Children's heart operations to be moved to all-Ireland surgical unit

Children’s heart operations in Ireland are set to be delivered on a cross-border basis from a single surgical centre in Dublin, it has been announced.

The joint policy statement from Minister for Health Leo Varadkar and his counterpart in Stormont, Minister Jim Wells, will bring an end to scheduled paediatric heart surgery in Belfast.

While surgical services will cease in Belfast, a cardiac centre of excellence will be set up in the city to provide diagnostics and aftercare to northern-based children with congenital heart defects.

The single all-Ireland surgical unit will be based in Our Lady’s Children’s Hospital at Crumlin, Dublin.

The plan, which will be subject to public consultation before it is rubber-stamped, is in line with recommendations made by an international working group commissioned to examine the issue of children’s cardiac services in Ireland by Mr Wells and Mr Varadkar’s respective predecessors in office, Edwin Poots and Dr James Reilly.

The group of experts concluded that the relatively few cases of congenital paediatric heart disease in Ireland could not justify the operation of two surgical centres on both sides of the border.

The joint statement will undoubtedly disappoint families who had campaigned for the retention of surgical capacity in Belfast.

Mr Wells, outlining his intent to the Stormont Assembly, said a number of measures would be implemented to address family concerns, such as the upgrade of paediatric transport services between Belfast and Dublin.

“The proposed model is absolutely focused on patient care and safety, and both my predecessor and I have been motivated throughout this work by the desire to provide the best possible standard of care for the people of Northern Ireland,” he said.

“The simple reality is that we cannot reach these standards alone – this is the clear message coming from the work of the IWG (international working group), and I cannot, and indeed will not, ignore their expertise and experience in reaching this view. Patient safety is central to that decision.”

There is already significant cross border co-operation on the delivery of children's cardiac care, with surgeons from Dublin currently travelling to Belfast to perform non-complex procedures.

Complex operations stopped in Belfast around two years ago, with many children currently having to travel to England for surgery.

The proposed plan envisages that in future all children on the island of Ireland should be able to have surgery in Dublin, without the need to travel across the Irish Sea.

It is envisaged that the new cross-border clinical network will take around 12 to 18 months to set up, with interim arrangements in place until then.

The report from the working group, which was chaired by Dr John Mayer from the Boston Children’s Hospital in the USA, was the fourth study on the issue to recommend a single surgical unit in Dublin.

Around 400 children a year in the Republic require heart surgery. In the North, the number of cases is around 140 per annum.

Minister Varadkar said he supported the implementation of all the working group’s recommendations as soon as possible, subject to the outcome of public consultation.

“The recommendations of the report provide a clear and objective mandate to develop an integrated networked service for the benefit of all children and young people with congenital heart disease and their families on the island of Ireland,” he said.

Mr Varadkar paid tribute to the management team and clinicians in Our Lady’s Children’s Hospital who have regularly provided surgical and cardiology support to their counterparts in the Belfast Health and Social Care Trust.

“I am sure that the close professional and collegial relationships developed between those involved in the care of these vulnerable patients will provide a stable basis for the development of an all-island networked service, as envisaged in the report,” he said.

The network would see four surgeons in Dublin each perform around 125 operations a year.

Other key recommendations in the working group’s report include:

* Establishing a family advisory group;

* Setting up a north-south single governance committee to oversee the network - a body that will include a families’ representative;

* Establishing an all-Ireland database of congenital heart disease patients;

* Flow of clinicians between Dublin and the centre of excellence in Belfast;

* Provision of 10 new intensive care beds at Our Lady’s to cope with the increased delivery requirements;

* Regular case and review conferences involving cardiologists from both jurisdictions.