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Consultation Statement relating to the Royal Brompton Hospital

from the Trustees of the Somerville Foundation 9 June 2017

The Somerville Foundation was established to represent patients throughout the United Kingdom who were born with a serious heart condition and survived into adulthood. It fully supports and welcomes the standards for adults with congenital heart disease (GUCHs) and their implementation.

The NHS England consultation on this implementation covers a number of hospitals, and the Somerville Foundation will make separate responses for each.

There is no suggestion that the Royal Brompton Hospital does not comply with the adult congenital heart standards. It is considered to be one of the leading GUCH centres in Europe. Despite that, the adult services are being put under threat due to the apparent failure of the Brompton to comply with the children’s standards (Paediatric Congenital Heart Disease Standards: Level 1 – Specialist Children’s Surgical Centres).

The patients that we represent, as well as their families and medical staff, have expressed a high level of concern and genuine anxiety about the future care of GUCHs cared for currently at the Brompton, which is the longest and largest established GUCH service in the UK.

The Somerville Foundation Board believes that the collateral cost on the medical care for adult patients is too high a price to pay. It is extremely concerned that the discontinuation of these adult services, which is the risk and likely outcome, will result in the service for these adult patients being considerably worse than it currently is. It is most likely to result in poorer outcomes both in cardiology, intervention and surgery.

It is reported that 8000 GUCHs would be affected and it has not been demonstrated that these patients can or will be catered for properly in the other units. Indeed, with the growing numbers of adult patients it is a concern that the other units are already finding it difficult to cope and increase appropriately trained staff.

There is no suggestion that the outcomes from the Brompton are anything other than good. The Brompton does have expertise and investment in equipment not found in other centres. There is a higher level of research carried out at the Brompton than other units, which must continue.

These are the reasons that the Somerville Foundation is unable to support the loss of the Level 1 and Level 2 adult service at the Brompton. 

NHS England has included in their consultation a question about adult services continuing at the Brompton. Having had a meeting with the Brompton it appears unwilling to consider the continuation of adult services without the children’s services. We believe that this position is wrong for adult patients and this must be considered. The adult patient population is now larger than children and continues to grow.

The Brompton have also advised that it has plans to relocate the hospital onto the St Thomas’ Hospital site that would enable it to comply with all the standards. We believe that ‘derogation’ (agreed delay to enable matters to be resolved) must be considered, as it has been for another unit.

We have had submissions from parents of children, as well as GUCHs, about the children’s standards. There appears to be a great level of concern over the one single standard out of the entire set of standards that is causing the Brompton to apparently fail to meet the children’s standards, through colocation.

Whilst the Somerville Foundation is not in a position to make a statement on this standard based on its remit, we feel we must highlight this concern, given the direct and considerable impact it has on the adult service. They have asked for the interpretation of this standard to be reviewed. 

The Somerville Foundation therefore considers that an outcome that does not result in the continuation of Level 1 or Level 2 services for the adults at the Brompton is flawed.

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