CF supported NHS England with their programme to reconfigure Congenital Heart Disease services following the decommissioning of services from the Royal Brompton Hospital. Support consisted of an independent review of the struggling programme, followed by development and stakeholder agreement on scope, a case for change, service models, and likely reconfiguration options.

  • Provided clear recommendations to bring the struggling programme back on track
  • Achieved stakeholder agreement on the scope for the first time in the programme
  • A finalised case for change achieved agreement on service models and interdependencies, achieved agreement on evaluation hurdles and understanding of likely shortlist of reconfiguration options


The national review of congenital heart disease services has a complex history. In 2017, following numerous reviews and consultations, there was a public consultation on decommissioning paediatric congenital heart disease services from the Royal Brompton Hospital. Following the NHS England board decision to consider alternative options associated with this decommissioning, a programme was established to implement the decision. The programme was struggling to make progress because the nature of the proposed change was complex on a number of levels, not least because the services in scope are highly specialised in their nature.


An independent review of the programme’s scope, governance, timelines and resource requirements between December 2018 and January 2019. And, following a request to extend, development of the case for change, service models, and options development.


Our support was dependent on our intimate knowledge of the service reconfiguration process and legal requirements, our ability to conduct clinical research into best practice care models for niche heart and lung services and our ability to synthesise this into pragmatic recommendations. We interviewed 29 stakeholders, attended 8 programme meetings and reviewed over 20 documents, enabling the team to:

  • Coalesce stakeholders around an agreed scope for the programme, which had not previously been achieved
  • Sign off the case for change and achieve clarity on the reasons for the proposed change
  • Agree on service models and interdependencies between services, allowing providers and commissioners to understand which services needed to be kept together and which could potentially be split between different providers
  • Agree a realistic, revised timeline to consultation and understand the governance structures that would be required to make decisions on service change
  • Agree on a set of hurdle criteria and understand the likely shortlist of options flowing from the evaluation


We provided a set of clear recommendations to be taken forwards by NHS England to get the programme back on track. We also supported the programme to achieve the major milestones of gaining stakeholder agreement on scope, developing the clinical models, agreeing on the case for change, and defining the likely short-list of options.