• Records of at least 200 patients who died after heart surgery to be reviewed
  • Independent review commissioned by NHS Improvement’s oversight panel
  • Review will include deaths from April 2013 to September 2018

An expert panel is reviewing records of hundreds of patients who died after heart surgery at a major teaching trust, whose cardiac unit is grappling with severe quality and staff concerns, HSJ can reveal.

The independent panel was commissioned by NHS Improvement and is made up of cardiac surgery, cardiology and anaesthetic consultants. They are examining the safety and quality of care provided by St George’s University Hospitals Foundation Trust.

It could be a year-long process, scrutinising the case notes of 200-250 patients who died having undergone cardiac surgery at the trust between April 2013 and September 2018. This is all the deaths, with no prejudgement about whether they are linked to poor care.

The cardiac surgery unit has grappled with team rows and mortality concerns for several years. This came to a head last year with the revelation one female surgeon had been sent a dead animal in the post, her suspension by the trust being overturned in court, and NHS Improvement stepping in to oversee management.

St George’s chief executive, Jacqueline Totterdell, today told HSJ: “It is absolutely essential that patients and their families have full confidence in the care our cardiac surgery team provide – and this review of past deaths will be a key part of that process.”

The timeframe for the new deaths review includes the April 2013 to March 2017 period, when the heart surgery unit was in mortality “alert” status. The trust had a statistically high death rate from heart surgery when compared with mortality rates from 31 other cardiac surgery units, according to Nicor, the national heart surgery monitor.

It is also looking at fatalities from April 2017 to September 2018, to cover deaths up to the point when internal improvements were made, according to NHS Improvement.

The expert panel will only be looking at deaths in cardiac surgery, not associated services like cardiology.

Problems in the team date to at least 2010, but Nicor first told the trust its mortality rates were higher than expected in spring 2017.

An external review of the service, the Bewick review, found deep dysfunction persisted within the heart surgery team and said it could lose the service entirely if it did not take drastic steps to reform the consultant team, as first revealed by HSJ in July.

The trust has made improvements, bringing in a new associate medical director, Steven Livesey, a consultant cardiac surgeon who has been overseeing the trust’s efforts to overhaul the heart surgery unit since he started at St George’s in early December.

The trust said it has made other improvements in line with the Bewick review recommendations, including appointing more heart surgeons to the team and implementing a multi-disciplinary team that meets on a daily basis to oversee the caseload. It is also receiving external support from neighbouring trusts including Guys and St Thomas Foundation Trust.

However, St George’s believes there is still a risk it could ultimately lose the surgery unit. A December board paper stated: “Over the last three months there has been a significant reduction in referrals into the [St George’s University Hospital] system. This, unless corrected, will have long-lasting impacts into the sustainability of the service.

“Improvements in relationships with system partners are being targeted through both cardiac surgery and cardiology in order to strengthen our referral source and patient pathways.”

More details about the issues within the service emerged last summer in a London court. A surgeon from the trust’s heart surgery unit was seeking an injunction to overturn her suspension from work pending a disciplinary process. 

The surgeon said she had tried to raise safety concerns about the performance of other surgeons in the unit but had been victimised for speaking up. She said it was part of a wider pattern of bullying she experienced because of her ethnicity and gender.

The trust vehemently denied she had been singled out in such a way because of her ethnicity or gender.

In December, the Care Quality Commission reported on its snap inspection of the heart surgery service in August 2018. It said the service was safe and highlighted the steps taken by the trust to make improvements. But the inspectors were “not assured there was credible and effective leadership or managerial oversight at service, divisional or trust level”.

In September, NHS Improvement established an external oversight panel, led by Sir Andrew Cash, after discussions with the trust. Its work continues, NHS Improvement confirmed this week.

HSJ has learned the oversight panel has made recommendations in letters to the regulator on work done to date at St George’s. However, NHS Improvement has so far declined requests for the recommendations to be released.

Update: this article has been updated to clarify in the final paragraph that, while the oversight panel has made recommendations to NHS Improvement, it has not made a formal report. It was further updated to clarify the trust’s position on the bullying Prof Jahangiri said she had received.