New proposals have been put forward in an effort to resolve a long-running row about the congenital heart surgery in England.The latest review, which has taken two years, suggests networks of surgeons working as teams across hospitals.

These fresh proposals will be considered by NHS England’s board later this week.

It warns that not all centres currently doing this work can meet the new standards.

Previous efforts to reduce the number of units performing delicate heart operations on very sick children in England led to acrimony.

They were eventually derailed, after being challenged in court and questioned by a panel of independent experts.

The government decided two years ago that the public had lost confidence in the reorganisation.

This new review has examined surgery for adults as well as children born with heart defects.

Fresh approach

It suggests cardiac surgeons should work in teams of at least four, with each of them doing more than 125 of these highly specialised operations every year.

The review warns that not all heart units are currently working in this way.

It says: “We are not making any proposals for changes to the configuration of specialist providers at this time.

“Some hospitals are undertaking very low volume practice.

“We intend to bring an end to this practice, which we do not consider to be in the best interests of patients.”

A separate paper, by a sub-group representing hospital providers, acknowledges that closing one or more centre could remain an option.

The paper warns: “Delivery of the standards requires providers to solve some knotty issues that previous processes have failed to solve.

“There is still a chance this process might break down.

“Although there have been points where participants have been frustrated, we seem to agree that the process has been worthwhile so far; that it has stimulated a different kind of conversation to the ones we have had before; that we are addressing some difficult issues; and that we are making progress.

“NHS England has indicated that it wants to commission the new service and have it up and running by April 2016.”