LETTERS
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From: Christine Waterland, NHS Yorkshire and the Humber Subject: Child heart surgery
Big is not beautiful – it is not ef- ficient and it is not quality care. Are the remaining centres going to increase their capacity for theatre time? Are they going to provide more overnight accommodation for parents of sick children? Is there going to be a faster way to get a really sick child safely to surgery at the other end of the country? Is there going to be more bed capac- ity for the additional children from other areas? Is there going to be an increase in staff to cope with the increased demand?
These are children’s lives that they are playing with. It won’t save money, it won’t improve quality, it won’t improve standards and most importantly of all it won’t save lives. When children are sick they need their family with them to help them heal quicker. What about people with other siblings, what are they going to do?
The stress levels for sick children’s parents will go through the roof. I think there needs to be more seri- ous investigation into this before it happens and not just dive in feet first because someone thinks it’s a good idea!
From: Colette Sparey, Leeds Teaching Hospitals NHS Trust Subject: Child heart surgery
Not sure that the original review was particularly independent. In Leeds, we have had concerns about the process from very early on based on the constitution of the committees, numerous damaging leaks throughout the review and a number of other pieces of infor- mation we have received.
This includes a letter sent out by some parent groups stating where they felt the centres should be before there had even been an as- sessment. One of the signatories to the letter was a parent who was, and remains, a key member of the
14 | national health executive Sep/Oct 11
Safe & Sustainable committee, de- spite us pointing out there may be a conflict of interest!
Anyway, it seems that the process has ignored the fact that in Leeds we have every single paediatric and adult inter-dependency on one site and that we are geographi- cally the best placed centre in the North to serve the population. Newcastle has the stand alone cardiac hospital at the Freeman, with no paediatrics, no neonates, no maternity and no fetal medi- cine on site. What will happen in the South if you select one of the three options that don’t include us is anyone’s guess.
What is clear is that this will mean:
1. 50% reduction in Leeds PICU beds (less flexibility in winter and impact on other key local services) 2. Massive pressure on paediatrics and transport to diagnose and safe- ly transfer patients long distances. 3. No transcatheter interven- tion in the region, so no sep- tostomies and more pressure on urgent transfer of babies. 4. Uncertainty about the network. Newcastle has no outreach clinics at all and no network (our network seems to have been given little credit in this review).
There will be huge pressure for paediatricians to take on more and more of the work locally which could be viewed either as a prob- lem or an opportunity.
I would be interested to hear what systems and investments will be made to support patients in the large geographic area that is cov- ered by Leeds and facilitate the transport of the large numbers of mothers and babies out of the re- gion? Will the maternity unit at the RVI in Newcastle be able to deal with the increase workload that the closure of the Paediat- ric Cardiology Unit in Leeds will bring? I doubt it, but it will be in- teresting to watch.
From: John Cornell, GP Subject: Child heart surgery
I really think the whole exercise has been rather a cosmetic one and hence a waste of public money.
It is perfectly obvious that all the people who use any of the centres and the local people around those centres will want “their centre” kept open. The general public are not in a position to make a rea- soned judgement against all the criteria that need to be consid- ered to make the best decision. Of course people would sign petitions to support their positions. To be told that they are being consulted and then told that it is too big an issue to be decided by the size of a petition is rather disingenuous. I suspect that even some of the pro- fessional responses are motivated from a personal involvement rath- er than purely objective reasoning. Of course it is too big an issue to be decided in any other way than
an objective independent assess- ment, and so we should never get into these positions.
The committee needs to have its independence ratified by those af- fected by the decision (it must be seen to be independent with no vested interests of its own) so that its final judgement is likely to be accepted. It can then set out the arguments objectively to support the need for change and then set specific criteria against which a judgement is to be made and these criteria consulted on and modified as necessary. The panel should then gather all the hard, objective evidence for each site against each criteria and make a judgment on the basis of that and hence be able to justify their decision in an ob- jective way.
I feel that the way in which the public are led to believe they are being consulted on these national issues, (particularly when anyone with any common sense could pre- dict what local communities are going to say/want), and then to blatantly indicate that local views are being ignored is hypocritical to say the least.
The cost in terms of time and re- sources put into conducting the exercise and diverted away from clinical care could have been far more usefully channeled into ser- vices and patient care. Why is this approach continually replicated?
Professionals are paid to make dif- ficult decisions – so long as they are seen and assessed to be open, transparent and fair – then it is surely OK for them to do it, instead of this pretence at democracy and public consultation.
From: Christopher Bradley Subject: iPad provision
The NHS can’t win can it? Often accused of being old fashioned and techno-phobic, they also get criticised if they use what is avail- able. The biggest worry is that there is no uniformity; it took me
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