Annex A > Chapter 7 - Supra Regional Services > The SRS system in operation

The SRS system in operation

Bristol in the SRS system 1984/85

87 In January 1984 the DHSS distributed the first in a series of annual papers explaining the Secretary of State's decisions (made on advice from the SRSAG) on the future development of the SRS for the next financial year. [72] The SRSAG had asked the Department to initiate a study of the services provided in each NICS unit and the costs involved. This was to lead to later recommendations as to the protection of expenditure for 1984/85 and the setting of funding levels for 1985/86. [73]

88 On 5 December 1984 an inter-unit NICS liaison group meeting was held at the DHSS in London, at which there was:

`A brief account by each of the nine centres about what difference (if any) the supra regional designation of the service has meant, what difficulties stand in the way of the service being improved, and what action might be taken to enable those improvements to happen.' [74]

89 It was also noted that:

`When the question of designating neonatal and infant cardiac surgery as a supra regional service had been referred to the Advisory Group, there had been no hesitation in recommending that the service met the criteria laid out in Annex B to HN(83)36.' [75]

90 The minutes of that meeting are available, [76] from which it can be seen that Dr Joffe and Mr Wisheart were present. [77] Each unit made a presentation to the meeting, the report from Bristol being:

`The children's hospital dealt with supra regional specialities of various kinds. The surgical work was carried out at the Bristol Royal Infirmary which treated only adults. Additional staff were needed since there was only one fully dedicated paediatric cardiac surgeon [78] and there was a shortage of nursing staff. A large amount of "soft" money had been used for the purchase of equipment; on the surgical side: the RHA was embarking on an extensive programme of expansion, and plans for the development of paediatric surgery lay within the development of cardiac surgery generally, which had obvious nursing and manpower implications.' [79]

91 In January 1985 the SRS system was in full operation and timetables had been set for the SRSAG's consideration both of future funding levels for existing designated services and of new applications for designation. [80] This included the requirement of an annual return to the Department from the centres on workload and expenditure (sent in June of each year). The Secretary of State's Decision Paper 1985/86 indicated, amongst other things, that Bristol's protected funding level for that year was the fifth highest of the nine centres. [81]

92 In February 1985 the RCP and RCSE published the Third Report of the Joint Cardiology Committee: Provision of Services for the Diagnosis and Treatment of Heart Disease in England and Wales. [82] It concluded, amongst other things, that SRCs were an appropriate means of dealing with NICS and funding should continue, but that nine centres were the `absolute maximum'. The report indicated that `no consideration should be given to the establishment of further [SRCs] unless there is a considerable increase in workload which, at present, seems highly unlikely.' [83]

93 On 4 October 1985 a meeting of consultants from the nine SRCs was again held at the DHSS. On this occasion Dr Jordan represented the Bristol SRC. His report on Bristol was:

`The Region have agreed to provide and equip a cardiac catheter laboratory and had tentatively accepted a new proposal for an additional cardiologist. There were no staff particularly dedicated to paediatric cardiology. They had acquired an ultrasound machine with doppler, and even in some of their peripheral clinics and [sic] access to ultrasound equipment.' [84]

94 Dr Jordan also stated that a major part of the cardiac work had been passed on to London units, because of organisational difficulties. There had been an increase in pressure to carry out coronary artery bypass grafts (CABGs) which had adversely affected the number of operations carried out on the under-1-year-olds and had resulted in longer waiting lists. [85]

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Footnotes

[72] HAA 0095 0023, HAA 0095 0024 - 0026 ; `Secretary of State Annual Report'

[73] HAA 0095 0026, HAA 0095 0024 - 0026 ; `Decisions for 1984-85 Following Recommendations from the Supra Regional Services Advisory Group and Regional Chairmen' (details of finance for the NICS service at Bristol are to be found in Chapter 6)

[74] ES 0002 0002; letter from A Hurst to Dr Silove dated 26 November 1984

[75] ES 0002 0007; minutes of meeting, 5 December 1984

[76] ES 0002 0007; minutes of meeting, 5 December 1984

[77] ES 0002 0006; minutes of meeting, 5 December 1984

[78] In fact, at that time, there was no fully dedicated paediatric cardiac surgeon at Bristol - see evidence of Dr Joffe T90 p.84 and Mr Wisheart's comments on the meeting T94 p.115-16

[79] ES 0002 0009; minutes of meeting, 5 December 1984

[80] DOH 0002 0248; `Secretary of State Annual Report'

[81] UBHT 0278 0521; `Secretary of State Decision Paper', 1985/86

[82] BCS 0001 0001 - 0006 ; `Third Report of a Joint Cardiology Committee', 1985

[83] BCS 0001 0005; `Third Report of a Joint Cardiology Committee', 1985

[84] ES 0002 0014; minutes of meeting, 4 October 1985

[85] ES 0002 0014; minutes of meeting, 4 October 1985