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‘Leaked’ report on St George’s Hospital cardiac unit causes concern

Posted: 08/08/2018

The Times has reported findings from a ‘leaked’ independent review into the cardiac surgery death rate at St George’s Hospital in Tooting. The review found that the cardiac unit at St George’s Hospital had a 3.7% death date, 1.7% above the national average of 2%.

The report was commissioned following the National Institute for Cardiovascular Outcomes Research (NICOR) alert in June this year, concerning the lower surgery survival rates at the cardiac unit. NICOR is responsible for six national clinical audits including the NICOR Cardiac Audit. It collects clinical information about cardiovascular patients in hospitals across the UK and provides information to the Care Quality Commission and other regulatory bodies as well as the Department of Health to enable comparison of survival rates between hospitals and to check that national guidelines on standards of care are met.

The investigation into the St George’s cardiac unit was conducted by former NHS England deputy medical director Mike Bewick. The Times reports that Mr Bewick reviewed ‘disturbing and often difficult information’. He found that toxic bickering between rival ‘camps’ within the unit contributed to the rise in patient mortality. Staff reported that a ‘dark force’ was at work within the unit with ‘tribal-like activity’ among surgeons. The cardiac surgical team was ‘viewed as dysfunctional both internally and externally’. Internal scrutiny was said to be ‘inadequate’. Conversations with 39 members of staff showed that, although staff were shocked by the death rate in the unit ‘most felt that poor performance was inevitable due to the pervading atmosphere’. Mr Bewick is reported to have called for ‘radical solutions to breaking up the current surgical team’.

A spokesman for St George’s Hospital said that Mr Bewick’s recommendations were being implemented ‘at pace’. Measures included the immediate relocation of all cardiac surgeons to a single-speciality practice. The spokesman said: “We would like to stress that the cardiac surgery service we provide for patients is safe. However, it is very clear that major and urgent improvements are required, which we are already taking action to deliver.” 

A spokesperson for the Royal College of Surgeons and the Society for Cardiothoracic Surgery (SCTS) said: “The Society for Cardiothoracic Surgery informed St George’s in both March 2017 and March 2018 that analysis of their results showed that early survival after cardiac surgery at the hospital for the periods of activity 2013-2016 and 2014-2017 was lower than the expected level, although still within the UK standard…Cardiac surgery within the UK is amongst the safest in the world…. [the St George’s cardiac unit] has never been below the required standard for the UK. All the other hospitals in the UK have shown that early survival after cardiac surgery is at the required standard, with only St George’s triggering the early warning alert over the last four years of surgery. Nevertheless the independent review has highlighted serious concerns so it is still crucial that St George’s address the findings of the report so that patients can be sure they are receiving the best possible care.”

Whilst it is reassuring that NICOR is keeping an eye on cardiac surgery death rates across the UK, it is less reassuring to read that, although the survival rates in the cardiac unit at St George’s Hospital had been lower than expected for some time, investigations were not started until June 2018. Given the extent of the reported problems within the unit, it is a pity that investigations did not begin earlier. 

Cardiac surgery is, by its very nature, a risky undertaking but patients need to know that standards of care are maintained and properly monitored. If you have concerns about the cardiac surgery treatment that you or a loved-one have received, Penningtons Manches’ specialist cardiac claims team may be able to help. The team can investigate whether treatment was of the appropriate standard and, if it was not, can seek redress on behalf of the injured patient.

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