Hearts and Minds again

The Safe and Sustainable programme to reorganise child heart surgery just 19 years after the Eye broke the story of the Bristol heart scandal is running in to difficulties. There are currently around 30 consultant heart surgeons who operate on children spread across 11 surgical centres in England.  All signed up to a process that was likely to recommend a reduction in the number of centres so specialist expertise and resources can be concentrated in fewer, safer centres better equipped for training and expansion. This process was made all the more urgent by the Oxford scandal (Eye 30.7.2010) and a report last year that found that 76 ‘excess deaths’ had occurred in just four centres between 2000 and 2008 (Oxford, Leeds, Guys and St Thomas’s and Leicester). This was the same methodology used to count the excess deaths at Bristol.

The Children’s Heart Federation, which exposed the Oxford scandal, has now written to the Care Quality Commission asking them to urgently investigate the high number of reoperations that appear to be occurring in the Leeds unit, and any damage associated with them. Meanwhile, Yorkshire MPs have this week secured a Commons’ debate to try to halt the reorganisation and save their local unit. Alas they appear to have been swayed by egos in the hospital rather than the safety of patients.

The Bristol Inquiry also recommended a decade ago that services for children with very rare heart conditions such as Truncus Arteriosus (TA), in which a single vessel comes out the ventricles rather than two, ‘should only be performed in a maximum of two units, validated as such on the advice of experts.’ The latest figures, for 2009, show that Birmingham performed 14 TA operations, Leicester and Newcastle 3 each, Leeds, Great Ormond Street and Alder Hey 2 and Oxford, the Brompton, Guys and Bristol just 1 each. Southampton didn’t do any but had done two the year before. MD wouldn’t let his dog go to a surgeon who does ‘1 a year’ of anything, especially if there’s another who does 14 a year just up the road. Despite the recommendations of a hugely expensive and very traumatic public inquiry, child heart surgeons are still being allowed to dabble in rare complex cases.

Lest we forget, disgraced heart surgeon James Wisheart told Jim and Bronwen Stewart in 1994 that their son Ian had a 67% chance of surviving his TA repair and that the chance of brain damage was very remote.  BBC Newsnight later revealed that, prior to Ian’s operation, Mr Wisheart had performed 11 TAoperations with nine ‘early’ deaths. Ian survived, suffered profound brain damage but appeared in the surgical audit as a ‘success’ because he was still alive after 30 days. The Stewarts had to fight for years for compensation, never got justice and publically derided the GMC hearing and Public Inquiry as hollow shams that would change nothing.

And they may have a point. Some of the centres are now having cold feet about merging. The Royal Brompton hospital (RBH) and Great Ormond Street hospital (GOSH) had even agreed, in April 2009, to merge cardiac services at GOSH in the report of ‘A Proposal to Establish A National & International Service for Children with Heart & Lung Disease’. Now RBH is taking the Safe and Sustainable Review to Judicial Review, which will cost the tax payer millions, delay implementation by many months and allow smaller, inadequately resourced units to keep struggling on and surgeons to keep dabbling in the rare stuff.  

The review itself has not been without problems. The needs of Isle of Wight’s 145,000 residents were not factored into the whittling down process; an omission which worked against the survival of Southampton’s unit, which is one of the best and safest in the country. Had the Isle of Wight been included – as it undoubtedly should have been – Southampton should have been safer for geographical reasons. The review says there should be a maximum of 3 hours’ (4 for remote areas) travel time to the nearest specialist centre, based upon the same methods used for deciding paediatric intensive care provision. If the Isle of Wight is factored in – and Southampton’s unit closed – the travel times from its main hospital St Mary’s to either Bristol or the two London units are over the four hour ‘remote’ deadline.   The review panel has now ‘developed scenarios that show it is possible for an ambulance from London or Bristol to reach the island in under 4 hours by road and ferry – but not all the time.’ So that’s all right then.   MD