Annex A > Chapter 7 - Supra Regional Services > Monitoring of quality > The number of neonatal and infant open-heart operations at Bristol
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The number of neonatal and infant open-heart operations at Bristol
263 Departmental Paper SRS (83)17 [288] was prepared in 1983 for consideration by the SRSAG as part of the process of considering NICS for SRS status. It includes tables showing regional rates of operation for under 18 years of age, together with estimated needs for NICS (based on the 1979 British Paediatric Association Report [289] and the Second Joint Cardiology Committee Report of 1981). [290]
264 Bristol figures for 1983-1984 are to be found in a document prepared by the Bristol clinicians, as part of the creation of the SRS in Bristol. [291] The figures for 1984-1985 show that Bristol carried out 13 open-heart and 39 closed-heart operations. [292]
265 At the meeting of consultants from NICS units held on 4 October 1985 figures were presented to indicate the number of open-heart operations at each of the nine centres for 1984-1985. Bristol figures appear as set out in the paragraph above. [293]
266 It was clear to the Birmingham representative, Dr Silove:
`... that several of the figures were spurious and in particular the representatives from Leeds and Newcastle suggested that the actual figures were very much less.' [294]
267 There followed an exchange of correspondence between Dr Silove and Mr Hurst, Administrative Secretary of the SRSAG 1983-1987. [295] In his letter of 2 January 1986 to Dr Silove, Mr Hurst wrote:
`I hope you will appreciate that Regions are responsible for the data they submit to the Department and that the Department is obliged to accept their submission.' [296]
268 On 6 January 1986 Dr Silove replied:
`I do appreciate that the Regions are responsible for the data that they submit to the DHSS. However, at the 4 October meeting several of the clinicians present indicated that the data from those Regions was a fiction.' [297]
269 The Bristol figures, in summary, for the period from 1983-1984 until 1992 are in the table below:
270 Dr Halliday was shown the figures for the number of NICS operations at Bristol. His evidence included this:
`Q. ... whatever the assurances that had been made to you by the Royal College of Surgeons on this rather nebulous basis, nothing in fact was happening very much to improve the throughput at Bristol?
`A. Well, it is increasing, but it is not significant.
`Q. That must have been a matter of concern, then, to the [SRSAG]?
`Q. It would imply, because of the low numbers, that the outcomes were unlikely to be as good as they would be in one of the larger centres?
`A. Well, as we have agreed, all the evidence suggests that the more operations you do, the better you are. But of course there are always exceptions to that and I can give you many examples of people who have done only a few operations, but their results are quite outstanding: the cardiac surgeon in St Bartholomew's Hospital, for example, who only did three heart transplants but his success rate was 100 per cent. So there are many factors that influence this.
`The other thing I think you need to take into account is at the time Bristol were only doing 11, 14, 24. There were other units in the country doing 11, 13, 24, and were getting outstanding accounts.' [298]
271 In relation to the Bristol figures Dr Halliday said:
`Q. So the Advisory Group were in a position in the 1980s to identify an under-performing unit?
`Q. Did they do so in respect of Bristol?
`A. Bristol was always a worry. It was a particular worry to me, but it was a worry in a sense that I could not understand why referrals were not increasing, and I made many visits to Bristol, to the Welsh Office, and met many people in the South West, clinicians I mean mainly, but also managers, to try and identify what the problem was. It never became clear. ... [299]
`Q. What I am asking, did it appear to you that there were questions to be asked in respect of Bristol?
`A. Questions to be asked in respect of Bristol?
`Q. Because you were able to compare its performance with the national, and the question is in two parts: did it seem to you that the performance was less good than the average, the first question; and the second question: if so, what if any steps did you take about it?
`A. The evidence did suggest that Bristol was not performing as well as the other units.' [300]
272 Sir Michael Carlisle told the Inquiry that he knew that `it has always been a struggle' for Bristol to increase its referral numbers. [301] However, as Chairman, he had no role in attempts to increase the number of referrals to Bristol. [302]
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Footnotes
[288] WIT 0482 0349 Dr Moore
[289] BPCA 0001 0014; 1979 BPA Report
[290] RCSE 0003 0017; 1981 JCC Report
[291] UBHT 0278 0577 - 0579 ; there are also calendar year figures (see DOH 0004 0028 and Mr Wisheart's evidence, T41 p.128-33)
[292] UBHT 0278 0507 and UBHT 0278 0487; form entitled NICS and a table in Secretary of State's announcement on SRS for 1986-1987
[293] ES 0002 0019; table entitled Neonatal and Infant Cardiac Surgery
[294] ES 0002 0021; letter dated 9 December 1985
[295] ES 0002 0020 - 0024 ; correspondence between Dr Silove and Mr Hurst
[296] ES 0002 0024; letter from Mr Hurst to Dr Silove dated 2 January 1986
[297] ES 0002 0023; letter from Dr Silove to Mr Hurst dated 6 January 1986
[299] Dr Halliday told the Inquiry that he did not perceive the split site as a barrier to Bristol's development