Following the publication, last month, of Professor Bewick’s independent report on St George’s cardiac surgery unit, which highlighted serious concerns about surgical and clinical practice, matters have moved swiftly.
Towards the end of August, The Times reported that health inspectors from the Care Quality Commission had visited St George’s Hospital during the week of 20 August 2018 in order to conduct a “snap inspection” of the unit. The Times reported that the purpose of the investigation was to look at the recent claims that there had been a cover-up over the actual level of mortality and morbidity rates and claims that patient safety was at risk.
Professor Bewick’s report was commissioned following the alert from the National Institute for Cardiovascular Outcomes Research (NICOR) in June 2018 which showed that St George’s cardiac unit had a 3.7% death rate – 1.7% above the 2% national average. This was the second NICOR report to highlight higher than expected death rates at the St George’s unit following cardiac surgery.
At the end of August it also emerged that the senior coroner for Westminster, Dr Fiona Wilcox, had written to St George’s to request a list of patients whose deaths may have been affected by the problems at the unit so that she could ensure that coronial investigation had been carried out or, where an inquest had been held, issues around cardiac or cardiothoracic surgery had been properly explored. A spokesperson for St George’s University Hospital NHS Foundation Trust, which administers St George’s Hospital, emphasised (as the hospital had done before) that “the cardiac surgery [at St George’s] was safe” and that, “the treatment provided at St George’s is within the UK standard and has never been below this. The trust’s position was that an external inquiry was not needed because, following Professor Bewick’s review, “the trust is focused on implementing its findings as rapidly as possible”.
There are two obvious problems with this approach. Firstly, Professor Bewick’s report only covered the six months from January to June 2018 and so did not include the majority of the time covered by the two NICOR alerts. Secondly, one of the major issues highlighted by Professor Bewick was his concern that the level of mortality and morbidity at St George’s cardiac unit did not accurately reflected the actual outcome of the cardiac and cardiothoracic procedures. In other words, if the mortality rates were not accurate, the figures could hardly be used to conclude that cardiac surgery at St George’s was safe.
On 4 September 2018, St George’s University Hospitals NHS Foundation Trust issued a further press statement in which it announced “extra steps to deal with the long-standing issues faced by its cardiac surgical service”. The trust announced that NHS Improvement had been invited to oversee the steps the trust was taking to improve the service provided by the cardiac unit. The plan was for NHS Improvement, as an external regulator, to oversee the improvements planned by the trust with oversight from an independent panel including “senior clinicians and managers from external organisations”.
On 10 September 2018, the trust announced that “the most complex cardiac surgery”, involving “a small number of patients” would be transferred to other hospitals in London. The move was “to maintain patient safety, and to protect the long-term future of our cardiac surgery service”. What was referred to as “routine cardiac surgery”, plus all cardiology services (planned and emergency) would continue at the hospital.
The next day, The Times reported that the number of cardiac surgery cases being transferred out of St George’s was between 5 and 10%. It also reported that “bosses” at St George’s had insisted that “staff were wrong to fear that [this] was a precursor to closing the unit”.
Finally, on 18 September 2018, The Times reported that NHS Improvement had now placed St George’s cardiac unit into “special measures”. The panel was to be headed up by the former chief executive of Sheffield Teaching Hospitals NHS Foundation Trust, Sir Andrew Cash. (Sir Andrew retired as chief executive of the Sheffield trust in July of this year.) Sir Andrew made it clear that he wanted “to resolve the issues with the cardiac services as quickly as possible…our main priority as a panel is to be a critical friend to the trust by providing advice and scrutiny to the chief executive and trust board as they work through their planned actions for improving cardiac surgery services”. The plan is to publish progress reports. The Times also reported that St George’s cardiac unit had now lost its trainee surgeons.
Camilla Wonnacott, an associate in Penningtons Manches’ clinical negligence team, said: “It is hardly overstating the position to say that the situation at St George’s cardiac unit, as set out in Professor Bewick’s report and in the recent Times articles, is hugely disturbing. A cardiac unit that had an enviable reputation in cardiac surgery has, it seems, been allowed, over the past few years, to deteriorate into a position where complex cardiac surgery can no longer be allowed to continue, the unit’s mortality and morbidity statistics are considered to be unreliable, and the outcome of the last five years of cardiac surgery, including the deaths of 150 people, have to be closely scrutinised.
“Furthermore, it is difficult to avoid the conclusion that, following the receipt by the trust of Professor Bewick’s independent report (which, we must remember, was only published after it was leaked to The Times on 9 August), the trust’s decision to allow complex cardiac surgery to continue for another four and a half weeks was less than wise.
"It is difficult to imagine the agony of those families caught up in this tragedy who must now face the prospect of investigations into the deaths of their loved-ones, quite possibly involving inquests or the re-opening of previous inquests. For those treated at the St George’s unit over the past five years, not to mention the families of those who have since passed away, this scandal means that they are living with the terrible uncertainty of whether the treatment received at St George’s was of the appropriate standard.