Final Report > Chapter 12: Responses to Concerns and Actions Taken, and Whether Such Actions were Appropriate and Prompt > Responses outside the UBH/T > The Welsh Office and the Department of Health
<< previous | next >>
The Welsh Office and the Department of Health
7 In 1986-1987 concerns which had arisen in Wales about the quality of care in Bristol came to the attention of the DoH. In our view, the expression of these concerns was (or could at the time have been judged to be) affected by the plans to establish a Welsh Centre for Cardiac Services in Cardiff. Professor Henderson's (Professor Emeritus, Honorary Consultant Cardiologist, University of Wales, College of Medicine) concerns lacked supporting evidence. Nevertheless, they were taken by the Chief Medical Officer (CMO) for Wales, Professor Gareth Crompton, to his English counterpart, Professor Sir Donald Acheson, who referred him to the Medical Secretary of the SRSAG, Dr Halliday. At the meeting between Professor Crompton and Dr Halliday, there seems to have been a failure of understanding. We are of the view that Dr Halliday failed to respond adequately to the concerns being raised. Dr Halliday should have acted on Professor Crompton's concerns by, for example, taking steps to try to obtain further data to ascertain whether the allegation that Bristol was at the `bottom of the UK league for quality' [3] was a real cause for concern, or by informing the CMO for England of his discussion with Professor Crompton. Several of the reasons advanced by Dr Halliday for not taking Professor Crompton's expressions of concern further were inadequate. In particular, the fact that the meeting with Professor Crompton was not a formal minuted meeting with an agreed agenda, or that Professor Crompton did not set out his concerns in writing to Dr Halliday should not have affected how Dr Halliday responded. [4] Moreover, it was wrong not to give sufficient weight to Professor Crompton's expressions of concern because of Dr Halliday's view that `allegations from Wales [were] nothing to do with the supra-regional arrangements in England', [5] especially since Wales did not have a PCS centre of its own at the time and was dependent on centres in England. Dr Halliday was also in error in discounting what Professor Crompton told him because he (Dr Halliday) assumed:
`that had the CMO [Wales] or anyone else in authority in the Welsh Office believed that there was substance to the allegations Professor Henderson was making they would have reviewed their policy and raised the matter formally with the Department. ... that the Welsh Office was not apparently taking seriously the allegation of one of their medical advisers rather undermined the credibility of such claims.' [6]
The Welsh Office did, in fact pursue the matter with a visit to the BRI, but were reassured by the Bristol surgeons' presentation, which attributed their results in the complex procedures to case mix. [7] We received no independent evidence to support the Bristol surgeons' contention.
8 Subsequent concerns about waiting times and outcomes in Wales, which were raised (in June 1987) and taken up by the media, were rejected by the cardiologists and the surgeons in Bristol. [8] The information available to the surgeons at this time included the mortality rate for open-heart surgery in under-1s in their Unit's 1987 Annual Report. The figure for 1984-1986 was 26.5%, compared with the most recent national data available at that time of 21.8% (UK Cardiac Surgical Register (UKCSR) 1984 data). Given the small numbers of cases in Bristol, and the surgeons' views that there was a higher level of complexity in the cases coming to them, there was no immediate reason in our view for the Bristol Unit to take action, other than to continue to monitor and discuss outcomes. It should be noted, however, that the clinicians' letter of rebuttal to the BBC at the time included a statement that their outcomes were `at least equal to those achieved by other paediatric units.' [9] This claim was later acknowledged by Dr Joffe in evidence to be a `partial overstatement.' [10]
<< previous | next >> | back to top
Footnotes
[3] T21 p.26 Professor Crompton
[6] WIT 0049 0035 Dr Halliday
[7] The Inquiry's Experts advised us that the term `case mix' refers to `underlying cardiac anomalies of the patients' who are treated, which consequently must be taken account of in any comparison between centres or clinicians. See Annex B (4a), `Overview of statistical evidence presented to the Bristol Royal Infirmary Inquiry concerning the nature and outcomes of paediatric cardiac surgical services at Bristol relative to other specialist centres during the period 1984 to 1995', September 2000, Dr Spiegelhalter et al. See also Annex A Chapter 19
[9] UBHT 0133 0031