In 2001, a public inquiry into the deaths of dozens of babies at Bristol Royal Infirmary said cardiac units should be barred from carrying out paediatric surgery unless they met safety standards, including carrying out a minimum number of operations per year.
The recommendation to ensure surgery was only carried out by those skilled enough to perform the most delicate procedures was made to prevent the recurrence of a scandal such as Bristol – dubbed “the killing fields” in the 1990s.
Later this month, the Department of Health (DoH) will say no unit will be allowed to operate unless it has four surgeons and carries out at least 400 operations a year.
The ruling will mean around half of Britain’s 11 child heart surgery units must close, while the remainder expand.
It means departments such as that at John Radcliffe Hospital, which suspended surgery last week following four deaths, and carried out just 100 operations in the last year, could not continue in their current form.
Today we reveal how:
- Ministers dismissed a warning in 2003 by the UK’s most senior heart surgeon that half of Britain’s units should be closed. As President of the Society for Cardiothoracic Surgeons (SCTS) of Great Britain and Ireland, Prof James Monro was commissioned by ministers to propose changes following the Bristol inquiry, yet “the Government did absolutely nothing” about his key demand, he told The Sunday Telegraph;
- Sir Bruce Keogh, medical director of the health service, told NHS bosses two years ago that he feared “another Bristol” tragedy because specialists were so thinly spread;
- The consultant told this newspaper “there has been frankly little progress” reorganising services to make them safer since the public inquiry reported in 2001. Sir Bruce recently told colleagues that failing to make changes now would leave “a stain on the soul” of his profession.
- Britain’s leading children’s heart charity says Labour ministers “ran scared” from introducing an overhaul of the specialist system which could have saved lives, and prevented major disabilities.
The public inquiry into the Bristol heart deaths scandal was the most damning in the history of the NHS.
It said botched heart operations killed 30 to 35 babies between 1990 and 1995, while over a longer period, up to 170 babies died who might have been saved elsewhere.
Sir Ian Kennedy, the inquiry’s chairman, ordered a reorganisation of services to improve safety, with each unit carrying out a specified minimum number of operations.
The DoH asked Prof James Monro, then President of the Society for Cardiothoracic Surgeons, to carry out a review, which in 2003 said the figure should be set at 300 operations annually – meaning the closure of at least half of the centres.
Prof Monro told The Sunday Telegraph: “That was our main recommendation and the Government did absolutely nothing about it at all. Not a single unit was closed, and many of them should have closed years ago”.
The surgeon, now retired, said he thought it was “extraordinary” that the whole process was being started again now, years after the recommendations were shelved.
Prof Monro said he never received an explanation for the rejection of his report, but said “politicians had their fingers in the pie” and were fearful of making changes which might upset local constituencies.
In 2003, Stephen Ladyman, the then-health minister, dismissed the recommendation claiming the report contained “no evidence” to justify such closures, despite its inclusion of studies showing higher mortality at small units.
Four years later, Sir Bruce Keogh, then President of the SCTS wrote to health service bosses, expressing concerns about the current and future safety of Britain’s paediatric cardiac units.
He wrote the letter because he feared several units had become perilously short-staffed.
Sir Bruce told this newspaper: “A number of surgeons had retired or stopped doing paediatric work, and I was worried things were looking a bit unstable.
“In short, I was worried about the risk of another ‘Bristol’, and I felt anxious that we had a situation where two or three units were working single-handed.”
Months after sending the letter, he was appointed NHS medical director, and ordered an urgent review of the service, which will result in a blueprint for children’s heart surgery, to be published later this month.
The document will say each service should carry out at least 400 and ideally 500 operations a year, and have 4 surgeons, so it can provide safe around-the-clock cover and perform a larger range of complex procedures.
As a result, about half of England’s 11 centres will be earmarked to close.
Sir Bruce was so fearful of an immediate crisis in cardiac care that in a letter seen by this newspaper, and sent in May 2008, he warned the head of NHS specialist services to draw up a “risk strategy” in case immediate problems emerged before the reorganisation could be carried out.
The letter followed his explicit warning to the NHS management board that “another Bristol” could emerge in the foreseeable future.
Anne Keatley-Clarke, chief executive of the Children’s Heart Federation, said families who had experienced the trauma of high-risk surgery were furious that politicians had delayed changes which could have saved lives.
“Parents who know about heart surgery are hugely angry and frustrated about this. The clinicians were ready to do this a long time ago, the parents expected it; we think the politicians ran scared and blocked it,” Mrs Keatley-Clarke said.
She added: “We will never know how many children these delays have affected; whether that is in terms of needless deaths, or more children ending up with learning disabilities because they suffered neurological damage which could have been avoided.”
Sir Bruce said there had been “frankly little progress” to make the changes since Kennedy reported in 2001, but said it was “too easy” to blame politicians given the likelihood of fierce constituency battles once the names of the units to close become public.
He urged fellow surgeons to show leadership, and support changes even if it meant uprooting themselves and moving hundreds of miles to a different unit. Any more delays would create “a stain on the soul” of his profession, he said.
The largest units at Great Ormond Street and Royal Brompton Hospital in London, and Birmingham Children’s Hospital, currently carry out more than 400 operations a year, while Alder Hey Hospital in Liverpool and Evelina Hospital, part of Guys and St Thomas’ Foundation trust in London carry out around 350.
The threat of closure looms largest over units at John Radcliffe Hospital in Oxford, which carried out just 100 operations in the last year, while hospitals in Leicester, Southampton, Newcastle, Bristol and Leeds all did less than 300.
This review will report this autumn, after considering which hospitals can best expand, and taking into account transport links for families.
However Sir Bruce indicated that the John Radcliffe, which last week suspended its service amid an investigation into the deaths of four babies operated on by surgeon Caner Salih, is at greatest threat of closure.
Sir Bruce said: “All of the judgements have yet to be taken, but the eye does fall on Oxford, given it’s got the lowest number of operations by far, and only one surgeon [since the departure of Salih]”.
Yesterday grieving mother Aida Lo, 29, from Oxford, spoke of her shock and anger at finding out that the death of her daughter, three-week old Nathalie, was one of four cases in less than three months which will form part of the inquiry announced last week.
The hospital said Mr Salih, who started work at the hospital just three months ago, has left the hospital to work elsewhere. A spokesman said his departure was not connected to the investigation.
Sir Ian, who headed the public inquiry into the Bristol deaths, has recently been appointed to run the Government panel which will decide which paediatric cardiac units can stay open.
Asked about the delay of almost a decade since he made his recommendations, he said only: “I did my bit – it was for others to take action.
“Obviously I made the recommendation in the expectation action will be taken; I look forward to that happening.”
The DoH said it had been monitoring children’s heart surgery closely, and that to date, all units were providing acceptable results.