Watchdog: Child and adult heart care should merge

HEALTHCARE for children with heart defects should be merged with adult services to improve safety and address ongoing staffing concerns, according to Scotland’s medical watchdog.

Health Improvement Scotland said Yorkhill in Glasgow – the only specialist children’s cardiac service north of the Border – should be combined with adult services at the new Southern General Hospital when it opens in 2015.

In May 2012, an independent panel said care could be “unsafe” if critical staffing problems – including a shortage of surgeons – were not addressed. Of 31 areas scored, 19 were rated poor, one as inadequate, six as acceptable, three as good and only two as excellent.

Health Improvement Scotland yesterday said in a follow-up review that care had improved but that problems remain. Among the key concerns was that no heart surgeon was on duty overnight.

“Plans were in place to recruit a dedicated clinical psychologist, but had not yet been realised”, the report said.

Three consultant paediatric cardiac surgeons provide emergency cover through an on-call system.

“We did not see any evidence of any safety concerns as a result of the emergency cover arrangements, and no concerns were expressed by the staff we spoke with during our review,” the report stressed.

“However, we had concerns about the lack of on-site expertise for complex surgery out-of-hours. There are risks following complex heart surgery and rapid intervention by an appropriately skilled cardiac surgeon or surgical assistant could be required.”

The report said having a consultant cardiac surgeon present in the hospital out-of-hours was “unachievable” with three surgeons, but suggested that specialist theatre nurses could be trained to carry out emergency surgery until a surgeon arrived.

It said: “The hospital could develop surgical assistant roles, whereby individuals such as operating theatre nurses receive appropriate training and experience to perform emergency surgery and are then supported by the on-call consultant when they arrive.”

NHS Greater Glasgow and Clyde was told to demonstrate it has “robust strategies” in place to mitigate the risks from not having a consultant cardiac surgeon in the hospital outside of regular hours.

However, inspectors found patients and their families were “strongly supportive” of the care they received at Yorkhill.

The watchdog said that “the entire life pathway of a child born with a congenital heart defect needs to be considered if the service is to be person-centred”, which could be achieved if services were brought together at the new South Glasgow Hospitals Campus in 2015.

Alex Neil MSP, Scotland’s health secretary, said: “This independent report shows that the childrens’ heart service in Glasgow remains safe and highlights that a wide range of improvements have been made.

“This is important progress, but there are also some recommendations that indicate more work must be done to strengthen resilience and improve safety even further. NHS Greater Glasgow and Clyde will continue to work with National Services Division and the Golden Jubilee to implement these recommendations.

“I will also ask the National Specialist Services Committee to assess the implications of combining paediatric and adult cardiac national services so we can fully consider this option.”

Kevin Hill, director of women and children’s services for NHS Greater Glasgow and Clyde, said: “We are pleased to note that HIS have recognised the action taken to improve the care given to children and young people with congenital heart disorder.

“The report also highlights that team working between senior team members has improved and that the service is fully focused on patients and their families who are strongly supportive of the care they receive.

“We continue to work with staff and patients and their families to further develop protocols to meet patients’ needs and will now develop an improvement plan in collaboration with National Services Division to address the further recommendations made by HIS.”