Final Report > Chapter 4: The Changing NHS 1984 - 1995 > The NHS and cardiac surgery

The NHS and cardiac surgery

37 Acquired heart disease in adults was (and remains) a major cause of illness and death. In addition to public health initiatives aimed at reducing the incidence of the disease, the 1980s and 1990s saw the recognition of the significant benefits of cardiac surgery, particularly coronary artery bypass grafts (CABG). A high priority was placed on carrying out CABG on adults with acquired coronary heart disease. The priority was translated into increasing pressure on cardiac units in hospitals to treat an ever-increasing number of patients. By contrast, congenital (as distinct from acquired) heart disease (CHD) in children is a relatively uncommon disease, affecting some 6-8 children in every 1,000. The numbers of children needing surgery were, therefore, small in comparison with adults. It is no surprise therefore that, as the demand for cardiac surgery on adults increased, so it attracted an increasing amount of investment and resources. Equally, health authorities responding to the national priority sought, after the NHS reforms of 1991, to purchase an increasing amount of care for adult patients.

38 In cardiac units which specialised only in children, the pressure from adult patients was less keenly felt. Furthermore, the creation of a supra regional service (SRS) specialising in neonatal and infant cardiac surgery provided secure funding for the treatment in specialist units of children with CHD. But Bristol's cardiac unit treated adults and children. While designated as a supra regional centre (SRC) for heart surgery on children under 1, it was under constant pressure to treat more adults. The two cardiac surgeons in Bristol cared for both adults and children, so they were exposed to the same pressure. Paediatric cardiac surgery in Bristol represented a very small part of the total activity of the UBH/T. The context in which the events in Bristol must be understood, therefore, was one in which a small service was always under pressure.