Infant Heart Surgery and Sixth Forms: The Same Problem!

The furore over the Leeds General Infirmary Heart Unit abated towards the end of last year, but today's report that it is safe but that standards of compassion were poor will raise the temperature again.

The problem, as so often, is that different issues are being conflated – in this case, the right size of an institution, the surgical care, and the non-surgical care. Of course both the surgical care and the non-surgical care need to be as good as they possibly can be, and where there are problems, they should be dealt with by management, training, and support. This is as true for schools and nurseries as it is for specialist hospital care.

But the best size of an institution should not be judged on particular cases and decisions should be based on assumptions that everything else is as good as it could be.

I have closed schools because of falling rolls, and have dealt with the professional and personal vitriol – and I have made it clear always that we were not closing a school because it was not a good school but because there were too many schools, and the result was that all the schools in the area were weakened.

The same is true of hospitals.

I'm not a specialist in child heart surgery, but I'm prepared to trust the people who are when the Safe and Sustainable review said that we needed only seven, not 10, centres, so as to concentrate expertise. And of course concentrating specialist expertise is important – when I had my hip resurfaced, it was in a specialist unit that did only hips and knees – perhaps 10 in a day. That gave me great confidence – and had I been in a general unit where the surgeons and ward staff were dealing with all sorts of problems, and doing only a couple of hips a week, I would have been much less confident. If I had a really sick child, I'd be much happier to be travelling further, if I knew that she or he was being treated in a genuinely specialist unit.

The politicians (local and national) who automatically rail against school and hospital closures for short-term electoral gain are doing a disservice to the people they represent.

Another example of this problem is sixth forms in secondary schools. Small sixth forms – less than 200 or so – offer poor choice, typically have poorer outcomes, are expensive, and offer poor support to specialist subject teachers (where they may only be one person in a department). Sixth form colleges and FE colleges offer more choice, better outcomes, better economy and better staff support. Setting up a small sixth form might be popular inside the school or academy but it's almost never in the best interests of the students.

John Freeman CBE is a former director of children's services and is now a freelance consultant