Paper confirms poor quality of paediatric heart surgery at Bristol during 1991–5

EDITOR—Spiegelhalter's paper represents further statistical evidence confirming the poor quality of paediatric open heart surgery at Bristol Royal Infirmary during 1991-5.1 It finally lays to rest the argument that the low number of operations was the only contributory factor to the high death rates.2 Spiegelhalter confirms that low numbers contributed to between 12% and 17% of the excess mortality observed at Bristol Royal Infirmary. When his findings are coupled with an article confirming that Bristol was an outlier in terms of its performance as a paediatric cardiac surgical centre at this time, the justification for attempting to obtain a review of the service seems incontrovertible.3

The conclusions of the Hunter/de Leval inquiry are difficult to understand in this context unless there was some interference in the processes of the inquiry by the management of Bristol Royal Infirmary, as there was in the publication of favourable articles in the BMJ …