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| Leading hospital under CQC scrutiny over high heart surgery death rate | Leading hospital under CQC scrutiny over high heart surgery death rate |
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| One of the country’s best-known hospitals has been told to report weekly to inspectors on the results of its adult heart operations after it was discovered too many of its patients were dying during and after treatment. | One of the country’s best-known hospitals has been told to report weekly to inspectors on the results of its adult heart operations after it was discovered too many of its patients were dying during and after treatment. |
| The Guardian can reveal that the Care Quality Commission (CQC) visited the Queen Elizabeth hospital, Birmingham before Christmas after it was alerted to the high death rate in open-heart surgery. Calculations by the Guardian suggest that 17 people may have died over the last three years who should have survived. | |
| Related: The history of heart surgery failures: tragedies born of arrogance not malpractice | Related: The history of heart surgery failures: tragedies born of arrogance not malpractice |
| The CQC team, including two heart surgeons from other hospitals, considered closing down the unit responsible for the operations following their inspections but chose instead to require weekly reports. University hospitals Birmingham NHS foundation trust (UHB) now reports its heart surgery results to the CQC by midday every Wednesday. An independent team led by members of the Royal College of Surgeons is conducting a review to determine what improvements are needed. | The CQC team, including two heart surgeons from other hospitals, considered closing down the unit responsible for the operations following their inspections but chose instead to require weekly reports. University hospitals Birmingham NHS foundation trust (UHB) now reports its heart surgery results to the CQC by midday every Wednesday. An independent team led by members of the Royal College of Surgeons is conducting a review to determine what improvements are needed. |
| The hospital has not indicated to patients that there are problems, while the CQC has not yet published its report nearly two months after its inspection and the public is unaware of any potential risk. | The hospital has not indicated to patients that there are problems, while the CQC has not yet published its report nearly two months after its inspection and the public is unaware of any potential risk. |
| Prof Sir Mike Richards, the chief inspector of hospitals at the CQC, said that the full report on heart surgery at the Queen Elizabeth hospital would be published shortly. “Our inspectors found significant concerns particularly with regard to the safety, effectiveness and responsiveness of the service,” he said. | |
| “Following our inspection we have told the trust to take immediate action, with regard to the service and have been monitoring individual patient safety and outcome data on a weekly basis.” | “Following our inspection we have told the trust to take immediate action, with regard to the service and have been monitoring individual patient safety and outcome data on a weekly basis.” |
| Data posted on the Society for Cardiothoracic Surgeons’ website last September – the most recent available – shows the hospital is what is known as a “red outlier”, with death rates substantially outside an acceptable range, over the last three years from April 2011 to March 2014. | Data posted on the Society for Cardiothoracic Surgeons’ website last September – the most recent available – shows the hospital is what is known as a “red outlier”, with death rates substantially outside an acceptable range, over the last three years from April 2011 to March 2014. |
| The published data shows that in those three years, the unit has operated on 1,713 patients. The survival rate, when adjusted for the risk of dying because of factors such as the patient’s age and state of health, is 95.54%. That means, of those who had surgery, 77 people died. If the survival rate had been at the bottom of the range deemed acceptable, 60 people would have died, which suggests that 17 Birmingham patients should have survived the operation who did not. | The published data shows that in those three years, the unit has operated on 1,713 patients. The survival rate, when adjusted for the risk of dying because of factors such as the patient’s age and state of health, is 95.54%. That means, of those who had surgery, 77 people died. If the survival rate had been at the bottom of the range deemed acceptable, 60 people would have died, which suggests that 17 Birmingham patients should have survived the operation who did not. |
| Over the last five months, the data has prompted a behind-the-scenes row between university hospitals Birmingham NHS foundation trust, the watchdog Healthcare Quality Improvement Partnership (HQIP) and the CQC. | Over the last five months, the data has prompted a behind-the-scenes row between university hospitals Birmingham NHS foundation trust, the watchdog Healthcare Quality Improvement Partnership (HQIP) and the CQC. |
| The above-average death rate was drawn to the attention of the trust by the National Institute for Cardiovascular Outcomes Research (NICOR) who analyse data submitted by heart surgeons around the country. It in turn alerted HQIP, which is contracted by the Department of Health to audit and publish data on treatment outcomes including deaths in heart surgery. | |
| The trust responded by arguing that the mortality figures were misleading. It said the data included figures from Ian Wilson, a heart surgeon sacked by the hospital trust in 2013 for allegedly fraudulently altering mortality data to make it look better. He is currently facing a General Medical Council disciplinary hearing. | The trust responded by arguing that the mortality figures were misleading. It said the data included figures from Ian Wilson, a heart surgeon sacked by the hospital trust in 2013 for allegedly fraudulently altering mortality data to make it look better. He is currently facing a General Medical Council disciplinary hearing. |
| The trust also claimed that a private hospital where its surgeons also operate should be included in the mortality figures. HQIP said excluding Wilson’s data made no difference to the death rate and that the private hospital would not be included because it was not the direct responsibility of the NHS trust. | The trust also claimed that a private hospital where its surgeons also operate should be included in the mortality figures. HQIP said excluding Wilson’s data made no difference to the death rate and that the private hospital would not be included because it was not the direct responsibility of the NHS trust. |
| HQIP referred the trust to the CQC, which sent in inspectors. Prof Danny Keenan, the medical director of HQIP, said: “When it appeared the required steps for responding to concerns were not being taken by the trust, HQIP, working with the audit provider NICOR, escalated those concerns to the CQC as regulator. | |
| “As that CQC review is ongoing, HQIP do not wish to comment further until it is complete. This does however illustrate the vital role clinical audits play in allowing trusts to monitor and improve the standards of care they provide – and the vast majority do use the information in this way.” | “As that CQC review is ongoing, HQIP do not wish to comment further until it is complete. This does however illustrate the vital role clinical audits play in allowing trusts to monitor and improve the standards of care they provide – and the vast majority do use the information in this way.” |
| The trust acknowledges mortality was too high over the years 2011-14. This was “multi-factorial”, it told the Guardian. It said that there was a cluster of deaths attributable to one surgeon, which internal systems picked up in 2012 and he was suspended and later dismissed. Another senior surgeon, the clinical lead in the hospital, died in autumn 2012 and locum surgeons were taken on to cover, the trust added. | The trust acknowledges mortality was too high over the years 2011-14. This was “multi-factorial”, it told the Guardian. It said that there was a cluster of deaths attributable to one surgeon, which internal systems picked up in 2012 and he was suspended and later dismissed. Another senior surgeon, the clinical lead in the hospital, died in autumn 2012 and locum surgeons were taken on to cover, the trust added. |
| A spokesperson for the trust explained why they felt that the mortality data was not entirely representative. “The data did not include 130 NHS zero-mortality cases, carried out by our surgeons at the Priory hospital [which is private]. The data included the Ian Wilson figures.” | |
| The problems continued beyond 2012 after Wilson’s departure and the death of the clinical lead. The trust said it knew there was an issue from July last year – two months before the official data was published. | The problems continued beyond 2012 after Wilson’s departure and the death of the clinical lead. The trust said it knew there was an issue from July last year – two months before the official data was published. |
| “A group of cardiac surgeons met with the medical director at UHB to flag up concerns about the unexpected mortality rate and operational issues within the service and asked him to agree to a quality improvement programme for cardiac surgery,” the trust said in a statement. It added that the programme was already having a positive effect before the CQC intervened. | |
| The independent review by the two members of the Royal College of Surgeons at the Queen Elizabeth took place this week, the trust confirmed. “We await the findings of their report,” it said in the statement. | The independent review by the two members of the Royal College of Surgeons at the Queen Elizabeth took place this week, the trust confirmed. “We await the findings of their report,” it said in the statement. |