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Thorac Cardiovasc Surg 2013; 61(04): 271-272
DOI: 10.1055/s-0033-1347332
Editorial
Georg Thieme Verlag KG Stuttgart · New York

Not for Turning…?

M. K. Heinemann
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Publication Date:
10 June 2013 (online)

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What does Margaret Thatcher, the former, highly controversial British prime minister, have to do with cardiac surgery? The death of an eminent politician is usually an incentive to reflect upon individual achievements and their role in what is called history. In 1988, persistent postponing of cardiac operations at the renowned Birmingham Children's Hospital because of lack of funding had triggered her government to subject the National Health Service (NHS) to its most fundamental restructuring to date. Mrs. Thatcher relieved health authorities from having to run hospitals. Since then the NHS “buys” health care from hospitals, which have to organize themselves and compete with each other. This was perfectly fitting the economic philosophy of the Iron Lady who firmly believed in the power of the markets. Not having to deal with everyday banalities also enabled the NHS to develop a greater view of what is actually happening in health care and to suggest “market” regulations where they seem necessary. The Safe and Sustainable program for the regulation of, again, congenital heart surgery, is only the most recent one.[1] [2]

Twenty-five years after Mrs. Thatcher's groundbreaking NHS reform this program has now entered its judicial phase. Only seven institutions are currently entitled to provide congenital heart services for the whole of England. Of course, something as rigorous as this spawned controversy from the outset. Now that everything has gone into effect, institutions have been dropped from the list, which in Germany would be among the top performers.

So it seems only befitting to scrutinize what happened in Germany over the last years. Basically, the problems are very similar to where England comes from: a grotesque multitude of so-called centres in which a couple of children are operated when they happen to come along; only seven “bigger” centres where more than 250 procedures per year are performed, some of them facing absurd problems when trying to educate younger people in this very sensitive specialty.[3] [4] It should be remembered that in England > 400 is regarded as an adequate number – which is met by only three German institutions at present. No German master plan is discernible. The only forward development was the introduction of a national quality control after an endless political debate.[5] One can only hope for an eventually extensive and complete analysis, no matter what the cost. The next step, and this is where eyebrows are being raised and lips pursed even now, but which would be the really important and decisive one, would be consequences.

If there is one thing Margaret Thatcher was unequivocally admired or feared for, it was her firmness. Once a decision had been made, there was no way back for her. This was the reason why the Russians coined her nickname “Iron Lady,” and why her biographies, which are about to enter the market, will bear titles alluding to her famous statement: “The lady is not for turning.”

In the interest of the children, who are our future (a platitude every politician loves to indulge in while being photographed kissing babies), a strict and obligatory structure for children's heart services in Germany seems long overdue. Cringing appeasement cannot be the solution although it is politically easy to convey. Where the lives of a future generation are at stake, there simply is no room for complacency or compromise. If a safe and sustainable solution cannot be found for Germany very soon too, the afflicted families might be well advised to metaphorically voice another Thatcher quote, which she originally addressed to the European Union: “I want my money back!”