FROM

Leslie Hamilton

Cardiac (adult and transplant) surgeon Freeman Hospital, Newcastle

Past President SCTS

Vice chair Safe+Sustainable Steering Group

Subject: “Safe and Sustainable”: the Jarman data
Date: Mon, 5 Nov 2012 20:40:58 +0000
From: Leslie.Hamilton

Dear Phil

We met at the very first national “Stakeholders”meeting when the review started. I have always enjoyed your MD column in Private Eye and have very much appreciated your support for the principles of the review. Your column in the current issue (Eye 1326) is no exception.

Nonetheless, I have significant reservations about Professor Jarman’s analysis of the outcome (mortality) data. I know he was a member of the panel for the Bristol Inquiry and am aware of his work through the Dr Foster organisation.

It would seem obvious to use outcome data to assess the quality of care when deciding which units to designate as the surgical units for the future. However the clinical Steering Group (who advised the JCPCT) was very clear that the data should not be used in this way.

In adult cardiac surgery we have a well established, internationally accepted risk stratification system (EuroSCORE) which

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How to choose a child heart surgeon

One key recommendation of the Bristol Inquiry 11 years ago was that ‘patients must be able to obtain information as to the relative performance of the trust and the services and consultant units within the trust.’ The Inquiry concluded that between 30 and 35 more children had died after heart surgery between 1991 and 1995 in Bristol compared to a typical unit in England at that time. So how are England’s child heart surgeons performing now?

The official figures for 2010-2011 look superficially reassuring. Over fifty procedures are listed and if you know which one you child is having, you can look at the results in your hospital and compare it to other units on a graph. If you look at, say, the results for the arterial shunt operation, you’ll see that half the units are above average, half are below average but none of them breach the ‘significant statistical outlier’ line that would trigger an investigation. The same is true of pretty much all of the procedures, but the problem is that for many operations, the numbers per hospital are so small as to be statistically meaningless and you’d have to

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Protecting Whistleblowers?

Well done the British Medical Association.  Having taken some flak for negotiating compromise agreements with gag clauses for doctors leaving employment (see Shoot the Messenge, STM), it hosted a conference on  October 2 called ‘Protecting Whistleblowers’ with the campaign group Patients First (MD is a patron).  Dr Kim Holt spoke about whistleblowing at the clinic run by Great Ormond Street Hospital (GOSH) where Baby Peter was treated (see STM). She was proud to be a whistleblower, but lived in fear of the GMC. A common thread amongst many whistleblowers is that their NHS employers engage in vindictive counter-accusations and referrals to the GMC or NMC. Dr Raj Mattu, the former consultant and internationally respected cardiologist at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) probably holds the record for this, with what he believes are over 200 allegations made against him by UHCW (who decline to clarify the number).

Mattu first blew the whistle in 1999 because he believed a patient had died as a result of UHCW’s policy of putting 5 patients in a 4 bedded bay to meet waiting time targets. This made it impossible to resuscitate effectively in an emergency (see STM).  In 2001,

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How to choose a hip surgeon

If you’re having a new hip put in, would you go for one with an established track record, or a brand new one with slick marketing but no safety data in humans? And which of the 107 cups to put with which of the 139 stems? A big or small head? Metal on metal, metal on plastic or ceramic on ceramic? A total hip replacement or just a resurfacing?  Unsurprisingly, most patients let their surgeon decide for them. Get it right and a hip replacement removes crippling pain and restores mobility for 15 years or more. When it fails – as 8,641did in 2011 – it can be a disaster, requiring extensive, expensive and unpleasant revision surgery that isn’t always successful. But if you ask ten different surgeons, you might get ten different opinions. So who can you trust?

In 1997, following the failure of the Capital Hip, MD advised patients to choose a hip surgeon who used a tried and tested prosthesis and had long term audit to show he or she was good at putting it in. I also campaigned for a compulsory National Joint Registry (NJR) that published comparative

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Medicine Balls Special: Metal Hips, Cancer Scares and the British Medical Journal  

To commercially damage any product, however inadvertently, all you have to do is link it with cancer in the public mind. The ensuing panic benefits lawyers and journalists, but it only helps the public if the risks are substantial and somewhere near proven. In March, a group of angry orthopaedic surgeons contacted the Eye to complain about the link of Metal on Metal (MoM) hips to cancer in the March 3^rd edition of the British Medical Journal^{1 2}, and a BMJ-Newsnight ‘special report’ on February 28^{th 3}. The cancer link was picked up in the Sunday Times ⁴ on March 4^th and fuelled an ongoing cancer scare in patients with MoM hips, and patients who weren’t sure what hip they had.

As for patients considering a new hip, who would now choose an MoM when a source as credible as the BMJ states there are ‘substantial concerns about the increased risk of cancer’? But there is no good evidence showing MoM hips cause cancer. Bristol University, one of the leading research centres looking at this told the Eye: ‘It is far too early to make any conclusions’

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