Final Report > Chapter 8: Paediatric Cardiac Surgical Services > The planning and funding of paediatric cardiac surgery for children under 1 year of age (neonatal and infant cardiac surgery) > The designation of Bristol

The designation of Bristol

21 Dr Barry Keeton, a consultant paediatric cardiologist at Southampton General Hospital since 1978, and a member of the Inquiry's Group of Experts, described his recollection of the process of selecting centres for inclusion in the SRS for NICS. He said:

`... I recall that prior to the setting up, there were eight centres that had been nominated for supra regional designation, and then my next recollection is that the Regional Medical Officers commissioned a report. I had some personal knowledge of this because the lady who did it came round to visit me and I gave her some help in the data, the statistics from Southampton. Following that Regional Medical Office report, there were then nine centres and that was the point at which Bristol was added on, I think in 1984, to the supra regional list.' [13]

22 The clinicians in Bristol were aware that centres were to be designated for NICS. Dr Joffe told the Inquiry he was `appalled' that those selecting centres for designation made: `no attempt ... to visit Bristol and see the centre and find out what it had to offer.' [14]

23 The clinicians, Dr Joffe, Dr Jordan and Mr Wisheart, wrote a joint memorandum to the Chairman of the SRSAG expressing their view that: `... Bristol has an irrefutable claim for recognition as a supra regional cardiac centre for neonates and infants. ... redirection of these [cardiac] patients to a centre elsewhere must result in a demise of meaningful paediatric cardiology in Bristol.' [15]

24 They argued:

`The paediatric cardiology service already functions as the de facto Regional and Supra Regional Centre (although not yet officially recognised as such), drawing 28% of new referrals to the unit from Avon, 48% from the rest of the SW Region and 24% from South Wales, North Wessex and elsewhere. ... The long-term management of patients is supervised near their homes through a system of Consultant Cardiac Clinics developed over many years and probably more comprehensive than in any other paediatric cardiology service in England. Regular peripheral clinics are held in Bath, Swindon, Cheltenham, Gloucester, Taunton, Barnstaple, Exeter, Torquay, Plymouth and Truro, and patients are referred by paediatricians in South Wales. Close liaison exists with paediatricians in all these centres, who would resist any curtailment in the services they and their patients receive.'

25 Further, they argued that it was:

`... unrealistic to base any such decision simply on current surgical volume in infants, without taking cognisance of other important factors such as geographical position and communications, association with a University Department of Child Health, historical evolution and ties with paediatricians in the region and adjacent areas of other regions, anticipated expansion and development, and standards of associated paediatric and neonatal services.' [16]

26 As set out above, a number of criteria were set for identifying appropriate centres for SRS. We heard evidence that Bristol did not meet the criteria set out in the 1983 Health Notice, but was nonetheless designated, mainly on the basis of geography. Sir Terence English, President of the RCSE, and a member of the SRSAG from 1990 until 1992, told us that it was also thought that Bristol had `the capacity to develop ... if the will were there'. [17]

Footnotes

[13] T51 p.112 Dr Keeton

[14] T90 p.70 Dr Joffe

[15] JDW 0001 0152; Memorandum on the Designation of Bristol as a SRC in NICS, July 1982

[16] JDW 0001 0150; Memorandum on the Designation of Bristol as a SRC in NICS, July 1982

[17] T17 p.76 Sir Terence English