���˿���

A review of children's heart surgery is expected to recommend that at least four out of 11 units across England should stop operating.

It was launched after the 1990s Bristol heart babies scandal when children having heart surgery died needlessly.

The review, to be published later, will say standards and safety will improve if surgery is confined to a smaller number of bigger units.

Oxford's John Radcliffe Hospital has already suspended its operations.

The decision came after several deaths there last year.

The review team has already said surgery will not take place there again. On Wednesday, a consultation document is expected to question the future of surgery at other units including Leicester, Leeds and one of three units in London.

Fewer, bigger, better

Around 3,600 operations are carried out each year on children in England and Wales, born with a range of heart defects.

Most children survive to adulthood, but there is widespread agreement among professional bodies that to provide a uniformly high quality of safe service, operations must be concentrated in fewer, larger centres.

This would enable surgeons to improve skills and share expertise.

Any talk of closures is likely to prompt strong local opposition, but parents will be told that most diagnostic and outpatient treatment will continue to be offered locally.

Anne Keatley-Clarke of the Children's Heart Federation said: "What our parents have told us is that they're willing to travel anywhere for surgery, they'll go to the ends of the earth as long as they have the on-going, long-term cardiology care locally. These changes are going in that direction."

The review, launched in 2008 by NHS Medical Director Professor Sir Bruce Keogh, will stress that no centre will close, but several should no longer offer surgery.

A minimum of four surgeons per unit is being recommended. The unit at the John Radcliffe Hospital had two surgeons, and most others have fewer than four.

The recommendations of the review team, led by Professor Sir Ian Kennedy, will go before a steering committee of Primary Care Trusts. If, as expected, it is approved, it will go out to consultation.

The review does not apply to Scotland, where all children's heart surgery is carried out in Glasgow.

Children from Northern Ireland have to travel to Dublin for surgery.

Children in Wales travel to England for surgery.