Annex A > Chapter 11 - Referrals > Referrals to Bristol from South Wales > Evidence of the actual pattern of referrals from South Wales
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Evidence of the actual pattern of referrals from South Wales
176 Dr Jordan confirmed that, in a number of places in Wales, Dr Hallidie-Smith had conducted clinics from the Hammersmith Hospital and that on her retirement Bristol took over a number of her clinics. He said: `I think particularly one that I dealt with in the East Glamorgan General Hospital'. [185] As to the clinics run by Dr Leslie Davies, he said that Bristol started to pick up some of his work `before Dr Davies' death, because what there was of paediatric cardiac surgery at that time in Cardiff had stopped before then'. [186]
177 Dr Agarwal [187] told the Inquiry:
`When I joined Swansea in 1976, the paediatric cardiac service was far from satisfactory. Children with cardiac problems were either referred to Cardiff or hospitals in London ... The follow-up of these children locally was often lost. Initially I persuaded Professor Muir and later Dr LG Davies from Cardiff to hold joint cardiac clinics with us in Swansea but because of lack of neonatal cardiac surgery in Cardiff, the situation was still not satisfactory.'
Dr Agarwal went on to explain how, in 1982 or 1983 at the suggestion of a colleague, he transferred a premature infant to the BRHSC. He said:
`Until this time, to my knowledge no paediatric cardiac patients had been sent to Bristol, however from this time onwards myself and my colleagues in Swansea started to send children ... to Bristol cardiologists. ... After the death of Dr LG Davies ... I persuaded Dr Hyam Joffe ... to hold regular clinics with us in Swansea starting some time in 1986.' [188]
178 Dr Dewi Evans, [189] who was appointed at Swansea in 1980, did alter his referral pattern when the Cardiff unit became operational in 1991. He told the Inquiry:
`... the services in Swansea were very ad hoc at that time [in 1980]. I arranged a link with the Hammersmith Hospital, with the late Dr Hallidie-Smith. As she came up to retirement I established links with Dr Hyam Joffe in Bristol. ... about 1985 I transferred my allegiance to the cardiac team in Cardiff when it was formed in 1991.'
Dr Evans said that whilst Dr Agarwal continued to refer all his patients to Dr Joffe until his retirement, Dr Evans began to refer to Cardiff `for reasons of expediency and practicality'.
179 Dr Palit of Haverfordwest [190] started to refer to Bristol when Dr Davies died. The reason for choosing Bristol was geographic. Dr Palit told the Inquiry that he `started a joint clinic in paediatric cardiology with the late Dr LG Davies from Cardiff, who used to visit Dyfed periodically ... he would then refer the patients further away for surgery ... [The] decision to send our children to Bristol was very easy because there was no other centre nearby us, who could give us a regular service.' After the death of Dr Davies, Dr Palit approached Dr Jordan and then had `no cause to refer children with heart problems elsewhere' until Dr Jordan retired.
180 However, Dr Palit's colleague, Dr G Vas Falcao, [191] told the Inquiry that `During this period all paediatric cardiac problems from Pembrokeshire were referred to the paediatric cardiac unit at University Hospital of Wales'.
181 Dr I Hodges [192] explained that in Mid Glamorgan, children's cardiological services were, at the beginning of the period of the Inquiry's Terms of Reference, provided by Dr Hallidie-Smith. Subsequently, referrals were to Dr Jordan until his retirement, and then to Cardiff.
182 Dr Hodges' colleague, Dr J Morgan, said that when he started practice in 1981 `children with cardiac problems were referred to the Hammersmith Hospital in London. Dr K Hallidie-Smith came down to Wales three times a year.' Any child needing ultrasound had to go to London, and any surgery was carried out at Hammersmith or Great Ormond Street.
183 Dr Morgan's evidence was that by 1989:
`... there were difficulties with continuing this service and negotiations between Bristol and Mid Glamorgan Health Authority resulted in cardiac services both medical and surgical being transferred to Bristol. ... The service that was then established from Bristol consisted of a very senior paediatric cardiologist, Dr Stephen Jordan who came to our hospital on a much more frequent basis. He was able to perform ultrasound cardiac scans as part of his clinic with us and this was very much appreciated by parents as they no longer had to go up to London for this investigation. ... When Dr Jordan retired, a cardiac service was being developed in Cardiff and the care of our patients were transferred to this service ...' [193]
184 Dr A Griffiths [194] of Abergavenny was appointed in 1969. He told the Inquiry:
`... initially our cardiac patients were referred to the teaching centre at Cardiff. In those days there was no paediatric cardiologist on the staff but the children were referred to Dr Leslie Davies who was an adult cardiologist. From the surgical point of view however this service became gradually more unacceptable, children being left on the waiting list for very long periods of time and eventually Dr Davies retired. ... therefore we contacted the Bristol team and their paediatric cardiologists would come out and run a combined cardiac clinic with us. ... The service for children with cardiac problems improved dramatically.'
185 This was confirmed by Dr Griffiths' colleague Dr T Williams [195] who was appointed in 1986, and who told the Inquiry:
`... in 1986 we had an inadequate service from Cardiff. We made contact with Bristol and have continued with their support since that time. Establishing the service led to a considerable improvement in the quality of care given to our local children...' [196]
186 Dr Edwards [197] said that from 1979 he referred to the Hammersmith and
Dr Hallidie-Smith:
`When Dr Hallidie-Smith retired in mid 1980s there was still not a fully functioning cardiac unit at Cardiff. ... We were also aware of the fact that peripheral clinics had been established from Bristol, mainly by Dr Jordan, in many hospitals in South Wales, with Consultant General Paediatricians being very pleased with the level of service that they were receiving, both from the local clinics and from Bristol itself. For these two reasons therefore ... we decided to link in with Bristol and established a pattern whereby bi-monthly clinics were held locally...'
187 His colleague, Dr Trefor Jones, [198] provided the Inquiry with a copy of a report prepared by him and Dr Edwards and Dr A Goodwin in November 1996 [199], confirming that they had referred to Dr Hallidie-Smith until her retirement, and thereafter to Dr Joffe, and then to Dr Martin.
188 Dr Ferguson [200] wrote:
`I don't recall referring any patients with heart problems to centres other than BRI again for the reason that the referrals were always invariably made through the visiting cardiologist, Dr Steve Jordan, who was based there.' [201]
189 Not all paediatricians who changed their referral pattern from Bristol to Cardiff as a result of the establishment of the unit in Cardiff or the later retirement of Dr Jordan were entirely happy to do so.
190 Dr Prosser [202] told the Inquiry:
`... from the opening of the first Severn Bridge in 1966, with the support of Dr LG Davies, Cardiologist at the University Hospital Wales, we started referring neonates and other small infants to paediatric cardiology services in Bristol. This was done because of the proximity of the Unit to the Royal Gwent and that as far as we were able to ascertain the services there were equal to those of other centres in the UK. ... Following the death of Dr Davies we decided to ask Dr S Jordan to take over our monthly paediatric cardiology clinic ... and our association with Bristol was strengthened. ... Even with the establishment of the Paediatric Cardiology Unit in Cardiff in 1990 or thereabouts I and my colleagues were reluctant to give up our association with Bristol and were more or less forced to do so by the financial constraints imposed on us by the Welsh Office.'
191 Dr Maguire [203] spoke of a change in the pattern in 1993:
`We changed our cardiac services from Bristol to UHW on the basis of a desire by Welsh Office to have the Welsh units using the newly developed paediatric cardiac services in Cardiff ...'
192 Dr Cawdrey [204] commented on the situation following the death of Dr Davies, who had previously carried out a clinic at the Royal Gwent Hospital. Dr Cawdrey wrote:
`Dr Steve Jordan started a regular clinic with us from that time. ... Therefore, from this time, all children and babies with heart problems were seen by Dr Jordan and consequently most if not all of those requiring surgery received this in Bristol. In 1991, a full paediatric cardiology and cardiac surgery service was established in Cardiff. As we understood at the time the reasons for doing this were largely "political". It was felt that establishing such a service would enhance general cardiology training in Cardiff, but there was also considerable public pressure to establish a unit in Wales so that children in Wales would no longer need to travel "abroad" for their treatment! We in Newport saw no reason to change our arrangements immediately and continued to use Bristol until the spring of 1993, when Dr Jordan retired, and we thought it opportune and more convenient to switch to Cardiff for paediatric cardiology and paediatric cardiac surgery ...'
193 Dr Jordan commented on the letter:
`I think Dr Cawdrey at that time was Chairman or President of the Welsh Paediatric Association and they were the people who had - well, some of them had at least supported the idea of having a new unit in Cardiff. We discussed this. I think he admitted to a certain amount of embarrassment that he was still sending his patients to Bristol when in theory the body of which he was the Chairman or the President had apparently supported the establishment in Cardiff.' [205]
194 Dr J Matthes, [206] however, told the Inquiry that she had been a senior registrar in Cardiff and, on appointment as consultant in 1993, wished to transfer the list that she inherited to Cardiff. She said that Dr Joffe `resisted this ... I was told that the Bristol cardiologists felt that it was not in the patients' interests to transfer them to Cardiff as some of them had quite complex conditions. At no time was it ever intimated to me that there might be poorer results with the surgery at Bristol than at other centres.' Her patients continued to be treated in Bristol.
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Footnotes
[187] Consultant paediatrician, Singleton Hospital, Swansea
[188] REF 0001 0085; letter from Dr Agarwal
[189] Consultant paediatrician, Singleton Hospital, Swansea, REF 0001 0087 - 0088
[190] Consultant paediatrician, Withybush General Hospital, Haverfordwest, REF 0001 0092 - 0093
[191] Consultant paediatrician, Withybush General Hospital, Haverfordwest, REF 0001 0094
[192] Consultant paediatrician, East Glamorgan General Hospital, Mid Glamorgan, REF 0001 0096 - 0097
[193] REF 0001 0136 - 0137 ; letter from Dr Morgan
[194] Consultant paediatrician, Nevill Hall Hospital, Abergavenny, REF 0001 0128 - 0129
[195] Consultant paediatrician, Nevill Hall Hospital, Abergavenny, REF 0001 0133
[196] REF 0001 0133; letter from Dr Williams
[197] Consultant paediatrician, Princess of Wales Hospital, Bridgend, REF 0001 0108
[198] Consultant paediatrician, Princess of Wales Hospital, Bridgend, REF 0001 0114 - 0115
[199] REF 0001 0116 - 0121 ; `A Review of the Provision of Paediatric Cardiology at Bridgend', dated November 1996
[200] Consultant paediatrician, Royal Gwent Hospital, Newport, REF 0001 0126 - 0127
[201] REF 0001 0126; letter from Dr Ferguson
[202] Consultant paediatrician, formerly at Royal Gwent Hospital, Newport, REF 0001 0131 - 0132
[203] Consultant paediatrician, Royal Gwent Hospital, Newport, REF 0001 0130
[204] Consultant paediatrician, Royal Gwent Hospital, Newport, REF 0001 0123
[206] Clinical Director, Paediatrics, Singleton Hospital, Swansea, REF 0001 0090