War of words continues over closure of Leeds child heart unit
Key NHS adviser defends figures behind suspension of surgery and says 'two relatively junior doctors' were left running the ward
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Sunday 31 March 2013
Another voice has entered the war of words over the suspension of heart surgery at children's hospital ward in Leeds.
Yesterday the health service's top doctor and a local MP clashed, with Greg Mulholland- Liberal Democrat member for Leeds North West- calling Sir Bruce Keogh's decision to suspend congenital heart surgery at the ward in Leeds General Infirmary (LGI) "an absolute scandal."
Disagreement centred on the validity of figures Sir Bruce, NHS Medical Director, used in the decision.
And this morning Professor Sir Roger Boyle, director of the group overseeing mortality data across the health service, said he advised the suspension, and that the figures were among a number of reasons for doing so.
He told BBC Breakfast that concerns were raised over two "relatively junior surgeons" who had been left in charge of the unit, as well as from families of patients who claimed their requests to be transferred to other units were ignored.
He said: "I was aware last weekend of other concerns being raised about Leeds, concerns raised by distinguished surgeons who don't work in the area.
"Concerns raised by families through the Children's Heart Foundation that they weren't being given the opportunity to be transferred to other units when they'd requested that.
"And I was also aware a senior surgeon was away on holiday, another surgeon was suspended and that left the service being offered to the public by two relatively junior, local surgeons.
"To have two relatively inexperienced people holding fort, without the ability for any senior advice, is a precarious situation in my view.
Doubts were cast over the early draft of mortality figures as sources at Leeds Teaching Hospitals Trust claimed as many as 150 cases may be missing from the Leeds data and, if they were included, the mortality rate would fall within the normal range.
But Sir Roger, director of the National Institute of Clinical Outcomes Research, and the Government's former national director of heart disease, said further analysis which included those cases still showed a "gap" in mortality rates at the hospital.
"In fact, the data has been re-analysed with these extra cases and we still see this gap in mortality rate," he said.
"I would not have been able to sleep this weekend knowing that there were people who might have been operated on in a potentially unsafe environment."
It was 8am on Thursday morning when Sir Bruce and two colleagues marched into the office of Maggie Boyle, chief executive of Leeds Teaching Hospitals Trust, and ordered her to suspend heart surgery on children.
He had been shown preliminary data on Wednesday by Sir Roger, indicating that the children’s heart surgery unit at LGI had a mortality rate for 2010-12 that was at least twice the average.
Coincidentally Sir Bruce had received calls from senior doctors in other units, including Bill Brawn, a recently retired cardiologist in Birmingham, expressing concerns about staffing at the Leeds unit and the referrals process it operated.
Hours later, Ms Boyle announced the temporary suspension to allow an internal review to take place, as instructed, as if it were the Trust’s own decision.
The timing was embarrassing, coming the day after the High Court quashed a plan to close the unit – part of a national reorganisation of children’s heart surgery – saying it was “legally flawed.”
The decision triggered a war of words between senior doctors and campaigners yesterday over the real reason behind the suspension, the credibility of the mortality statistics, and the motivation of the whistle-blowers.
Dr John Gibbs, chair of the paediatric cardiac clinical audit which supplied the mortality data and who is recently retired from LGI, said he was “furious” the data had been used because it was “not fit to be looked at by anyone outside the committee”.
And Mr Mulholland said he was “stunned and appalled” by Sir Bruce’s action and called on him to resign. “To have arrived in Leeds and done this, without warning, just one day after the decision to close the Leeds unit was proved in a court of law to have been unlawful, beggars belief. I am absolutely confident not only that his action was unjustifiable but that it was based on incorrect factual information and biased cardiologists at rival units.”
Sir Bruce, a former heart surgeon who pioneered the publication of comparative death rates for adult cardiac surgery a decade ago, said there had been “rumblings” in the cardiac surgical community for some time that “all was not well with Leeds”. Speaking on Radio 4, he said he had made the decision to intervene at Leeds after receiving two phone calls on Tuesday from “highly respected surgeons” who had told him they “had to speak out”.
He added: “I was really disturbed about the timing of this. I couldn’t sit back just because the timing was inconvenient, awkward or would look suspicious, as it does.”
His decision was backed yesterday by Sir Roger and an adviser to the Safe and Sustainable Review, who alerted Sir Bruce to the latest mortality statistics on Wednesday.
Speaking to The Independent, Sir Roger said: “This data that has caused all the uproar arrived on Wednesday morning at a time when the service in Leeds was running on two junior locum heart surgeons. Social media had carried reports of a spate of deaths [at Leeds] and 15 families had complained to the Children’s Heart Federation that they had not been given the opportunity to be treated elsewhere.
“The data is preliminary, and it has not been validated, and I told Bruce that was the case. But when you put it together with all the other concerns, there was no alternative but temporarily to suspend operating. The fact that it happened on the day the judge told us our consultation process was illegal was chance.”
Dr Gibbs said in an email to The Independent: “This data was in its very early stages and was nowhere near robust enough to be released to anyone.
“The steering committee has only had one working day to look at it and has already found a systematic error which excluded some cases, with a substantial resulting change in Leeds’ standardised mortality ratio.
“I sense a conflict of interest here. It rings of politics rather than proper process.”
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