Final Report > Chapter 9: The Paediatric Cardiac Surgical Service in Bristol > The paediatric cardiac surgical service in Bristol

The paediatric cardiac surgical service in Bristol

Referrals and cardiology clinics

12 Generally, a child would be referred by a GP or a paediatrician within the catchment area to a Bristol-based cardiologist, with the request for an opinion or investigation. The referral might come from the paediatrician at the hospital where the baby was a patient. Or, in cases where there were perhaps no immediately obvious signs of a problem at birth, the referral could be made once the baby's condition was diagnosed days or weeks later, when signs were noted by parents, a midwife, a health visitor or a GP.

13 The UBH/T provided a PCS service to a large geographical catchment area, encompassing much of the South West of England and South Wales. [8] During the 1970s joint outreach clinics [9] with local consultant paediatricians were established throughout the South West Region. Dr Ian Baker [10] explained the concept of outreach clinics in his statement: `"Outreach" clinics were clinics where paediatric clinicians from Bristol practised way from their base facilities at BRHSC and BRI in facilities of other Health Authorities'. These were conducted thereafter by the Bristol-based cardiologists, Dr Stephen Jordan and Dr Hyam Joffe and, from February 1989, by Dr Robin Martin. A great deal of time was spent by the cardiologists in travelling to and from these clinics. Outreach clinics were held in over a dozen hospitals across the South West and South Wales such as Gloucester, Torbay, Carmarthen and Swansea.

14 During the late 1980s, as we have seen, a national shortage of paediatric cardiologists developed which a joint working party of the British Cardiac Society (BSC) and the Royal College of Physicians of London regarded as `very worrying'. [11] The situation was described as `unacceptable' in the British Medical Association's report for 1988 and `perilous' in the report for 1992. [12]

15 This national shortage was reflected locally in the South West, but it was particularly felt because there were few large hospitals in the area - Truro, Plymouth (for part of the time) and Bristol, and because there were no paediatric cardiologists in the whole of Wales. Additionally, the PCS service in Bristol was not recognised by the Royal Colleges as suitable for the allocation of a training post, with the result that the cardiologists lacked the support of trainees.

16 The Bristol cardiologists would first see the child either at an outreach clinic or at the BRHSC. After 1987, cardiological investigations, including catheterisation, would take place at the BRHSC (before then cardiac catheterisation took place at the BRI). If the cardiologist considered surgery was required, the child would be referred to a paediatric cardiac surgeon. Usually a child needing surgery who had been referred to a cardiologist in Bristol would be referred by the cardiologist to one of the cardiac surgeons in Bristol, Mr Wisheart or Mr Dhasmana. On rare occasions, the cardiologist in Bristol, by himself or in conjunction with the surgeon(s) in Bristol, would refer a child to another centre for surgery.

Footnotes

[8] The two PCS centres closest to Bristol were at Birmingham and Southampton

[9] See Annex A, Chapter 10 for a detailed description of outreach cardiology clinics

[10] Formerly the DMO for B&WDHA from July 1984 to October 1991, and subsequently a consultant in public health medicine for the B&DHA from October 1991 onwards

[11] BPCA 0001 0001

[12] BCS 0001 0017 and BCS 0001 0096; Chamberlain, et al. `BMA report on staffing in cardiology in the UK in 1988' and `BMA report on staffing in cardiology in the UK in 1992'