Guardian News and Media/London

A consultation paper on the future shape of children’s heart services has been launched by NHS England in a bid to win agreement from families, charities, politicians and hospitals after more than a decade of controversy.

Past plans, which included proposals to close down children’s heart surgery at the Royal Brompton hospital in London and Leeds General Infirmary, became bitter battlegrounds and ended up in the courts.

Local politicians and doctors, backed by families, fought to keep surgery at their own hospitals.

Surgery at Leeds was suspended - while concerns about death rates were investigated - and reinstated a week later, followed by several reviews into patient care. 

NHS England took over when the independent reconfiguration panel, called in by the Health Secretary, Jeremy Hunt, ruled the process had been flawed.

Yesterday’s consultation document is the result of more than a year of discussions with all the interested and aggrieved parties, in a bid to find an agreed way forward.

Instead of listing units to keep and units to close, NHS England, which is now the commissioning body, put forward a set of standards that hospitals will be expected to meet.

Under the proposals, all 10 hospitals that offer children’s heart surgery could in theory keep operating.

The review encompasses for the first time adult and children’s congenital heart services, and envisages that demand will grow as more children born with heart defects survive and need treatment as adults.

However, every unit must have at least four surgeons, the review says, to ensure that it can provide treatment around-the-clock and cope if one or even two surgeons are away or sick. At present many do not. Every surgeon must carry out at least 125 operations a year, to ensure they are expert in the complex procedures.

Also it is envisaged that patients may have to travel to get their surgery in the best unit for them, although the care before and after the operation may be closer to home. In the past there has been emphasis on the geographical spread of units, which has turned into turf wars.

Over more than a decade there have been attempts to rationalise children’s heart surgery - on the premise that there are insufficient children born with rare heart defects - to ensure that all the specialist teams in the country get the experience they need in these difficult procedures on tiny hearts.

This came to crisis point over deaths of babies at the Bristol Royal Infirmary. It was argued that some could have survived if they had been operated on by better skilled teams at other hospitals.

All the stakeholders families and the charities that support them, surgeons, doctors, hospital managers and politicians have been brought into the discussions to try finally to reach consensus.

Asked whether the new approach would end the controversy, Dr Jackie Cornish, national clinical director for children, young people and transition to adulthood at NHS England, said: “I personally hope so. I hope there is recognition that we have very effectively engaged with patients, parents and families and placed them right in the middle of our decision making process. They have been integral to developing the standards and we have responded to their needs and suggestions.

“I hope everybody will understand that constantly reviewing these services over the past 10 years has led to a level of uncertainty in clinical teams, and at times children and families lacked confidence in services.

“They all deserve the stability of knowing there is a uniform process with uniform standards for quality to improve outcomes and experiences across the whole life course and treatment pathway. We need good, sustainable, well-audited services, strong in governance processes. I would hope that having been such a consultative process, this time we will actually reach that goal.”

The standards cover 13 areas including communication with patients and their families; staff levels and skills needed in teams; transition for children moving between child and adult services; working with other healthcare services patients might need; and support for patients and their families when their disease is not responsive to treatment.