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NHS medical director defends his decision to pause paediatric heart surgery at Leeds

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2245 (Published 09 April 2013) Cite this as: BMJ 2013;346:f2245
  1. Clare Dyer
  1. 1BMJ

Leeds General Infirmary is to resume children’s heart surgery from 10 April, after a review team called in to investigate concerns about death rates and staffing levels pronounced it safe.

The surgery, which was stopped on 28 March after a visit from NHS England medical director Bruce Keogh, will restart gradually, beginning with low risk operations, while the review continues to explore other issues about the unit.

The first stage of the review by a multidisciplinary clinical team found that Leeds Teaching Hospitals NHS Trust’s data for monitoring surgical results were “uniquely poor, triggering concerns about death rates and gaps in information,” NHS England said. It would be asking for “significant improvement to the way the unit monitors the quality of care so it can be compared with similar services.”

Keogh told BBC Radio 4’s Today programme that the unit, for example, omitted to record the weight of the baby operated on in 35% of cases, compared with between 0% and 1.4% in other units.

Leeds was earmarked as one of three children’s heart surgery units facing closure in the “Safe and Sustainable” review, aimed at concentrating services in larger, more specialised centres. Campaigners fought a legal battle to try to keep it open, and Keogh’s intervention came just a day after a High Court judge quashed the closure decision and ordered the review to redo part of its consultation.

He was criticised by local MPs, who questioned his motives. But Stephen Bolsin, the anaesthetist whose revelations of high death rates in children’s cardiac surgery at Bristol Royal Infirmary in the early 1990s sparked a public inquiry, told the Today programme on Saturday that politicians “have to be prepared to have the blood of children on their hands” if children died.

NHS England said that it originally raised concerns about Leeds because of “preliminary data suggesting high mortality, concerns about staffing levels, whistleblowing information from clinicians and complaints from patients.”

Keogh said, “If we have learned anything from public inquiries such as Bristol and Mid Staffordshire, it is that patients were harmed while organisations argued about the veracity of data used to measure clinical results, rather than addressing the underlying issues. We would not have been forgiven if a child had died or suffered unnecessary harm while we sat on our hands.”

He added, “I want to be clear that NHS England will do everything in its power to make sure that measuring clinical outcomes will be given priority in the new NHS. Organisations cannot know they are providing effective or safe care unless they are measuring and monitoring their services.”

The second stage of the review will look at the way patients’ complaints have been handled, including concerns raised by the Children’s Heart Federation, an umbrella organisation of patient support groups. It will also complete a review of patients’ case notes over the past three years.

In addition, NHS England will “explore issues raised about referral practices to ensure they are clinically appropriate.” Some patients had alleged that clinicians were reluctant to refer patients elsewhere.

The Leeds trust’s chief executive, Maggie Boyle, said, “The review of our services found ‘no evidence of significant safety concerns in terms of governance, staffing, or the management of the patient pathway for surgical care in the unit or referral to other units as required.’ [It also found that] ‘a further analysis of paediatric surgical mortality data undertaken by NICOR (the National Institute for Cardiovascular Outcomes Research) has concluded there is not a safety problem in Leeds or in any other children’s heart surgery centre in England.’”

Notes

Cite this as: BMJ 2013;346:f2245