• Investigation aimed at discovering if trust could have “confidence” its heart surgeons could deliver a “safe and sustainable service”
  • Independent report was completed last year, but it emerged it had been effectively shelved in December
  • “Mediation and behaviour” expert hired to help fix the “dysfunctional” unit and will start work in March

A major teaching hospital in south London is refusing to release a long-awaited workforce investigation that was completed late last year.

St George’s University Hospitals Foundation Trust has been trying to fix problems – particularly the difficult working relationships between surgeons – in its cardiac surgery service for more than a year

In August, it commissioned an independent review of the surgical team to discover if “it is possible to have trust and confidence in the cardiac surgical consultant team, both collectively and individually, to deliver a safe and sustainable service”. The investigation was expected to be completed in the autumn. 

But the Hollywood review, named after the consultant brought in to conduct it, was effectively shelved when it emerged last December that its findings were not going to be taken forward. 

HSJ requested a copy of the review under a Freedom of Information Act request, but was told this was not possible “because to do so would compromise the confidentiality of those staff who took part in the review”.

“This is a duty and responsibility we take very seriously,” the trust added when turning down the request. 

HSJ has asked the trust to review this decision. 

An earlier separate review of the unit – the Bewick review – described the consultant team at the top of the service as “dysfunctional”, while staff said there was a “persistent toxic atmosphere” and a “dark force” in the unit.

The then-acting medical director told the High Court in the summer there was a clear indication from this review that the surgeons were divided into two camps and the issues between them “were having an impact on patient safety and causing patient harm”.

“The poor behaviours were impeding communication and decision making and this was a material risk to patient safety. The Hollywood review is aimed at resolving those issues,” he said in a hearing involving the exclusion of a surgeon, Marjan Jahangiri, who claimed she was a whistleblower.

An interim report from the Hollywood review raised “serious concerns” that relationships between Professor Jahangiri and her fellow surgeons had broken down, “potentially irreparably”.

This interim report was used to exclude Professor Jahangiri for a second time, according to a letter sent to the surgeon on the day of her High Court hearing from the trust’s then-acting medical director.

The High Court overturned both exclusions

But a St George’s spokesman said in January the Hollywood Review “does not enable the trust to resolve the concerns around team behaviour within the service”.

“As a result, Ms Hollywood’s review will not be used by the trust to inform our improvement plan for the service going forward,” he added. 

The trust has now engaged an “expert in mediation and behaviour” to support the trust’s ongoing efforts to improve the culture and behaviour in the surgical unit. She will start work in March.

And, in December, the trust brought in a new clinical lead for its heart surgery unit, Steve Livesey. The spokesman said the trust is confident Mr Livesey “will play a crucial role in rebuilding strong and professional working relationships within the unit”.

Mr Livesey’s appointment came after a Care Quality Commission visit to the trust in August last year. The regulator said it was “not assured there was credible and effective leadership or managerial oversight at service, divisional or trust level”.

An independent panel of experts from NHS Improvement is overseeing the trust’s improvement efforts while a second panel is reviewing the cases of up to 250 patients who died having undergone heart surgery at the trust between April 2013 and September 2018. This review covers all the deaths during that time period, with no prejudgement about whether they are linked to poor care.

Surgical trainees were also withdrawn from the trust in September, while the trust revealed at a board meeting earlier this year the disputes in the unit had cost the provider £11m from the loss of complex cardiac cases