Annex A > Chapter 11 - Referrals > Referrals to Bristol - evidence of the actual pattern of referrals from the South West of England > Referrals from Plymouth
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Referrals from Plymouth
125 As noted above, the Bristol clinicians were aware that there were few referrals to Bristol from Plymouth. The Inquiry heard from six Plymouth paediatricians. [129] A number of factors influencing this practice emerged from their letters.
126 Dr Perham, [130] who was appointed at Derriford Hospital in 1972, explained:
`You should know historically why Plymouth has had a different service compared to other paediatric centres within the South West peninsula. ... in 1972 the consultant paediatricians here ... had regular visits from Dr Ronald Gibson, Consultant Cardiologist from the Royal Brompton Hospital, London. Children were referred to his hospital for investigation and paediatric surgery if necessary.'
Dr Perham explained how, on the retirement of Dr Gibson, Plymouth had contact with Dr Barry Keeton who had previously been a senior registrar in paediatric cardiology at the Royal Brompton and had moved to Southampton. Dr Perham explained that:
`The [Southampton] unit offered an extremely good clinical, caring service both from the paediatric cardiology medical point of view as well as the surgical point of view. Gradually this became formalised with the team from Southampton undertaking regular joint outpatient appointments with us and these now occur every two weeks. ... We therefore had a contact with the Southampton team and very seldom would the children be referred elsewhere ...' [131]
127 Professor Sutherland was a cardiologist at Southampton General Hospital from 1983 until 1987. He told the Inquiry that at some time in 1986-1987 Dr Perham contacted his colleague Dr Barry Keeton.
128 Professor Sutherland told the Inquiry:
`[Dr Perham] expressed concern to Dr Keeton that the surgical results for complex congenital heart disease in the Bristol centre were worrying him and asked if it would be appropriate for the Southwest region to send complex cases to the surgeons in Southampton where the surgical results were documented and appeared substantially better. Dr Keeton discussed the problem with me and we decided to set up a clinical service for the Southwest region ... This involved one of us performing a monthly clinic in Plymouth General Hospital and the surgical cases who were complex being subsequently referred to Southampton General Hospital. Dr [Perham] and his other paediatric colleagues wished to continue to support the Bristol centre and continued to send their non-complex cases for surgery there.
`During 1986 I was personally contacted by Prof. A Henderson ... with regard to paediatric cardiology services in Wales. ... Prof. Henderson expressed his concerns to me about referring children from Wales to Bristol in view of the poor surgical results in that department. He suggested that it would be appropriate that I offer a service to Cardiff similar to that Dr Keeton and I were offering to Plymouth.' [132]
`Patients were referred to me from Plymouth starting soon after I was appointed to Southampton in October 1978 as the first paediatric cardiologist in the Wessex Cardiothoracic Centre. I think that, initially, this happened when the Brompton were unable to accept emergency referrals but gradually more and more of the patients came to Southampton. My diary indicates that I visited Plymouth in 1979 and although I cannot be certain precisely when the regular Plymouth clinics performed by Dr George Sutherland and myself started I was certainly visiting to do clinics in 1984 and have been going regularly since then.' [133]
130 Dr Perham referred to a meeting in the early 1980s with the members of the Bristol Unit that he thought was the result of pressures exerted on the Bristol paediatric team by its management to increase paediatric numbers. He said:
`I believe the request was management driven but there seemed to be no way that the Bristol surgical unit could cope with increased numbers, particularly from the Plymouth district.' [134]
131 Similarly, Dr A Cronin [135] referred to a long-standing relationship between Plymouth and Southampton (although he also pointed out that the Bristol cardiologists, Dr Jordan and Dr Hayes, saw some children from Plymouth).
132 Dr R Evans [136] confirmed that when she was employed by Plymouth NHS Trust in 1991 she followed the `established local practice' of referring children to Southampton.
133 Dr P Ward [137] also told the Inquiry that he followed the established Plymouth pattern of referring to Southampton.
134 Dr R Jones [138] thought highly of the Southampton service, and was `aware of [its] good results'. He told the Inquiry that he thought Bristol was unlikely to be as good. The reason he gave for thinking this was that:
`Whilst I was aware that Mr Wisheart had a good reputation, backup surgical services when he was unavailable or on leave were not entirely satisfactory.'
135 Dr C Sainsbury [139] told the Inquiry:
`I did become aware that my colleagues in Plymouth chose to refer children to Southampton as their tertiary centre, rather than Bristol. I recall being surprised by this, because of the difficult nature of the journey from Plymouth to Southampton. I do recall discussing this with my colleagues, at South Devon Healthcare Trust ... and I remember at the time we agreed the service that we were getting from Bristol seemed to be a good one and I did not see any reason to refer differently to the established practice for South Devon Healthcare.'
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Footnotes
[129] Dr H Baumer (REF 0001 0076 - 0077 ), Dr AJ Cronin (REF 0001 0078), Dr R Evans (REF 0001 0079 - 0080 ), Dr RWA Jones (REF 0001 0081 - 0082 ), Dr P Ward (REF 0001 0084) and Dr TGM Perham (REF 0001 0146 - 0148 )
[130] Consultant paediatrician, Derriford Hospital, Plymouth, REF 0001 0146
[132] REF 0001 0149; letter from Professor Sutherland
[133] REF 0001 0152; letter from Dr Keeton
[134] REF 0001 0147; letter from Dr Perham
[135] Consultant paediatrician, Scott Hospital, Plymouth, REF 0001 0078
[136] Consultant community paediatrician, Scott Hospital, Plymouth, REF 0001 0079 - 0080
[137] Consultant paediatrician, Derriford Hospital, Plymouth, REF 0001 0084
[138] Consultant paediatrician, Derriford Hospital, Plymouth, REF 0001 0082
[139] Consultant paediatrician, Torbay Hospital, Torquay, REF 0001 0066 - 0067