Annex A > Chapter 12 - Waiting Lists > Waiting lists at Bristol > Explaining the waiting list
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Explaining the waiting list
17 In a letter to Mr Arthur Wilson, Regional Treasurer, SWRHA, dated 17 February 1992, Dr John Roylance, Chief Executive, UBHT 1991-1995, wrote:
`... waiting time is the glaring problem, and of course is due to the historic and ongoing pressure which has been relentlessly placed on the Cardiac Unit in Bristol, in the context of the inadequate provision in the region as a whole.' [19]
Volume of cases
18 The Inquiry heard evidence concerning the increase in the numbers of paediatric cardiac operations during the period of the Inquiry's Terms of Reference.
19 The 1987 `Annual Report on Paediatric Cardiology and Cardiac Surgery' [20] noted that:
`Total admissions have more than doubled, and infant admissions have more than trebled, since 1980. This is in keeping with the unit's growing regional role, and its designation as supra regional centre for infants since 1984. Although admissions from the SW Region appear to have stabilised in 1987, those from Wessex and especially South Wales continue to increase. This trend is even more striking in respect of infants.' [21]
`Prior to 1980 and in the early 1980s, we had been undertaking a total of about probably on average between 60 and 70 operations for congenital abnormalities each year.
`By the end of the 1980s, we were doing about double that number, namely, 140 to 150.
`One might ask, well, how come that the total number increased when you have the same number of abnormalities occurring in the community, give or take a little bit? I think that at the time we thought some came from South Wales, and that was undoubtedly true but it was not the whole answer, so I do not know the whole answer to that question.' [22]
21 Mr Wisheart explained that the throughput at the BRI increased in the 1980s but that the increase `was predominantly in the adult area at that time'. [23] He stated:
`Over the period as a whole, the constant pressure to increase adult work did of course impinge on me because I was constantly involved in efforts to increase the facility, but in terms of my operating, the number of adults I operated on obviously fluctuated from year to year, but broadly stayed the same over the whole period of time.
`In other words, the proportion of my time that was devoted to children was nearly protected.
`The sessions which Mr Dhasmana and I did devote to children amounted to three a week - I do not mean three half days; there were three operations a week of whatever length, at least, which were children, so that meant that we could achieve 150 a year, plus or minus, and in that sense, we were actually meeting in full the demand that we understood to exist for paediatric cardiac surgery each year.
`That could never be said for the adult work.' [24]
22 Mr Dhasmana explained that the pressure to obtain beds for adults and the pressure on operating theatres from adults had an effect upon the waiting list for children. It later became known that the children were waiting longer for operations than they would have been if the Unit had been solely a paediatric unit. He said:
`We now know that is the case. At that time, I did not know that.' [25]
23 Mr Wisheart was asked whether the fact that he and Mr Dhasmana both carried out adult as well as paediatric cardiac surgery meant that, in effect, the paediatric work suffered in a way it would not have done had one dedicated paediatric surgeon been appointed. Mr Wisheart told the Inquiry that there were enough sessions to deal with the paediatric demand, but the waiting list remained. He said:
'I believe that, had there been one full-time paediatric surgeon rather than the two of us, and that that one surgeon had been working in the Infirmary as we were working, that he would have had a number of allocated operating sessions to use for his paediatric work in exactly the same way as Mr Dhasmana and I ...
`So I think that in that context ... a full-time paediatric surgeon would have made a marginal difference.
`If we consider an alternative context ... that the full-time surgeon was able to operate in the Children`s Hospital and had ... full control of his operating and post-operative care resources, then I think that that would probably have made a substantial difference. ...
`I suppose the final point I would like to make is that there is a difficulty about having one single surgeon, even if he is full-time, and that is the obvious one, that it means he is on call all the time when he is present, but when he is away, then there is nobody in town to look after that work.' [26] [27]
24 Mr Wisheart's evidence included this exchange:
'Q. If there was enough time available and enough resources available to cope with the demand - to cope with the demand and no more - the only way of reducing the waiting list will be to have some form of waiting list or additional time spent on attacking the waiting list, presumably?
`A. Or else the ability to be more flexible and to operate from time to time on children in sessions when one would have normally operated on adults. But, I mean, we are not just talking of access to an operating theatre. The ability to operate on a child requires a whole package. You need to have a paediatric cardiac anaesthetist. Most of the nurses in theatre would have been able to do the work with a child, but some were certainly better than others, and again, as the nurses will describe to you, they tried to have nurses with experience looking after children in intensive care.
`So the whole package has to be provided and not just access to an operating theatre slot.' [28]
25 On 18 January 1987 Mr Dhasmana had written to Dr Robert Johnson, the Chairman of the Division of Anaesthesia, asking for an extra operating session at the BRHSC. He was then only operating on alternate Wednesday mornings:
'As you are well aware, we have been designated as a supra regional Specialty Centre ... As a result, an increasing amount of work has been coming from all parts of the South West and also from South Wales. ... Having been given only one half day list in a fortnight, my Waiting List to deal with these problems has progressively lengthened and in many of these cases I have been operating as an emergency in the evenings or during the weekend. Some of these would have been operated during the routine hours if I had an operating session allocated to me during the week.' [29]
26 Mr Wisheart was asked whether the letter meant that, if Mr Dhasmana did an extra session at the BRHSC, he would have done one less adult session at the BRI. Mr Wisheart said:
`I do not think he would have, although I think you would need to ask him, because it would depend on the details of his programme at that time, but I think he is actually saying that he has the freedom to operate at whatever time he is proposing.
`I would like to say, this is of course closed work we are talking about now, not open-heart work, and I mean, he only had one half-day alternate weeks, I think. ...
`Had he had more, then some of his other operating could have been accommodated on it, but of course, emergency work by its nature does not occur in proximity to your planned operating sessions.' [30]
27 Mr Wisheart commented on the suggestion in the letter that some operations which were described as 'emergency` could have been done during routine hours. Mr Wisheart said:
`Some of it, but that certainly was a problem, because for each of us, in the Children's Hospital there was a much higher proportion of work that was urgent or emergency than in the Infirmary, amongst children, and it was work that did have to be done within a day or two, frequently, and so it was not uncommon to operate in the evening or at the weekend. It had to be done. That was the need of the child. Certainly, if that could have been reduced, that would have been a very good thing.' [31]
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Footnotes
[19] UBHT 0038 0407; letter dated 17 February 1992
[20] UBHT 0055 0009; `Annual Report on Paediatric Cardiology and Cardiac Surgery', 1987
[21] UBHT 0055 0011; `Annual Report on Paediatric Cardiology and Cardiac Surgery', 1987
[27] The paper - `Options for Development of Audit and Paediatric Cardiac Services in UBHT' of May 1994 - also noted that one of the benefits of relocating paediatric cardiac surgery to the BRHSC would be `impact on waiting times'. See UBHT 0088 0135
[29] JPD 0001 0002; letter dated 27 January 1987. Seven years later, the paper - `Options for Development of Adult and Paediatric Cardiac Services in UBHT' of May 1994 - warned, `With the loss of designation as a supra regional centre, BRCH [sic] must compete for paediatric services with other centres which are known to have shorter waiting times'. See UBHT 0088 0140