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May 7, 2012

Medicine Balls, Private Eye, Issue 1313
Filed under: Private Eye — Dr. Phil @ 8:15 pm

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? Politicians rarely show strategic leadership in the NHS, particularly when it necessitates the closure or down-grading of a specialist unit in their constituency. There are currently around 30 consultant heart surgeons who operate on children spread across 11 surgical centres in England. The latest review, Safe and Sustainable, is overseen by a Department of Health-mandated organisation called the Joint Committee of Primary Care Trusts (JCPCT). It managed to get all 11 centres to sign up to a process that was highly likely to recommend a reduction in the number of centres. After the most exhaustive and transparent consultation in NHS history, options were proposed for future centres which the Royal Brompton and Harefield trust didn’t like. Last year, it derailed the review by getting the process of choosing centres quashed, with the judge ruling the assessment had not taken proper account of the London hospital’s research strengths.


For good measure, the Brompton also threw in allegations of bias and impropriety against specialist advisers to the JCPCT who are connected with Great Ormond Street Hospital, the Evelina Children’s Hospital and Southampton General Hospital. The JCPCT appealed against the judicial review finding, and on April 19th three Court of Appeal judges ruled that the Safe and Sustainable process for the public consultation was fair, lawful and proper, and dismissed as unfounded all of the allegations raised by the Royal Brompton Hospital. In the meantime, the Brompton has blown at least £1.5 million on legal fees that should have gone on patient care, and the process of making child heart surgery safe has been delayed for another year.


Stephen Bolsin, the cardiac anaesthetist who sacrificed his NHS career by blowing the whistle in Bristol, would doubtless be horrified that the culture of infighting, commercial interest and misguided institutional loyalty that blighted Bristol twenty years ago is still prevalent in the NHS now, and that babies undergoing complex heart surgery are still suffering ad a result. Professor Bolsin is flying in from Australia speak to the Patient Safety Congress on May 29th in Birmingham. As Professor Bolsin puts it: ‘Improved ethical behaviour in health and social care is mandated by professional and managerial failings such as Bristol, Mid Staffs, North Staffs and ‘Baby P’. The benefit is a significant quantifiable cost saving amounting to billions of pounds each year.’ As the Royal Brompton has proved, litigation is a very expensive and harmful substitute for proper consultation.