Press Release

Varadkar welcomes publication of the Report of the expert International Working Group on the Assessment of Cardiology and Cardiac Surgery for Congenital Heart Disease in Northern Ireland and the Republic of Ireland

Varadkar welcomes publication of the Report of the expert International Working Group on the Assessment of Cardiology and Cardiac Surgery for Congenital Heart Disease in Northern Ireland and the Republic of Ireland

Minister for Health Leo Varadkar today (Tuesday, 14 October 2014) welcomed the publication of the report of the expert International Working Group on the provision of All-Island Cardiology and Cardiac Surgery Services for Congenital Heart Disease.

The Minister together with his counterpart in Northern Ireland, Minister Jim Wells, issued a joint policy statement underlining their commitment to accept and implement in full the recommendations set out in the Report, as soon as possible, respecting the legal and accountability frameworks that operate in both jurisdictions and giving full consideration to the outcome of all necessary consultation.

Minister Varadkar said “I am very grateful to the expert International Working Group for their time and expertise in preparing the report.  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 also paid tribute to the management team and clinicians in Our Lady’s Children’s Hospital Crumlin who have regularly provided surgical and cardiology support to their counterparts in the Belfast Health and Social Care Trust, and said “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”.

Minister Varadkar noted that the existing Service Level Agreements between the Belfast Health and Social Care Trust and Our Lady’s Children’s Hospital Crumlin will continue in operation and will be augmented to enhance the current arrangements and then as soon as possible be replaced to deliver the longer term solution envisaged in the report.  In the interim, children from Northern Ireland will receive elective treatment in Great Britain, whilst capacity is expanded in Crumlin to facilitate their treatment in Dublin, with Belfast and Dublin cardiologists working as an integrated team to support these developments.

The implementation of the Report’s recommendations provides a key opportunity for joint cross-border co-operation, providing a critical service for the benefit of people in both jurisdictions.

Ends

Editors Note:

The Report of the Expert International Working Group is available here.

The full text of the Joint Policy Statement is as follows:

Joint Policy Statement by the Minister of Health and Social Services and Public Safety Northern Ireland, Jim Wells and the Minister of Health in the Republic of Ireland, Leo Varadkar on the report of the expert International Working Group (IWG) on the Assessment of Cardiology and Cardiac Surgery for Congenital Heart Disease in Northern Ireland and the Republic of Ireland

On 9 December 2013 the then Health Ministers in Northern Ireland and the Republic of Ireland, Edwin Poots and Dr James Reilly, jointly announced that they had appointed a team of international clinicians to carry out an independent assessment and recommend the optimal model for a Cardiology and Cardiac Surgery and Interventional Cardiology service for Congenital Heart Disease (CHD) to meet the respective needs of the Republic of Ireland (ROI) and Northern Ireland (NI).

The expert International Working Group (IWG) was, chaired by Dr John Mayer, Boston Children’s Hospital and included Dr Adrian Moran, Maine Medical Centre, USA, and Dr John Sinclair, Royal Hospital for Sick Children  Glasgow.  Nursing expertise and advice was provided by Dr Patricia Hickey, Boston Children’s Hospital. We are grateful to the IWG, for their commitment and dedication in taking forward this assessment.

The IWG has completed its assessment and presented its Report to the respective Departments of Health in Northern Ireland and the Republic of Ireland last month.  It makes clear and explicit recommendations on the development of a single congenital cardiac service for Northern Ireland and the Republic of Ireland.

A total of 14 recommendations are presented which together form the IWG’s proposed model for a service that would meet the needs of the entire population with congenital cardiac conditions, whether adult or child, in Northern Ireland and the Republic of Ireland.  The IWG has underlined in its Report the necessity to implement all of the recommendations therein in order to ensure the viability of the proposed solution.

We are satisfied that the terms of reference for the review have been fulfilled and we jointly accept all of the recommendations set out in the Report of the IWG and are committed to their full implementation as soon as possible, respecting the legal and accountability frameworks that operate in both jurisdictions and giving full consideration to the outcome of all necessary consultation.

We recognise this clear acceptance of the proposed solution and associated recommendations to be essential to remove any doubt as to the model and framework for the future provision of these services. It is necessary to provide the certainty essential for all stakeholders including patients, their families, clinicians, the wider population and political representatives in Northern Ireland and the Republic of Ireland and to enable currently existing arrangements to continue and be expanded in a well-planned manner to deliver the longer term solution envisaged in the Report.

The unequivocal acceptance of and support for the proposed solution at Ministerial and administrative level will, it is anticipated, allow clinicians in both jurisdictions to build on the robust professional relationships that have been formed through implementation of the current service level agreements (SLAs) between the Belfast Health and Social Care Trust and Our Lady’s Children’s Hospital Crumlin.

In the short term, it will be important to ensure a well-managed extension of the currently operating SLAs between service providers in both jurisdictions, where appropriate. It is most important that the existing SLAs continue in operation, augmented as necessary to enhance the current arrangements and are quickly replaced by the single service model proposed by the IWG.

Further implementation will give full consideration to the outcome of all necessary consultation, and will be on the basis of early agreement on the resource timelines and service integration requirements. It will be driven and carried out within appropriate structured project management arrangements with all the necessary steering, oversight and consultation structures required in line with the IWG Report recommendations, in particular recommendation 1 (regarding a governance group for the services concerned). We have therefore instructed our respective officials to take forward preparation work with immediate effect, with a view to having a clear action plan agreed and in place by end December 2014.

The IWG has made a clear recommendation that paediatric cardiac surgery and paediatric interventional cardiology services will cease in Belfast.   We recognise fully the   importance of clarity for patients, their families, clinicians, and other stakeholders on the immediate implications for service delivery.  The immediate impact of the removal of surgery from Belfast is that more children from Northern Ireland are likely to receive elective surgery at a specialist centre in Great Britain as required until appropriate capacity is in place in Crumlin.   Interventional cardiology will cease in Belfast and Northern Ireland children will receive this service in Crumlin, delivered by the Belfast and Dublin cardiologists working as part of an integrated team in Dublin.

In the short term between October 2014 and April 2016 there will be:

  • An extension and expansion of current Service Level Agreements to provide for agreed provision of emergency and urgent surgical and interventional cardiology care to children from NI.
  • Expansion of Paediatric ICU, other inpatient and associated facilities at Crumlin to facilitate growth of elective surgical capacity.
  • Enhancement of access for clinicians and support staff to both Belfast and Dublin.

In the medium term between April 2016 and April 2019:

  •  Provision of emergency, urgent and elective surgery and interventional cardiology on an all-island basis at Crumlin in line with the IWG’s report recommendations.
  • Provision of lower complexity adult congenital cardiac surgical and interventional catheterisation procedures and associated surgical interventions which may arise on an all-island basis at Belfast in line with the IWG’s report recommendations.

In the long term from April 2019:

  • Upon completion and commissioning of the new children’s hospital in Dublin, all paediatric congenital heart disease services will move to the new site.

The provision of an optimal service, with the critical mass to provide safe high quality outcomes for congenital cardiac surgery and associated cardiology services for all children and young people in Northern Ireland and the Republic of Ireland is the goal of all of the work described above.  The implementation of the recommendations of the IWG report provides a key opportunity for joint cross–border working in a critical service area which will benefit the people in both jurisdictions: this work must be initiated as soon as possible, with all the required resources provided when needed and maintained to ensure that this goal is reached as soon as possible.

The IWG perception, arising from its site visits in April 2014, was that “there is a real willingness at a political level, at a clinical level, at a policy and management level, and at a parental level to make an all Island solution work”.

We are pleased to confirm the veracity of that perception and commit to realising the implementation of the Report’s recommendations in collaboration with all those who are similarly committed to the provision of a safe, high quality, sustainable service, meeting best international standards, for all children and young people in Northern Ireland and the Republic of Ireland affected by congenital heart disease. We are making the report available on Departmental websites today at  http://health.gov.ie/blog/publications/cardiology-and-cardiac-surgery/  and www.dhsspsni.gov.uk/iwg-report141014.pdf