Suspension of paediatric heart surgery in Leeds provokes controversy

Children’s heart surgery at Leeds General Infirmary was suspended last week on the day after campaigners won a High Court ruling quashing a decision to close the unit as part of a plan to concentrate services in fewer, larger, and more specialised units.

Surgery at the Leeds unit was put on hold pending an internal review, after the NHS’s medical director, Bruce Keogh, visited Leeds Teaching Hospitals NHS Trust on Thursday 28 March, along with representatives of the Care Quality Commission.

Keogh acknowledged that the timing of his intervention looked suspicious, coming only the day after Leeds campaigners won a High Court ruling that the “Safe and Sustainable” review would have to redo part of the process leading to its decision to close the Leeds unit and two others.1

But he told BBC Radio 4’s Today news programme that he could not refrain from taking action just because the timing was embarrassing. He had been telephoned on Tuesday by two “highly respectable, temperate” surgeons from outside Leeds, one alleging that the Leeds unit was refusing to refer complex cases elsewhere and the other raising concerns about staffing levels. Both had begun by saying that “they had to speak out.”

These were followed by a phone call on Wednesday from an “extremely agitated senior cardiologist” who had a preliminary report of mortality data showing that the Leeds figures for 2010-11 and 2011-12 were “considerably higher than any other unit in the country,” he added.

Keogh’s intervention sparked a war of words in the media. A local MP called for his resignation, and John Gibbs, chairman of the paediatric cardiac clinical audit, which supplied the mortality data, was quoted as saying that he was “furious” that the figures had been used, because they were in the very early stages and not robust enough to be released.

The next day Roger Boyle, director of the National Institute of Clinical Outcomes Research at University College London, defended Keogh on the BBC Breakfast television programme, saying that he had advised suspension of surgery at the unit himself. “I was aware last weekend of other concerns being raised about Leeds—concerns raised by distinguished surgeons who don’t work in the area, concerns raised by families through the Children’s Heart Federation that they weren’t being given the opportunity to be transferred to other units when they’d requested that,” he said.

“And I was also aware that a senior surgeon was away on holiday, another surgeon was suspended, and that left the service being offered to the public by two relatively junior locum surgeons. To have two relatively inexperienced people holding the fort without the ability for any senior advice is a precarious situation, in my view.”

But Elspeth Brown, a consultant cardiologist at the hospital, told the BBC that the mortality figures were wrong and incomplete. She added that the two locum consultants had been in their posts for six months and that, although they were relatively junior in terms of their consultant career, “they are both very experienced surgeons, and I have no concerns about them whatsoever.”

Brian Jarman, head of the Dr Foster Intelligence Unit, which produces standardised mortality ratios, told the Independent on Sunday newspaper that the Leeds mortality figures were “a little high” but not significantly higher than those of other units.

Maggie Boyle, chief executive of Leeds Teaching Hospitals NHS Trust, said, “The trust has agreed to carry out an internal review independently validated and supported by external experts. We have taken the decision to temporarily pause children’s cardiac surgery and associated interventions while this review is conducted, a process we would aim to complete in around three weeks.”