News

Review clears Harefield surgeons

Jacqui Wise, London

A review of paediatric surgery at Harefield Hospital, Middlesex, has found no evidence of a major clinical failure in the treatment of patients during 1984-99. The independent review was called for after statistical evidence presented to the Bristol Royal Infirmary public inquiry suggested that there was excess mortality among child patients treated for congenital heart problems at the Harefield Hospital during this period.

The consultant leading the review warned, however, that failing institutions are difficult to identify because the current national system of collecting clinical outcomes is inadequate.

Dr Stewart Hunter, consultant in paediatric cardiology at the Freeman Hospital in Newcastle upon Tyne, said that the two currently available national sources on clinical outcomesthe hospital episodes statistics and the cardiac surgical registerare inadequate in providing accurate, reliable, verified, comparative data that are understandable and usable.

"This represents a serious gap in the system and means that the public might not be properly safeguarded against a repeat of a similar situation to that which arose at the Bristol Royal Infirmary."

Dr Hunter said: "Our report demonstrates that the clinical staff at the Harefield Hospital during the period under review worked at the leading edge of surgery for congenital heart disease in children, tackling some of the most difficult cases around, and coping well under the circumstances."

The review did find that in some areas mortality was higher than average. For example, between 1991 and 1995 there was strong evidence of excess mortality for open heart surgery carried out on children aged over 1 year. Fontan procedures were associated with a high mortality, particularly in the more severe cases from abroad. These suboptimal results were noticed by the clinicians, and, after an internal audit, surgical practice was modified and mortality improved substantially.

There was another run of poor performance between 1995 and 1999, when there were identifiable areas of higher mortality in infants aged under 1 year, particularly for Fallot surgery. But this was recognised and a decision made to limit this more difficult surgery to Professor Magdi Yacoub.

Dr Hunter commented: "Internal audit procedures worked effectively, and when clinical outcomes dipped for certain procedures, as they will occasionally do in any hospital, these trends were identified and appropriate steps were taken to modify procedures."

The review concluded that Harefield was a small unit, run for most of the periods in question by a single surgeon and cardiologist carrying out extremely innovative work while being chronically underfunded. It said that such a situation with singlehanded paediatric surgeons and cardiologists would be deemed unacceptable today.

The Royal Brompton and Harefield NHS Trust has decided to transfer the existing Harefield unit to the Royal Brompton Hospital in the spring of 2001. The review noted that larger units seem to produce better results and so commended this decision.

A full copy of the report can be found on the Royal Brompton and Harefield NHS Trust's website (www.rbh.nthames.nhs.uk).

(Credit: FIONA HANSON/PA) Professor Sir Magdi Yacoub (left) with his youngest ever transplant patient, Sophie Park, and Gerald Lewis, his first transplant patient