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Readers' panel: Should service planners always prioritise safety and quality over accessibility?

NHS England has told three major hospitals – in London, Manchester and Leicester – to stop performing complex cardiac surgery on people born with congenital heart problems. The move is designed to improve standards and outcomes, but some parents of young patients have said they will be unable to cope with travelling long distances to another unit for treatment.  Nursing Standard readers' panelists have their say on this controversial decision. 

NHS England has told three major hospitals – in London, Manchester and Leicester – to stop performing complex cardiac surgery on people born with congenital heart problems. The move is designed to improve standards and outcomes, but some parents of young patients have said they will be unable to cope with travelling long distances to another unit for treatment. Nursing Standard readers' panelists have their say on this controversial decision


Pete Hawkins is a staff nurse in the emergency department at Southmead Hospital, Bristol
Pete Hawkins
Pete Hawkins


Safe and effective care is essential, but it doesn’t sit well when it’s at the expense of patients’ ability to access a service - I have seen how tiring, frustrating and expensive it can be for patients travelling long distances to receive specialist treatment.
Although I would begrudgingly agree that planners should prioritise safety and effectiveness over accessibility, a better outcome would be to invest in these units to enable them to provide the level of care required. This is yet another example of the underinvestment the NHS has been suffering from for a long time.


Linda Drake is a practice nurse in south London
Linda Drake
Linda Drake

Paediatric cardiac surgery is one of several specialties where the volume of cases treated is directly related to patient outcomes, and centralisation of provision has been recommended.
While I sympathise with the parents of children affected by this, if my child needed complex cardiac surgery I would make every effort to access the care which offered the best possible outcomes.
Regular audit and data sharing now allows us to identify how to provide this care, and improve quality and safety.


Rachel Kent is a mental health nurse at Camden and Islington NHS Foundation Trust, London
Rachel Kent
Rachel Kent

This is a no-win situation; whatever you do, someone won’t like it, and there will be valid reasons for and against.
We should always be striving to improve the safety and quality of care, but accessibility can be equally important to patients.

I am also concerned that fewer, more specialised services will lead to a decrease in the talent pool, rather than promoting and increasing it. I would rather see services supported to improve quality than see them diminished to condense it.


Edwin Chamanga is tissue viability service lead at Hounslow and Richmond Community health, London
Edwin Chamanga
Edwin Chamanga

All health care services should be safe and accessible, with parameters in place to ensure the service can be benchmarked or standardised.
Even if the need for quality care is greater than the need for accessibility, any inadequacies identified in a service need addressing rather than the service being stopped altogether, which will have an impact on patient outcomes, health and quality of life.
If we shut down any institution that is not performing as expected, we will soon have the whole NHS on lockdown.

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