Annex A > Chapter 29 - Concerns 1994 > Concerns > September
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September
88 Following Dr Doyle's reply to Professor Angelini, Dr Roylance wrote to Dr Doyle. Dr Roylance had been made aware of the correspondence that had passed between Dr Doyle and Professor Angelini as Professor Angelini had copied Dr Roylance in to his letter to Dr Doyle. [111] Further, Mr Wisheart had written to Dr Roylance on 4 September commenting on Professor Angelini's letter of 19 August. Mr Wisheart referred in the letter to the `limited nature of the problem'. [112]
89 In his letter to Dr Doyle dated 12 September 1994, Dr Roylance stated that:
`I felt I should write to confirm the Trust Board's awareness of this problem, for which reason we are seeking to appoint another full-time Consultant Paediatric Cardiac Surgeon, and the Appointments Committee is due to meet on the 20th September.
`The decision has already been taken by the Trust Board, and plans are in hand, to move Paediatric Cardiac Surgery into the Children's Hospital. I have every confidence this move, and the appointment of the new surgeon, will resolve the situation for the future.' [113]
90 Dr Roylance was asked by Counsel to the Inquiry:
`Q. When you say you write to confirm the Trust Board's awareness, did you tell the Trust Board at this time of this correspondence?
`A. I do not know. I do not know. I may well not have done ... .' [114]
91 Mrs Maisey, in her written evidence to the Inquiry, made this comment on the letter:
`As an executive board member, I should like to confirm and clarify that I was not aware of such matters at that time. My recollection is supported by the Board minutes which show that the first time that concerns surrounding paediatric cardiac surgery were drawn to the attention of the Board was at a meeting on 24 February 1995, following the de Leval and Hunter visit.' [115]
92 As to the `problem' referred to, there was the following exchange with Dr Roylance in the course of his giving evidence to the Inquiry:
`Q. When you ... write in the second paragraph that you felt you should write to confirm the Trust Board's awareness of this problem, ... you did not know what the problem was that the Department of Health had in mind?
`A. I thought I did. I mean, I thought there was no doubt. If you read Gianni's letter, he says there is a particular treatment with which they have had very poor results. That could only have meant, in my belief at the time, the neonatal Switch procedure, which had stopped. That is what Gianni Angelini said. There was one problem, as I remember - I cannot remember his exact words, but there was one problem of treatment, which was being addressed - something like that. I knew, because we were at that time, as it says, seeking a paediatric cardiac surgeon to reinstitute neonatal Switches.
`Q. The words he used were "a greater mortality than perhaps could be expected in any particular surgical procedure"?
`A. In "a particular surgical procedure", yes. I knew a particular surgical procedure was neonatal Switches. It was part of the work-up to the appointment of a paediatric cardiac surgeon. So I thought I was entirely aware of what the conversation was about.
`Q. Did you know that the neonatal Switch had in fact ceased the previous October?
`Q. A year before this, almost?
`A. Yes.' [116]
93 In his letter to Dr Doyle, Dr Roylance wrote in the final paragraph:
`I will continue to monitor the situation with Gianni Angelini, and I see that he has promised to keep you informed.' [117]
`Q. ... you continued to monitor the situation with Gianni Angelini. What were you monitoring?
`A. The arrival of the new surgeon and the move up the hill. I am sorry to say the Health Service has a long track record of not achieving its firm decisions, and that was what I was monitoring.
`Q. So we read "continue to monitor the situation" as meaning to ensure that these two promises are kept?
`A. Yes.' [118]
95 The letter from Dr Roylance led to a reply from Dr Doyle in which he said:
`I was very relieved to hear from Gianni Angelini that a change in the service had been planned. Under the circumstances I think it best to leave the Trust to effect the proposed changes as quickly as possible.' [119]
96 Dr Roylance wrote back to Dr Doyle on 22 September 1994 to inform Dr Doyle that Mr Ashwinikumar Pawade had been appointed as a consultant paediatric cardiothoracic surgeon and to state that:
` ... [UBHT] is progressing the move of paediatric cardiac surgery to the Bristol Royal Hospital for Sick Children.
`The Trust is confident that these changes will assist with the continued progress of paediatric cardiac surgery.' [120]
97 Dr Doyle replied thanking Dr Roylance for keeping him up to date. [121]
98 Professor Farndon, in his written evidence to the Inquiry, stated that it was also in September 1994 that:
`As the possible appointment of a new cardiac surgeon became more imminent I certainly did meet with Mr McKinlay, the then Chairman of the Trust. I may have mentioned concerns at that meeting, although I cannot remember having done so. This meeting was held between myself, Mr McKinlay and Professor Angelini. By that time it had been resolved that we would look for an appointment in paediatric cardiac surgery and we knew of the possible candidacy of Mr Ash Pawade. Professor Angelini and I wanted to ensure that there would be no administrative problems in the possible appointment of Mr Pawade associated with his move from Australia ... .' [122]
99 Professor Angelini and Mr McKinlay stated that there was a discussion about the poor performance of the paediatric cardiac surgery service at this meeting. [123] Professor Farndon told the Inquiry that he could not recall this. According to Mr McKinlay, both Professor Farndon's and Professor Angelini's concern:
`... was centred on the poor performance of the Switch operation and the controversy over the time taken by Mr Wisheart on some procedures. The Switch operation had been suspended and the position would be resolved by the appointment of a new full time paediatric cardiac surgeon.' [124]
100 Professor Farndon's recollection was that:
` ... some smaller part of that meeting was concerned with paediatric cardiac surgical outcome and performance.' [125]
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Footnotes
[111] UBHT 0061 0273 - 0274 ; letter from Professor Angelini to Dr Doyle dated 19 August 1994
[112] UBHT 0061 0276; letter from Mr Wisheart to Dr Roylance dated 4 September 1994. In June 1996, Mr Wisheart was to report in his `Statement to the Clinical Directors of UBHT' that: `Paediatric cardiac surgery had disappointing results in about 2% of its work for reasons which have not been clearly identified. However, paediatric cardiac surgery was not a disaster area and ironically in the years '92 to '95 the results were the best we had ever achieved. Audit was active, healthy and was used. True information was given to parents and consent was informed. Decisions to operate were deliberate and not cavalier.' UBHT 0054 0007
[113] UBHT 0061 0278; letter dated 12 September 1994
[114] T89 p.48 Dr Roylance. No minute indicating that the Trust Board was made aware of the particular problem raised by Professor Angelini was produced to the Inquiry
[115] WIT 0337 0062 Mrs Maisey. See Chapter 30
[117] UBHT 0061 0278; letter dated 12 September 1994
[119] UBHT 0052 0283; letter from Dr Doyle to Dr Roylance dated 20 September 1994
[120] UBHT 0061 0280; letter from Dr Roylance to Dr Doyle dated 22 September 1994
[121] UBHT 0061 0281; letter from Dr Doyle to Dr Roylance dated 3 October 1994
[122] WIT 0087 0009 Professor Farndon
[123] WIT 0073 0055 Professor Angelini, WIT 0073 0016 Professor Angelini
[124] WIT 0102 0028 Mr McKinlay