Final Report > Chapter 20: Understanding and Assessing the Quality of Clinical Care in Bristol > Introduction

Introduction

1 We have described how aspects of the management, organisation and delivery of the paediatric cardiac surgical service (PCS service) in Bristol militated against the service's developing towards the standard of care which may have seemed a possibility in the early 1980s. We have also seen how some aspects of the service, notwithstanding our recognition of the difficulties and circumstances of the time, did not consistently reach an adequate standard.

2 In this section, we are concerned to determine what, during the period covered by our Terms of Reference, the clinicians in Bristol knew, or should have known, about the quality of care which they were providing: specifically, how they were performing in terms of outcome.

3 It is important for what follows to understand what `outcome' (in the context of surgery) meant to anyone who might be concerned with outcome in Bristol at that time. For clinicians in Bristol, as elsewhere, the main guide to measuring outcome which they used was the rate of mortality following surgery, based on deaths recorded as having occurred in hospital within 30 days of undergoing surgery. This mortality rate was used to assess outcome for the unit as a whole and for particular procedures. By no means does it give a full account of outcome. It says nothing about how well the children fared if they did not die within 30 days: whether they thrived or failed to do so. Thus, even in the context of concerns about outcome, death within 30 days of surgery is, at best, a crude measure.