A bitter row has broken out between some of Britain’s best known hospitals following plans to reorganise heart surgery for children and babies.
As ever, the free market in the NHS and competition between “providers” is obscuring the real issues.
Health bosses at NHS England last week announced they want to concentrate complex but rare procedures in a smaller number of hospitals so that only surgeons with extensive experience perform the operations.
Fewer than 4,000 of these type of surgery are done each year with 80 percent of children born with these heart defects surviving into adulthood.
But how and where the operations are carried out has been at the centre of a fierce debate since the publication in 2001 of a damning report into high death rates among babies undergoing heart surgery at Bristol Royal Infirmary.
The surgeons at Bristol performed these operations less often than staff at other hospitals dealing with comparable cases and more babies died there. But subsequent reports showed that staff shortages and cuts also played their part in the worse outcomes.
Last time plans to reorganise this surgery were put forward in 2011 it led to a bitter fallout, pitting hospitals against senior health bosses. Two years later the proposals were scrapped with NHS bosses told to look again.
There are some fairly clear cut examples of hospitals that are doing too few operations to be safe, and where there are good centres nearby, it makes sense to concentrate expertise there.
But there are also grey areas.
Some centres that are earmarked for closure have a good case to remain open. University Hospitals of Leicester is one example. It says that it will meet the target number of operations to remain viable but that health chiefs are insisting on closure.
This will be a blow to patients across the whole of the east of England who will now be forced to travel to either Birmingham or London for treatment.
While this will not have the same effect as the closure of a local A&E unit where journey times are critical, it will undoubtedly affect families that are trying to care for seriously ill children who will need to be in hospital for a considerable period.
Unfortunately, what should be a debate about the best clinical outcomes and ways to support families caring for seriously ill children some way from home, has become symptomatic of the way the market pits hospital against hospital.
NHS Trusts, such as the Royal Brompton and Harefield, worry that the loss of the ability to perform this kind of surgery will lead to their downgrading overall. The lost revenue will then result in the break-up of good clinical teams with the best surgeons moving to the new centres.
That could threaten the long term viability of the Brompton hospital in central London.
But central London currently has four centres that specialise in complex heart surgery, it should not matter in which particular hospital you are treated. But with NHS finances on a knife-edge the overall viability of a hospital can depend on whether it is allowed to perform a variety of procedures and earn revenue.
These pressures will likely see the proposed changes challenged in lengthy and expensive court cases. Uncertainty will hang over the threatened hospitals – and patients’ families will worry about whether their children are getting the best care possible.
Only by ridding the NHS of the market will we be able to make decisions about how to allocate resources and the most skilled surgeons and staff