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) > Caseload

Caseload

27 Prior to designation, the South Western Regional Health Authority was of the view that `... Bristol is not necessarily large enough to fulfil the criteria [for an SRS] of a catchment population of 5 million ...' [18]

28 NICS referred to both open- and closed-heart operations. We are particularly concerned with open-heart surgery. A paper prepared for the SRSAG in 1988 stated that, based on a unit with two surgeons: `... the minimum [appropriate] open-heart workload is likely to be at least 80 cases per year'. Three of the designated units, Guy's, Bristol, and the Freeman in Newcastle, at that time, four years after designation, were described by the paper as falling `far short'. [19] Sir Terence English agreed with the 1988 paper. He told us that the minimum caseload necessary for a centre to maintain sufficient expertise was regarded as 40 or 50 open-heart operations performed by a single surgeon per year in the under-1-year age group and that there should be at least two surgeons in the unit, giving a total of 80-100 open-heart operations per year. [20]

29 In the year before designation, the Bristol Unit carried out a very few (three, four or 11) [21] open-heart operations on children under 1 year of age. In 1991, seven years after designation and the year before de-designation, the two surgeons providing the NICS service in Bristol carried out 46 open-heart operations between them on children under 1 year.

30 Dr Halliday told us that, in terms of caseload, Bristol `certainly did not perform anything like on a par with the other units'. [22]

Footnotes

[18] HAA 0095 0071; draft report (this document appears to be dated 14 November 1983: see HAA 0095 0073)

[19] DOH 0002 0242 Paper SRS(88)2

[20] T17 p.69-70 Sir Terence English

[21] The figures differ depending on whether they refer to the financial or calendar year

[22] T13 p.27 Dr Halliday