Eye success

In 1997, the Eye first exposed the wide variation in quality of care in the UK for the treatment of children with cleft lip and palate, with large numbers of centres doing relatively few operations with poor cosmetic results. A North West of England audit had found that 48% of children required major and often multiple reconstructive surgery, largely because of failure of the original surgery. In addition, Royal College of Surgeons guidelines were being flouted and a petty turf war was being fought out by plastic surgeons and maxillo-facial surgeons to the detriment of patients (Eye 937). Four months’ later, the Clinical Standards Advisory Group of the Department of Health (CSAG) echoed the Eye’s warnings. After investigating 297 children aged 5 and 277 aged 12 who had all undergone cleft repair in Britain, they found that 40% had poor dental bite, less than a third had a good lip appearance at the age of 12 and under half could speak with normal intelligibility at that age.

The CSAG stated that of the 57 centres carrying out the operation, only 6-8 provided good to
excellent care and the overall results were 5-12 times poorer than

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Lansley Vs Nicholson Round 12

Any health secretary hoping to force untested free-market health reforms on a resistant NHS needs a chief executive with a similar ideology to push them through. Unfortunately for Andrew Lansley, he’s got David Nicholson, a command and control former member of the Communist party. At this year’s Patient Safety Congress, MD asked Nicholson whether he supported Lansley’s reforms. He said: ‘I lack the imagination to have come up with them.’ Even more damning was that not a single one of 700 delegates thought the Health and Social Care Act would make the NHS safer for patients, and a majority thought it would make it less safe.

Massive structural change at a time of massive debt creates a perfect storm in the NHS for Mid Staffs type disasters, as staff take their eyes off patients to balance the books whilst endlessly reorganising. In August 2009, David Cameron promised : ‘We will not persist with the top-down re-structures and reorganisations that have dominated the last decade in the NHS.’  In government he has done the opposite, implementing reforms that Nicholson says ‘are so big, you can see them from space.’

Nicholson remains in office to oversee the

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Time to investigate Alder Hey?

What has been done to properly investigate allegations of avoidable death, suboptimal care and lack of informed consent at Alder Hey Children’s Hospital?  Back in 2007, it was alleged that a baby died hours after surgery despite the explicit advanced warning of a specialist surgeon not to operate at that stage. An excellent outcome would normally be expected in the overwhelming majority of such cases. The whistleblowing surgeon raised his concerns with the then Clinical Director, who did not investigate but instead made his life difficult through withholding on-call work, job plans and travel payments. The whistleblower was then suspended on the trumped up charge of being a ‘self-harm risk’.

In 2010, another baby allegedly suffered avoidable bowel damage during routine surgery at Alder Hey. No incident form was completed. X-ray evidence suggested a leak from the bowel and the child died a few days later. Another surgical whistleblower tried to get both cases properly investigated but thus far without success.

A subsequent Royal College of Surgeons (RCS) visit registered ‘incomprehensible failure’ at the lack of proper investigation, but this was excised from the publicized report along with anonymous cases of suboptimal

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The Brompton Blues

Two consultants from the Royal Brompton hospital – cardiologist and intensivist  Susannah Price and anaesthetist Sarah Trenfield – are unimpressed with MD’s criticism of their hospital for it’s expensive legal challenge to the Safe and Sustainable review of child heart surgery (Eye last).  ‘The review will lead to the closure of one of the top three paediatric (and one of the most successful) cardiac centres in the country, jeopardising the largest paediatric cystic fibrosis unit in the UK, together with the biggest adult congenital heart disease unit in the country. Such centres comprising teams with world renowned expertise and outstanding results take decades to construct, and cannot be reconfigured piecemeal elsewhere without serious damage.’

MD is unmoved.  All eleven child heart surgery centres signed up to the review on the understanding that to continue to improve the service, and avoid future scandals, surgery should be concentrated in fewer, larger units with the appropriate staffing, expertise, throughput, resources, training and ability to expand.  This would not mean a cut in services, but some teams transferring to a different site, which in London would only be a short distance away.

During consultation,  75% of respondents supported the proposal that

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Unhappy Anniversary

It’s now twenty years since the Eye broke the story of the Bristol heart scandal (Eye May 8, 1992). It took seven years to get a public inquiry which, in 2001, declared that 30-35 more children under one year died from open heart surgery in Bristol between 1984 and 1995 than at other comparable units. A similar number were left severely brain damaged. The overriding conclusion was that to make the service safe, complex child heart surgery has to be concentrated into fewer, larger units with the appropriate staffing, expertise, resources, audit and training – and the crucial ability to expand. Twenty years later, we’re still waiting.

We have, however, had a further scandal in a small unit (Oxford), an estimation of another 78 ‘excess deaths’ spread over four units in eight years, two expert reviews calling for a reduction in the number of centres and the clinical director of the NHS – Sir Bruce Keogh (himself a cardiac surgeon) –declaring that ‘failure to reconfigure child heart surgery will be a stain on the soul of the specialty and will compromise the treatment of the most vulnerable members of the next generation.’ (Eye 20.1.10)

So why the delay?

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