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Newcastle heart surgeons ‘damaged trust’ by stoking Leeds safety fears Newcastle heart surgeons ‘damaged trust’ by stoking Leeds safety fears
(about 3 hours later)
The final reports from a lengthy investigation into children’s heart surgery in Leeds have criticised doctors at a rival centre in Newcastle, who cast doubt on the quality and safety of the Leeds service at a time when one or the other was likely to face closure. The final report from a lengthy investigation into children’s heart surgery in Leeds has criticised doctors at a rival centre in Newcastle, who cast doubt on the quality and safety of the Leeds service at a time when one or the other was likely to face closure.
Verita, an independent investigation agency, was called in to carry out the final reviews of the children’s heart unit at Leeds General infirmary, which was the subject of a prolonged and angry battle between parents and NHS England after data appeared to show that death rates among babies born with heart defects who needed complex surgery were higher than they should be. Surgery was temporarily suspended while investigations began. Verita, an independent investigative agency, carried out the final reviews of the children’s heart unit at Leeds General infirmary, which was the subject of a prolonged and angry battle between parents and NHS England after data appeared to show that death rates among babies born with heart defects who needed complex surgery were higher than they should be. Surgery was suspended while investigations took place.
Among the causes for alarm were comments by heart surgeons at Newcastle’s Freeman hospital. Both hospitals had been extensively reviewed as part of an attempt to rationalise children’s heart surgery in England and ensure surgeons operated on enough patients to remain expert in the difficult operations. Leeds was fighting against the closure of its unit – which would have meant most patients went to Newcastle instead, ensuring its survival. Among the causes for alarm were comments by heart surgeons at Newcastle’s Freeman hospital. Both hospitals had been extensively reviewed as part of an attempt to rationalise children’s heart surgery in England and ensure surgeons operated on enough patients to retain expertise. Leeds was fighting the closure of its unit – which would have meant most patients went to Newcastle instead, ensuring its survival.
The Leeds parents and clinicians, who fought to keep their unit open, said the Verita reports provided the balanced investigation they had been looking for. In March 2013, NHS England medical director Sir Bruce Keogh was alerted to some Leeds data that suggested death rates were unacceptably high. Later it became clear the data was incomplete and there was not a problem. But Keogh also got a call from Asif Hasan, the senior paediatric cardiac surgeon at Newcastle, who “told him that he was very worried about Leeds, who he said were referring patients they should not be referring and not doing the right operations on patients,” says the report.
“Verita’s analysis makes clear that many of the claims and accusations that led to the suspension of surgery and the subsequent unbearable scrutiny of the Leeds unit were unfounded or incorrect, and in some cases were made due to vested interests,” said Sharon Cheng, chief executive of the Children’s Heart Surgery Fund. Later Sir Leonard Fenwick, chief executive of the Newcastle Trust, sent a dossier of 14 former Leeds cases that he said were cause for concern. But the report found the complaints were largely those of families, not doctors. There had been a “single, troubling event”, says the report, that had caused Newcastle to look for problems over the previous year. “They compressed the period of their concerns in a way that put Leeds in an unfairly poor light, even if all the concerns had been substantiated.” .
“We understand the need to act on any concerns about healthcare provision in the UK. However, the need for swift action should not negate the processes designed to ensure that concerns are valid and safeguard patients. We believe that NHS England has put new processes in place to ensure that this type of action, which is so damaging to patient and staff confidence, never happens again. We would ask them to ensure that these processes are followed, without exception.” Children’s heart surgery is a small and specialised field, where the surgeons know and train each other. But with the threat of closures of some of the units, relations soured between Leeds and Newcastle. “The depth of antipathy was … evident when we spoke to a group of Newcastle consultants and the chief executive of the trust, Sir Leonard Fenwick. One told us, without challenge from colleagues, that if it came to choosing between what parents had told Newcastle and what the Leeds notes revealed, he would doubt the accuracy of the Leeds notes,” says the report.
The report suggests the reorganisation process, called the Safe and Sustainable review, had caused bad feeling, she added. “This report concludes that the Safe & Sustainable cardiac review pitted units against each other and created a climate of fear and uncertainty. The whole sad affair of the last 18 months has been a symptom of this. Newcastle upon Tyne NHS foundation trust said it had exercised freedom and a responsibility to patients and the NHS to fulfil the duty of candour in speaking out over what it believed was poor practice.
The Leeds parents and clinicians, who fought to keep their unit open, welcomed the Verita report. Sharon Cheng, chief executive of the Children’s Heart Surgery Fund, said: “Verita’s analysis makes clear that many of the claims and accusations that led to the suspension of surgery and the subsequent unbearable scrutiny of the Leeds unit were unfounded or incorrect, and in some cases were made due to vested interests.
“We understand the need to act on any concerns about healthcare provision in the UK. However, the need for swift action should not negate the processes designed to ensure that concerns are valid and safeguard patients,” she said. “This report concludes that the Safe & Sustainable cardiac review pitted units against each other and created a climate of fear and uncertainty. The whole sad affair of the last 18 months has been a symptom of this.
“Verita recommends that current or future reviews actively seek the input of all relevant stakeholders, notably families and their representatives. We support this wholeheartedly and would ask that the new review go to every length to comply with this recommendation.”“Verita recommends that current or future reviews actively seek the input of all relevant stakeholders, notably families and their representatives. We support this wholeheartedly and would ask that the new review go to every length to comply with this recommendation.”
NHS England said the Leeds service was now shown to be safe and had improved under scrutiny. “Patients should be reassured that this service has been rigorously scrutinised and has improved as a result,” said NHS England’s deputy medical director, Dr Mike Bewick. “Patients and the public can have confidence that this is a well-run unit and is now in a position to go from strength to strength. NHS England said the Leeds service had been shown to be safe and had improved under scrutiny. “Patients should be reassured that this service has been rigorously scrutinised and has improved as a result,” said NHS England’s deputy medical director, Dr Mike Bewick. “Patients and the public can have confidence that this is a well-run unit and is now in a position to go from strength to strength.
“Not only have we learned about service in Leeds, we have learned lessons of relevance nationally. We are currently consulting on new standards for children’s heart surgery across the country and the review in Leeds has made a significant contribution.“Not only have we learned about service in Leeds, we have learned lessons of relevance nationally. We are currently consulting on new standards for children’s heart surgery across the country and the review in Leeds has made a significant contribution.
“This thorough process would not have been possible without the full cooperation and participation of patients, families and clinicians. Reliving painful events or opening oneself up to public scrutiny is not easy. This review has been characterised by the willingness of individuals and organisations to do just that.”“This thorough process would not have been possible without the full cooperation and participation of patients, families and clinicians. Reliving painful events or opening oneself up to public scrutiny is not easy. This review has been characterised by the willingness of individuals and organisations to do just that.”