Final Report > Chapter 27: Care of an Appropriate Standard > Messages from Bristol

Messages from Bristol

• The absence of explicit agreed clinical standards of care for patients who received paediatric cardiac surgical (PCS) services, whether in Bristol or elsewhere, made it very difficult, either at the time or subsequently, to assess the quality of care.
• Standards of care in Bristol, as elsewhere, were regarded as a matter for individual clinicians to determine, doing the best for their patient, based on their professional skills and the knowledge they could acquire over time.
• As regards the monitoring of the PCS service, a good deal of data was available at the time in Bristol about the PCS service. Yet the nature of the data coupled with the prevailing mindset were such that no real understanding of performance emerged, whether of Bristol or of other hospitals, for the purpose of comparison. To the extent that the clinicians at the time understood and reflected on their performance, they only had to satisfy themselves that the service was of sufficient quality. There was no systematic mechanism for monitoring clinical performance. Explanations of poor performance could be advanced which were plausible but lacked evidence, in the absence of sound data.
• As regards the absence of both explicit standards and any rigorous monitoring of outcomes, the Bristol PCS service as a specialty was little different from other areas of clinical practice at the time.
• From the perspective of parents whose children were cared for in Bristol, it was assumed by many that because the UBH/T was designated as a `supra regional centre', its standards of care and treatment were amongst the best in the country.
• Few parents whose children were cared for in Bristol had any idea that there was no real way of knowing this: that there were no agreed standards of care and not only no external monitoring of clinical performance but no real mechanism for doing so.