Alder Hey’s heart of gold: charity, cardiac surgery and the distortion of paediatric provision in a nationalised health service, 1948–91

Liverpool is perceived as exceptional, a city apart from the nation, and its health services are no different. Alder Hey, the city's children's hospital, reaffirms this perspective. Its name is inseparable from the scandal surrounding the unlawful removal and retention of thousands of organs, mostly hearts, from children for research purposes over decades culminating in the 2001 Redfern report. This paper contextualises these events by reconstructing how paediatric cardiac surgery, as an emerging subspecialty, disproportionately shaped the development of children's hospital services for the city and its region. Such cumulative, compounding impacts are invisible in the historiography, focused on national trends and high politics. Recognising but eschewing established policy narratives, the paper follows enduring tensions between teaching and research, service and specialty, centre and periphery, managers and clinicians and patients and professional prestige, which remained unresolved from the inception of the National Health Service (NHS) in 1948 to the Royal Liverpool Children's Hospital becoming a self-governing trust in 1991. Using archival documents to reconstruct complex organisational and clinical decision-making within the shifting architecture of the NHS at national, regional and local levels over time, this paper shows how children's hospital services in Liverpool were distorted by another heart. One of gold: charity. Public appeals and philanthropic support for paediatric provision outweighed competing claims for compassionate giving in Liverpool. The availability of alternative funding to develop highly specialised paediatric cardiac surgery, and to lever further statutory resources at the expense of competing specialties, impacted the shape of nationalised health services in the city and its wider region. Ultimately, the paper demonstrates how children's care, clinicians and charity confounded efforts to organise universal, nationalised health services.