A review into children’s congenital heart surgery at Leeds Teaching Hospitals Trust is underway after NHS England intervened to ask the trust to suspend services.
The surprise move on Thursday led to accusations about the validity of an “early cut” of mortality data which was one of the factors behind the decision to intervene. The figures were said to suggest the unit had death rates twice the national average.
NHS England medical director Sir Bruce Keogh said he had also been contacted with concerns by clinicians, and raised questions about staffing of the unit. He said two “relatively inexperienced” surgeons were left “holding the fort” while one consultant was on holiday, and a second suspended.
The trust denies that the surgeon is suspended and said he was currently not carrying out operations, as a voluntarily move, not connected with mortality data. It said the two locum surgeons were both consultant level and experienced.
The timing of the suspension of services – just 24 hours after a court ruling which effectively quashed a decision to stop children’s heart surgery at the unit – has angered Leeds politicians. Leeds North West Liberal Democrat MP Greg Mulholland described it as “a deliberate attempt” to undermine the unit.
Leeds was one of three units which would stop surgery after an England-wide review by a national joint committee of primary care trusts. This had been challenged by a Leeds-based organisation Save Our Surgery which argued that the criteria used to assess the units was flawed – an argument accepted by the High Court, which made the details of its decision public on Wednesday. It is not yet clear how the NHS will response to Wednesday’s ruling and how long it will delay a reduction in the number of sites offering this complex surgery.
On Thursday, Sir Bruce and a Care Quality Commission team visited the department after concerns were raised with him on Tuesday and Wednesday by a small number of cardiac clinicians – including Sir Roger Boyle, director of the National Institute of Clinical Outcomes Research. On Thursday evening, it became public that the trust would suspend operations while a review – expected to take three weeks – was carried out.
The trust said this would be an internal review, independently validated and supported by external experts. It has set up a hotline to advise parents of children awaiting surgery and is contacting them individually. Some are being transferred to Birmingham for surgery.
Sir Bruce’s intervention led to a row about mortality data over the weekend. Sir Brian Jarman tweeted a link to his own data, covering several years, which did not show Leeds as an outlier among hospitals carrying out this surgery. The BBC reported that John Gibbs, of the Central Cardiac Database, said that the data had not been fully analysed. A cardiologist from the Leeds Teaching Hospitals Trust has also publicly criticised the use of the data.
Sharon Cheng of the Save Our Surgery campaign group said: “It is now clear that there are serious errors in the data used as the initial justification for suspending children’s heart surgery in Leeds. In short, the numbers were wrong and NHS managers did not bother to verify them or ask the standard questions before moving to force the unit to suspend surgery.”
But the Children’s Heart Federation said it had raised concerns about children not being referred on from the unit before.
“My concern is that it appears that managers and clinicians in Leeds, together with the parent support group, have put their own interests ahead of the well-being of critically ill children and their very vulnerable parents,” said chief executive Anne Keatley-Clarke.
In a joint statement issued today, NHS England and the Leeds trust said: “ollowing a constructive meeting at 8 am this morning between NHS England, the Care Quality Commission, Leeds Teaching Hospitals Trust and the National Trust Development Authority; it was agreed that there would be further information shared today and talks between the parties will continue.
“Our first consideration is patient safety and the arrangements put in place over the bank holiday weekend have been effective. These arrangements will continue for the time being .We are trying to resolve this as quickly as possible in the best interests of patients.”
Information provided to HSJ