In September of last year, NHS Improvement was appointed as an external regulator to oversee improvements at the cardiac unit of St George’s Hospital in Tooting (administered by St George’s University Hospitals NHS Foundation Trust). The appointment followed the publication of the independent report of Professor Bewick which listed a catalogue of sub-standard treatment in the unit. (The report had been commissioned after the cardiac unit had been subject to the second National Institute for Cardiovascular Outcomes Research (NICPR) alert in two years highlighting higher than expected death rates following cardiac surgery.)
Further information on the background to the problems at St George’s cardiac unit can be found in two previous articles: Report reveals shocking, sub-standard treatment at St George’s cardiac unit and Further worrying developments culminate in complex cardiac surgery being moved to other London hospitals.
In December 2018, the Care Quality Commission published a report on the unit which was intended to follow up on the concerns raised by Professor Bewick’s report. It showed that improvements were being made but there was still a long way to go. Key findings included ‘a lack of ongoing and regular oversight of some aspects of the cardiac services’; a lack of a ‘culture of learning from incidents, mortality and morbidity amongst consultants’; multiple patient records systems which meant that patient notes were not recorded centrally, risking information not being available or handed over adequately; and a ‘lack of cohesion and poor working relationships between surgeons’.
That said, the report noted that progress had been made since August 2018. Comprehensive risk assessments of patients were being carried out; multidisciplinary team meetings were being held daily and involved neighbouring trusts; and there was an independent scrutiny panel for cardiac surgery set up by NHS Improvement. Thankfully, the CQC felt that there were ‘no immediate concerns with regards to patient safety and patients were well-prepared for surgery’.
In January 2019, NHS Improvement announced that it was planning to review 250 deaths following heart surgery at St George’s Hospital, between April 2013 and September 2018. The review was to be conducted by an independent panel of cardiac surgeons, cardiologists and anaesthetists. The plan was to consider the medical records of each patient who had died, looking at the safety and quality of care provided. Any investigations undertaken by the trust at the time of death were also to be considered. The study was expected to take up to a year to complete.
Camilla Wonnacott, an associate in Penningtons Manches’ clinical negligence team, finds it difficult to understand how care at the unit was allowed to deteriorate to a point where 250 deaths need to be reviewed. She comments: “Although steps are now being taken to improve the standard of care, it is clear that there is still a good deal of work to do. Despite the various positive comments made by the CQC in its December 2018 report, it should be remembered that the majority of complex cardiac surgery was removed from St George’s in the early autumn of last year, well before the CQC report was published.”