- NHS Improvement called in to oversee trust’s effort to resolve problems in cardiac surgery service
- Independent panel formed less than two weeks after surprise CQC inspection of surgery unit
- “Dysfunctional” relationships between consultant surgeons a long standing problem
A beleaguered London teaching trust has called in NHS Improvement to oversee its efforts to turn around its heart surgery unit.
St George’s University Hospitals Foundation Trust today announced it has asked the regulator to form an independent panel to “provide oversight of the actions the trust is taking” as it tries to resolve long standing issues within its cardiac surgery unit.
The trust has taken this significant step after the dysfunction within its team of consultant surgeons, and between surgeons and management, were widely exposed in the media and a London court.
St George’s has been aware of trouble within its heart surgery team since at least 2010 but the situation seems to have worsened in recent years year.
The Care Quality Commission carried out a surprise inspection of the unit on 23 August in response to concerns about recent developments in the unit, HSJ revealed last week.
Its heart surgery team’s mortality rates are higher than the national average, which has triggered a national surgery outcomes auditor to put the unit in “alert” for two successive years.
An external review conducted after the second alert, and leaked to the HSJ in July, reported “a dysfunctional surgical team”, “tribal behaviours”, and a “dark force” in the unit.
The review was carried out by former deputy medical director of NHS England, Dr Mike Bewick. He provided the trust with a long list of recommendations but said ultimately “these will all be unachievable if the continuing behaviours and poor relationships persist.”
He said the trust was at risk of losing the heart surgery unit and recommended the board “considers more radical solutions to break up the current surgical team if it cannot be assured of any material change in the current situation.”
The trust quickly responded to Dr Bewick’s findings. It called on Guy’s and St Thomas’ Foundation Trust to provide “on the ground surgery leadership support” to the unit.
Another external review was commissioned to look into Bewick’s findings. Two surgeons were subsequently suspended, pending internal investigations of their actions, after claims they had interfered with this review, named as the “Hollywood review” after the consultant engaged to carry it out.
At least one of the surgeons, Professor Marjan Jahangiri, has since been reinstated. Last week, a High Court judge overturned her exclusion, saying the trust’s decision to suspend her was a breach of contract. However, the internal inquiry into her alleged attempt to interfere with the Hollywood review is ongoing.
However, her court hearing exposed deep fissures between the trust management and some surgeons, as well as within the surgical team.
In a witness statement submitted to the court, Jahangiri said her suspension was “the latest in a long line of detriments I have suffered at the hands of [the trust] for approximately four years and in particular during the last 18 months at the hands of Professor Andrew Rhodes (the acting medical director).”
She said she had been “subjected to unfair and retaliatory treatment as a result of raising serious concerns regarding the management and operation of [St George’s].”
The trust vigorously refuted these allegations in witness statements submitted to the court by the chief executive and Professor Rhodes.
However, Jahangiri’s statement included serious claims about the treatment she had received. In April 2017, she said she received a dead animal and decapitated doll in an anonymous package sent to her home. She “strongly suspects” this was in retaliation for concerns she raised two weeks earlier, using whistleblower protection policies, about the conduct of some of her colleagues.
Professor Rhodes said “it was not practicable for the trust to seek to establish” who sent the package containing the dead animal and headless doll. However, he did cover “inappropriate behaviour such as this” in a letter he sent to the whole cardiac service that month.
In a statement, NHS Improvement said its priority is to ensure “all NHS staff have the right to work in a safe and supportive workplace.”
It set up the panel in response to the trust’s request for help, the regulator added. It will “provide the trust with the specific specialist advice it needs to deal with these issues quickly so staff are equipped to provide high quality patient care.”
The trust chief executive, Jacqueline Totteredell, said: “My priority, and that of the trust board, is to ensure patients receive safe, high quality care at all times, and today’s announcement reinforces that. This remains our focus.
“Yesterday, we met with our partners and had extremely helpful discussions on the challenges we face, and next steps to improve cardiac surgery services at St George’s.”
Information provided to HSJ; court documents
August and September 2018