Ten patients died awaiting investigation or treatment of urgent heart complaints at four south- east London hospitals over a six- month period to the end of last March, according to the report, a copy of which has been obtained by the Independent.
The deaths happened while doctors, managers and regional administrators spent months grappling in 'confusion and great uncertainty' with new contracts imposed by the creation of an internal market two years ago.
Even though health ministers have had the report since last spring, some heart specialists in London say people are still dying while awaiting urgent treatment.
The Department for Health ordered an inquiry last year to investigate allegations made by Dr Graham Jackson, consultant cardiologist at Guy's and Lewisham NHS Trust, that four of his patients had died because cash constraints prevented his treating them. Douglas Chamberlain and John Parker, president and president-elect of the British Cardiac Society, and Robin Stott, the trust's medical director, made up the inquiry team.
Their report, sent last May to Virginia Bottomley, Secretary of State for Health, has not been published - despite its call for a 'wider public debate' about rationing in a cash-limited service. The Department for Health and the Guy's and Lewisham NHS Trust have since insisted that the issues raised amount to 'an internal matter' for the trust.
Although the inquiry team admonished Dr Jackson for speaking out about the deaths, the report makes clear that they happened against a backdrop of strict financial constraints, misunderstandings and disputes between professionals over the new contracting system. 'Few had the relevant experience to handle (the new contracting system) during the early stages, and the new philosophy was introduced with extreme rapidity, given the extent of the changes demanded.'
It recommends medical need should always take priority over financial concerns when deciding which patients to treat, although it observes that resources for treating heart complaints are 'considerably less' than those available in most of Europe. 'Waiting list deaths do occur relatively commonly. They are too common because waiting lists are too long.'
The four patients whose cases formed the crux of Dr Jackson's original complaints died during a period when heart patients in the Lewisham and north Southwark were being treated only if they were considered emergency cases. Regional health and Guy's Trust administrators defined an emergency as a heart disease patient 'with a risk of death or significant deterioration within 24 hours'.
Mrs Bottomley last week exhorted doctors and managers to ensure that patients requiring urgent treatment did not face delays. Admission and treatment of patients had to be paced and monitored 'to avoid sudden service restrictions for financial reasons'.
Dr Jackson, who faced disciplinary action last year for speaking to the Independent about his patients' deaths, declined to comment on the report.
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