rather go to Liverpool than Newcastle were Leeds to close. This did not include patients from Lincolnshire or Hull and East Yorkshire from where people would have to travel up to three hours to go to Newcastle and would also be more likely to go across the M62 to Liverpool or south to Birmingham.   Interviews with parents and members of the public show that under Option B, those living in the postcode areas of Doncaster, Leeds, Sheffield and Wakefield would not choose Newcastle as their preferred choice of location for treatment. This is noted by the analysis: “There was more reluctance amongst members of the public to consider travelling to Newcastle as a centre.”   When reported at the meeting yesterday it was said that patients, whilst preferring to go somewhere other than Newcastle, would be influenced by GP referral and the quality of treatment available, and the assumption made was that these would point them to Newcastle. No justification was given for this and there is no reason why these would not also point patients to Liverpool, Birmingham or London.   The Review argues that under Option B, if only 25% of the forecast caseload from Leeds, Wakefield, Doncaster and Sheffield chooses to go to Newcastle, the unit there would achieve 403 procedures a year and therefore pass the 400 minimum threshold. But this is the bare minimum of surgical procedures necessary for a safe and sustainable unit, and nowhere near the optimum 500. Assuming that even 25% of people in these postcode areas would choose Newcastle is incredibly optimistic and against all the evidence of the survey.   It was stated that Newcastle could reach a sustainable number of surgical procedures if patients were “managed”; in other words, if patients were told where to go. This completely flies in the face of patient choice as enshrined in the NHS constitution.   The petition collected in support of the Leeds Unit was signed by 600,000 people from the region indicating their choice to use Leeds if they need to. This was dismissed by the Chair of the JCPCT as “we don’t count heads.”   Whether the Secretary of State allows this decision to be implemented will be a first test of the NHS constitution. This enshrines the right for patients to make choices about their NHS care. Specifically, it reads: “You have the right to make choices about your NHS care and to information to support these choices.” Newcastle is Unsustainable   Allowing for patient choice and without the flow of patients from the populous areas of Yorkshire as evidenced by the traffic flows survey by PwC, it is clear that Newcastle would not meet the minimum 400 surgical procedures threshold let alone the optimum number of 500.   Given existing demand and with an extra surgeon, Leeds could already perform 400 procedures and with extra cases from the North East, could soon achieve 500. Serving the Local Community   The Review has been inconsistent on the question of whether population density matters when deciding where the future surgical centres should be. The consultation document accepted the principle that it matters in the case of Birmingham: “The Birmingham centre should remain in all options because of the high number of referrals it gets due to the large population in its immediate catchment area.”   But it doesn’t appear to have applied to Leeds, which serves a regional population of 5.3 million, which is double that of Newcastle and the Northeast of England at 2.6m.  Moreover, 2008-based projections suggest that the Yorkshire and Humber region could have 6.2 million residents by 2030 – 16.5% more than in 2010. This increase is higher than the projected 14.4% population increase in England as a whole. By contrast, the Northeast population is projected to increase by only 8.2%, half that of Yorkshire and well below the national rate.   This result flies in the face of logical health planning which is for services to be based according to where the population lies. With far more people living closer to Leeds than Newcastle, it makes little sense moving clinicians and surgery away from major population centres. Doctors should travel to where the patients are, rather than the other way round; a sentiment shared by the British Congenital Cardiac Association (BCCA): “Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”   In assessing travel times, it is a nonsense that the children’s heart surgery unit at Glasgow was excluded from being taken into consideration. Scotland is not yet an independent country and the unit is easily accessible for many English based patients who currently use Newcastle. No account was taken of this in assessing travel times were Newcastle to close. There is already a small amount of cross-border patient flow, with the Galashiels postcode area using Newcastle; moreover, Glasgow currently has a low number of surgical procedures. There is, therefore, no reason in principal or in practice why patients in the Northeast could not use Glasgow. Health Impact   According to the Health Impact Assessment, Options G and I were the only two that would induce the fewest negative impacts. So it is admitted that the chosen Option B, will have more negative impacts than the second highest, which is G.   It was noted that Option B would have a very detrimental effect on paediatric intensive care in Yorkshire and the Humber, whereas Option G would have only a slight detrimental effect on intensive care in the North East. The Health Impact Assessment was not made available before the consultation and was only released at yesterday’s meeting. Co-location   It is strange that Newcastle qualified as a co-located centre when its paediatric facilities are not all on one site but are some two miles apart – a strange definition of co-location. At Leeds all children’s services are on one site. The co-location of inter-dependent services on a single site is recommended by the British Congenital Cardiac Association and the Bristol Inquiry, which was the spur behind this Review.   The Panel advising the Review stated that the co-location of services on a single site was ‘optimal’. Decision Fails Secretary of State’s Tests for Re-Configuration   In a speech to the NHS Confederation on 21st June 2012, the Secretary of State for Health referred to the four tests stipulated for redesigning services: • clear clinical benefits   – All centres are deemed to meet the required standard but the Health Impact Assessment said that Option G had fewer negative impacts than the option chosen • clinician support – this decision flies in the face of all best practice health care planning • views of the public  – 600,000 people signed a petition against closing Leeds and MPs, patients and the public in the region have made it clear that that they want Leeds to stay open • will it support patient choice?  – The survey undertaken of patients in West and South Yorkshire clearly demonstrates a choice of not travelling to Newcastle   He pointed to positive changes to cardiac and stroke services that mean patients can get the care they need as quickly as possible. – It cannot make sense then to force large patient numbers to travel for two or three hours to Newcastle when they could have a much shorter journey to Leeds.   Andrew Lansley said: “If they [plans to change services] don’t meet the four tests, the service change shouldn’t happen.” If the Secretary of State is to be consistent, he cannot accept the decision of the JCPCT which clearly fails all of his tests. A Decision Made for Managers Not Patients   What was clear from yesterday’s meeting was that the evidence has all been made to fit the desire by managers for Newcastle to remain open because of its specialist treatments.   It is clear that NHS politics has taken precedence over the rights and needs of patients which is the fear we have expressed all along.   This is a devastating blow to patients, families and the general public in Yorkshire and the Humber, the north Midlands and north Lincolnshire. The Review has consistently failed to listen to the people of Yorkshire.   This is an unacceptable decision which will deny the majority of children and patients in the region their nearest centre.   Given all the evidence, it is clear that the case for Leeds remains as strong as ever.

Children’s Heart Surgery Fund. Registered Charity: 700753

 

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