Annex A > Chapter 12 - Waiting Lists > Waiting lists at Bristol
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Waiting lists at Bristol
3 In the management of cases awaiting surgery, there are three categories of case for the purposes of understanding waiting lists: the emergency, the urgent and the elective. Mr James Wisheart, consultant cardiac surgeon, explained these three categories of patient:
`For some of the patients, the question of timing and the optimal timing varies. For an emergency case, the optimal timing is now. For an urgent case it will be within the next few days, a week or two. For those sort of patients, those requirements would be met, or at least, something very close to them.
`Then there are a group of patients who are not as urgent as that and who would generally be called elective, and amongst those there will be some for whom the timing is really not particularly critical and there will be others at the other end of the spectrum for whom it will not be urgent but it should probably be within - or at a particular time, plus or minus a few months.' [2]
4 This chapter sets out the evidence relating to waiting lists and waiting times for elective paediatric cardiac surgery. [3] Although the focus is on paediatric cardiac surgery, reference is also made from time to time to adult patients. This is because both Mr Wisheart and Mr Janardan Dhasmana, consultant cardiac surgeon, operated on both adults and children and because open-heart surgery could only be carried out at the BRI, [4] such that both adults and children were operated on there. Thus, the interaction between the management of adult and paediatric cases becomes relevant. The process of designating patients as emergency, urgent or elective is described elsewhere. [5] By focusing on elective patients, it should not be assumed that patients in the other categories were seen without waiting. It is merely that they were not subject to the waiting process described here.
5 Mr A Jooman [6] prepared tables for the Inquiry describing the cardiothoracic waiting list for the period 1984 to 1995 at both the BRI and the BRHSC. However, these tables are of limited value in ascertaining waiting lists in respect of paediatric cardiac surgery because he said they cannot be categorised between adults and children. [7]
6 An understanding of waiting times at Bristol within the period 1984-1995 can, however, be gained from other documents submitted to the Inquiry. But that understanding is somewhat limited, as records showing the position in regard to paediatric cardiac surgery for the entire period with which the Inquiry is concerned were not available.
7 The Inquiry heard some evidence that waiting times were around 12 months in 1987. For example, on 4 June 1987, the Secretary of the South Gwent Community Health Council (CHC) wrote to Mr J Evans at the Association of Welsh CHCs regarding a delay in operating on patients awaiting paediatric cardiac surgery:
`I thought I should let you know that I have recently had occasion to accompany two young parents from Gwent, whose 31/2 year old child died the day following cardiac surgery in Bristol last December ... The child had been referred to Bristol when a few months old and the parents had to take him to the Out-Patient clinic every 12 weeks initially. The frequency was then increased to every 6 weeks. The child was also seen by a paediatrician in Gwent every 12 weeks.
`In November 1985 the parents were told that the time had arrived for surgery to be undertaken and that it was hoped to admit the child in January or February 1986. In spite of repeated requests by the parents and several letters from the Royal Gwent Paediatrician expressing concern at the boy's condition, he was not reviewed in Bristol during this 10/11 month delay in admission. During the interview, Mr Wisheart said that the delay in admission was entirely due to the pressure of demand faced by the department and the inadequacy of resources to meet that demand. He said that it was impossible to determine whether the delay had had any serious adverse effect on the baby's prospects ...' [8]
8 Commenting on that letter Mr Wisheart said:
`I would have to make reservations about when the optimal time was and how long the optimal period might have been. I do not know who told the parents January or February 1986, but with that reservation, I would certainly agree that there were delays, significant delays, in surgery both for adults and children at that time and probably at all times during my consultant career. We were working constantly to try and change that by increasing the facility. You will have noticed that this was immediately prior to the significant expansion of the facility in 1987/88.' [9]
9 In March 1987 Mr Wisheart wrote to Dr Stephen Jordan and Dr Hyam Joffe, consultant cardiologists:
`I just want to let you know that at the present time my paediatric waiting list stands at 74 patients. This represents a good year's work but, of course, many patients will not have their operation for more than a year in view of the urgent cases who will inevitably present during that period.' [10]
10 On 2 April 1987 Mr Dhasmana wrote to Dr Joffe referring to Mr Wisheart's letter:
`... I wish to add that I have got about 30 paediatric patients on my Waiting List for routine open-heart procedures. On my present schedule I cannot operate on more than one paediatric case per week, that means already a seven and a half months Waiting List has developed. Combining these with Mr Wisheart's, our Waiting List for paediatric cases at this Centre stands at more than 100 cases. Even with the expansion, I do not foresee the possibility of operating on more than three or maximum (rarely) four cases a week without affecting the adult cardiac surgery. As we are all well aware the plans for any future project take a long time to implement, it may be feasible to look into the prospect of open heart surgery at the Children's Hospital now rather than in the distant future.' [11]
11 In September 1987 Mr Dhasmana wrote to Dr Rees and Professor Vann Jones, consultant cardiologists at the BRI, saying:
`There are 55 CHILDREN (of whom 21 went on the waiting list before 1.1.87).' [12]
12 A table dated 7 March 1988 indicated that Mr Dhasmana had 29 children on his cardiac surgery list and Mr Wisheart had 57, making a total of 86. [13]
13 In April 1988 Mr Dhasmana wrote to Miss Marion Stoneham: [14]
`The Waiting List ... is still considerably high under my care. I hope that with the expansion ... it would be possible to reduce some of the Waiting Lists.' [15]
14 The Inquiry also heard evidence that between 1988 and 1991 the `usual' waiting time for elective paediatric cardiac surgery was between six and nine months. [16]
15 In 1990 the report of the B&WDHA, referring to waiting times generally for cardiac surgery at the BRI and the BRHSC, noted:
`Waiting lists of unacceptable length, up to 12 months (dependent on Consultant)' [17]
but did not distinguish between adult and paediatric patients.
16 This 12-month waiting period is referred to in a strategy document prepared by the SWRHA in May 1991. Although again, it does not distinguish between adults and children, it states in relation to waiting lists for cardiac services in general at the BRI and the BRHSC that:
`While urgent patients appear to be treated by giving them a date for operation, some wait for over a year which is not acceptable and will be remedied by the booking system. For those who are referred to London hospitals some long waits are known to the referring consultants.' [18]
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Footnotes
[3] It is recognised that an elective case could later become an urgent or emergency case
[4] Until October 1995
[5] See Chapter 13
[6] District Statistical Information Officer, B&WDHA
[7] UBHT 0349 0001; note from Mr Jooman
[8] HAA 0119 0035; letter dated 4 June 1987
[10] UBHT 0092 0006; letter dated 26 March 1987
[11] JPD 0001 0005; letter from Mr Dhasmana dated 2 April 1987
[12] UBHT 0154 0220; letter from Mr Dhasmana dated 25 September 1987 (emphasis in original)
[13] HAA 0120 0011; table dated 7 March 1988. Note that Mr Dhasmana commenced work in 1986 and his waiting list is, as a consequence, shorter than Mr Wisheart's, who began in 1975
[14] Manager of B&WDHA's Children's and Obstetric Services
[15] UBHT 0190 0008; Mr Dhasmana wrote a memorandum to Mr Wisheart dated 28 February 1989, saying that he had 25 patients on his waiting list. See UBHT 0179 0141
[16] T84 p.113 Mr Dhasmana; UBHT 0179 0138; letter from Mr Dhasmana to Dr Roylance dated 25 February 1991
[17] JDW 0001 0333; report `Development of Cardiac Services' dated 30 November 1990
[18] UBHT 0156 0209; `Towards a Strategy for Cardiac Services in the South Western Regional Health Authority' dated 29 May 1991