Annex A > Chapter 26 - Concerns 1991 > Concerns
<< previous | next >>
Concerns
Accreditation of a training post in cardiology by the Royal College of Physicians
1 On 17 January 1991 [1] Dr Elliot Shinebourne, a paediatric cardiologist at the Royal Brompton Hospital, visited Bristol Royal Hospital for Sick Children (BRHSC) as a representative of the JCHMT [2] in order to assess the establishment of a senior registrar post in paediatric cardiology. [3] After the visit Dr Shinebourne recommended that the training post not be accredited, `essentially because of the split site'. [4]
2 Dr Robin Martin, consultant cardiologist, told the Inquiry about his application for a senior registrar post in paediatric cardiology:
`A. ... I applied to the Joint Committee on Higher Medical Training for approval of a post ... it might have been 1990 when I actually made the application. We were visited by Dr Shinebourne to look at the potential setup of the post that we proposed and the training opportunities that it gave. ...
`Q. ... His recommendation was that there should not be accreditation; am I right?
`Q. The basis for that was what?
`A. I think he accepted that we had plenty of cardiological throughput and training opportunities. As I remember, his main objection, or main concern, was the separation of the two sites for surgical care and it is an important part of training for the senior registrar, as it was then, the specialist registrar, to have input and participation in post-operative care of open-heart cases. That is specified in the training programme. He was concerned that that would not be feasible.' [5]
3 Dr Stephen Jordan, consultant cardiologist, explained in the following exchange:
`A. My recollection is that they had no problems with the investigational side but they did not like the fact that there was no open-heart surgery on the same site, that is the Children's Hospital, and there was no involvement or there was no planned involvement in post-operative care which they considered was an essential part of training.
`Q. There is no reason particularly why you should, Dr Jordan, have considered the evidence Dr Shinebourne gave at the GMC hearings. He said there "The paediatric cardiologists in Bristol were pretty much divorced from post-operative care" ... That was one of his two main concerns: one was the split site for surgery and the other was a lack of involvement in post-operative care?
`Q. The hypothetical senior registrar in paediatric cardiology who might be appointed, when he or she came to the hospital Dr Shinebourne's concerns would be they would not be properly exposed, if you like, to the surgery and to the post-operative care?
`A. That is correct.' [6]
4 Dr Hyam Joffe, consultant cardiologist, told the Inquiry about the lack of support for the consultant paediatric cardiologists:
`... we did not have a regular substantive post as senior registrar [in paediatric cardiology] until 1992 or 1993. And of course this put us all under great duress. We had applied, I think, two or three times and ... the penultimate [visit], was when Dr Shinebourne came to visit Bristol.' [7]
5 Dr Stewart Hunter, consultant in paediatric cardiology, told the Inquiry how the senior registrar post was eventually approved:
`A. ...There had been a previous visit about a year before by a Dr Shinebourne from the Brompton Hospital, and he had decided not to give full approval because of the problems which he considered in the split-site geography: that it was difficult, he felt, to maintain a good level of supervision of the junior staff between the two sites. The people at the Children's Hospital then asked the JCHMT if they could have a follow-up visit, because they had by then plans to first of all move more onto the children's site, but also that they had plans in the long term to join the two sites together. I therefore made the follow-up appointment. I personally did not feel that the two-site geography invalidated the training process. I have other views about the management of patients, but it did not invalidate the training process, and I said so, as a result of which, the senior registrar post in paediatric cardiology was accredited following my visit.' [8]
<< previous | next >> | back to top
Footnotes
[1] UBHT 0195 0015; programme for the day, addressed from BRHSC to JCHMT
[2] Joint Committee on Higher Medical Training of the Medical Royal Colleges
[3] Approval was needed from the Royal College of Physicians (RCP) before a post could be designated as a training post