An inquiry into heart surgery at the cardiac unit at Liverpool's Alder Hey children's hospital has found no evidence that an action plan had been put in place after an earlier investigation.

The study into the quality of cardiac services, published last week, concluded that death rates for children having heart surgery were lower than average and the overall pooled outcomes for cardiac surgery 'compare with the best in the country'. But the inquiry, by north west regional director of public health John Ashton, said multiprofessional audit in the cardiac unit had to be strengthened. It also said it had not been possible to establish whether trust management had drawn up an action plan following an earlier review eight years ago.

The 1992 study identified some working practices in the cardiac unit as 'unsatisfactory' and said there was poor team working and low morale. A second review of the unit was commissioned by the trust in March this year after a surgeon raised concerns.

Review of the Cardiac Unit at the Royal Liverpool Children's Hospital trust Alder Hey.