In the small world of child heart surgery, almost everyone has a conflict of interest

With medical decisions, perfect, unbiased information is rarely forthcoming

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Was it conspiracy or coincidence? The timing of Thursday's decision to suspend children's heart surgery at Leeds, coming a day after plans to close it were derailed in the High Court, looks very much like the former. Even Sir Bruce Keogh, NHS medical director, who ordered the decision, acknowledged that.

It is easy to see why. The Leeds unit is involved in a desperate battle for survival. There are not enough children in the country with congenital heart problems requiring surgery to maintain the necessary level of expertise in the 11 existing units. It is agreed on all sides that four must close. But which four?

Those earmarked, which include Leeds, are using every means at their disposal to hang on to their own service and position the axe over others. On Wednesday, they scented victory when Mrs Justice Nicola Davies allowed a challenge against the Leeds unit closure saying there had been a "fundamental unfairness in the consultation process".

Yet less than 24 hours later Sir Bruce turns up in the office of Maggie Boyle', the Leeds Teaching Hospitals' chief executive, and tells her in plain terms what she must do with her paediatric heart service.

Small wonder that local MP Greg Mulholland reacted with fury. He quickly discovered the whistleblowers were from rival units, and the mortality statistics which triggered Sir Bruce's action had not been validated, with some cases apparently missed.

The new data, which have taken more than a year to develop, have been risk adjusted for the 150 different types of paediatric heart operation and are aimed at providing a more accurate comparator between units.

But John Biggs, who led the team that produced the figures, said they were not ready for release and warned darkly of a conflict of interest.

The problem is that almost everybody in this saga has a conflict of interest. The world of paediatric cardiac surgery is a small one and all the major players are identified with one unit or another. Even John Biggs, the expert closest to the figures, is recently retired from Leeds.

In an ideal world all medical decisions would be made with perfect, unbiased information. That is rarely forthcoming. In this instance, preliminary data, unvalidated, indicated a possible problem at Leeds.

Put together with warnings from other specialists, complaints from families and long- standing concerns, Sir Bruce knew one thing. He could not, as he said, do nothing.

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