17:26

For our last appointment of the day, we meet Robert Craig, the chief operating officer at Royal Brompton. NHS England’s plans to close the unit might be emotionally distressing for staff and patients, but if giving other hospitals more consultants, doing regular complex work in bigger hospitals and closing smaller ones improves outcomes, isn’t that the best way to “future-proof” the NHS?

Craig firmly disagrees with that proposition. Instead, he says he believes there are clear-headed clinical arguments against closure.

Robert Craig. Photograph: Alicia Canter/The Guardian

“Yes it’s an emotional, almost visceral thing for people who work here,” he says. “It was the first adult congenital unit in the country; it’s one of the biggest in the country; our outcomes are among the best and they compare well with the rest of the world. But no, it isn’t just an emotional issue. It’s a logical, clinical question too. Why seek to fragment the biggest centre in the country?”

The Guardian asked Craig to read arguments made earlier on the blog by Prof Huon Gray, the NHS national clinical director for heart disease – and respond directly to his case for closing the unit.

NHS surgeons … must perform between them at least 500 operations a year, which is about three each every week. That is a minimum.”

“We absolutely agree with that, we do more than the standards require,” says Craig.

“There is an argument being made that small, specialist hospitals are outdated. The argument I always make is that there used to be a hospital specifically for skin diseases, which got taken over by St Thomas’s and became a dermatology ward. And we don’t yet have a cure for psoriasis. I’m not saying that’s cause and effect, but I don’t know if something might have been different if we still had a specialist skin hospital. Because you lose the focus that clinicians can identify. Our services are different to the cardiac wards at Hammersmith or or St George’s hospital.

Their services, as judged by mortality data, are safe … [But] that is a different argument from saying do we think in the future we could do better when children are born with a complex cardiac disease where treatment previously would not have been thought feasible?

Craig says things are already improving. “The number of people now surviving through to adulthood is vastly more than 20 years ago,” he said.

PICU consultant Nitin Shastri attends to two-week-old baby Mason. Photograph: Alicia Canter/The Guardian

“The challenge now is thinking of this as a predominantly adult service to manage, because of survival rates. And we’re in the perfect position to do that. We see people transition through. There is a risk as a teenager, and frankly getting fed up with treatment plans and hospitals. And at that exact moment, they have to be taken away from the team they’ve known all their lives to a new adult hospital. Lots of US evidence suggests that people get lost to follow-up, and our setup enables that to be much rarer.”

Co-location is Gray and NHS England’s key argument:

If I were a parent sitting beside the bed with a child who needed other specialist input, I would feel much more comfortable knowing that it was two floors down.

“I would say, has he asked the patient or parents?” Craig responds. “Surgeons are timetabled to work at both hospitals, they have to be flexible but that is what doctors do.

“Gastroenterologists are here when we need them, surgeons are here when we need them. They can be here every half an hour, they can be here every day of the week. So it does become a bit emotional yes, because it’s like, ‘why don’t you get this?’ This feels like such a matter of an interpretation of standard, the paranoid among us think there’s something else going on.

“The number of people you need for a 1,000 bed hospital means it can be impersonal. You pick up the phone to talk to the labs here and you know who they are. Would it be better to build a brand new hospital with everything under one roof? Where’s the money to do that? And what’s the benefit? It’s the theoretical risk, which hasn’t happened, that the surgeon might not be there when we want him. What actually happens is one of his colleagues covers. Even in bigger hospitals, there’s no guarantee the paediatric surgeon is immediately available either. We have done this for decades with outcomes which are the envy of the world.”

That’s all from today’s liveblog. A huge thank you goes out to the staff and patients at Royal Brompton hospital, and to you of course for reading.