Children’s heart surgery might restart at Leeds next week

BMJ 2013; 346 doi: (Published 05 April 2013) Cite this as: BMJ 2013;346:f2204
  1. Clare Dyer
  1. 1BMJ

Children’s cardiac surgery at Leeds General Infirmary may resume the week beginning 8 April if a full analysis of data and a review by independent expert clinicians over the weekend indicate that the service is safe.

A joint statement from Leeds Teaching Hospitals NHS Trust and NHS England said that agreement was reached on 4 April “to work together to restart surgery on the site early next week subject to independent assurance of concerns raised.”

The announcement follows a “risk summit” including representatives of the trust, NHS England, the NHS Trust Development Authority, and the Care Quality Commission. All the agencies “will work together to provide sufficient assurance to all interested parties that this service is safe and can therefore re-open next week,” the statement said.

Surgery was halted at the unit on 28 March after a visit to the trust by Bruce Keogh, medical director for NHS England, and representatives of the Care Quality Commission. Keogh later told the BBC that he took action after hearing a “constellation” of concerns, including preliminary data seeming to show a mortality rate twice as high as other units.1

Other concerns were around staffing—with one surgeon having stopped operating amid questions over his outcomes and a senior surgeon on holiday, two “relatively junior” locum surgeons were holding the fort—and an alleged reluctance, which the trust denies, to refer complex cases elsewhere. Health secretary Jeremy Hunt has backed Keogh’s intervention.

A trust spokesman told the BMJ, “We are still providing data so the work hasn’t been completed.” He said that the surgeon who had been on holiday had now returned.

The Leeds unit was one of three earmarked for closure as a result of the Safe and Sustainable review, an exercise to concentrate children’s heart surgery in fewer, larger centres. But the day before Keogh’s intervention, the Leeds campaign group “Save our Surgery” won a High Court ruling quashing the closure decision and requiring part of the consultation to be carried out again.

Ian Dalton, deputy chief executive of NHS England, told BBC Radio 4’s World at One programme on 5 April that the trust had presented new data at the risk summit about outcomes, staffing, and quality of care. “The conclusion was that that was very positive,” he said.

Over the weekend, independent expert clinicians would visit the unit, look at the mortality data, and speak to staff, he added. If those further probes indicated that the quality of care was such as NHS patients had a right to expect, then surgery could restart.

The Safe and Sustainable review did not focus on the outcomes of surgery at the units, in the absence of an accepted method of adjusting for case mix. A pilot of a new model for units to monitor their own surgical outcomes in real time, taking account of surgical procedure, diagnosis, age, weight and comorbidity, was published online in the journal Heart on 4 April.2


Cite this as: BMJ 2013;346:f2204